The History of Depression

Accounts, treatments, and beliefs through the ages

Hippocrates, polychrome majolica, detail, cloister of Old Cemetery, Padula charterhouse (Certosa di San Lorenzo), Padula, Campania, Italy

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While there is no single person who can be credited with discovering depression, there have been a whole series of great thinkers who have contributed—and continue to contribute—to our growing understanding of just what this illness really is. Here's an overview of the history of depression.

Earliest Accounts of Depression

The earliest written accounts of what we now know as depression appeared in the second millennium B.C. in Mesopotamia. In these writings, depression was discussed as being a spiritual rather than physical condition, with it, as well as other mental illnesses, thought of as being caused by demonic possession. As such, it was dealt with by priests rather than physicians.

The idea of depression as being caused by demons and evil spirits has existed in many cultures, including the ancient Greeks, Romans, Babylonians, Chinese, and Egyptians, and was often treated with such methods as beatings, physical restraint, and starvation in an attempt to drive the demons out. The ancient Greeks and Romans, however, were of two minds on the matter, with many doctors also considering it to be a biological and psychological illness. These doctors used therapeutic methods such as gymnastics, massage, diet, music, baths, and a medication containing poppy extract and donkey's milk to treat their patients.

Ancient Beliefs in Physical Causes of Depression

As far as physical causes, a Greek physician named Hippocrates is credited with the idea that depression, or melancholia as it was known then, was caused by an imbalance in four body fluids, called humors: yellow bile, black bile, phlegm, and blood. Specifically, melancholia was attributed to an excess of black bile in the spleen. Hippocrates' treatments of choice included bloodletting, baths, exercise, and diet.

A Roman philosopher and statesman named Cicero, in contrast, believed that melancholia was caused by psychological causes such as rage, fear, and grief. In the last years before the common era, a very common belief among even educated Romans was that depression and other mental illnesses were caused by demons and by the anger of the gods.

Depression Causes and Treatment in the Common Era

Cornelius Celsus (25 BC-AD 50) is reported as recommending the very harsh treatments of starvation, shackles, and beating in cases of mental illness. A Persian doctor named Rhazes (AD 865-925), however, did see mental illness as arising from the brain and recommended such treatments as baths and a very early form of behavior therapy which involved positive rewards for appropriate behavior.

During the Middle Ages, religion, especially Christianity, dominated European thinking on mental illness, with people again attributing it to the devil, demons or witches. Exorcisms, drowning, and burning were popular treatments of the time. Many were locked up in "lunatic asylums." While some doctors continued to seek physical causes for depression and other mental illnesses, they were in the minority.

During the Renaissance, which began in 14th century Italy and spread throughout Europe during the 16th and 17th centuries, witch hunts and executions of the mentally ill were still quite common; however, some doctors were revisiting the idea of mental illness having a natural rather than a supernatural cause.

In the year 1621, Robert Burton published a book called Anatomy of Melancholy in which he outlined both social and psychological causes of depression such as poverty, fear, and loneliness. In this volume, he made recommendations like diet, exercise, travel, purgatives (to clear toxins from the body), bloodletting, herbs, and music therapy in the treatment of depression.

The 18th and 19th Centuries

During the 18th and 19th centuries, also called the Age of Enlightenment, depression came to be viewed as a weakness in temperament which is inherited and cannot be changed, with the resulting idea that people with this condition should be shunned or locked up.

During the latter part of the Age of Enlightenment, doctors began to suggest the idea that aggression was at the root of this condition. Treatments such as exercise, diet, music, and drugs were now advocated and doctors suggested that it was important to talk about your problems with your friends or a doctor. Other doctors spoke of depression as resulting from internal conflicts between what you want and what you know is right. And yet others sought to identify the physical causes of this condition.

Depression treatments during the Age of Enlightenment included water immersion (people were kept under water for long as possible without drowning) and a spinning stool to induce dizziness, which was believed to put the brain contents back into their correct positions. Benjamin Franklin is also reported to have developed an early form of electroshock therapy during this time. In addition, horseback riding, diet, enemas, and vomiting were recommended treatments.

Recent Beliefs About Depression

In 1895, the German psychiatrist Emil Kraepelin became the first to distinguish manic depression, what we now know as bipolar disorder, as an illness separate from dementia praecox (the term for schizophrenia at the time). Around this same time, psychodynamic theory and psychoanalysis—the type of psychotherapy based on this theory—were developed.

In 1917, Sigmund Freud wrote about mourning and melancholia where he theorized about melancholia as being a response to loss, either real (for example, a death) or symbolic (failure to achieve a desired goal). Freud further believed that a person's unconscious anger over his loss leads to self-hatred and self-destructive behavior. He felt that psychoanalysis could help a person resolve these unconscious conflicts, reducing self-destructive thoughts and behaviors. Other doctors during this time, however, saw depression as a brain disorder.

Treatments for Depression in the Recent Past

During the late 19th and early 20th centuries, treatments for severe depression were generally not enough to help patients, leading many people desperate for relief to have lobotomies, which are surgeries to destroy the frontal portion of the brain. These surgeries were reputed to have a "calming" effect. Unfortunately, lobotomies often caused personality changes, a loss of decision-making ability, poor judgment, and sometimes even led to the patient's death. Electroconvulsive therapy, which is an electrical shock applied to the scalp in order to induce a seizure, was also sometimes used for patients with depression.

During the 1950s and 60s, doctors divided depression into subtypes of "endogenous" (originating from with the body) and "neurotic" or "reactive" (originating from some change in the environment). Endogenous depression was thought to result from genetics or some other physical defect, while the neurotic or reactive type of depression was believed to be the result of some outside problem such as a death or loss of a job.

The 1950s were an important decade in the treatment of depression thanks to the fact that doctors noticed that a tuberculosis medication called isoniazid seemed to be helpful in treating depression in some people. Where depression treatment had previously been focused only on psychotherapy, drug therapies now started to be developed and added to the mix. In addition, new schools of thought, such as cognitive-behavioral and family systems theory emerged as alternatives to psychodynamic theory in depression treatment.

Our Understanding of Depression Today

At the present time, depression is considered to arise from a combination of multiple causes, including biological, psychological, and social factors. Psychotherapy and medications that target molecules called neurotransmitters are generally the preferred treatments, although electroconvulsive therapy may be utilized in certain instances, such as in treatment-resistant depression or severe cases where immediate relief is required.

Other, newer, therapies, including transcranial magnetic stimulation and vagus nerve stimulation, have also been developed in recent years in an attempt to help those who have failed to respond to therapy and medications, since, unfortunately, the causes of depression are more complex than we yet understand, with no single treatment providing satisfactory results for everyone.

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