The History Of Depression And How Mental Health Treatment Developed Over Time

In general, depression is not a new phenomenon. While it may seem like something we are just starting to learn about, it has likely been around for thousands of years. There are believed to be accounts of depression from many different cultures in history, including the Egyptians, Greeks, Babylonians, Romans, and Chinese. However, people in ancient history didn’t necessarily know what depression was, nor were they familiar with the concept of a mood disorder or mental health disorder. They typically had very different ideas about what caused it and how to treat it. Today, we know that in-person and online therapy can often be very effective in treating depression.

Depression in the ancient world

In ancient Greece and Rome, depression was usually referred to as melancholia. The Greek physician Hippocrates believed the body was made up of four fluids, or “humors”: phlegm, yellow bile, black bile, and blood. 

How did the humors theory relate to the origins of depressive disorder?

According to the humors theory, if the body produces too much or too little of any of these fluids, various maladies could result. In the origins of depressive disorder, too much black bile, Hippocrates believed, typically produced melancholia. Therefore, to treat melancholia, the easiest answer was generally to reduce the black bile in the person's body, usually through bloodletting, purging, and medication.

While this theory may sound silly to us today, Hippocrates also believed that symptoms of depression may have had something to do with the brain.

How did the history of depression and bipolar disorder influence views on madness?

Several notable ancient Greeks also believed some forms of “madness” (the term they frequently used for depression in those times) could be linked to creativity and genius. In the context of mental health, the philosopher Aristotle once wrote, “No great mind has ever existed without a touch of madness.” Indeed, he claimed that Plato and Socrates were melancholic figures and that this was part of the reason for their brilliance.

“Inspired” or “frenzied” forms of madness were often especially venerated. Socrates himself, glorifying madness, is reported to have said, “There is also a madness which is a divine gift, and the source of the chiefest blessings granted to men,” and that when it comes to poetry and art, “the sane man disappears and is nowhere when he enters into a rivalry with the madman.” 

The type of "madness" referred to in the quote above may have been bipolar disorder. Bipolar disorder is a treatable mental illness that may cause symptoms of mania and/or depression.

Depression in the Middle Ages

The widely accepted theory of the Medieval view of mental health is generally that mental illnesses were viewed as evidence of demonic possession, witchcraft, or the consequence of sin.

However, the full picture appears to be somewhat more complex. A study of 57 accounts of various mental illnesses from the Middle Ages found that just 16% of those attributed the conditions to supernatural causes. In most of those cases, the medieval authors appeared to be attacking a perceived enemy of their religious values.

Another study on supposed “exorcisms” on the mentally ill found most of these accounts were literary inventions, rather than eyewitness accounts.

Rather than exorcisms, the mainstream medieval approach to treating depression and other mental health conditions was primarily based on humor theory. Treatment methods used focused on “purging” the body via laxatives and bloodletting, among other approaches.

While the narrative of demon-obsessed hysteria may not stand up to scrutiny, cruel treatment did sometimes occur. A person who disturbed the peace due to a mental health disorder could be given physical punishment or be locked up.

Yet, while they may have been a long way off from modern treatment methods, medieval people usually had a better understanding of the nature of mental health than they’re typically given credit for. Evidence suggests they may have been open to multiple causes of mental illness, with overwork and misuse of alcohol being among those considered.

Compassion may not have been unheard of during these times. In 13th-century England, for example, individuals known to be mentally disturbed would often be given state evaluations to determine whether or not they had soundness of mind. The examiners were generally open to some people simply being more prone to madness, and they normally used naturalistic and common-sense methods to make their determination, rather than burnings or drownings. Those found incapable of appropriate behavior or caring for themselves would usually be entrusted to the care of state-supervised guardians.

Oftentimes, these guardians would include clergy constituents. Monks would sometimes surround those deemed not to have soundness of mind in a circle of hands of support and angelic voices. 

This approach, frequently called the “laying on of hands,” generally has some scientific support. A 2020 study found that laying on hands typically led to lower levels of depression, anxiety, and stress in patients, even if they weren’t religious.

Depression in the Renaissance

Much like in classical and medieval times, the Renaissance understanding of mental illness primarily continued to be influenced by the humor theory, as well as the idea of madness being a divine gift. However, it was generally around this time that many people began to investigate the natural causes and treatment of depression.

Depression in the Enlightenment

During the Enlightenment era, beliefs regarding depression often began to change, and it was during this time that they may have begun to approach our modern understanding. While doctors often continued to be influenced by the humors theory, some believed depression stemmed from displaced and excessive anger, a theory which may have some basis of support.

For example, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is the handbook of the American Psychiatric Association, lists “irritability” as one of the symptoms of depression for children and adolescents. 

Although that symptom is not mentioned in adult cases, large studies have often found high levels of anger and irritability in those surveyed with a depressive disorder.

