He believed that a balance between the four brought on good health, while an extreme deficiency or excess of one caused physical ailments. Greek physician and philosopher Galen AD — c.
According to the humors theory, melancholic personality type was created by an excess of black bile. Melancholics were accordingly seen as introverted, deep thinkers, who typically related more to the sadder part of the emotional spectrum.
It is from this perception of melancholia that our current concept of depression eventually evolved. Kraepelin also took a dual approach to mental illness, separating depression into two categories: manic depression and dementia praecox. The distinction Kraepelin made between both types of depression is still relevant today: many patients continue to recount how people are more willing to offer sympathy if the source of their depression is clearly understood: as such, an individual whose depression was caused by witnessing a traumatic event is likely to receive more social support than someone whose depression appeared during adolescence.
Sigmund Freud, the father of psychoanalysis, published his own thoughts on depression in his essay, Mourning and Melancholia. In it, Freud described melancholy in a similar manner to our current view on depression, elaborating that melancholy is defined by a sense of loss that arises when the object that has been lost is unknown, due to the mental process of repression.
Freud posited that depression interferes with the normal mourning process, causing the individual to feel a general sadness when coming in contact with the world at large, while experiencing the anguish and hopelessness assailing them as inescapable.
Rather than internalize the positive aspects of the person or object that has been lost, and come to terms with their shortcomings, the person experiencing melancholy redirects any lingering resentment toward themselves, while maintaining the memory of their lost loved one as an ideal, untouchable version of who they were in real life.
Moving away from psychoanalysis, in favor of a more empirically-based approach to depression, was Swiss psychiatrist Adolf Meyer. The eventual President of the American Psychiatric Association, Meyer argued in favor of considering biological factors, together with mental and familial ones, as elements that significantly contribute to the appearance of depression. With mental health theories abounding from the end of the 19th Century, it became necessary to reach a working consensus on how to identify, group and treat mental health conditions based on statistical field data.
Thus, a number of attempts were made to create a comprehensive mental health classification system. While the ICD examines both physical and mental ailments and is used across the globe, the DSM specifically examines mental disorders and is primarily used in the US.
During the latter part of the Age of Enlightenment, doctors began to suggest the idea that aggression was at the root of the condition.
Treatments such as exercise, diet, music, and drugs were now advocated and doctors suggested that it was important to talk about your problems with your friends or a doctor. Other doctors of the time spoke of depression as resulting from internal conflicts between what you want and what you know is right. And yet others sought to identify the physical causes of this condition.
Treatments during this period included water immersion staying underwater for long as possible without drowning and using a spinning stool to put the brain contents back into their correct positions. Additional treatments included:. Benjamin Franklin is also reported to have developed an early form of electroshock therapy during this time. In , the German psychiatrist Emil Kraepelin became the first to distinguish manic depression , what we now know as bipolar disorder, as an illness separate from dementia praecox the term for schizophrenia at the time.
In , Sigmund Freud wrote about mourning and melancholia where he theorized about melancholia as being a response to loss, either real for example, a death or symbolic such as failure to achieve the desired goal. Freud further believed that a person's unconscious anger over their loss leads to self-hatred and self-destructive behavior. He felt that psychoanalysis could help a person resolve these unconscious conflicts, reducing self-destructive thoughts and behaviors.
Other doctors during this time, however, saw depression as a brain disorder. The behaviorist movement in psychology contributed to the idea that behaviors are learned through experience.
The behaviorists rejected the idea that depression was caused by unconscious forces and instead suggested that it was a learned behavior. Just as these depressive behaviors had been learned, they could also be unlearned. Principles of learning such as association and reinforcement could be used to establish and strengthen more effective, healthier behaviors.
While psychologists today recognize that experience is not the sole determinant of behavior, behaviorism led to the development of a number of treatment approaches that continue to play an important role in the treatment of depression and other mental disorders.
During the s and s, cognitive theories of depression began to emerge. The cognitive theorist Aaron Beck proposed that the way that people interpret negative events could contribute to symptoms of depression. Beck suggested that negative automatic thoughts, negative self-beliefs, and errors in processing information were responsible for depressive symptoms. According to Beck, depressed people tend to automatically interpret events in negative ways and view themselves and helpless and inadequate.
The psychologist Martin Seligman suggested that learned helplessness could play a role in the development of depression. According to this theory, people often give up on trying to change their situation because they feel that nothing they do will make a difference.
