[The melancholic-delusional depression as a disturbance of the drive]

Distinguishing between melancholic and non-melancholic depression is still of significant importance in the classification and differentiation of depressive disorders. Melancholy appears to be a psychopathological and biologically based entity which can be described as a disorder of drive and which finds its extreme culmination in depressive delusion. Its pathogenesis ranges from the melancholic predisposed personality, mostly of the Typus melancholicus, over psychomotor inhibition and depersonalization, to depressive delusion. Delusion arises from the fear that the realization of basic human values, such as one's existence for important others or ideals, health and livelihood has become hopeless. A clear understanding of the nature and pathogenesis of melancholic delusional depression not only facilitates the diagnostic process, and the empathic assistance to the patient, but also has direct consequences for an appropriate treatment of this disorder.