uestion: Does this depression meet DSM-IV criteria for melancholic features (listed below)?

• Yes
• No

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Help: Melancholia reflects the most biologic/genetic and severe, and least related to "neuroticism," of the depressive disorders.¹ The treatment pathway for melancholia is slightly different in this algorithm.

Criteria for melancholic features: Both 1 and 2 must be met.

1. Loss of reactivity to usually pleasurable stimuli;
2. Loss of pleasure in almost all activities;
3. Plus any three of the following:

• distinct quality of depressed mood
• morning worsening
• waking two hours early
• marked retardation or agitation
• significant anorexia or weight loss
• excessive guilt

¹Kendler KS. The diagnostic validity of melancholic major depression in a population-based sample of female twins. Arch Gen Psychiatry 1997;54:299-304.