Does melancholia predict response in major depression?

We examined the value of the melancholic distinction for predicting response to 1 week of hospitalization without antidepressant drugs and to a 4-week fixed plasma level desipramine (DMI) trial in patients with unipolar non-psychotic major depression. Both DSM-III and III-R criteria were tested. Response to hospitalization (HDRS less than or equal to 12) was much less common in DSM-III melancholic than in non-melancholic patients (1 of 19 vs. 18 of 37, chi 2 = 8.69, df = 1, P less than 0.001) and severity did not account for this association. DSM-III-R melancholia criteria were also associated with poor hospital response but slightly less predictive. Melancholic patients, however, diagnosed with either set of criteria, were not more likely to respond to drug treatment on any of the measures examined.