From Melancholy to Prozac

The identification of depression as a recognizable state has a very long history.
Clinical depression was described as early as the eighth century b.c.e.

in the biblical descriptions of Saul. During the fourth century b.c.e., Hippocrates
coined the term“melancholy” to describe one of the three forms of
mental illness he recognized. Later, Galen attempted to provide a biochemical
explanation of melancholy based on the theory of “humors.” Indeed, repeated
descriptions and discussions of depression are present from classical
times through the Middle Ages and into modern times.
The first comprehensive treatment of depression in English was provided
by Timothy Bright’s Treatise of Melancholia (1586). In 1621 Robert Burton
provided his own major work on depression, The Anatomy of Melancholy. Most
of the credit for developing the modern understanding of affective disorders,
however, is given to Emil Kraepelin, a German psychiatrist. It was in
Kraepelin’s system that the term “depression” first assumed importance.
Since classical times, there has been debate about whether depression is
best considered an illness or a response to an unhappy situation. Indeed, it
is obvious to the most casual observer that sadness is a normal response to
unhappy events. Even now, there is less than complete agreement on when
fluctuations in mood should be considered pathological and when they are
within normal limits. To help resolve this problem, diagnostic criteria have
been developed, and structured interview procedures are often used to determine
whether a particular individual should be considered depressed.
In the American Psychiatric Association’s Diagnostic and Statistical Manual
of Mental Disorders: DSM-IV-TR (rev. 4th ed., 2000), a common diagnostic
tool, unipolar depression is divided into the categories Dysthymic Disorder,
Major Depressive Disorder-Single Episode, and Major Depressive Disorder-
Recurrent, while bipolar depression is divided into Bipolar I Disorder, Bipolar
II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise
Specified (NOS). In most articles, the term “depression” refers to unipolar
depression only. Because unipolar depression is much more common
than bipolar depression, it is likely that it will continue to attract a larger
share of research attention in the future.
Throughout history, models of depression have become increasingly sophisticated,
progressing from Hippocrates’ theory that depression was produced
by an excess of black bile to modern biochemical, cognitive, coping,
stress, and interpersonal models. In the future, even more sophisticated
models of depression may provide guidance for the next great challenge facing
clinical psychology: reversing the trend inWestern societies toward everincreasing
rates of depression.
Sources for Further Study
Beach, Stephen R. H., E. E. Sandeen, and K. D. O’Leary. Depression in Marriage.
New York: Guilford Press,, 1990. Summarizes the literature on basic
models of depression. Provides the basis for understanding the important
role of marriage in the etiology, maintenance, and treatment of depression.
Beck, Aaron T. Cognitive Therapy and the Emotional Disorders. 1976. Reprint.
New York: New American Library, 1979. Clearly lays out the basics of the
cognitive model of depression. An important start for those who wish to
understand the cognitive approach more thoroughly.
Burns, David D. Feeling Good: The New Mood Therapy. Rev. ed. New York: Avon
Books, 1999. Provides a very entertaining and accessible presentation of
the cognitive approach to depression. Presents basic results and the basics
of cognitive theory as well as a practical set of suggestions for getting
out of a depression.
Coyne, James C., ed. Essential Papers on Depression. New York: New York University
Press, 1986. Includes representatives of every major theoretical position
advanced between 1900 and 1985. Each selection is a classic presentation
of an important perspective. This source will acquaint the reader
with the opinions of major theorists in their own words.
Coyne, James C., and G. Downey. “Social Factors and Psychopathology:
Stress, Social Support, and Coping Processes.” Annual Review of Psychology
42 (1991): 401-426. This influential essay ties together stress and coping
with interpersonal processes to provide a deeper understanding of the
nature of depression. Also provides an account of advances in the way
both depression and interpersonal processes related to depression may
be studied.
Kleinman, Arthur, and Byron Good. Culture and Depression. Berkeley: University
of California Press, 1985. This exceptional volume examines the
cross-cultural research on depression. Anthropologists, psychiatrists, and
psychologists attempt to address the diversity that exists across cultures in
the experience and expression of depression.
Paykel, Eugene S. Handbook of Affective Disorders. 2d ed. New York: Guilford
Press, 1992. Provides comprehensive coverage of depression, mania, and
anxiety in relation to depression. Includes detailed descriptions of symptoms,
assessment procedures, epidemiology, and treatment procedures.
Solomon, Andrew. The Noonday Demon: An Atlas of Depression. New York:
Charles Scribner’s Sons, 2000. Solomon, who suffered serious depression,
provides an insightful investigation of the subject from perspectives
of history, psychology, literature, psychopharmacology, law, and philosophy.
Stahl, Stephen M. Essential Psychopharmacology of Depression and Bipolar Disorder.
New York: Cambridge University Press, 2000. Coverage of the rapidly
expanding options in drug treatments for depression.
Stephen R. H. Beach
See also: Abnormality: Psychological Models; Bipolar Disorder; Clinical
Depression; Cognitive Behavior Therapy; Cognitive Therapy; Death and Dying;
Drug Therapies; Emotions; Mood Disorders; Suicide.