To wonder what people did before antidepressants?

[dottypotter]

Don't know how long anti depressants have been around for depression and anxiety etc, but what happened before they were invented does anyone wonder?
Did people go mad?
Put up with it, but never get better.
Did their depression etc just go away. Intrigued.

They’d walk into the canal, sadly that was commonly reported in the newspaper but rarely depression was mentioned. There’d be other recordings of suicide in the coroners records.

asylum records don’t seem to mention depression, other afflictions but not that one. I’ve read a fair few over the years

Heard of a lobotomy?

I think it would depend on your social class.

Though across all levels of society alcoholism would be rife, and drug use would be high if you were affluent. There were plenty of opium and laudenum addicts.

Life expectancy was much lower.

I think there is historical evidence that many mental health conditions as we know them existed. There's a long record of "melancholy" - to do with the four humour theory. When out of sync the person would become ill. Women were cold and wet so more likely to suffer with it than men who were hot and dry.

I haven't heard of depression being the main malady of inmates at Bethlem etc. They tended to be more "violent" / "delusions" - bipolar disorders etc but I could be wrong. It's been a while since I read the source material at uni

Watching tv show Vienna Blood. Freud devotee Jewish Max Liebermann, 1900, other doctors use electric therapy on patients.

ECT was wonderfully effective in curing my PND (which was so severe that I was barely able to function at all).

Alcohol was consumed

They locked my bipolar grandmother up in an asylum and gave her electric shock treatment.

my father, a little boy at the time, was able to visit her, kept in those conditions. He never got over it, and takes about how horrific it was in his eighties.

Much the same as now, mostly, I think.

Modern antidepressants like SSRIs (e.g. sertraline, citalopram, fluoxetine etc.) have an NNT or "number needed to treat" in depression of about 7, which means that you need to give the antidepressants to 7 depressed people in order for one person to benefit. The other six, some of them will get better through the placebo effect, some will get better on their own, and some won't get better at all. Other classes of antidepressants (SNRIs, TCAs, MAOIs, others) have similar NNTs. Antidepressants just aren't that effective, even though they're on a par with many drugs for physical conditions.

So I suppose that like now, many people got on with life despite feeling like shit if they were able to, relied on family to support them, turned to alcohol or recreational drugs, killed themselves, made life or lifestyle changes (radical or otherwise), were unable to cope and sank under the pressure becoming homeless or otherwise failing to function, tried traditional remedies, tried remedies that had a placebo effect, tried religious rituals, or tried to change the way they felt by talking to someone — a therapist, a religious mentor, a friend, someone with claimed magical powers, or whoever might fill that role in the society they lived in.

Depending on the period in history there were also different medical or other socially-approved treatments, with different levels of success based either on medical effects, psychosocial mechanisms or placebo effect. Psychiatric hospitals, asylums and institutions for those with severe enough problems or who could pay, physical treatments with electricity and insulin and cold water to try and shock the brain into changing, traditional herbal or other folk remedies (some of which are effective antidepressants), drugs that aren't strictly antidepressants but can help some people with depression, brain surgery, traditional social interventions that work on a family or village level, various things really.

But I suspect mostly it was fairly similar — a lot of people with depression eventually felt better through natural recovery or recovery assisted by non-antidepressant factors, a lot of people just pushed on through their ongoing or recurrent depression, and a few people weren't able to function or ended up dying from it.

They were outside much more. If it was mild depression then they used lavender, and other natural herbals. If it was clinical depression then they were hidden away at home or put into an institution.

Most mild-moderate depressions will eventually resolve automatically. It takes a while, though, so I suspect that most people were simply miserable until the problem resolved by itself.

Those with severe mental problems were often institutionalized under horrible conditions, mostly to keep them away from society. Their conditions were considered to be either contagious or caused be devillish possession. Wasn't pretty.

You can agree or disagree with today's use of antidepressants, but the alternative "back in the day" certainly wasn't better and led to unnecessary suffering, isolation in asylums, self medication with alcohol, poverty, and violence.

I'm not so sure most would've ended up hidden away in an asylum or hospital. I think many would've just trudged on but never realised their potential. Intelligent people scraping by in 'manageable' but dreary jobs with little positive outlook. Much like in today's society.

I actually think in some cases necessity might help (whilst also understanding that in others it might be crippling to have no safety net). I used to really struggle with motivation but when I had to pick myself up for risk of losing my job etc (and by extension my ability to house and feed myself) I always seemed to manage by hook or crook. I think people in generations past often didn't have the luxury of reflection that we do.

Obv I'm talking about depression as per the OP, not things like schizophrenia and disassociative disorders.

I think they might work for some people - my siblings who had milder depression and anxiety benefited from them whereas I didn't at all.

Also, a large proportion of people on long term sickness benefits take SSRIs. Again, suggesting they don't radically work for everyone.

