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The history of depression over the last 75 years

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It’s a great feeling when you feel positive and content with yourself and your life but your mood ebbs and flows. It’s the nature of all humans. The term melancholia once described those gloomy symptoms before the term depression was invented. With the development of depression theory and research a lot of changes took place in the field of mental health. Let’s take a look at the history of depression, and how our understanding of depression and depression treatments has evolved throughout the last 75 years.

 

Defining depression

Even though the word depression was just introduced in the late 19th century, similar symptoms have been mentioned in describing this state for centuries[1]. There was always a need for a classification of mental health conditions[2]. The first version of the Diagnostic and Statistical Manual, also known as DSM-I used by clinicians who diagnose psychiatric diseases, was published in 1952 by the American Psychiatric Association Committee[3]. From then on, four more editions were published. Today, clinicians are leaning on the DSM-5 version while diagnosing patients[4]. Throughout the years, definitions became more explicit, promoting more reliable clinical diagnosis and influencing the development of depression research[2,5]. When depression was first defined in a manual for clinicians, the understanding of this mental health condition was there had to be significant changes in the environment for someone to develop symptoms of depression[3,5,6,7]. In the next years, clinicians started to be more aware of the power a word, describing something a patient is dealing with, can have[8,9,10,]. They renamed the supercategory explaining the symptoms of depression with a more patient-friendly term[11,12]. They have also defined shorter episodes lasting for at least 2 weeks which can form the mental health condition known as depression [8,9,10]. This came in handy for a more in-depth diagnosis. Today, the term depressive disorders joins together many subcategories, such as major depressive disorder, persistent depressive disorder, and substance/medication-induced depressive disorder[10].

 

Assessment of depression

Until the first Diagnostic and Statistical Manual, clinicians used to assess whether someone was dealing with depression by talking to them. This is a valid method which is still used today. The main differences between depression assessment in 1948 and today are that clinicians can now lean on a manual that automatically enables a more objective assessment[13]. Today, clinicians use established, research-backed interview guidelines, screening tools, checklists, and other criteria to help them make a diagnosis of depression[13]. 

 

Medical treatment: from lobotomy to antidepressants

Lobotomy treatment was first performed by the Portuguese neurologist Moniz[14]. The operation consists of cutting a part of the fibre in the frontal regions of the brain. Until the late 1960s, the procedure has been widely employed to treat many types of mental health conditions. When successful, the "easier than curing a toothache" or “operation Ice Pick” procedure as it was named by clinicians and the media then, relieved patients of overwhelming anxiety[15]. Though reputed to have a calming effect, lobotomies often caused personality changes, a loss of decision-making ability, and poor judgment[14].

The 1950s became a critical decade in the treatment of depression when clinicians noticed that a tuberculosis medication called Isoniazid seemed to help treat depression in some people[16,17]. One of the first drugs to emerge for the treatment of depression provided relief for many people with depression but was often accompanied by serious side effects[18]. Other antidepressants emerged from 1987 to 1992, which usually have fewer side effects than their predecessors. Newer antidepressant drugs have been developed in the past couple of decades. Thanks to the improved understanding of the causes of depression, additional effective treatments have been researched[18].

Research results from multiple studies show that depression is linked with lesser serotonin production[19,20,21]. Serotonin impacts your mood and sleep-wake cycle. In the last 50 years, multiple studies also researched the effect that the serotonin booster known as 5-htp has on people dealing with depression[19,20]. 5-htp is produced naturally from serotonin’s building block, called tryptophan, and can increase serotonin production in the brain[20]. 5-htp taken orally is highly absorbed, and it also crosses the blood-brain barrier very easily. Researchers found that significantly less 5-htp crossed the blood-brain barrier in people dealing with depression than in healthy people[19,20]. Multiple studies confirm the theory that 5-htp can help people dealing with depression experience remission, especially with longer treatment duration[19,20,21]. Therefore, 5-htp could have the potential as a depression treatment. However, the sample of participants should be bigger, the dosage invariant between studies, and the treatment duration more controlled, to be able to confirm the theory[20]. Serotonin production is important for all people. You can ensure the body has enough serotonin to release it in higher amounts by opting for high-quality food supplementation. Try brain feed’s smallest, nutrient-dense serotonin enhancement tablet for £13.99 GBP. Enter code ‘NEW15’ for 15% off your first-ever order. 

 

Psychology and psychotherapy in mental hospitals

In the UK, a few mental hospitals changed their regime by 1948. The clinicians believed patients should freely cooperate in the newly-introduced occupational therapy, music and art classes held in mental hospitals[22]. In the later years, people who were treated with antidepressants but continued living their lives in the outside world could also join classes in mental hospitals. That stimulated the shift to mental hospitals being viewed as more open and inviting. As mental health destigmatisation was on the rise throughout the years, more people were willing to address their symptoms of depression by taking part in some kind of psychological and psychotherapeutic interventions provided by professionals[23]. Today, psychological counselling and different forms of psychotherapy are known as effective and noninvasive forms of depression treatment[23]. Counselling psychologists and psychotherapists help people who are dealing with depression by providing effective coping mechanisms which also have a positive effect on changes in brain activity[23,24,25,26,27,28].

