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Depression & Anxiety


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.

1895: German 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 side effects.


From The Johns Hopkins Medical Letter: Health After 50, June 1999.


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