We describe the syndrome of ‘Organic melancholia’, i.e. the form of melancholia which in addition to the endogenous symptoms also shows organic psychopathological symptoms and is connected with brain damage. We found considerable differences between organic and cryptogenic melancholia: the development of organic melancholia has a regular course which can be distinguished into four stages: (1) the asthenic-hypochon-driac, (2) the purely depressive, (3) the organically depressive and (4) the purely organic stage. The outcome of organic melancholia – a severe organic psychodeficiency, often combined with neurological symptoms, and the irreversible destruction of the professional life of the patient – is one of the more important differences distinguishing the organic and the cryptogenous type. Our findings are based on long-term observations of 30 patients.