 

Successfully battling depression with a holistic approach

Wondering how to look after mental health and how to feel better mentally? Read through what a holistic approach to treating depression looks like. 

  • How do antidepressant, and psychological and psychotherapeutic interventions work together?

    A study found that combined antidepressant and psychotherapy treatment appears to be more effective than treatment with antidepressant medication alone[29]. While psychological counselling and psychotherapy may involve only the individual, they can include others[30]. For example, family or couples therapy can support those relationships. In contrast, group therapy and support groups bring people with similar illnesses together in a supportive environment which can assist the participant in learning how others cope in similar situations[30]. Lastly, let’s take a look at natural remedies for depression.

    • While exercise is primarily known for its physical health benefits, it is increasingly recognised for its mental health and antidepressant benefits[31,32,33,34].

      Empirical evidence indicates that exercise is effective in treating individuals with depression[27,28]. Exercise can also positively impact your mood and energy level[31]. Meditation, yoga, and deep breathing, while not proven to treat depression, can help manage the symptoms and help you calm down[34]. Also, when someone is feeling stressed, they often take quick breaths or have a hard time catching their breath. When you take a slow, deep breath in, your lungs fill with oxygen, which helps to lower your heart rate. By focusing your mind on the breathing process during breathing techniques or yoga, you shift the focus away from whatever is causing the stress. You can also try out a mindfulness meditation session: a mental practice that helps us slow down our racing thoughts. You can read more about it here

      • Another great self-help trick is helping your body produce more of the cuddle hormone, called oxytocin which regulates the stress response.

        One study noted a jump in oxytocin levels after high-intensity martial arts training[35]. Music and bonding also seem to possess the ability to increase oxytocin levels in your body[36]. Take an A Capella group for example: when you are part of one, your oxytocin levels increase with singing and additionally while bonding with your co-singers. A simple act of touch also seems to boost the release of oxytocin[36]. Giving someone a massage, cuddling, having sex, or hugging someone leads to higher levels of this hormone and a greater sense of well-being. A warm and empathic relationship with your therapist can also make you feel supported and is likely to induce similar effects[36,37]. Click here, if you want to know more about oxytocin and stress.

        • Maintaining a healthy diet and weight is also of great importance[34].

        Eating a healthy and balanced diet can keep your blood sugars more stable and helps calm your mood. This stability is especially important if you’re dealing with depression. Larry Christensen, PhD, professor of psychology, found that “about 20% to 25% of their patients find relief from depression when they cut caffeine and added sugar from their diet”[34]. You can read more about the Mediterranean diet that helps your mental health here.

         

        Knowing what you know about depression now, make sure to encourage yourself or those who are dealing with depression to choose a treatment plan and give it a try for at least several weeks. Keep in mind that there are many different ways to deal with depression you can try out, and if you can, opt for a holistic approach. 

         

         

        References:

        [1] Horwitz, A. V., Wakefield, J. C., & Lorenzo-Luaces, L. (2017). History of Depression. In R. J. DeRubeis & D. R. Strunk (Eds.), The Oxford Handbook of Mood Disorders (pp. 11-23). Oxford University Press. 

        [2] DSM History (n.d.). American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm#:~:text=The%20APA%20Committee%20on%20Nomenclature,the%20first%20edition%20of%20DSM

        [3] Cooper, R., & Blashfield, R. K. (2016). Re-evaluating DSM-I. Psychological Medicine, 46(3), 449–456. 

        [4] Blashfield, R. K., Keeley, J. W., Flanagan, E. H., & Miles, S. R. (2014). The Cycle of Classification: DSM-I Through DSM-5. Annual Review of Clinical Psychology, 10(1), 25–51.

        [5] History of the DSM (2022). PsychDB. https://www.psychdb.com/teaching/1-history-of-dsm

        [6] Bourin, M. (2020). History of depression through the ages. Archives of Depression and Anxiety, 6(1), 010–018.

        [7] The Committee on Nomenclature and Statistics of the American Psychiatric Association. (1952). Diagnostic and Statistical Manual: Mental Disorders (1st ed.). American Psychiatric Association.

        [8] American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). American Psychiatric Association.

        [9] American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association.

        [10] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.

        [11] American Psychiatric Association. (1968). Diagnostic and Statistical Manual of Mental Disorders (2nd ed.). American Psychiatric Association.

        [12] Mason, B. L., Brown, E. S., & Croarkin, P. E. (2016). Historical Underpinnings of Bipolar Disorder Diagnostic Criteria. Behavioral Sciences, 6(3), 14. 

