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History and Treatment of Depression

Introduction

Depression is currently one of the most common medical conditions that are affecting many people in the United States and around the world, regardless of one’s age. Shally-Jensen defines depression as “a mood disorder that causes a persistent feeling of sadness and loss of interest and affects how one feels, thinks, and behaves and can lead to a variety of emotional and physical problems,” (67). Some of the common symptoms of depression include lack of sleep, lack of appetite, reduced energy levels, poor concentration, and loss of self-esteem, anxiety, irritability, restlessness, hopelessness, mood swings, weight loss or weight gain, and possible thoughts of suicide (Schimelpfening par. 2). An individual who is going through depression may experience significant impairment in their daily lives, making it difficult to undertake normal duties. If left unchecked and the triggers still exist, it may lead to other serious medical conditions such as hypertension and a possible stroke (Callahan and Berrios 249). As such, it is always strongly recommended that an individual who is depressed should seek immediate medical attention so that they can get assistance at the right time. In this paper, the researcher seeks to investigate the history and treatment of depression.

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History of Depression

Depression is one of the medical conditions that have been in existence since the history of humankind. Although it has not been possible to credit a specific individual with the discovery of the problem, studies suggest that some great thinkers helped in defining the problem and classifying it as a medical condition. In the bible, depression is identified as one of the problems that people such as King Saul suffered from during his reign. The paper will analyze the history of the condition from the ancient age to modern history and how it has been managed during that period.

Ancient/Earliest Accounts of Depression

The earliest accounts of depression can be traced back to ancient times Mesopotamia. According to Schimelpfening, written accounts of what is currently defined as depression appeared in the Millennium B.C.E. (par. 2). It was recorded in the ancient Greeks, Egyptians, Romans, Babylonians, and Chinese. During this period, the condition was believed to be caused by demonic spirits. Physicians could not explain why the condition would cause significant pain and discomfort while it was not related to any physiological disorder. As such, the only rational explanation that they could have was evil spirits. It was believed to be a punishment for one’s sins or mistakes committed by one’s parents. The fact that the condition was associated with one being possessed with demonic spirits, most people suffered in silence (Shally-Jensen 57). They not only feared the approach to treating this condition but also the stigma that was attached to it.

Great thinkers in the Greek and Roman empires were keen on explaining this condition beyond the simplistic view of one being possessed by demons. Hippocrates, an ancient Greek physician, was one of the great philosophers to classify the condition as a medical problem (DeRubeis and Strunk 54). He defined it as melancholia, a condition he believed was caused by imbalanced body fluids (blood, black bile, yellow bile, and phlegm) (Schimelpfening par. 2). He explained that when excess black bile is released from the spleen, one may get depressed. He proposed various medical approaches to dealing with the condition. During this era, Cicero, a Roman statesman, and philosopher, also made significant contributions to understanding this condition, explaining that melancholia is caused by psychological factors such as grief, rage, or fear (Shapero et al. 88). Despite these major efforts made by the two philosophers to explain the condition as a medical problem, the majority of people still believed that depression was caused by evil spirits.

Depression during the Common Era

During the Common Era, the belief that depression was caused by evil spirit still dominated the civilized societies at that time. It is important to note that during the period (middle ages), religion had started gaining popularity in many civilized societies. Christianity was one of the major religious beliefs that became common in the Roman Empire. As such, it was easy for society to associate the problem with being possessed with demonic spirits. The approach started changing during the Renaissance period, especially from the 14th to 17th centuries when doctors started to acknowledge that depression could be associated with a mental problem that is not related to one being possessed. Robert Burton’s 1621 publication, Anatomy of Melancholy, outlined psychological and social causes of depression (Callahan and Berrios 249). He identified factors such as loneliness, poverty, and fear as the possible primary causes of melancholy. His work was based on the findings made by Hippocrates and Cicero on the possible causes of depression. The publication made most of the doctors during that era redefine their beliefs and perception towards this condition.

Depression in the Age of Enlightenment (18th, 19th, and 12th Centuries)

The Age of Enlightenment marked a major shift in the understanding of depression in the medical field. Schimelpfening explains that during this period, doctors acknowledged that depression was considered a weakness in temperament (par. 2). They believed that the condition was inherited and it was not possible to change it. The belief that this was an inherited trait that could not be changed during the 18th century meant that these people were shunned because of the fear of spreading the problem to others. Some doctors argued that melancholia was primarily caused by aggression while others believed that it was a result of internal conflicts in one’s mind, between what an individual wants and what they know is right (Shally-Jensen 32). Others believed that the condition was possibly had physical causes that were yet to be explained appropriately.

