What Did Depression Look Like Before 'Antidepressants'?

Tracing the historical trends and how a rare condition became an epidemic

In coffee shops and on social media, in classrooms and boardrooms, the phrase "I'm depressed" has become as commonplace as discussing the weather. Young adults list their mental health struggles in their dating profiles, while celebrities bare their battles with depression to millions of followers. Support groups for depression span every demographic, and antidepressant medications are among the most prescribed drugs in the world. Depression, it seems, has become an integral part of our collective identity.

Yet, if we could transport ourselves back throughout the 20th century, we'd find ourselves in a distinctly different mental health landscape. The notion of casually "identifying as depressed" would be met with confusion, if not outright disbelief. Depression, prior to 1990, was a term reserved for the most severely afflicted, often confined to psychiatric wards. It conjured images of profound despair, not the everyday malaise we now associate with the term. The term melancholy has been written about for centuries.

"I write of melancholy by being busy to avoid melancholy.”

-Robert Burton

In her seminal 1968 work, "The Epidemiology of Depression," Charlotte Silverman unveiled a startling fact: community surveys from the 1930s and 1940s had found that fewer than 1 in 1,000 adults experienced an episode of clinical depression annually. This figure, almost unbelievable by today's standards, paints a dramatically different picture of mental health in mid-20th century America. Most striking? Clinical depression in young people, at the time, almost unheard of.