| Dimension | Major Depressive Disorder—Melancholic Type | Dysthymic Disorder |
|---|
| Cause | Primary disturbance in structure and function of brain and nervous system | Severe, prolonged stress, unresolved conflicts; chronic anxiety, fears, anger |
| Onset | Rapid and without apparent cause | Gradual |
| Form of depression | Restlessness and agitation, or psychomotor retardation; severe; tends to be worse in morning and better in evening | Mixed; mild to severe; unpredictable mood; usually optimistic in morning and depressed in evening |
| Sleep | Insomnia after being awakened; early-morning awakening | Easily awakened, but goes back to deep sleep in morning |
| Appetite | Anorexia leading to weight loss | Varied (anorexia leading to compulsive eating) |
| Activity | Chronically tired; needs structure at all times | Occasional energy bursts (feels embarrassed at lack of energy) |
| Self-esteem | Very low | Fluctuates from high to low |
| Fears | Intense fear of being alone | Multiple fears about present and future |
| Decision making | Totally indecisive | OK on minor decisions; indecisive on important decisions |
| Memory | Poor | Unreliable |
| Contact with reality | Poor; paranoid, self-deprecatory delusions, distorted judgment | Varies |