Emil Kraepelin, a German psychiatrist, was the first to define and distinguish manic depression (bipolar disorder) from dementia praecox (schizophrenia) in 1895 (Schimelpfening par. 2). His work formed the basis of psychoanalytic explanations to depression as a medical condition that had nothing to do with one being possessed with evil spirits. The work of Sigmund Freud in 1917 that focused on melancholia and mourning, theorized that depression was a direct response to a loss such as death or the inability of an individual to achieve a specific goal (Shapero et al. 51). An individual would have an unconscious response (anger) to the loss that would lead to self-hatred and sometimes self-destructive behavior (Foster and Herring 131). They start blaming themselves for the loss, feeling that they could change the outcome but fail to do the right thing. In 1970, various medical models emerged that explained mental illness as a problem that is primarily caused by physiological factors (DeRubeis and Strunk 64). Factors such as brain chemistry, hormones, brain anatomy, and genetics became the new frontiers in the study of depression.

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Depression in the Modern Era (21st Century)

Understanding of depression in modern society has significantly changed from what it was during ancient times. During this period, there were major advances made in this study, which was based on the developments made during the Enlightenment Era. It is now understood that depression is a medical condition that should not be associated with evil spirits. A team of psychiatrists developed the term major depressive disorder in the late 1970s to explain the state when one’s condition moves from simple stress to clinical depression (Schimelpfening par. 2). Experts currently believe that the condition is caused by a combination of various causes, from social to biological and psychological factors.

Experts have noticed that the condition may be cyclic and can easily deteriorate to cause other major medical conditions. For instance, it has become evident that the condition can cause imbalances in diet, sleep, activity levels, and these factors may, in turn, lead to depression. It means that if the vicious cycle is not interrupted, it can snowball into a major medical problem as the symptoms become more serious than it was when it started. Doctors have realized that some medical conditions such as hypothyroidism may be a potential cause of depression. When one is in constant pain, caused by various health problems, they may become depressed, especially when they become disillusioned. It has also become evident that constantly setting goals beyond one’s reach and failing to achieve them may lead to depression. Every time there is a failure, one will become depressed (Shally-Jensen 112). If the problem is not identified and addressed at the right time, it can degenerate into depression.

Treatment of Depression

The treatment of depression has gone through a major transformation from the time it was first discovered as a problem to modern society. According to Shapero et al., the approach to managing this condition depended on the understanding and perception that people had towards it (88). It is necessary to look at the evolution of the treatment of this medical condition from ancient times to the 21st century.

Ancient Strategies of Managing Depression

During ancient times, melancholy was classified as a problem caused by demonic possession. It meant that it was beyond the scope of physicians. When one was depressed, they would be attended to by priests. The treatment method was rather crude as it involved physical restraints, beatings to drive out the spirit, and starvation in an attempt to kill the spirit. Schimelpfening explains that some of these methods were so extreme that they would end in the death of the patient (par. 2). At that time, it was better for such an individual to die to ensure that they do not spread the spirit to other members of society.

In the later years of this period, Roman and Greek doctors started getting increasingly involved in the management of depression. They believed that the problem could be managed in a better way than causing physical pain to the patient. DeRubeis and Strunk believe that the change of strategy was motivated by the fact that powerful rulers also started becoming distressed (34). They could not be subjected to crude methods of physical punishment or death because they were believed to be representatives of gods. As such, more lenient strategies such as massage, gymnastics, diet, baths, music, and various other forms of medication emerged (Foster and Herring 131). Biblical accounts show that King Saul relied on music as a way of overcoming the depression that he was going through at the ruler. Although society still associated the problem with evil spirits, the approach of driving out these demons started changing.

Depression Management during the Age of Enlightenment

The middle ages saw major advancement in the management of this medical condition. However, Shally-Jensen explains that the rise of religion during this period negated some of the gains that had been made (92). For instance, some early Christians believed in exorcism, burning, and drowning as means of managing the problem. It meant that the patient had to die to limit the spread of the problem. Locking up people in lunatic asylums became common as Christianity continued to spread in Europe. One would only be allowed back to the society if the priest confirmed that they were fully healed. In most of the cases they were never allowed back into society (Callahan and Berrios 249). There was a constant fear that they would spread the problem to people close to them.

It is important to note that while these retrogressive approaches to managing depression continued during this period, some doctors were convinced that there were better ways of treating melancholy. They were also convinced that the problem was associated with challenges that people face and other medical problems. Rhazes, a Persian doctor, argued that depression was a mental illness that arose from the brain (Schimelpfening par. 2). He developed some of the earliest forms of behavioral therapy involving positive rewards for one’s appropriate behavior (DeRubeis and Strunk 93). He believed that such rewards would have a positive effect on the brain and motivate an individual to focus on positive aspects of life, hence reducing levels of stress. He also suggested that baths would help relieve an individual from physical discomfort (Foster and Herring 131). His works were furthered by Italian doctors in the 16th and 17th centuries who believed that mental illnesses had natural causes, not supernatural forces. Robert Burton recommended practices such as diet, travel, exercise, bloodletting, and purgatives as some of the most effective ways of managing depression (Shally-Jensen 78). These practices gained popularity during this period.

