The purpose of this study was to compare outpatients who met DSM-III-R versus DSM-IV criteria for melancholia. Of 176 consecutive outpatients with unipolar depression, 40 (22.7%) met DSM-III-R criteria and 29 (16.5%) met DSM-IV criteria for melancholia. Patients with DSM-IV melancholia had higher mean scores on measurements of clinical severity as compared with those who qualified for a DSM-III-R diagnosis. These results suggest that the criteria for melancholia proposed in the DSM-IV are more restrictive and define a more severely depressed population than criteria in the DSM-III-R.