Introduction

Depression has been known as a disorder for thousands of years. One of the most vivid descriptions is presented in the Bible when Job loses his possessions and his family, and laments:

My days are past, my purposes are broken off, even the thoughts of my heart. They change the night into day: the light is short because of darkness. If I wait, the grave is mine house: I have made my bed in the darkness. I have said to corruption, Thou art my father: to the worm, Thou art my mother, and my sister. And where is now my hope?

Hippocrates in the fifth century BC coined the term "melancholia" (the Latinised form of the original Greek term) to cover this disorder, though he considered it to result from an excess of one of the four humours, black bile. The term "depression" (from the Latin "deprimere" meaning "to press down") was not introduced into English until the 17th century, though it was only in the late 19th century, and early 20th century, in the writings of Griesinger and Kraepelin, that the term began to replace "melancholia" as a diagnostic label (see Jackson, 1986, for a detailed history).

The term "depression" now refers to a wide range of disorders and a number of different classification systems. Nevertheless, the majority of these systems consider depression to be a combination of depressed mood and at least some of the following symptoms:

(1) loss of interest in normal activities (anhedonia)

(2) slowness in thinking and, in severe cases, slowness in movement (retardation)

(3) feelings of self-condemnation

(4) appetite disturbance

(5) excessive tiredness

(6) sleep disturbance

(7) loss of libido

(8) suicidal thoughts and attempts.

Mood Disorders: A Handbook of Science and Practice. Edited by M. Power. © 2004 John Wiley & Sons, Ltd. ISBN 0-470-84390-X.

There have been various attempts at classification which have made distinctions such as reactive-endogenous and neurotic-psychotic. However, it has now been shown that the majority of depressions of all types are preceded by negative life events, so the attempt to distinguish reactive from non-reactive types has largely been abandoned (see Champion, 2000). One distinction that does appear to be useful, though, is that between unipolar and bipolar depression. Bipolar disorders typically show periods of mania or hypomania in addition to periods of severe depression; in contrast to unipolar depression, bipolar disorders have a high genetic loading; and the primary form of treatment is with lithium (Goodwin & Jamison, 1990). Nevertheless, there are interesting signs that even such an apparently biologically determined form of depression may also demonstrate considerable sensitivity to psychosocial factors, in relation both to first onset and to the course of the disorder, and that approaches such as cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are useful adjunctive therapies (see Chapters 14 and 15).

Understanding And Treating Bipolar Disorders

Understanding And Treating Bipolar Disorders

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