The condition that today we label depression has been described by a number of ancient writers under classification of “melancholia.” The first clinical description of melancholia was made by Hippocrates in the 4th century B.C. He also referred to swings similar to mania and depression.
Aretaeus, physician living in the 2nd century, A.D described the melancholic patient as “sad, dismayed, sleepless…They become this by their agitation and loss of refreshing sleep…At more advanced stage, they complain of a thousand futilities and desire death.” It is noteworthy that Aretaeus specifically delineated the manic-depressive cycle. Some authorities believe that he anticipated the Kraepelinian synthesis of manic depressive psychosis.
Pinel at the beginning of the nineteenth century described melancholia as follows:
“The symptoms generally comprehend by the term melancholia are taciturnity, a thoughtful pensive air, gloomy suspicious and a love of solitude. Those traits, indeed, appear to distinguish the characters of some men otherwise in good health, and frequently in prosperous circumstances. Nothing, however, can be more hideous than the figure of a melancholic brooding over his imaginary misfortune. If moreover possessed of power, and endowed with a perverse disposition and a sanguinary heart, and image is rendered still more repulsive.”
Because the disturbed feelings are generally a striking feature of depression, it has become customary in recent years to regard this condition as a “primary mood disorder” or as an “affective disorder.” The central importance ascribed to the feeling component of depression is exemplified by the practice of utilizing affective adjective check lists to define and measure depression. The representation of depression as an affective disorder is a misleading as it would be to designate scarlet fever as a “disorder of the skin” or as a “primary febrile disorder.” There are many components to depression other than mood deviation.
Depression may now be defined in terms of the following attributes:
- A specific alteration in mood: sadness, loneliness, apathy
- A negative self concept associated with self-reproaches and self blame.
- Regressive and self punitive wishes: desires to escape, hide or die.
- Vegetative changes: anorexia, insomnia, loss of libido
- Change in activity level: retardation or agitation.
