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Letter to the Editor

Melancholia as a Useful Subtype of Major Depression

David A. Solomon, MD

Published: September 15, 2009

Melancholia as a Useful Subtype of Major Depression

To the Editor: The article by McGrath et al1 in the December 2008 issue of the Journal yielded the interesting finding that melancholia may be significantly associated with a reduced probability of remission from major depression. I am writing to point out a related finding from the National Institute of Mental Health Collaborative Depression Study. Our group examined major depressive disorder and tachyphylaxis, which refers to the phenomenon in which depressed patients who are successfully treated with an antidepressant eventually suffer a recurrent episode of major depression despite maintenance pharmacotherapy. In our study,2 the risk of tachyphylaxis was significantly elevated among subjects who recovered from an episode of melancholic major depressive disorder. Thus, it appears that patients with melancholia have worse outcomes compared to those without melancholia.


1. McGrath PJ, Khan AY, Trivedi MH, et al. Response to a selective serotonin reuptake inhibitor (citalopram) in major depressive disorder with melancholic features: a STAR*D report. J Clin Psychiatry. 2008;69(12):1847-1855. PubMed doi:10.4088/JCP.v69n1201

2. Solomon DA, Leon AC, Mueller TI, et al. Tachyphylaxis in unipolar major depressive disorder. J Clin Psychiatry. 2005;66(3):283-290. PubMed

David A. Solomon, MD

Dr McGrath was shown this letter and declined to comment.

Author affiliations: Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, and the Mood Disorders Program, Rhode Island Hospital, Providence, Rhode Island. Financial disclosure: Dr Solomon has served as an investigator for research funded by the National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, Janssen, Merck, and Wyeth-Ayerst; as a consultant to Novartis, Shire, and Solvay; and on the lecture bureaus of AstraZeneca, GlaxoSmithKline, Pfizer, and Shire. Funding/support: None reported.


© Copyright 2009 Physicians Postgraduate Press, Inc.

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