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Diagnosing melancholic depression: some personal observations

Objectives: The objective of this study was to offer some personal observations as to how melancholia can be diagnosed and differentiated from the non-melancholic depressive conditions. Methods: Personal clinical and research-based observations are presented following a critique of common current strategies. Results: The paper offers views on the most differentiating clinical features, argues for adding illness course variables to symptoms and provides details of the Sydney Melancholic Prototypic Index, a measure with a high overall classification rate in differentiating melancholic and non-melancholic depression. Conclusions: Greater precision in differentiating melancholic from non-melancholic depression is advanced by weighting signs and symptoms of psychomotor disturbance, as well as including illness correlates and family history in the diagnostic process.