11.17 Melancholic Depression in the Adolescent Patient

Abstract

This poster aims to review risk factors, clinical patterns, diagnostic workup, and available treatments in melancholic depression in the adolescent patients. A qualitative literature review was conducted. A search was conducted in the PubMed database using “melancholic depression” AND “adolescent,” yielding 62 results. After eliminating unrelated articles, 15 articles were reviewed. Adolescents with depressive disorders are at high risk for substance abuse, legal problems, exposure to negative life events, physical illness, early pregnancy, poor life, and psychosocial functioning. Compared with patients with nonmelancholic depression, patients with melancholic depression have a higher depression score and overall illness severity score, suicidal ideation, and behavior. In adults, melancholic patients were more likely to be male and older in age. They were also more severely depressed, had a higher frequency of depressive episodes, and had shorter episode duration when compared to atypical and nonmelancholic patients. Adolescents compared to children can have more melancholic symptoms. Melancholic patients have poorer performance compared to nonmelancholic depressed patients when it comes to tasks that include verbal and visual memory, executive function, sustained attention and span, and psychomotor speed. Melancholic features are found to be more frequent in the inpatient setting as opposed to the outpatient setting and are more likely to occur in those with psychotic features. A meta-analysis that was performed comparing atypical depression and melancholic depression as a predictor of therapeutic outcome of CBT did not find any indication that either of these types can be a significant outcome moderator. Research data suggest that the presence of melancholia predicts a poor response to psychotherapy and a relatively good response to antidepressants and ECT. There is a limited amount of data focused on the melancholic depression subtype, specifically in adolescent patients. There may be potential benefit in more research on this topic and approaching melancholic depression as a separate entity than typical and atypical subtypes, particularly with focus on adolescents. This would also include further research on treatment specific for melancholic depression.