        [13] Nezu, A. M., Nezu, C. M., Friedman, J., & Lee, M. (2009). Assessment of Depression. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of Depression (pp. 44–68). The Guilford Press. 

        [14] Myerson, A., & Myerson, P. G. (1947). Prefrontal Lobotomy in the Chronic Depressive States of Old Age. New England Journal of Medicine, 237(14), 511–512. 

        [15] Prentice, C. (2022). Doctor Ice Pick. Amazon Original Stories.

        [16] Ramachandraih, C., Subramanyam, N., Bar, K., Baker, G., & Yeragani, V. (2011). Antidepressants: From MAOIs to SSRIs and more. Indian Journal of Psychiatry, 53(2), 180.

        [17] Haenel, T. (1986). Historical notes on the therapy of depression. Schweizerische Medizinische Wochenschrift, 116(47), 1652–1659.

        [18] Schimelpfening, N. (2023). The History of Depression: Accounts, Treatments, and Beliefs Through the Ages. verywell mind. https://www.verywellmind.com/who-discovered-depression-1066770

        [19] Birdsall, T. C. (1998). 5-Hydroxytryptophan: A Clinically-Effective Serotonin Precursor. Alternative Medicine Review, 3(4), 10.

        [20] Javelle, F., Lampit, A., Bloch, W., Häussermann, P., Johnson, S. L., & Zimmer, P. (2020). Effects of 5-hydroxytryptophan on distinct types of depression: A systematic review and meta-analysis. Nutrition Reviews, 78(1), 77–88.

        [21] Meyers, S. (2000). Use of Neurotransmitter Precursors for Treatment of Depression. Alternative Medicine Review, 5(1), 8.

        [22] Mental health and the NHS: What's changed and what's to come? (n.d.). National Institute for Health and Care Excellence. https://indepth.nice.org.uk/mental-health-and-the-nhs/index.html

        [23] Hollon, S. D., & Dimidjian, S. (2009). Cognitive and Behavioral Treatment of Depression. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of Depression (pp. 586–603). The Guilford Press. 

        [24] Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: A comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105–115. 

        [25] Linde, K., Sigterman, K., Kriston, L., Rücker, G., Jamil, S., Meissner, K., & Schneider, A. (2015). Effectiveness of Psychological Treatments for Depressive Disorders in Primary Care: Systematic Review and Meta-Analysis. Annals of Family Medicine, 13(1), 56–68. 

        [26] Lueken, U., & Hahn, T. (2016). Functional neuroimaging of psychotherapeutic processes in anxiety and depression: From mechanisms to predictions. Current Opinion in Psychiatry, 29(1), 25.

        [27] Huang, X., Huang, P., Li, D., Zhang, Y., Wang, T., Mu, J., Li, Q., & Xie, P. (2014). Early brain changes associated with psychotherapy in major depressive disorder revealed by resting-state fMRI: Evidence for the top-down regulation theory. International Journal of Psychophysiology, 94(3), 437–444.

        [28] Wiswede, D., Taubner, S., Buchheim, A., Münte, T. F., Stasch, M., Cierpka, M., Kächele, H., Roth, G., Erhard, P., & Kessler, H. (2014). Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli. PLoS ONE, 9(10), e109037.

        [29] Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: A meta-analysis. World Psychiatry, 13(1), 56–67.

        [30] Torres, F. (2020). What is depression? American Psychiatry Association. https://www.psychiatry.org/patients-families/depression/what-is-depression

        [31] Ross, R. E., VanDerwerker, C. J., Saladin, M. E., & Gregory, C. M. (2023). The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes. Molecular Psychiatry 28, 298–328.

        [32] Cooney, G. M., Dwan, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., McMurdo, M., & Mead, G. E. (2013). Exercise for depression. Cochrane Database of Systematic Reviews, 9, CD004366. 

        [33] Depression: Alternative Therapies (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/9303-depression-alternative-therapies

        [34] Greenlaw, E. (2010).  A Holistic Approach to Treating Depression. WebMD. https://www.webmd.com/depression/features/holistic-medicine

        [35] Rassovsky, Y., Harwood, A., Zagoory-Sharon, O., & Feldman, R. (2019). Martial arts increase oxytocin production. Scientific reports, 9(1), 12980.

        [36] Uvnas-Moberg K, Petersson M. (2005). Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 51(1), 57–80.

        [37] Olff, M., Frijling, J.L., Kubzansky, L.D., Bradley, B., Ellenbogen, M.A., Cardoso, C., Bartz, J.A., Yee, J.R., & van Zuiden, M. (2013). The role of oxytocin in social bonding, stress regulation and mental health: An update on the moderating effects of context and interindividual differences. Psychoneuroendocrinology, 38(9), 1883–1894.

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