A Cure for Darkness: The Story of Depression and How We Treat It

by Alex Riley

A fascinating, “rich, and generous” ( Financial Times ) look at the treatment of depression by an award-winning science writer that blends popular science, narrative history, and memoir.

Is depression a persistent low mood, or is it a range of symptoms? Can it be expressed through a single diagnosis, or does depression actually refer to a diversity of mental disorders? Is there, or will there ever be, a cure? In seeking the answers to these questions, Riley finds a rich history of ideas and treatments—and takes the reader on a gripping narrative journey, packed with fascinating stories like the junior doctor who discovered that some of the first antidepressants had a deadly reaction with cheese.

“Interweaving memoir, case histories, and accounts of new therapies, Riley anatomizes what is still a fairly young science, and a troubled one” ( The New Yorker ). Reporting on the field of global mental health from its colonial past to the present day, Riley highlights a range of scalable therapies, including how a group of grandmothers stands on the frontline of a mental health revolution.

Hopeful, fascinating, and profound, A Cure for Darkness is “recommended reading for anyone with even a peripheral interest in depression” ( Washington Examiner ).

Genres: Nonfiction, Psychology, Mental Health, Self Help, Science, Health, History

464 pages, Hardcover

First published April 13, 2021

About the author

Alex Riley is an award-winning science writer and the author of Super Natural and A Cure for Darkness. A former research scientist at the Natural History Museum in London, he has coauthored peer-reviewed scientific research and published his popular science reporting in New Scientist, PBS’s NOVA Next, the BBC, Aeon, and Nautilus Magazine, among others. He lives in Devon, UK, with his family.

Reviews

[Katy · Rating 5 out of 5]

Readers looking for a fluffy self-help book need not apply. A Cure for Darkness is for readers seeking an in-depth history of how the field of mental health and depression came to be recognized by society. As a clinical psychologist, I found Riley's historical account of depression fascinating and inspiring. He paints the major players in mental health with beautiful color and depth to their lives, which brings much-needed personality to an otherwise dry topic. Riley leaves his opinions off the page and allows the reader to make up their own mind as to the ethics of certain figures and events.

More research-based than pop-culture psychology and more engaging than a textbook, A Cure for Darkness is not meant to be a 'how-to' or memoir of the author's self-disclosed treatment of depression. I predict that this text will become required (or at least recommended) reading at many graduate mental health programs in the very near future. It is the best mainstream text of psychological literature I've read in a while, but again, I'm pretty biased as a clinical psychologist.

[Alex · Rating 5 out of 5]

‘A Cure For Darkness’ is a recently published blend of scientific theory and personal memoir. Written by Alex Riley, a science writer who’s struggled with depression himself, it is by no means a self-help guide, but an informative book that does exactly what it says on the tin: it tells the story of how our understanding of the causes and our approach to the treatment of depression (and mental illness in general) has changed over the millennia. Throughout the book, Riley highlights the complexity of this common, but still misunderstood condition, and discusses the various treatments that have been used since antiquity, treatments diverse, and sometimes dangerous, quite like depression itself. The book is divided into four parts, which are further divided into a total of 27 chapters.

The first part, ‘Cutting Steps Into The Mountain’ is primarily focused on the work of Sigmund Freud and Emil Kraepelin, two leading figures of modern-day Psychiatry, two pioneers whose clinical and academic work contributed to our current understanding of mental (or psychiatric) disorders. Once we’re introduced to Freud and Kraepelin, Riley takes us back to antiquity and then to the Middle Ages before returning to the twentieth century. He shows how our approach to the understanding and treatment of depression throughout the centuries has followed a non-linear course; ancient wisdom and compassion gave way to a misunderstanding that led to the inhumane conditions of mental asylums, where patients were chained and bled.

In the two middle parts of the book, the author discusses the development of the so-called biological treatments for depression (brain surgery, electro-convulsive therapy (ECT), antidepressant medication) during the twentieth century. He then talks about the psychological treatments (talking therapies), as well as the challenges of talking about, let alone treating, depression in the third world. The final part, ‘The Universe Within’, is about current practice, as well as cutting-edge research into the causes and treatment of depression. For example, here, Riley talks about the insights from recent neuroimaging studies and the little-understood links between depression, inflammation and diet, as well as the use of deep brain stimulation (DBS) and psychedelic drugs in the treatment of the condition.

