History of Depression

Understanding the history of depression helps us to get a better idea of its complexity. But it also equips us with the knowledge to help destigmatise depression and provide support for those suffering from it.

The History of Depression: A Timeline

Ancient Mesopotamian Understanding of Depression

In ancient Mesopotamia, the signs and symptoms of depression were considered to be a result of demonic possession. Treatment included exorcism and performing healing atonement.

Greek and Roman Perspectives on Depression

Ancient Greeks and Romans abandoned the idea of demonic possession. They instead saw depression as a mental disorder, known as melancholia, although the cause was unknown.

Hippocrates, the pioneer of modern medicine, believed it to be caused by imbalances in “bodily humours” (blood and bile). Treatments included exercise, a healthy diet, and music therapy.

Greek philosopher Aristotle noted that melancholia seemed to happen more to intellectual men, leading to an idea that it was linked to creativity and contemplation. Other scholars of the day believed that it was a result of love troubles.

Depression in the Islamic Golden Age

From the 8th to the 13th century, Islamic scholars carried on the work begun by ancient Greek and Roman physicians. Treatments for depression included music, reading, and sexual stimulation in an attempt to “cheer patients up”.

Persian physician Avicenna labelled melancholia as a depressive mood disorder, listing symptoms including suspicion and developing phobias. Arab psychologist and physician Najab ud-din Unhammad built on this, and created a detailed classification of mental disorders, including symptoms of “agitated depression”.

Another doctor, Rhazes, described melancholia as a brain disorder. He was one of the first ever to recommend behavioural therapy, using a “positive reinforcement” system with rewards for good behaviour.

Depression in the Middle Ages

Christianity dominated the early Middle Ages, which caused the idea of a spiritual cause for depression to rise up again. Exorcisms, burnings, and drownings were common, as people assumed that demons were responsible.

By the 14th century, some physicians had begun turning back towards the idea of a natural cause. Witch hunts still occurred, but “bedlams” (hospices) were also created to house and treat patients.

The Renaissance

Robert Burton’s book “Anatomy of Melancholy” was first published in 1621. It’s considered both a medical textbook and a piece of literature based on Burton’s own experience of melancholy. It referenced potential psychological causes like loneliness and fear.

Based on his own experience, Burton recommended good sleep, a healthy diet, music, and talking with a friend as treatments. He also spoke of “meaningful work” (having a purpose) as part of possible treatment.

Age of Enlightenment

In the 1700s and 1800s, research swung more towards aggression and personal internal conflicts being reasons for melancholia. Treatment methods also became more experimental, and included:

• Enemas
• Water immersion (for as long as possible)
• “Swinging” (created by Joseph Cox)
• Opioids and narcotics

Also during this time, the first primitive forms of electrotherapy were introduced by Benjamin Franklin and Giovanni Aldini.

19th to 20th Century

This period saw huge innovations and discoveries in the field of melancholia.

Formalising Depression

During this time, the phrase “depression” was coined. It was seen as different to melancholia – rather than considered to be an illness, it was seen as a natural temperament.

Kraepelin’s Work

In 1895, Emil Kraeplin became the first person to separate manic depression (bipolar disorder) from schizophrenia. This was a notable milestone in identifying different types of depression.

Freud’s Influence

In 1917, Sigmund Freud’s “Mourning and Melancholia” was published. He put forward the idea that melancholia could take two forms. One is associated with mourning a loss, while the second, depression, is related to a tendency to blame yourself or put yourself down for perceived failures.

He based his ideas on unconscious, unaddressed anger within a person. Freud believed that psychoanalysis could reveal hidden anger and help people resolve their anger in a less destructive way.

ECT’s Introduction

Electroconvulsive therapy (ECT) first took place in 1938. The first patient, a known schizophrenic, responded so well to several ECT treatments that his psychosis eased enough for him to return to normal life.

