A Brief History of Depression
Once considered a rare and stigmatizing mental
defect that inevitably led to hospitalization or suicide, depression
is now recognized as a commonplace and highly treatable organic
illness not unlike, say, hypertension. While there's certainly
still room for improvement, treatment for depression has evolved
over the past century into more precise and effective therapies
with fewer adverse consequences.
psychiatrist Emil Kraepelin develops the current classification
of depression, distinguishing it from schizophrenia and recognizing
that some patients experience alternating periods of low mood
(depression) and elevated mood (mania).
1917: Sigmund Freud
publishes Mourning and Melancholia, a seminal work explaining
depression as "anger turned upon the self." In America,
Freud's psychodynamic theories dominate the first half of the
20th century with an understanding of depression as a disorder
of the mind. As the century moves on, depression is seen increasingly
as a disorder of the brain.
1938: Italian clinician
Lucino Bini performs electroconvulsive therapy (ECT) for the
first time, with significant benefit to his patient. ECT is eventually
refined so that, by the mid-1950s, it becomes a standard therapy
for severe depression and psychosis.
Early 1950s: Several
clinicians observe that iproniazid, a drug developed for tuberculosis,
produces elevated mood in some patients. This monoamine oxidase
(MAO) inhibitor becomes the first pharmacologic treatment of
depression. Although it is discontinued after several years of
widespread use owing to its side effects, it paves the way for
future MAO inhibitors, an important class of drugs to this day.
1955: A trained practitioner
of Freudian psychoanalysis, Albert Ellis, rejects Freud's techniques
as superficial and unscientific. He invents his own nonmedical
approach, Rational-Emotive Therapy. The focus is on altering
behavior by confronting patients with their irrational beliefs
and persuading them to adopt rational ones.
1958: Roland Kuhn
tests the tricyclic compound imipramine in psychiatric patients.
It appears to work by blocking the reuptake of two neurotransmitters
(chemicals that carry nerve impulses from one neuron to another),
norepinephrine and serotonin, in the brain. Imipramine becomes
the first of many tricyclic antidepressants, another mainstay
of contemporary therapy.
1976: Aaron Beck publishes Cognitive
Therapy and Emotional Disorders. Cognitive therapy aims
to halt recurrent negative thoughts that lead to depression.
Early 1980s: The "second
wave" of antidepressants arrives when European scientists
develop a class of drugs that specifically affect the mood-modifying
neurotransmitter serotonin. These drugs, known as selective serotonin
reuptake inhibitors (SSRIs), prove no more effective than first-generation
antidepressants but take effect more rapidly and produce fewer
side effects (except for sexual difficulties). In 1987, the U.S.
company Eli Lilly develops its own SSRI, fluoxetine (Prozac),
which becomes the most successful psychiatric drug in history.
1990s: New antidepressant
drugs including dopamine reuptake inhibitors (bupropion) and
alpha-2 receptor antagonists (mirtazapine) become available.
Because these drugs, like SSRIs, act selectively on specific
neurotransmitters, they tend to produce fewer and less severe
From The Johns
Hopkins Medical Letter: Health After 50, June 1999.