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date: 21 October 2020

Abstract and Keywords

The symptoms that define depressive conditions have been recognized for millennia of medical history. The earliest Hippocratic writings not only define depression in similar ways as current works but also use context to differentiate ordinary sadness from depressive disorder. Sadness was understood as a natural reaction to loss; symptoms indicated a disorder only if they were not attributable to an identifiable trigger or if they displayed disproportionate intensity or duration to their triggers. The first serious approaches to subcategorize different types of depressive disorders developed in the seventeenth century. Despite agreement that a melancholic or psychotic form of depression existed, researchers debated the categorization of neurotic or nonpsychotic depressions until 1980 when the DSM- III introduced major depression as a unitary category. The DSM’s diagnostic system was historically anomalous because its diagnoses did not consider the context in which symptoms arose. The only exception within the DSM, for uncomplicated symptoms that follow bereavement, was removed from the DSM-5 in 2013 so that depressive diagnoses now thoroughly conflate adaptive responses to loss with pathological depressions.

Keywords: depression, Hippocrates, DSM-III, diagnosis, melancholia, melancholy, Emil Kraepelin, Sigmund Freud, major depressive disorder, symptoms

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