History of Research on Clinical Depression

Historical Background

Descriptions of depression and depression-related mental disorders date back to antiquity (Summerian and Egyptian documents date back to 2600 BC). However, it was Hippocrates (460–370 BC) and his disciples who first studied these conditions systematically and introduced the term ‘‘melancholia’’ to describe the symptoms and to provide a physiological explanation of their origin. Hippocrates described a syndrome of melancholia as a distinct disease with particular mental and physical symptoms; he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment.  It was a similar but far broader concept than today's depression; prominence was given to a clustering of the symptoms of sadness, dejection, and despondency, and, often, fear, anger, delusions and obsessions were included.

The Hippocratic School attempted to link the balance of the postulated four humors (blood, yellow bile, black bile and phlegm) with the temperament and personality, and the latter two with the propensity to  develop  one  of  the  four  diseases  (mania,  melancholia,  phrenitis  and paranoia). It is interesting that Hippocrates considered symptom duration as a diagnostic criterion for melancholia by stating in one of his aphorisms (the 23rd) that ‘‘if sorrow persists, then it is melancholia’’.

Subsequent eminent authors of antiquity (Aretaeus of Capadokia, Galen and others) continued using the term melancholia and elaborated further on its symptomatology, its causation and its delineation from related disorders. The essentials of the traditional views on melancholia were retained during the middle ages and long after. The publication of Robert Burton’s Anatomy of Melancholy in 1621, in addition to presenting an excellent description of a sufferer’s feelings, provided an informative review of the prevailing concepts on the nature of the illness at the time.

Influenced by Greek and Roman texts, physicians in the Persian and then the Muslim world developed ideas about melancholia during the Islamic Golden Age. Ishaq ibn Imran (d. 908) combined the concepts of melancholia and phrenitis. The 11th century Persian physician Avicenna described melancholia as a depressive type of mood disorder in which the person may become suspicious and develop certain types of phobias. His work, The Canon of Medicine, became the standard of medical thinking in Europe alongside those of Hippocrates and Galen.  Moral and spiritual theories also prevailed, and in the Christian environment of medieval Europe, a malaise called acedia (sloth or absence of caring) was identified, involving low spirits and lethargy typically linked to isolation.

The term depression itself was derived from the Latin verb deprimere, "to press down". From the 14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English author Samuel Johnson in a similar sense in 1753. The term also came in to use in physiology and economics. An early usage referring to a psychiatric symptom was by French psychiatrist Louis Delasiauve in 1856, and by the 1860s it was appearing in medical dictionaries to refer to a physiological and metaphorical lowering of emotional function. Since Aristotle, melancholia had been associated with men of learning and intellectual brilliance, a hazard of contemplation and creativity. The newer concept abandoned these associations and through the 19th century, became more associated with women.

The term ‘‘melancholia’’ survived as the only specifier of morbid mood and disposition until Kraepelin, at the end of the nineteenth century, introduced the term ‘‘manic-depression’’ to separate nosologically mood disorders from dementia praecox, known after Bleuler as schizophrenia.

Sigmund Freud likened the state of melancholia to mourning in his 1917 paper Mourning and Melancholia. He theorized that objective loss, such as the loss of a valued relationship through death or a romantic break-up, results in subjective loss as well; the depressed individual has identified with the object of affection through an unconscious, narcissistic process called the libidinal cathexis of the ego. Such loss results in severe melancholic symptoms more profound than mourning; not only is the outside world viewed negatively, but the ego itself is compromised. The patient's decline of self-perception is revealed in his belief of his own blame, inferiority, and unworthiness.  He also emphasized early life experiences as a predisposing factor.  

Meyer put forward a mixed social and biological framework emphasizing reactions in the context of an individual's life, and argued that the term depression should be used instead of melancholia.  The first version of the DSM (DSM-I, 1952) contained depressive reaction and the DSM-II (1968) depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a depressive type of manic-depressive psychosis within Major affective disorders.

Historical Approaches to the Depression Treatment

The ancient scientists did not possess the knowledge, equipment, and opportunity of the modern researchers, however, their therapeutic approach is interesting not just from historical perspectives. May be, the humanistic views, not contaminated by the modern civilization, have the core values, you can use in your daily life…

Early Egypt                       

Cause of Depression: Loss of Status or Money

Treatment: Talking it Out , Religion, Suicide is accepted

Old Testament 

Cause of Depression: Despair, Cognition 

Treatment: Faith

Aeschylus

Cause of Depression: Demons

Treatment: Exorcism

Socrates                             

Cause of Depression: Heaven – sent, Not shameful                                  

Treatment: None, A Blessing

Aristotle

Cause of Depression: Melancholia

Treatment: Music

Hippocrates                     

Cause of Depression: Melancholia, Natural and Medical Causes

Treatment: Abstinence excesses, Vegetable Diet, Exercise

Celsius

Cause of Depression: A Form of Madness

Treatment: Entertaining Stories, Diversion, Persuasion Therapy

Galen

Cause of Depression: Psychic functions of the brain affected

Treatment: Confrontation, Humor, Exercise

Sources and Additional Information:

Depressive Disorders by Mario Maj and Norman Sartoris

http://en.wikipedia.org/wiki/Major_depressive_disorder

http://en.wikipedia.org/wiki/History_of_depression

http://www.bipolarworld.net/Bipolar%20Disorder/History/pharoah.html

Ice Water and Googles Therapeutic Approaches for Depression Treatment

Two new theories of depression are refining traditional interest in the once fashionable topic of how the left and right sides of the human brain interact.