What Riley successfully demonstrates throughout this book is that depression is an incredibly complex and diverse clinical condition. He shows how our understanding of the biological, psychological and sociocultural mechanisms underpinning depression has improved, alongside the sometimes empirical, sometimes scientific treatments. By doing so, he sheds light on the reasons why successful treatment of depression can be such a huge challenge for clinicians and patients alike.

As a Consultant Psychiatrist myself, I think that Riley does absolute justice to such a complex, diverse and ultimately misunderstood condition. His approach follows the holistic bio-psycho-social model (that Psychiatrists currently use) with regards to both causation and treatment of depression (and mental illness in general). Talking about the past, present and future treatments of depression, he offers a comprehensive overview of those, and overall he follows a well-balanced and rounded approach. As a reader, I found Riley’s writing engaging and I certainly enjoyed reading this book. I would definitely recommend it to trainee psychiatrists, as well as to anyone who wants to better understand the complex causes of depression and gain an insight into the challenges that clinicians face when it comes to its treatment.

[Karen · Rating 4 out of 5]

A CURE FOR DARKNESS
BY ALEX RILEY

The reason that I requested this was to learn and better understand depression, the best treatments for it, what if the treatments don't work and finally what is on the horizon for treatments scientifically or cutting edge. My oldest son who is 22 started to have a low grade depression and was seeing a psychologist. He didn't want to take antidepressants and wanted to work through it on his own utilizing exercise and a positive out look and solving it on his own. I thought by reading this I might learn something that I could talk to him about or at least understand what causes it.

I was extremely disappointed that this book was not for me. It is very dense and starts out talking about Freud dissecting eels for testes. It slowly chronicles the historical dating back to the 1800's.
I definitely think the author's audience is for a more scholarly background in such details that weren't helpful to me. I don't feel like it is accessible to the average reader as it records a lot of historical facts.

The author, Alex Riley suffers from depression and in the very beginning he talks about going off his antidepressants. He is taking SSRI inhibitors which I understood and talks about the regimen of those along with talk therapy being what is commonly prescribed today. He mentions in the past using ECT. That I understood. I really think that this book could be so much more helpful to the everyday lay person if he didn't pack this with so much minutia about every single historical detail. I was hoping that this would be made to be much more accessible to people who just want to learn about how to be helpful and aren't clinicians which in my opinion is a better target audience for this book. I did learn that this can affect as many as 322,000,000 people today in the world. Also that fifteen percent of those who don't seek treatment are likely to be suicides. This just wasn't for me.
I did find the work of Mayberg, a woman who published a paper of about six pages in length in the American Journal of Psychiatry of her experiments fascinating. I am summarizing here that her famous paper introduces an area of the brain mapped and called area 25. How when volunteers were asked to think of something painful in their pasts that they experienced and how on a PET scan it displayed a blue like pattern on area 25 on their brain's while parts of their prefrontal cortex switched off. The prefrontal cortex didn't show activity. How amazing it is that when these same volunteer's stopped thinking about a sad experience from their past Area 25 quietened. The frontal cortex where rational thought takes place jumped back to the previous homeostasis. Also revealing, that people with depression, this same pattern only repeated with subjects taking antidepressants. As Mayberg, reasoned that people who are depressed were stuck and couldn't switch off this "sadness center." It just kept firing, and firing. With such a constant barrage of painful signals, the circuitry within the brain starts to take on a different shape. Pieces start to malfunction. Parts of the cortex are silenced and pushed out of practice. Even after slight disappointments, full-blown depression becomes the normal. The brain settles into a disordered state that only medication can untangle. Area 25 is in the limbic system which is a key component that connects regions of the frontal lobe section involved in motivation, drive, and rational thought with those more central parts of the brain that are crucial to memory and emotional regulation. She also found a reverse of what she thought to be a common blueprint of depression by scans revealing that the prefrontal cortex displaying a sort of red blobs, where she previously understood the red like blobs should instead be blue. The volunteer's area 25 was quiet. What was reduced was increased making this raise the question of are there depressions that are different in nature? And if so, could this explain why some people respond to different treatments and might data from brain scans be used to guide treatment of depression? This was fascinating compared to the dense historical data that most of the book focuses on. There was a lot that I left out regarding her experiments and research for reasons of keeping this review brief.