War’s Toll: The Rise of Depression

The World Wars were a time of extreme violence and loss. The aftermath changed how we thought about mental health, particularly depression and post-traumatic stress disorder (PTSD). The widespread trauma of these wars made it clear how deep and lasting the effects of such experiences could be. It also became clear that it affected not just the soldiers on the front lines, but also the civilians back home.

Shell Shock and PTSD

The horrors of World War I led to the discovery of a condition that was named “shell shock” at the time. Sufferers were plagued by nightmares, flashbacks, and severe anxiety. Today, shell shock is called PTSD, a condition closely linked to depression.

Combat Fatigue and Beyond

World War II provided even more information on psychology. Research emerged on the effect of mental exhaustion, as well as anxiety and depression in female civilians and children.

Long-Term Trauma

The World Wars also highlighted the long-lasting effects of traumatic experiences. Soldiers carried emotional and mental scars for many years, even decades, after the war. Anxiety and PTSD persisted, often descending into depression.

Impact on Civilians

The difference between soldiers’ and civilians’ trauma became more clear in the years following the wars. Constant threats of bombs, being displaced from their home, and fear for or loss of loved ones caused extreme psychological stress.

This opened up a new avenue for research, especially as anxiety and depression persisted for years for many civilians as they did for soldiers.

Societal Effects

Although the psychological effects of the World Wars caused plenty of damage, this was also an important turning point in the world of psychology. Not only did it multiply the opportunities for detailed research, but it also increased awareness of mental health.

Modern Era (1950s to Present): War’s Legacy Shapes Understanding Depression

The 1950s saw an influx of exciting innovations in the world of psychology and depression research. Much of it was influenced by the discoveries during the war. Here are some of the modern era’s innovations.

Expanding Biological Explanations

From the 1950s onward, the biological understanding of depression began to deepen, starting with the discovery of the first antidepressants. These medications, including Monoamine Oxidase Inhibitors (MAOIs), tricyclic antidepressants, and later, Selective Serotonin Reuptake Inhibitors (SSRIs), revolutionised treatment.

They offered concrete evidence that biochemical processes influence mood disorders. This discovery helped researchers shift from the belief that depression was a simple chemical imbalance to understanding how nuanced it can be.

Current research emphasises that depression results from a complex interplay of genetics, brain structure, life experiences, and environmental factors.

Early 20th Century: The Rise of Psychoanalysis

Sigmund Freud’s psychoanalytic theories revolutionised the understanding of depression in the early 20th century. His approach introduced a new way of thinking about mental illness.

As a result, psychoanalysis became enormously popular and was the primary method for treating depression. This method viewed depression through the lens of unresolved internal conflicts that often stemmed from traumatic early life experiences.

The dominance of psychoanalysis in treating depression continued for several decades. However, the treatment was not without its limitations. The often long and intensive nature of psychoanalytic therapy, combined with mixed results, led to a shift to other treatment options.

Practitioners began looking at newer theories that saw faster results, although Freudian theories remain an important milestone in psychology.

Mid-20th Century: Expanding Talk Therapy

One of the new therapies that practitioners explored was “talk therapy”. These types of non-invasive therapies can be split into:

Humanistic Therapies

Humanistic therapies focus on personal growth, self-actualisation, and the therapist-client relationship in the healing process. These therapies aim to help people realise their full potential through increased self-awareness and self-understanding.

A notable example of this approach is Carl Rogers’ client-centred therapy. It’s grounded in the belief that people naturally strive toward growth and healing in a supportive and non-judgmental therapeutic relationship.

Similarly, Abraham Maslow’s concept of self-actualisation suggests that the ultimate goal of human existence is to achieve a state of fulfilment and realisation of your potential.

Both theories highlight the importance of focusing on the individual’s subjective view of the world. The foundation is fostering a nurturing environment where personal worth and the development of self are key.

Cognitive Behavioural Therapy

Developed by Dr. Aaron T. Beck, Cognitive Behaviour Therapy (CBT) is a groundbreaking approach for treating depression. It focuses on the interplay between thoughts, feelings, and behaviours.

