"It's easy if you try" might sing John Lennon if he were alive today. But actually I am having a very difficult time imagining such a world. Antidepressants have earned their status as a cultural icon. Prozac is as widely known as Coca-Cola. And it seems everyone and their grandmother has tried an antidepressant at one point or another. Either your doctor or the television has promoted their magical abilities. "Depression hurts" blares from our television as visuals of slumped over figures ignoring their dogs, kids, and spouses illustrate this point. You get to see the immediate and dramatic after effects of the advertised medication with that once depressed pet owner finally taking the dog for a walk. I bet that dog was relieved. Who knows how long he had been waiting? Or you get to see a husband and wife smiling as they step out onto the dance floor. Or was that the commercial for Viagra?
Have you ever wondered how many antidepressants there are? In my highly unofficial guesstimate, I counted 34 different types of antidepressants listed on Wikipedia alone. Have you ever wondered how many of us are taking an antidepressant? I did wonder and found a very intriguing article in the February issue of Scientific American entitled, "The Medicated Americans: Antidepressant Prescriptions on the Rise" where the author, Charles Barber provides the answer: "Close to 10 percent of men and women are now taking drugs to combat depression."
How did we evolve to this? And what on earth did we do to treat depression when antidepressants did not exist? Somehow the world survived without these pills for thousands of years. Did our ancestors have any good ideas of how to treat depression? I invite you now to leap through history to imagine that world without antidepressants. These sporadic leaps through the history of depression are courtesy of a fascinating article called The "Historical Understandings of Depression" by Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
According to these authors, in the early Greek and Roman eras, doctors believed that depression was both a biological and psychological disease. That is not so far off from today. In those days "gymnastics, massage, special diets, music, and baths, as well as a concoction of poppy seed extract and donkey's milk were used to alleviate depressive symptoms."
Okay out of these I would go for the massage, the music, and the baths. I am not much of a gymnast and I don't think I would like the donkey milk concoction. How about you?
And now moving right along to the days of Hippocrates who believed that depression was nothing more than a case of too much black bile in the spleen. Does this mean he thought depression was equivalent to being constipated? His method to cure melancholy? Bloodletting. Leeches sure were popular back then. No thanks I already gave to the blood bank and I am still depressed.
After the popularity of Hippocrates had faded a dude named "Cornelius Celsus (25BC-50 AD) recommended starvation, shackles (leg irons), and beating as "treatments." Now when they said "Depression hurts" they really meant depression hurts. Yeah I am thinking I would pass on beatings and torture.
History is looking mighty dismal for us depressives so far!
I am afraid to say that things don't get better. Take the Middle Ages for example. During the Middle Ages people looked to Christianity to explain mental illness. And their explanation? "Most people thought that mentally ill people were possessed by the devil, demons, or witches and were capable of infecting others with their madness. Treatments of choice included exorcisms, and other more barbaric strategies such as drowning and burning." Ah yes there's nothing like a good exorcism. And drowning and burning? Gee those leeches are looking mighty good now.
Let's get out of the dreaded Middle Ages and leap into 1621 where Robert Burton publishes the Anatomy of Melancholy, in which he describes " the psychological and social causes (such as poverty, fear and solitude) of depression." What does he recommend? I know you are shuddering to know. Whew! All he says to do is try "diet, exercise, distraction, travel, purgatives (cleansers that purge the body of toxins), bloodletting, herbal remedies, marriage, and even music therapy as treatments for depression." Yay! I like this Robert Burton fellow. Okay so he does mention bloodletting but now we know this is not as bad as some treatments like torture or death. Whether it is better than marriage is still being debated.
Now we will jump to the beginning of the 19th century. Surely by now they will have some enlightened means to help those of us with depression. Fat chance! They must have gone back for ideas from the Middle Ages or were time travelers from GuantÃ¡namo Bay. Treatment for depression included "water immersion (keeping people under water for as long as possible without drowning them) and a special spinning stool to induce dizziness (to rearrange the contents of the brain into the correct positions). In addition, Benjamin Franklin introduced an early form of electroshock therapy. Horseback riding, special diets, enemas and vomiting were also recommended therapy."
Gee that all sounds like fun! Let's see, so much to choose from. I choose the enemas and vomiting because I am not really so fond of horses, spinning, being shocked, or enduring water boarding. And hey, maybe I can also lose weight in the process!
We will continue to move ahead in time. I am so optimistic that there will be something really good to help with depression! So what do you think they came up with during the late 19th and early 20th centuries? Something truly innovative by golly! That's right. The lobotomy. Makes sense. If you are depressed, just remove part of your brain. Who cares if you can't think, go into a coma or die. At least you aren't depressed anymore. And if you elect not to go for the lobotomy route you can always be locked up in an asylum. I told you those leeches are looking good right now.
Let's speed up to the 1950's with the emergence of looking for organic causes and treatments for depression. This is the time when antidepressants were born: "In 1952, doctors noticed that a tuberculosis medication (isoniazid) was also useful in treating people with depression. Shortly after this significant finding, the practice of using medications to treat mental illness gained full steam." During this era talk therapy was in its heyday with many different approaches including behaviorism, cognitive-behavioral therapy, humanistic therapy, and traditional psychotherapy.
Which leads us full circle to present day and our many choices of both therapies and medications. Maybe, just maybe, things are not so bad after all. Prozac or leeches anyone?