Objectives
This paper is a pilot study on the relationship between the melancholic type of personality or typus melancholicus (TM) and post-partum depression. The monograph Melancholy 1 is the most detailed attempt to describe the premorbid personality of persons vulnerable to melancholy. Based on the analyses of six cases of post-partum depression reported by Tellenbach and six more cases taken from our own practice, we developed the hypothesis that the characteristics of TM can be a pathogenic factor in the post-partum period. Also, we advance the hypothesis that the situation that characterizes the first period of motherhood has many analogies with a situation which is termed “despair” and characterizes the prodromes of melancholy.
Methods
We extracted from the 119 cases described by Tellenbach 6 clinical vignettes with a clear diagnosis of post-partum depression and we compared them with 6 cases from our own clinical practice, extracted from a larger sample. To establish the diagnosis of TM, we applied the Criteria for Typus Melancholicus 2, a semi-structured interview that includes four criteria – “orderliness”, “conscientiousness”, “hyper/heteronomia” and “intolerance for ambiguity” (Table I). Also, we extrapolated the clinical characteristics of post-partum depression using the criteria described in a preceding paper 3 (Table II). We characterized the pre-melancholic situation, i.e. the subjective experience of women facing the “motherhood” life event, using an operationalized version of pre-melancholic situation as described by Tellenbach including the concepts “includence”, “remanence”, and “despair” (Table III).
Results
Our analysis suggests that the TM personality structure can represent a valid model for the early diagnosis of women at risk to develop an episode of post-partum depression also in those cases in which a clear history of major depression is not present. The TM construct can also enhance our capacity to improve the understanding of the interplay between personality traits, the characteristics of the “motherhood” life event and the presentation of depressive symptoms. The major limitations of this study are the small number of patients and the absence of a standardized scale for the assessment of TM which could be applied to a larger sample of patients. Overcoming these limitations is part of our research agenda.
Conclusions
The comparison between Tellenbach’s case vignettes and our own patients, as well as the analysis of our cases through the Criteria for the Diagnosis of TM, allows us to assess the consistence of our research hypothesis and consider it worth-developing and -testing in a large scale quantitative study.