Dr. Jack Pettigrew, a neuroscientist at the University of Queensland in Brisbane, Australia, proposed that people with manic depression have a ''sticky switch'' somewhere deep in their brains.



In normal people, the switch allows either the left or right hemisphere to be dominant during different mental tasks, with the two sides constantly taking turns. In people with manic depression, one hemisphere becomes locked into a dominant position in periods of depression while the other hemisphere is locked at times of mania. In a truly bizarre finding, Dr. Pettigrew reported that the placement of ice water into one ear seems to unstick the switch.



The second theory is being put forth by Dr. Frederic Schiffer, a psychiatrist at Harvard Medical School. He maintains that one hemisphere can be more immature than the other and that this imbalance leads to different mental disorders. Dr. Schiffer has designed special goggles to help people ''talk'' to each half of the brain separately, to learn which is less mature, and to bring the two hemispheres into harmony.



Both ideas have been well received by brain lateralization authorities eager to see a revival of their specialty.



''It's nice to see the left and right hemispheres are back,'' said Dr. Brenda Milner, a cognitive neuroscientist at the Montreal Neurological Institute in Quebec. The notion that the human brain has two halves and that the left side is associated with logical, analytical thinking while the right side is more intuitive, emotional and creative was popularized about 20 years ago, she said, and soon became received wisdom about how the brain works. ''This idea fell from fashion not because people didn't like it but because they got interested in other things,'' she said.

Dr. Marcel Kinsbourne, a cognitive scientist at the New School for Social Research in New York City and early pioneer in brain lateralization studies, believes that left and right brain ideas also fell from fashion because they were oversold. People looked for universal dichotomies -- the left brain is a whiz at legal briefs but the right brain is deft at poetry -- that carried things too far. But the new theories are ''intriguing,'' Dr. Kinsbourne said, although they have a long way to go before they can be accepted as valid. ''We are in half-baked land here,'' he said.



The new theories are also appealing to many experts because they take on a question that has divided researchers for decades. Do people have one overarching mind that spans the two hemispheres? Or are they born with two separate minds -- one on the left and one on the right -- which operate so seamlessly that the person simply does not notice that there are two?



The subjective sense of having just one mind is overwhelming and unmistakable, said Dr. Joseph Bogen, a neurosurgeon at the University of Southern California in Los Angeles. But if the thick band of fibers connecting the two hemispheres is severed, he explained, humans seem to end up with two separate minds that show different abilities. In one dramatic disparity, the left hemisphere does all the talking while the mute right hemisphere has better access to emotions. For example, when the right brain is shown a photograph, the talkative left brain will say that it does not see anything and cannot comment. But the left hand, which is connected to the right brain, can raise a thumb up or down in response to the question, ''Do you like the picture?'' These kinds of experiments led to a dichotomy of opinion among neuroscientists, Dr. Bogen said. One camp held that in splitting the brain, a single mind is cut into two but that it is abnormal to have two brains. The other camp said every person is born with two brains but because the two sides get along so well, people simply have the illusion of one mind.



After thousands of experiments carried out on normal subjects and split-brain patients, scientists still passionately disagree. But one feature has clearly emerged, said Dr. Terry Sejnowski, a neuroscientist at the Salk Institute in San Diego: Human brains show enormous variation in lateralization. The claim that certain talents or abilities lie in one hemisphere or the other is usually based on averaging the brains of many people, he said. Because each individual brain is a complex system that evolves in response to a unique environment, many brain functions do not end up in the same place. This is further complicated by the fact that the left and right hemisphereprobably communicate through deeper pathways that are not affected in split-brain patients.

The new ideas about lateralization will not resolve the question of one versus two brains, but they do add insights and suggest new ways to treat mental patients, said Dr. Schiffer, whose research was set off by his observation that many of his patients seemed to have a kind of double personality. ''On the one hand, they are very mature and stable, but on the other hand, they can be irrational, overly emotional and compulsive,'' he said. ''Often these two sides appear to struggle against or sabotage each other. The troubled part seems

stuck in a traumatic past, whereas the other part seems more mature and in control.''



Suspecting he was seeing two minds working at cross purposes, Dr. Schiffer designed a pair of goggles that forced his patients to view the world from either the left or right hemisphere separately.



Many experiments show that it is possible to stimulate one hemisphere and inhibit the other so that a person looks at the world using half a brain at a time, Dr. Schiffer explained. When people gaze to the far right and engage their left brains, they do better on verbal memory tasks, he said, and when they look far to the left, to engage the right brain, they feel more inertia and fatigue.