This lack of control leaves people feeling helpless and hopeless. The emergence of these cognitive models of depression played an important role in the development of cognitive behavioral therapy CBT , which has been shown to be effective in the treatment of depression.
Where older conceptualizations of depression stressed the role of early experiences, more recent approaches increasingly stress the biopsychosocial model that looks at the biological, psychological, and social factors that play a role in depression. During the s, the medical model of mental disorders emerged and suggested that all mental disorders are primarily caused by physiological factors.
The medical model views mental health conditions in the same way as other physical illnesses, which means that such conditions can also be treated with medication. Biological explanations for depression focus on factors such as genetics, brain chemistry , hormones, and brain anatomy.
This view played an important role in the development and increased use of antidepressants in the treatment of depression. During the late 19th and early 20th centuries, treatments for severe depression generally weren't enough to help patients.
Desperate for relief, many people turned to lobotomies, which are surgeries to destroy the brain's prefrontal lobe. Though reputed to have a "calming" effect, lobotomies often caused personality changes, a loss of decision-making ability, poor judgment, and sometimes even death. Electroconvulsive therapy ECT , which is an electrical shock applied to the scalp in order to induce a seizure, was also sometimes used for patients with depression.
In the s and 60s, doctors divided depression into subtypes of " endogenous " and "neurotic" or "reactive. The s were an important decade in the treatment of depression thanks to the fact that doctors noticed that a tuberculosis medication called isoniazid seemed to be helpful in treating depression in some people.
In addition, new schools of thought, such as cognitive behavioral and family systems theory emerged as alternatives to psychodynamic theory in depression treatment. One of the first drugs to emerge for the treatment of depression was known as Tofranil imipramine , which was then followed by a number of other medications categorized as tricyclic antidepressants TCAs.
Such drugs provided relief for many people with depression but were often accompanied by serious side effects that included weight gain, tiredness, and the potential for overdose. Other antidepressants later emerged, including Prozac fluoxetine in , Zoloft sertraline in , and Paxil paroxetine in These medications, known as selective serotonin reuptake inhibitors SSRIs , target serotonin levels in the brain and usually have fewer side effects than their predecessors.
Newer antidepressant drugs that have emerged in the past couple of decades include atypical antidepressants such as Wellbutrin bupropion , Trintellix vortioxetine , and serotonin-norepinephrine reuptake inhibitors SNRIs. The term major depressive disorder MDD was first introduced by clinicians in the United States during the s.
Hippocrates thought that melancholia was caused by too much black bile in the spleen. He used bloodletting a supposedly therapeutic technique which removed blood from the body , bathing, exercise, and dieting to treat depression. In contrast to Hippocrates' view, the famous Roman philosopher and statesman Cicero argued that melancholia was caused by violent rage, fear and grief. This was a mental explanation for depression rather than a physical one.
In the last years before Christ, the influence of Hippocrates faded. The predominant view among educated Romans was that mental illnesses like depression were caused by demons and by the anger of the gods.
Treatments for mental illness often involved hydrotherapy baths and early forms of behavior therapy positive rewards for appropriate behavior. After the fall of the Roman empire in the s AD, scientific thinking about the causes of mental illness and depression again went backward.
During the Middle Ages, religious beliefs, specifically Christianity, dominated popular European explanations of mental illness. Most people thought that mentally ill people were possessed by the devil, demons, or witches. They also thought it was possible for these people to infect others with their madness. Treatments included exorcisms, and other crueler strategies such as drowning and burning.
A small minority of doctors continued to believe that mental illness was caused by imbalanced bodily humors, poor diet, and grief. Some people with depression were tied up or locked away in "lunatic asylums". The Renaissance began in Italy in the 14th century and spread throughout Europe in the s and s. During this time, thinking about mental illness was characterized by both forward progress and backward thinking. On the one hand, witch-hunts and executions of the mentally ill were quite common throughout Europe.
On the other hand, some doctors returned to the views of Hippocrates, asserting that mental illnesses were due to natural causes, and that witches were actually mentally disturbed people in need of humane medical treatment. In , Robert Burton published Anatomy of Melancholy, in which he described the psychological and social causes of depression.
These social causes included issues such as poverty, fear and social isolation. In this work, he recommended diet, exercise, distraction, travel, purgatives cleansers that purge the body of toxins , bloodletting, herbal remedies, marriage, and even music therapy as treatments for depression.
