ABSTRACT
INTRODUCTION The core elements ofwhatwenowcallmajor depressive disorder (MDD) are as old as the history of humankind. Hippocrates (460-377 BC) described melancholia, a condition that was very similar to today’s MDD specifier of the same name (1): prolonged despondency, blue moods, detachment, anhedonia, irritability, restlessness, insomnia, aversion to food, diurnal variation, and suicidal impulses. Mourning and grief were viewed as normal responses to loss, and only the presence of excessive, psychotic, or unmotivated sadness was construed as “disordered.” This distinction was maintained for many years in the definition of “depressive neurosis” as described in theDiagnostic and StatisticalManual ofMental Disorders (DSM)-II (2). Starting with DSM-III (3), however, theoretical underpinnings of the causes of mental illnesses, includingMDD, were removed. Mental illnesses were now conceptualized as symptom-based, categorical diseases (4).
