Major Depressive Disorder with melancholic features can be described by certain specifiers. The major specifier for major depressive disorder with melancholic features is a total loss of interest or pleasure in all, or almost all, activities. The mood of an individual showing melancholic features will not improve when something good happens and the individual will fail to react to usually pleasurable stimuli. In addition to the loss of interest and pleasure in activities, three of the following symptoms will be present: the depressed mood has a distinct quality, depression that is regularly worse in the morning, waking early in the morning, psychomotor retardation or agitation, significant anorexia or weight loss, and excessive or inappropriately assigned guilt. (Arm Med Media Group, 2010)  Those with melancholic features are less likely to have a personality disorder, to be able to name a clear precipitant to the episode, or to respond to a placebo medication trial. Melancholic features will occur at the lowest point of a major depressive episode and can only be applied to the most recent or current major depressive episode. (Arm Med Media Group, 2010)

Major Depressive Disorder with melancholic features can be treated can be treated with one of the three most common treatments for depression disorders: psychotherapy, medication, and electroconvulsive therapy. The last, electroconvulsive therapy, is considered an extreme measure and is used only as a last resort. Psychotherapy is the most common and preferred method for treating adolescents under the age of 18, since this age group tends to suffer more side effects, including an increased melancholic mood, from medication. For adults, a combination of psychotherapy and medication can be used in treatment. Two classes of drugs, MAOIs and SSRIs can be effective. Examples of each class of drug used in treatment include Nardil and Parnate for MAOIs and Prozac, Paxil, and Zoloft for SSRIs. (Arm Med Media Group, 2010).