During the beginning of the Age of Enlightenment the s and early s , it was thought that depression was an inherited, unchangeable weakness of temperament. This led to the common thought that affected people should be shunned or locked up. As a result, most people with mental illnesses became homeless and poor, and some were committed to institutions.
Depression Article References. An Interview with Daniel Strunk, Ph. Goldberg Depression Questionnaire. What Is Wrong With Me? Please Help. The word is avoided by the writers who really feel it, abandoned by the psychiatrists, but still used in the current language or it designates a state of mind, a sentimental disposition, a mixture of reverie and comfortable sadness.
On the other hand, melancholy enters psychoanalysis with the famous contribution of Sigmund Freud. Sigmund Freud : the psychoanalytic revolution. Freud, meets several important personalities for the development of psychoanalysis, of which he is the principal theoretician [30]. This Viennese doctor brings together a generation of psychotherapists who, little by little, develop psychoanalysis. He relies on elements of his personal life to write his works, which contributed to the advance of psychoanalysis.
This tyrant, I found him and enslaved him body and soul, his name is psychology. A little outside the nosography description and systematic classification of the time, Freud describes melancholy as "subjective fate". Inspired by a paper presented by Karl Abraham at the Third Congress of Psychoanalysis in , he proposes an analogy between melancholy and the work of mourning.
In short, the self identifies with the lost object to the point of losing itself in the infinite despair of an irremediable nothingness " In , he published "Mourning and Melancholia" [31], founding text for psychoanalysis of the theory of melancholy. In fact, to a certain extent, what happens in the melancholy crisis is entirely like the loss suffered by the death of a loved one.
A painful state of mind, a lack of interest in the outside world as well as the inability to choose a new object of love and in general the abandonment of any social activity characterizes the mourning. With one exception, the loss to which the melancholic reacts is unconscious, and is not directly related to a real loss as in mourning. The only difference between mourning and melancholy is thus manifested by the presence, in the last, of a deprecating attitude towards one's own self, which goes as far as "delirious" forms of violence, among which suicide remains the most radical.
This trait manifests itself through the discourse of the subject suffering from depression and is most often realized by complaints that the analyst must not reject.
For Freud, the melancholy has made the objectual disinvestment, but the quantity of libido remains intact and affixed to the ego, which then becomes the lost object. The melancholy thus regresses to narcissistic identification, becoming its own object, and privileging the side of hatred: it can explain self-reproaches. Psychoanalysts Sigmund Freud, Karl Abraham and Melanie Klein define depression as the result of a psychic conflict oedipal or narcissistic and not as the passive carrier of a disease to heal.
For Freud, it is a question of resolving the repressed conflict by analyzing the resistances, so that the patient finds the freedom to decide for this or that thing [32]. Nowadays the diagnostic criteria for the major depressive episode are listed in ICD International Classification of Diseases, 10th Edition [33] and the DSM-5 Diagnostic and Statistical Manual, 5th Edition with symptoms ranging from the mild to moderate depressive episode and the so-called severe episode, published on May 18, by the American Association of Psychiatry.
Fatigue or loss of energy At least 2 of the symptoms all day, almost every day. Recurring thoughts of death, recurrent suicidal thoughts without specific plan or suicide attempt or specific plan for committing suicide. It is a very common form of depression. Minor depression is depression that can affect anyone.
We talk about depression, but it is less severe than other forms of depression. The symptoms of depression that manifest with this form of depression are the common symptoms of depression.
You can find these symptoms in the symptoms of depression section or in the main article on depression. The maximum number of symptoms of depression observed for this form of depression can amount to 4 symptoms. If this criterion is exceeded, we speak of a more serious form of depression. Dysthymia is therefore a mild form of depression because there are only a limited number of symptoms of depression.
This is not to say that the person's subjective suffering cannot be treated as much or at all. Although this is a milder form of depression, you can effectively combat your suffering and symptoms of depression. The milder the symptoms, the sooner you seek treatment, the sooner you will see the effect of this treatment. Major depression: In order to speak of a diagnosis of major depression, one should observe between 5 and 9 symptoms of depression.
This form of depression is also common. It may be one of the lesser known forms of depression when it is often encountered. G Blazer and R. Kessler, The symptoms that should be observed for this form of depression are the common symptoms that are spoken of in the event of depression.