To test how this affects psychiatric patients, Dr. Schiffer made two types of goggles. One permits vision only in the right visual field, thus activating the left brain. The other allows a person to see objects in the left visual field, which activates the right brain. Each brain hemisphere controls the opposite side of the body. When patients looked through goggles, they reported very definite feelings, depending on which side of the brain was being engaged, Dr. Schiffer said. Some felt negative symptoms like anxiety and sadness when the right brain was activated. Others felt bad when the left brain was engaged. In general, he said, depressed patients felt worse when the right side was stimulated and people with post-traumatic stress syndrome fared poorly when the left side was more active.



Dr. Schiffer speculates that in certain mental disorders, one hemisphere is less mature than the other. The immature side is the repository of past traumas and can come to dominate the healthy side. Thus each hemisphere has mental properties with some autonomy from the other side. Each can hold separate opinions, have a different sense of human and carry a different perspective on the world.



Many people feel no mood difference when wearing the goggles, Dr. Schiffer said. This may be because both their hemispheres have similar outlooks, being equally calm or equally troubled.



Dr. Schiffer uses the goggles in therapy sessions to help patients recognize their two minds and to help the mature side take control over the immature side. Patients wearing goggles can actually converse with the opposite hemisphere, he said, and through talk therapy work toward recovery. The goggles do not support the idea that the right brain is poetic and the left is logical, Dr. Schiffer said. People are very different. Each hemisphere is individualistic; either one can be messed up or both sides can be in balance.



Dr. Pettigrew, who invented the sticky-switch idea of depression, also falls into the two-minds camp. He theorizes that patients cycle between bouts of mania and depression for days, weeks or months at a time. ''Because the hemispheres have different cognitive styles, I thought it doesn't make sense to have them both working at the same time,'' Dr. Pettigrew said in an interview at the neuroscience meeting. ''So I thought there should be a switch. This would allow each side to take turns dominating.''



Dr. Pettigrew said there was plenty of evidence that different parts of each hemisphere cycle back and forth, left and right, during everyday tasks. Parts of the visual cortex switch dominance every few seconds, he said, whereas parts of the frontal lobes cycle every couple hours.

To measure how fast the two sides switch dominance in a visual task, Dr. Pettigrew used a standard apparatus that measures so-called binocular rivalry. When a target of horizontal lines is shown to the right eye and vertical lines are shown to the left eye, and the targets are flashed, the brain does not fuse the lines into a hatched pattern. One side of the brain sees vertical, the other side sees horizontal and the two take turns seeing a pure target. Most people switch sides every two to three seconds, Dr. Pettigrew said. But patients with manic depression require 20 to 30 seconds to switch between the two targets. ''I think they have a sticky switch between the hemispheres,'' he said. If the switch is stuck, it may be possible to unstick it, Dr. Pettigrew said, by turning to a strange observation made several years ago by Italian scientists.



''If you tilt a person's head 30 degrees to the side and put ice water into one ear, the opposite brain hemisphere will become activated,'' he said. Thus cold water in the left ear, activating the right hemisphere, might temporarily reduce the symptoms of mania. Depression might be temporarily reduced by placing cold water in the right ear.



Ice water in the ear is a traditional neurological test that has been performed, among other things, on astronauts in space to help understand space sickness. How ice water stimulates one hemisphere is not precisely known, but it seems to activate orientation pathways in one ear (which tell people where they are in space), and these pathways are connected to mid- and higher-brain regions in the opposite side of the head, Dr. Pettigrew said. Trying the ice water in his own left ear, Dr. Pettigrew, who suffers from manic depression, said, ''I sat on my couch at home for 40 hours, ruminating about my life.'' His left brain was stuck in the depression phase. It was, he said, an unpleasant experience.



While both theories provide interesting insight a give way to new practical therapeutic approaches, they probably cannot be considered as stand-alone therapies. "But I don't do goggle therapy," Schiffler says firmly. "The glasses are just a tool I use as an adjunct to traditional psychotherapy. They sometimes assist in freeing a patient who gets stuck at a certain point in therapy, and they can be useful in providing insights to a patient about his or her problems."



Sources and Additional Information:

http://www.appliedmeditation.org/The_Heart/hemisphere_balance.pdf

http://www.healthyplace.com/depression/shocked-ect/can-taped-goggles-heal-emotional-disorders/menu-id-1362/

http://www.ect.org/selfhelp/goggles.html

http://www.news.harvard.edu/gazette/2002/04.04/01-goggles.html

Historical retrospectives of depressive disorder

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time.

Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 1950s and 60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job.

The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it can also be used to describe other types of psychological depression, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide have depression or another mood disorder.

Major Depressive Disorder

In the 1970s and 80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree that:

1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.


2. Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished activity and participation.


3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.


4. Depressive disorders are a huge public-health problem, due to its affecting millions of people.

·         The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism.

·         In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in two categories of problems, as often as coronary artery disease.

·         Depression can increase the risks for developing coronary artery disease, HIV, asthma, and some other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these conditions.

5. Depression is usually first identified in a primary-care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently under-diagnosed.


6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.

Major Depressive Disorder

Sources and Additional Information:

http://www.medicinenet.com/

http://en.wikipedia.org/wiki/Major_depressive_disorder