Looking back on gloom, looking forward with hope
Depression has been with us since we evolved into thinking, feeling beings. Two thousand years ago, Hippocrates referred to Democritus who wrote a treatise on “melancholy,” (what we call “depression”). In 1586 Timothy Bright wrote “a Treatise on Melancholie,” credited as the first psychiatric book in the English language. In 1621, Robert Burton wrote “The Anatomy of Melancholy,” arguable the first self-help book in the English language.
Today, depression is more prevalent than ever. The Studies of Environmental Catchment Area found that among those born before World War I, 1 percent suffered depression, but among those born around 1925 4 percent suffered depression — a fourfold increase. Today’s rate is over 9 percent. You might think that the growth in rates of depression is related to the two world wars. Not so. People born after 1967, 21 years after World War II, are 10 times more likely to suffer depression than people born before 1933. The National Institute of Mental Health conducted the Relatives Study, a study on the incidence of depression in the general population, and found a tenfold increase in depression over the course of the century. Compared to our recent times of prosperity, fewer were depressed during the Great Depression. Ours is the era that deserves the moniker “Great Depression,” but with a twist — there are far more effective medical and psychological ways to treat it.
In the past, the words “vegetative depression” described the plight of those with the most severe depression, those who had no desire or energy to move, who didn’t get out of bed for months, who suffered enormous changes in appetite and weight, and for whom little could be done except to wait for the depression to “lift.” Then came tricyclic antidepressants that shortened the duration and severity of depression, but often with significant side effects. Today, we have SSRI antidepressants which have fewer side effects and do not make one drowsy, a blessing for those who have to remain alert and productive.
With depression where there is severe disturbance of sleep, gross suppression of appetite or rejection of food, drastic weight change, or inability to perform simple movements due to exhaustion or fatigue, psychological therapies must be combined with medication in order to bring that person up to a level that allows for participation in therapy. It takes strong determination and enormous energy to change the debilitating patterns of thought, feeling and behavior that initiate and perpetuate depression. Not only have antidepressants become more effective, psychological therapies have become sharper and shorter. Therapists can identity more precisely and facilitate change in the thoughts, feelings and behaviors that produce and support depression and for mild or moderate depression, research is clear that psychological therapies alone are highly effective.
It is important to stress that just to depend on antidepressants without changing the psychological make-up that supports it is like taking medication for a heart disease without attempting to change one’s lifestyle, e.g. diet, exercise, alcohol consumption, etc. Thoughts create feelings. Thoughts and feelings create corresponding chemicals in the brain and the body, just as chemicals in the brain and body manufacture corresponding thoughts and feelings. In some cases, people just need skills, but in other cases they need pills and skills — either way, at some point, those who are determined to stop the cycle of depression must examine the thoughts, feelings, attitudes and believe that lead to and sustain it. In today’s world, there is just not need to suffer depression. Help is available — take it — and thrive.