CBT highlights how negative thought patterns contribute to the maintenance of depression. It centres on teaching people to recognise harmful thoughts and actively challenge them, shifting towards more balanced and realistic thinking.

By combining strategies that address problem thoughts with interventions aimed at changing actions, CBT helps relieve depressive symptoms and encourages more positive behavioural patterns.

Expanding the Toolkit: Modern Talk Therapies

The world of therapy continues to move upwards, ever-expanding. New, powerful techniques for addressing depression include:

• Interpersonal Therapy (IPT) specifically works on the challenges within a person’s relationships.
• Mindfulness-based therapies use practices like deep breathing and meditation to increase awareness of thoughts and emotions. Being aware means you can choose your response instead of reacting immediately.
• Modernised psychodynamic therapies are based on the initial breakthroughs in psychology, these talk therapies offer a focused approach that’s faster than traditional psychoanalysis.

Refining Diagnoses

Modern research has helped us to refine depression diagnoses. We no longer have an umbrella heading of “melancholia” – instead, we can now distinguish between depression, bipolar disorder, anxiety, and other mood disorders. This refinement allows us to treat depression more effectively with modern medicine.

Biomedical Advances

While antidepressants were discovered first (1950s), the innovation led to new, exciting treatment options. The 1960s brought CBT to the forefront, which was followed in 1985 by the introduction of TMS – transcranial stimulation, a now-revered non-medical method of treating depression.

Pharmacological Revolution

With the shift towards pairing medication and therapy, medication started becoming the subject of more detailed research. Antidepressants evolved from the original discovery of MAOIs to tricyclics to SSRIs, each one working slightly differently on the brain to effectively reduce the symptoms of depression.

Ketamine As A Treatment

Ketamine is a popular modern treatment for depression. It was originally used in the 1970s as an anaesthetic. In 2000, the Yale School of Medicine held the first randomised, controlled clinical trial to show its antidepressant effects.

A decade later, so many physicians believed in the power of ketamine that they began using it in their practices, despite it not being approved for use. The FDA finally approved a ketamine-based medication (Spravato) for treatment-resistant depression and major depressive disorder in 2019.

Psychedelics as Potential Treatments

Research into psychedelics for depression treatment began in the 1950s, when the National Institute of Mental Health (NIMH) sponsored an interesting study. Patients with terminal illnesses were given psychedelics to reduce depression, and the results were startlingly positive.

Research halted when the drugs were banned, but has made strides in recent years thanks to dedicated researchers. In 2023, Australia became the first country to down-schedule psilocybin and MDMA so they could be used for treatment. Both have been moved from schedule 9 (prohibited drugs) to schedule 8 (controlled drugs).

Combined Approaches

Combined therapies have become popular. Talk therapy and medication, or neuromodulation techniques and antidepressants are often paired. This gives the patient the best chance for lasting change.

Changing the Stigma

The world is gaining a deeper understanding of depression year upon year. This rise in awareness has been influenced by organisations like the World Health Organization (WHO) and the NIMH. Not only have they set global and local treatment standards for depression, but they’ve also taken an active role in spreading knowledge and awareness.

Celebrities have also been more open about their own struggles with depression. High-profile actors and musicians have shared their struggles with their fans, bringing more acceptance to the condition.

History of Depression FAQs

Who are some famous historical figures who suffered from depression?

Some of the most famous people throughout the ages suffered from depression, or melancholy, including:

• Abraham Lincoln, the 16th President of the United States
• Winston Churchill, the British Prime Minister during WWII
• Vincent van Gogh, the famous Dutch painter
• Ludwig van Beethoven, the celebrated composer
• Frida Kahlo, the renowned Mexican painter
• Virginia Woolf, the acclaimed English writer
• Sylvia Plath, the American poet, novelist, and short story writer
• Queen Victoria, the Queen of Great Britain in the 1800s

History of Depression FAQs