A Cure For Darkness – The Story of Depression and How We Treat It, by Alex Riley, 2021

In 2019, 8% of Americans had been diagnosed with a depressive disorder, and the arrival of the pandemic in 2020 saw a 28% increase in that number. For such a widespread condition, we know surprisingly little about what causes depression, how it can be categorized, and which treatments work best for which types. “A Cure For Darkness” is an enjoyable, easy to read history of the different theories about what causes depression, and the various ways doctors and therapists have described and treated it. It is well-referenced enough to suit someone who wants to pursue further reading of various research studies, and well-explained enough that a more casual reader won’t need to, especially if you, like me, have been following the subject for a while.

Starting with hysteria, melancholia, and an imbalance of black bile, the book begins with a quick review of (thankfully) obsolete treatments, such as enemas and bloodletting, and then introduces famous and seminal characters such as Freud, who found depressive patients boring, and Emil Kraepelin, who was the first to attempt to categorize different kinds of mental disorders. We see the two main approaches to treatment – the therapeutic approach, which led to interpersonal and cognitive behavioral therapy, and the biological approach, which led to lobotomies, electric shock therapy, the modern range of pharmaceuticals, and deep brain stimulation. The book takes time to look at how depression is viewed and treated in other parts of the world, where a more communal approach can be successful, and how peer counseling might look in an American setting.

The historical chapters are interspersed with the personal story of the author’s own journey through diagnosis, therapy, and medication. Having my own journey to compare it to, I felt the personal additions made the book feel more like sitting with a knowledgeable friend, rather than attending a college lecture. The book concludes with a look at a number of new studies about things like whether gut bacteria or inflammation is related to depression, the return of interest in LSD or ketamine in therapy, the effects of diet and exercise on mood, what brain scans can tell us about different types of depression, and whether therapy or medication or a combination are more effective. There is still so much we don’t understand about how to decide which treatments will work best for which people, but I was surprised and pleased to hear about the success rates of the various options available, and those still being studied. I recommend this book for anyone who has a personal or family interest in the subject, and for health professionals looking for an overview with an extensive appendix of articles for more in-depth reading.