Background and method: There have been recent proposals to have melancholia reinstated in classification systems as a disorder distinct from major depressive disorder. Data from two epidemiologically complete cohorts of patients presenting to mental health services in North Wales between 1875-1924 and 1995-2005 have been used to map the features of melancholia.
Results: The data point to a decline in the contemporary incidence of hospital admissions for depressive psychosis, and greater heterogeneity among hospitalized severe non-psychotic depressions today. They indicate that historically untreated episodes of "melancholia" had a sudden onset, an average duration of less than 6 months and a lesser likelihood of relapse than severe depressive disorders have today.
Limitations: This is a study of the hospitalized illness rather than the natural illness and the relationship between illness and being hospitalized remains at present poorly understood.
Conclusions: These are the first data on the comparative incidence and natural history of melancholia in historical and contemporary samples. They point to the distinctiveness of the condition and support arguments for its separation from other mood disorders.
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