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Involutional melancholia or involutional depression is an obsolete name for a psychiatric disorder affecting mainly elderly or late middle-aged people, usually accompanied with paranoia.
- It is classically defined as “depression of gradual onset occurring during the involutional years (40-55 in women and 50-65 in men), with symptoms of marked anxiety, agitation, restlessness, somatic concerns, hypochondriasis, occasional somatic or nihilistic delusions, insomnia, anorexia, and weight loss."[1] Involutional melancholia is not recognized as a psychiatric disorder by the DSM-5, the American Psychiatric Association's (APA) classification and diagnostic tool.
- Depression and the risk for coronary heart disease
- The term “broken heart” has been coined to characterize an association between mood disorders and heart disease. As early as 1937, Malzberg described an increased cardiovascular mortality in hospitalized patients with “involutional depression.” Of course, mere association of disorders does not allow one to assume a causal relationship and longitudinal studies had to be awaited in order to determine whether depression indeed is a risk factor or, at least, a risk indicator for coronary heart disease.
- It was thought to develop, particularly in women, after the menopause, during the involutional years(40-55 in women and 50-65 in men).
Signs & symptoms
- Previous depressive conditions
- Despondency and hypochondriacal delusions
- Late onset of the disorder
- Hodophobia is specific phobia as classified in the DSM-5.
- Involutional melancholy's 'course was chronic, with agitation, depersonalization and delusions of bodily change and guilt' featuring strongly, but 'without manic features'.
- Symptoms of fear are also considered to occur, as well as despondency and hypochondriacal delusions.
- The late onset of the disorder was matched with a prolonged course with poor prognosis and/or deterioration, in the absence of treatment.
History
- Emil Kraepelin (1907) was the first to describe involutional melancholia as a distinct clinical entity separate from the manic-depressive psychosis, arguing that 'the processes of involution in the body are suited to engender mournful or anxious moodiness'. Right up until 'the seventh edition of his textbook Kraepelin considered involutional melancholia as a separate disease', of acquired origin, but (partly in response to Dreyfus) 'he decided to include it in the eighth edition under the general heading of manic depressive insanity'.
- Dreyfus (1907) had challenged Kraepelin's concept of an acquired origin, maintaining it to be endogenous in origin - although 'a recent statistical study of Dreyfus's old series has also shown that his conclusion that the natural history of involutional melancholia was no different from that of depression affecting younger subjects was wrong'.[9] Kirby (1909) described it as a distinctive syndrome, as did Hoch and MacCurdy in 1922. Titley (1936) described the premorbid personality and narrow range of interests, etc., Kallman (1959) found incidence of schizophrenia in the families of such patients.
- Debate about causation - endogenous or environmental - as well as its status as a clinical entity continued into the late twentieth century. Some contend that whereas 'involutional melancholy was conceptualized as an acquired rather than constitutional disorder, these ideas have not survived careful scrutiny'. R. P. Brown in 1984 maintained that 'there is insufficient evidence to view involutional melancholy as a separate clinical entity', but at the same time that 'clinical characteristics of patients with unipolar endogenous depression may be influenced by age'.
Treatments
- Treated with antidepressants and mood elevators.