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During the enlightened age of the 18th and 19th centuries, treatments such as music and exercise gained massive popularity. Doctors also encouraged patients to talk about their problems with friends and doctors as a way of reducing the burden of keeping the issue to themselves self. However, it is important to note that some of the medical solutions that were tried during this period could not address the problem. Enemas (the practice of injecting fluids into the rectum to stimulate the emptying of the bowel) and vomiting were common practices in the management of melancholy (Schimelpfening par. 2). It was believed that they helped in relieving internal pressure. It is important to note that although these methods have been proven to lack any therapeutic in managing depression, they had the placebo effect (Shapero et al. 47). Given the fact that depression is a psychological problem, the belief that patients had in these forms of medications improved their conditions.

In the 20th century, psychologists developed better explanations and ways of managing depression. It was during this period that cognitive-behavioral therapy (CBT) emerged as a means of treating depression (Foster and Herring 131). It was also during this period that electroconvulsive therapy started gaining massive popularity in Europe and the United States, tricyclic antidepressants (TCAs), and other antidepressants such as Prozac, Zoloft, and Paxil emerged during this period (Shally-Jensen 65). These medications were classified as selective serotonin reuptake inhibitors (SSRIs) and they specifically targeted serotonin levels in the patient’s brain (Schimelpfening par. 2). At this stage, depression was classified as a medical condition that needed medical attention.

Current Strategies of Managing Depression

The current strategies used in the management of depression are based on the advancements made during the 19th and 20th centuries. Major advances have been made in this field because of emerging technologies and improved knowledge about this medical condition. Currently, doctors have classified depression management techniques into lifestyle modification, psychotherapies, and medication. The first class of lifestyle modification involves avoiding the triggers and other causes of depression. Doctors encourage people to engage in regular exercise to keep physically fit and to avoid junk food that may lead to obesity (DeRubeis and Strunk 122). It is also important for one to avoid highly stressful conditions.

Psychotherapy is another common way that is currently used to manage stress. As Schimelpfening observes, the process involves a face-to-face talk with a trained therapist who will be keen on identifying the possible cause of the problem, how it has developed over time, factors that have made it worse, and how the patient has been dealing with the problem (par. 2). The therapist will then develop a plan that the patient will use based on the severity of the condition, its identified causes, the environment in which the patient lives, and other personal factors that they have to encounter during the recovery process.

It may be necessary for the patient to be given some form of medication, especially if it is established that their condition is getting worse even after psychotherapy sessions. Medications, which target specific molecules known as neurotransmitters have become the preferred mode of managing this condition. Vagus nerve stimulation and transcranial magnetic stimulation have become common ways of treating patients with chronic depression. Sometimes the patient may be given some pills to help them calm down. Some of the depression pills which are still in use include fluoxetine, sertraline, citalopram, and escitalopram (Shally-Jensen 48). It is always advisable for one to use the first two (lifestyle modification and psychotherapy) classes of managing depression before the condition degenerates to the level where it requires medication.

Conclusion

Depression is currently one of the most common medical conditions among the adult population in the United States. The current lifestyle in the country, cost of living, the desire to achieve success, and the fact that people rarely realize that they have the condition until its impact starts becoming more severe are the reasons why depression is common in the country. The analysis above has outlined the history and treatment of depression since ancient times. It is evident that when this condition was first discovered, it was classified as a problem that is caused by evil spirits. As such, priests have the primary role of helping these patients. They used rudimentary strategies such as exorcism, starvation, immersion into water, or beating the patient to drive away from the evil spirit. However, improved knowledge of the condition has led to the emergence of better ways of addressing the problem such as lifestyle modification, psychotherapies, and medication.

References

Callahan, Christopher, and German Berrios. “Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940–2004.” The Primary Care Companion to the Journal of Clinical Psychiatry, vol. 7, no. 5, 2005 pp. 249-250.

DeRubeis, Robert, and Daniel Strunk. The Oxford Handbook of Mood Disorders. Oxford University Press, 2017.

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Foster, Charles, and Jonathan Herring. Depression: Law and Ethics. Oxford University Press, 2017.

Schimelpfening, Nancy. “The History of Depression: Accounts, Treatments, and Beliefs through the Ages.” Mental Health. Web.

Shally-Jensen, Michael. Alternative Healing in American History: An Encyclopedia from Acupuncture to Yoga. Greenwood, 2019.

Shapero, Benjamin, et al. The Massachusetts General Hospital Guide to Depression: New Treatment Insights and Options. Humana Press, 2019.

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