Melancholia is a historical concept according to which the clinical condition is characterised by gloom, apprehension and psychomotor disturbance, vital symptoms and psychotic phenomena. The condition needs to be accurately diagnosed if treatment is to be appropriate. If a patient shows no clear signs of depression, psychomotor disturbance is often not recognised as a feature of severe depression and as a result treatment is delayed. On the basis of two case studies we show that psychomotor symptoms can be extremely important for an accurate clinical evaluation.