Psychiatric specifier

With melancholic features

Profound loss of pleasure or mood reactivity occurs with a characteristic biological and psychomotor pattern.

Episode features

Major depressive episodes

At a glance

Applies to: Major depressive episodes
Deciding signal: Pleasure and emotional reactivity are markedly reduced, not merely overshadowed by stress.
Ask this: Is there a pervasive non-reactive depressive pattern with characteristic biological or psychomotor change?
Wording outcome: Major depressive disorder, current episode, with melancholic features

Mood reliably brightens with positive events or interpersonal connection.
Reduced enjoyment is better explained by sedation, negative symptoms, cognitive disorder, or environmental deprivation.

Fit and exclusions

Start with the deciding signal, then test chronology, competing explanations, and the effect on diagnostic wording.

There is marked anhedonia or very limited mood reactivity.
The episode includes a coherent pattern such as early waking, diurnal change, psychomotor change, or excessive guilt.
The presentation is qualitatively different from ordinary sadness or understandable distress.

Document the biological and psychomotor pattern because it may influence treatment intensity and monitoring.

Focus: Non-reactive, biologically patterned depression
Time course: Persists across the depressive episode
Look for: Anhedonia, non-reactivity, diurnal change, psychomotor change, guilt
Avoid: Severity alone does not establish melancholic features

Major depressive disorder, current episode, with melancholic features

At a glance

Applies to

Major depressive episodes

Deciding signal

Pleasure and emotional reactivity are markedly reduced, not merely overshadowed by stress.

Ask this

Is there a pervasive non-reactive depressive pattern with characteristic biological or psychomotor change?

Wording outcome

Major depressive disorder, current episode, with melancholic features