I did find her research and experiments interesting as someone who was a biochemistry major who changed majors once I found that I couldn't dissect a cadaver so my aspirations for becoming a psychiatrist were finished. I still find that I am interested in psychiatry even though I didn't attend medical school for the reason stated above. I like reading about contemporary psychiatry and biochemistry of the brain and enjoyed the book from this point onward. I was skeptical about requesting this because I am not a historian and didn't want to read a textbook about 1700's, and 1800's of densely packed details which are cited earlier in this review. I am interested in Freud and Carl Jung but not about Freud's use of the microscope dissecting eels testes. I am giving my opinion and do realize that doctor's and researchers and other's could find this meticulous research that this author has included enjoyable. I prefer to learn about contemporary material and am grateful that I stuck it out because there is much that is interesting that I learned from. Also the author suffers from depression and I admire his ability to write a book that encompasses the details looking at it from the point of view of a historian. I don't mind if people disagree with my opinion and wish the author the best of luck and good health. I keep editing this because I want to give credit to the effort that went into writing this. I did end up enjoying the biochemistry aspects and experiments and the efforts made to expand on contemporary endeavors. This will appeal to many reader's at this point in time more than ever.

Publication Date: April 13, 2021

Thank you to Net Galley, Alex Riley, Scribner and for anybody who read this disjointed review. I apologize for my rambling on. All opinions are my own

#ACureforDarkness #AlexRiley #Simon&SchusterScribner #NetGalley

[Dea · Rating 2 out of 5]

I was expecting something like an update to what “The Noonday Demon” was, but was disappointed. This is a good start to the topic, but doesn't offer much depth or detail.

The overview of older cures felt like that there was a deliberate avoidance mentioning some terrible things the 'cures' were used for, as well as minimization of the damage those 'cures' did even if there was improvement of their symptoms.

The overview of new cures felt insubstantial and not very scientific. Instead of making me feel like I was learning something new, I found myself wondering if it was new age quackery that we would all laugh at in a decade or two.

So if you know nothing on the topic, this is an OK source to start the journey. But if you are intimately familiar with the topic, you are better off trying elsewhere.

[Donna · Rating 4 out of 5]

I enjoyed the author's back story to the clinical aspects of this book.

[Paz · Rating 2 out of 5]

This book was not what I expected. It had a textboook vibe, more informational and than a memoir. It needed more of a memoir feel. This book is great for someone who knows almost nothing about the history of depression./mental health.
I do appreciate the small cultural piece that was in the book.

Depression and mental health are broad and it was great that the author took this approach . Maybe this book wasn’t for me ...

[Kelly · Rating 4 out of 5]

4.5 stars, rounded down

This book is an extremely detailed nonfiction of how depression was identified and treated along with the author's own personal experience mixed in. It was fascinating to hear about how depression was seen in various time periods and which treatment methods and medications were used.

4.5 stars rounded down because it was a bit lengthy. I don't read a lot of nonfiction, but I pushed myself to finish this audiobook.

Thanks to San Diego County Library for the digital audio version via Libby app.

[Audio: 12 hours, 42 minutes]

Time spent reading: 10 hours, 12 minutes

[Anannya Das · Rating 4 out of 5]

Super interesting book about the history of depression, main figures as well as treatments. I thought the story made as well as the author’s story parallel each other in ways that explain the past as well as the present. By humanizing this story, the book shows us hope for depression and how far we’ve come from so little. This showed me many new perspectives on this topic, as someone who has already read many books on mental health. A must read for people wanting to learn more about disease as well as how to perhaps become the best version of yourself with chronic illness.

[Kay · Rating 4 out of 5]

Very interesting

[Steve Hunt · Rating 4 out of 5]

Great overview of depression.

[Peter · Rating 5 out of 5]

One of the most important books I've read.

[Brett Milam · Rating 5 out of 5]

Even though we are taught to not allow depression to subsume our identity — we are people with depression, afflicted with it as one is afflicted by any other disease or ailment — it has a way of doing that. So much so, that when its pernicious rewiring (degradation) of the brain ceases, and is lifted, we feel like an entirely new person. We were carrying that this whole time? Indeed. Alex Riley, a British science writer and a person who is afflicted with depression, too, aptly said on the first page of his treatise on the topic, 2021’s A Cure for Darkness: The Story of Depression and How We Treat It: “The suicide plan that I had once sketched out didn’t just seem like a distant memory, but the memory of a different person.” When I think back to my longer-suffering 20s with depression (maybe even longer), where I also thought regularly of suicide and had etched a plan in my head of how depression would one day kill me, once I came out the other side healthier and depression abated, that person and his daily thoughts seemed remote enough from where I am now to be a different person. Riley’s book, part-memoir and part-tour de force through depression and its various treatments across millennia and several continents, from talk therapies to electroconvulsive therapy (ECT) to gut bacteria to psychedelics to Friendship Benches, is a clarion call that depression need not kill so many of us globally, nor hamper our quality of life. Shame and stigma reinforce the disparate approach, however, alongside particular policy choices and an unwillingness to see mental health as a challenge global in nature. A holistic treatment plan for depression, taking into account how inaccessible such treatment plans are for large swaths of the global population and remedying such inaccessibility, is what is needed to end the scourge of depression. As Riley said, we may not be able to “kill depression, but, with treatment, we can stop it from killing us.”