When it comes to major depression, the known symptoms of depression appear for a single period for at least two weeks. A major depression is therefore a single period which can last from several weeks to several years.
If more than one episode occurs, this is called another form of depression. Chronic depression: In the case of chronic depression, the symptoms of depression appear repeatedly. This means that you are going through several depressive periods, unlike major depression.
This form of depression belongs to the encompassing forms of depression. Chronic depression, however, is a lesser-known form of depression, as the most well-known forms of depression only occur once. You can find common symptoms of depression also for this kind of depression. Between periods of depression, there must be a period of at least two months. During these two months, you cannot experience any symptoms of depression, otherwise it is called persistent depression.
Chronic depression is a period in which you have no symptoms of depression. After these two months, you can go through a depressed period again with the associated symptoms. Bipolar depression: To be able to speak of a diagnosis of bipolar depression, depressive periods must alternate with periods of high euphoria or agitation. Euphoric periods are also called manic periods. During these periods, the patient feels "king of the world" and is quickly irritated.
Many people also do irrational things during manic times, such as making purchases that they cannot afford. After this manic period, the client relapses into a depressive period. During this depressive period, the client experiences several symptoms of depression in an overwhelming climate. We will therefore feel constantly sullen and depressed. These depressive periods generally last longer than manic periods. In bipolar disorder 2 the manic episodes are replaced by hypomania [35].
Other forms of depression: There are also fewer common forms of depression, such as postnatal depression [36], a form of depression that occurs after the birth of a child, seasonal depression, a type of depression that occurs primarily during a particular season, etc.
These forms of depression can be linked to certain hormones, such as in the case of postnatal depression, or to the perception of light, as in the case of seasonal depression. You may then feel depressed in winter, for example, because you are not getting enough sunlight. After the revolution of nineteenth-century brainwashing with the role played by the hypothalamus, the regulating center of the needs and orders of the great metabolism, we can cite Von Economo, Vogt and Brodman, who describe the architecture of the brain by exploring the motor areas [37].
At the beginning of the 20th century, the first truly effective therapies were shock methods such as insulin treatments or electroconvulsive therapy ECT. It is also the successes of pharmacology that have brought depression to its current dimension. If we do not know enough how to define it, we at least try to cure it. Henri Laborit, Pierre Deniker and Jean Delay discover the first neuroleptics in Paris in , this discovery inaugurates the era of commercialization of modern psychotropic drugs.
Roland Kuhn, a Swiss psychiatrist, close to psychoanalytic circles who in , elaborated the antidepressant effects of imipramine [38]. The scientists are based on the study of chemical mediators whose action is at the level of neuronal synapses: acetylcholine, norepinephrine, adrenaline and dopamine, whose dysregulation excess or depletion could be the cause of a certain number of symptoms.
These first antidepressants were prescribed in the hospital mainly by psychiatrists for fear of side effects. The understanding of the brain has led to the discovery of more effective biological therapies and especially less disabling. From the late s, newer antidepressants came on the market with fewer side effects. In parallel, the development of cognitive psychology will join the progression of brain imaging techniques to gradually build the wide field of neuroscience.
It is clear that the great currents of contemporary psychiatry, at the origin of models as different as psychoanalysis or neuroscience, sometimes complement each other, often oppose or ultimately ignore each other. Thus, on the psychiatric level, the etiological data, from clinical studies and follow-up, of investigations on cohorts of individuals or groups of individuals, reiterated over a given period of time to which studies of pharmaceutical laboratories, have made it possible to highlight more precisely today the so-called mood disorders, or of syndromes much more known under the term depressive disorders.
The brain is constantly being remodeled [39]. For the links between depression, plasticity and recent events, we must briefly talk about the mode of action of antidepressants, which are increasingly believed to have cerebral neurotrophic effects. This means that antidepressants activate the secretion in the brain of molecules, which are peptides, whose properties are to make neurons grow or their extensions. This would imply that there is some kind of atrophy or agenesis of certain neurons, or neuronal extensions, in the brain of the depressed, a hypothesis that not everyone shares some researchers even believe that if antidepressants stimulate secretion neurotrophic factors, that's because they themselves have neurotoxic properties.
Electroshock also stimulates the production of neurotrophic factors, as do certain mood stabilizers, but it would be wrong to say that the neurotrophic theory of depression has now completely found its mark.
0コメント