Involutional melancholia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Involutional melancholia or involutional depression is a traditional 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]

Emil Kraepelin (1907) was the first to describe Involutional melancholia as a distinct clinical entity separate from the manic-depressive psychosis. Dreyfus (1907) challenged his concepts of origin and he thought it to be endogenous in origin. 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.

• Previous illness of depressive conditions
• Symptoms of fear
• Despondency and hypochondriacal delusions
• Late onset of the disorder
• Prolonged course with poor prognosis and/or deterioration

It was first thought to be of acquired conditions till as early as 1907, when Dreyfus challenged it to be of endogenous origin after studying 85 of Kraepelin's original patients.

Involutional melancholia is classically treated with antidepressants and mood elevators.

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