Melancholia that is identified early and is treated vigorously by the available methods resolves rapidly. Treatment becomes challenging, however, when the patient has a comorbid general medical or neurologic condition that affects its delivery, or is very young or very old. The presence of psychosis or a history of a manic-depressive course are also complicating circumstances, but acute treatment of a melancholic episode in these circumstances is often straightforward and is discussed in Chapter 11. So-called “treatment-resistant depression” is discussed here.

Melancholia in pregnancy and breast-feeding

From 5 to 10% of women become clinically depressed during pregnancy. A depressive mood disorder is a risk factor for obstetrical difficulties, low infant birth weight, newborn irritability, retarded child development, and neurological deficits. Depressive moods and abnormal vegetative signs during pregnancy anticipate postpartum depression.

Women with mood disorders during the childbearing years and while sexually active need to be educated about the risks for the fetus of the illness and its treatments. They and their partners need a long-range treatment plan.