There is still a debate, if melancholic symptoms can be seen rather as a more severe subtype of major depressive disorder (MDD) or as a separate diagnostic entity. The present European multicenter study comprising altogether 1410 MDD in- and outpatients sought to investigate the influence of the presence of melancholic features in MDD patients. Analyses of covariance, chi-squared tests, and binary logistic regression analyses were accomplished to determine differences in socio-demographic and clinical variables between MDD patients with and without melancholia. We found a prevalence rate of 60.71% for melancholic features in MDD. Compared to non-melancholic MDD patients, they were characterized by a significantly higher likelihood for higher weight, unemployment, psychotic features, suicide risk, inpatient treatment, severe depressive symptoms, receiving add-on medication strategies in general, and adjunctive treatment with antidepressants, antipsychotics, benzodiazepine (BZD)/BZD-like drugs, low-potency antipsychotics, and pregabalin in particular. With regard to the antidepressant pharmacotherapy, we found a less frequent prescription of selective serotonin reuptake inhibitors (SSRIs) in melancholic MDD. No significant between-group differences were found for treatment response, non-response, and resistance. In summary, we explored primarily variables to be associated with melancholia which can be regarded as parameters for the presence of severe/difficult-to treat MDD conditions. Even if there is no evidence to realize any specific treatment strategy in melancholic MDD patients, their prescribed medication strategies were different from those for patients without melancholia.

仍然存在争议，是否可以将忧郁症状视为重度抑郁症 (MDD) 的更严重的亚型或单独的诊断实体。目前的欧洲多中心研究包括总共 1410 名 MDD 住院和门诊患者，旨在调查 MDD 患者中存在的忧郁特征的影响。完成协方差分析、卡方检验和二元逻辑回归分析，以确定患有和不患有忧郁症的 MDD 患者之间社会人口统计学和临床​​变量的差异。我们发现 MDD 中忧郁特征的患病率为 60.71%。与非忧郁型 MDD 患者相比，他们的特征是体重、失业、精神病特征、自杀风险、住院治疗、严重抑郁症状、一般接受附加药物策略，尤其是抗抑郁药、抗精神病药、苯二氮卓类药物 (BZD)/BZD 类药物、低效抗精神病药和普瑞巴林的辅助治疗。关于抗抑郁药物治疗，我们发现在忧郁型 MDD 中使用选择性 5-羟色胺再摄取抑制剂 (SSRIs) 的频率较低。在治疗反应、无反应和耐药性方面没有发现显着的组间差异。总之，我们主要探索了与忧郁症相关的变量，这些变量可以被视为存在严重/难以治疗的 MDD 病症的参数。即使没有证据表明对抑郁症 MDD 患者有任何特定的治疗策略，他们的处方药物策略也与没有抑郁症的患者不同。