That said, many also believed that those living with depression simply needed to do physical labor and get more exercise to correct the problem. There were also some extreme forms of treatment, such as the spinning stool. It was believed that spinning someone until they were dizzy could correct things in the brain and put an end to depression. It's also reported that Benjamin Franklin may have come up with one of the first types of electroconvulsive therapy.

Near the end of the Enlightenment period, French psychiatrist Philippe Pinel called for the end of the shackling of mentally ill patients, provided some of the earliest writings on schizophrenia and other mental health disorders, and introduced the classification of mental illness. It was also around this time, and moving into the 19th century and Victorian era, that the field of clinical neuroscience generally began to take shape.

Depression in the Victorian era

The field of cognitive psychology began to emerge during the Victorian era. The term “depression” is typically believed to have appeared for the first time during this century. However, there was still much confusion about what caused depression and how to treat it.

Many believed that depression was caused by the modern world. They thought that those who lived white-collar lives tended to be more susceptible, and those who were blue-collar workers may have been immune to depression. Therefore, they believed that physical labor and exercise could be important parts of treatment. Doctors began creating sanitariums where people could go to be exposed to fresh air, exercise, and healthy eating.

In the 19th century, some of those looking to make money started to sell nerve and brain pills to people who were experiencing melancholy. In addition, it wasn't until this time in history that people typically started to connect melancholy (or depression) with emotions. This was a significant shift in perspective because it often helped doctors begin to see that emotions and the way people think could also impact the body, instead of it only working the other way around.

As we neared the 1900s, the German psychiatrist Emil Kraepelin began to separate melancholy based on levels of severity and pushed to treat it through medical interventions. Over the next hundred years, there were incredible leaps and bounds made in the understanding of depression, depressive symptoms, and forms of treatment. 

Adolf Meyer is usually believed to have separated the term “melancholy” from depression, thus giving us the medical term depression as we know it today. The idea of affective disorders is believed to have been proposed by the English psychiatrist Henry Maudsley.

Depression today: Understanding bipolar disorder and depressive disorder or major depression through history and modern treatment approaches

Today, we generally have a more thorough understanding of the human brain. We have learned a lot about the biological factors behind depression, such as how different parts of the brain can control different things, and how genetics work. We also learned there could be different depressive states, rather than simply depression.

The medical model of depression continued to take shape in the 1920s, as experts in cognitive psychology divided depressive states into reactive and endogenous depression. The concept of depression as a mood disorder, in which depressive symptoms were seen as a medical issue, also gained further acceptance.

There was also a lot of progress made in 1952, when mental health professionals, such as psychiatrists and psychologists, created the American Diagnostic and Statistical Manual of Mental Disorders (DSM). This generally created more rigorous diagnostic criteria, as well as paved the way for more formal and standardized treatments for depressive disorders.

In 1956, Swiss psychiatrist Roland Kuhn pioneered the use of Imipramine, the first modern antidepressant. For many years thereafter, the use of tricyclic antidepressants continued to grow, with some believing it to be the best form of treatment for depression.

The DSM also continued to be updated over the years as professionals in the field continued to break down different forms of depression. In the 1960s, unipolar disorders like depression were separated from manic depression, which is now commonly known as bipolar disorder. Mental health professionals also began to come up with a list of symptoms that could be used to diagnose depression. 

In the 1970s, the term major depressive disorder (major depression) was introduced by the DSM-III of the American Psychiatric Association. In the 1980s, seasonal affective disorder (SAD), another type of mood disorder, was coined by National Institute of Mental Health psychiatrist Norman E. Rosenthal.

Our understanding of depression as a complex condition was further enhanced in 1997, when the World Health Organization put out the 10th edition of the International Classification of Diseases (ICD-10). The ICD-10 broke the concept of a depressive episode into two sub-categories: mild depressive episode and major depressive episode.

With all the knowledge that psychologists and psychiatrists have gained, we have continued to develop new and effective treatment options for major depression, such as cognitive behavioral therapy, a type of cognitive therapy that can help individuals learn to replace negative thoughts with positive ones.

Over the years, we’ve learned that a combination of treatments can be ideal for addressing depression. We have also recognized the importance of self-care, such as eating right and exercising, just as many people theorized throughout history.

Benefits of online therapy

If you’re living with depression, it can be challenging to make it through the day, take care of your routine responsibilities, and even leave the house. Seeking treatment may seem like a daunting task, but online therapy platforms can make it quick and simple. With online therapy, you can receive the professional insight and guidance you deserve from the comfort of your home. You can also match with a therapist who has experience helping others manage depression.

Effectiveness of online therapy for patients with major depression

According to a 2019 study, online therapy can be an effective treatment for depression. The researchers noted that “depression symptom severity was significantly reduced after the use of the multimodal digital psychotherapy intervention.”