My depression was really bad as a teen and in my 20s. By my 30s I'd learnt how to work full time in a demanding job despite episodes and almost never take a sick day. I've been unmedicated for years. Being self-employed helps since I have targets to meet regardless of how tired or low I am. It's also a good distraction.

If SSRIs worked as well as this thread suggests, the suicide rate wouldn't be so high.

I don't think there's really any basis for that claim. For a start, there will be a large proportion of suicide victims who are not and never have been taking SSRI's, another proportion who have not received any form of mental health treatment whatsoever, those who haven't engaged because they simply haven't realised they have a mental health condition, those who have conditions with suicidal ideation that SSRI's are not prescribed for in any case, and a few with conditions where the illness is actually exacerbated by the prescription of SSRI type drugs.

It really isn't anywhere near as simple or straightforward as people committing suicide because their medication fails. It's often the case that people aren't even at their lowest point when they commit the act, as it usually takes some form of wherewithal and functional ability to actually carry it out, so it's often people who have recovered somewhat and outwardly appear calm and in control.

Suicide rates aren't that high, historically.

Graph from: academic.oup.com/ije/article/39/6/1464/736597
showing rates in England and Wales from 1863 to 2007.

My mother (born 1925) was prescribed a cocktail of drugs in the 70s but it didn't do her much good and she would go from being a zombie to an aggressive screaming monster and made several sucide attenpts. I dont think these were 100% serious as she tended to do it in front of people. It made my teens very difficult and, as I had no-one sensible for advice, I ended up making bad decisions myself.

She eventually came off the drugs although always had a difficult personality so that years later her decline into dementia went unnoticed for a while.

My problem with this thread is it heavily suggests that SSRIs are a magic fix. Other than the fact there are various psychiatric illnesses that don't benefit from SSRIs, studies indicate they don't work for a significant number of people who take them.

Plenty of people on SSRIs or other mental health treatments go on to die from suicide.

Suicide rates have increased despite SSRI use being more common and less stigmatised:

www.bmj.com/content/370/bmj.m3431

"Data published by the Office for National Statistics on 1 September showed that in 2019 the suicide rate among men and boys was 16.9 deaths per 100 000, the highest since 2000 and slightly above the 2018 rate of 16.2 per 100 000. The suicide rate among women and girls was 5.3 deaths per 100 000 in 2019, up from 5.0 per 100 000 in 2018 and the highest since 2004."

I think they're far from a magic fix. I read earlier (and mentioned I think) that they only have a 40-60% first time effectiveness, and a circa 45% relapse rate. Plus some studies of large population sizes (e.g. 17 million people) have found long term outcomes to often not be better than going unmedicated.

They got worse and sent to institutions

It doesn't read like that at all to me.

The vast majority of people being treated with SSRI are people who have are experiencing a mild depressive episode, or suffer recurring episodes. For those SSRI's are reasonably effective at relieving symptoms. People who have more profound depressions and psychiatric illnesses are usually referred on, treated by psychiatry, and SSRI's either supplemented by other drugs, other types of treatment, or the SSRI treatment is discontinued because it's no longer relevant.

The fact that mental health care is insufficient in most respects, and some people who commit suicide have undoubtedly been let down by it, isn't indicative of SSRI's failing at what they are intended to do, it's more indicative of the fact that our healthcare systems do not adequately detect or triage profound illness. When SSRI's are used as intended and in the situations they are designed to tackle, they are more effective than any other type of treatment to date.

Of course plenty of people who are on SSRI's or other forms of treatment still go on to commit suicide, nobody is denying that, but that is for a whole gamut of reasons, only one of which is 'SSRI's aren't as effective as they would be in an ideal world'.

If the thread contains a number of posters extolling the virtues of SSRI's, then I'd suggest that's perfectly in keeping with what we understand about mental illness in the general population, and the role SSRI's play in treating that - the vast majority of instances of poor mental health are one-off mild depressive episodes, which SSRI's are reasonably effective in tackling, especially if they are combined with other forms of therapy and lifestyle/environmental changes. They're not intended to treat more profound conditions, and nobody is pretending they are a guaranteed cure.

My father was deputy medical superintendent of a large mental hospital (asylum) from the early 1950s until the late 1970s. (We lived at the hospital until I was 8 so I knew it very well.) It wasn’t perfect by any means but many people stayed there, were treated, got better and returned to their lives. There were beautifully kept gardens to walk in, medical and occupational therapy, weekly cinema shows and dances, parties and pantomimes at Christmas, cricket and football matches between patient and staff teams in season, a farm where many patients were able to work and recuperate and which supplied produce for the kitchens where food was cooked from fresh ingredients. There were also locked wards for unfortunate patients who couldn’t be cured despite all efforts and some people with disabilities who were institutionalised and never left.
In some ways it was better than what is available now and in other ways worse. My father retired at the point where modern antipsychotic drugs enabled the introduction of “care in the community” and he was fearful that it would be disastrous for many people who would be unable to access the sort of compassionate care that would help them to get better.