Riley, who is the same age I am, was taking sertraline, a selective serotonin reuptake inhibitor (SSRI), for his depression, which I believe was after a miserable experience on a prior SSRI. But Riley didn’t want to be reliant, for lack of a better word, on the drug for the rest of his life. Sertraline was also mitigating the vibrancy of life, the intimacy of life, he said. This is where talk about his previous suicide plan came from: he surmised he was in a better place and thus, better able to manager his depression. So, he decided to go off of sertraline in February 2020. Oof. While much of Riley’s book goes on to deal with the tension that’s existed more than a century between the physiological and the psychological underpinnings of depression — nature versus nature — obviously, an event like a once-in-a-century global pandemic and its attendant consequences can and does exacerbate all manner of mental illnesses, including depression. I was on the opposite journey as Riley during the pandemic. It was January 2021 when I first sought out antidepressants, a big step for me. However, that antidepressant, much like Riley’s, didn’t work and had side effects I didn’t like. It would take me another six months — and a brutal and embarrassing bottoming out — before I not only tried a different, better antidepressant (venlafaxine), but I also sought therapy, along with changing my diet and exercising more. I brought to bear the entire holistic approach Riley espouses in his book to my depression. And it worked tremendously. But I understand Riley’s initial apprehension at being on a SSRI for an extended period of time, if not indefinitely. You start to wonder who you actually are. The you who planned a suicide was you, but not one you’d like to go back to. But the new you who doesn’t consider suicide anymore is also you, but it’s a you augmented, or perhaps, steadied, by a drug. I think the ideal for any person experiencing depression would be to not have depression and also not have to rely on a SSRI and its side effects to combat it. Alas. Additionally, Riley, like me, also worried about having children. Having a child, while engendering many happy moments and feelings, can also exacerbate depression symptoms, in addition to the concern about genetically passing down depression to a child. Indeed, studies have shown that having a depressed parent increases the risk of depression in children threefold. While Riley rightly noted that predisposition isn’t destiny, it’s still something to consider with some trepidation, at least for me. At the end of the book, Riley revealed that he not only went forward with a child with his significant other, but that he went back on sertraline, embracing it. He said, “I came to the conclusion that antidepressants are effective treatments for my depression and feel overwhelmed with relief that they exist.” That is the same conclusion I arrived at as soon as I realized venlafaxine worked. That aforementioned lifting of depression and the oppressive, repeated negative and suicidal thoughts is a game-changer for a better quality of life. While, again, I approached my depression in a multifaceted way, venlafaxine deserves much of the credit.

The two poster children of biological versus environmental, physical treatment versus psychological treatment, are Emil Kraepelin and Sigmund Freud, both of whom were born within months of each other in 1856. But, if what I’ve said about Riley’s thesis has been any indicator, this is a false choice and ultimately, always was. Treating depression isn’t a binary matter. We have to take into consideration all of it: biology and the environment, physical treatment and psychological treatment. Kraepelin is also the one who categorized depression. While it’s hard to fully categorize something as amorphous as depression, such categorizations at least provide some light in the darkness: endogenous depression (coming from within) and reactive depression (instead of biologically determinant, it’s a reaction to life events and found in certain personality types). There’s a third category I’ll take about shortly. That all said, I did see a binary of a sorts, a “versus” between the disposition of Kraepelin and Freud. The former came across humble and candid about the shortcomings of his scientific endeavors, while Freud was arrogant and stubborn about admitting fault, and had a vested interest in achieving fame and fortune. Early on, though, he would receive scorn for helping to propagate cocaine, which he took in liquid form, and to him, was magic. Cocaine was essentially the first antidepressant before that word was coined, albeit, obviously, its use was scorned by Freud’s peers for a reason.

Psychiatry is rife with horrors, abuse, maliciousness, and extermination of “undesirables.” So, it’s not altogether shocking that there were many stumbles along the road to treating depression. The “rest cure” was in vogue in the late 1800s, for example, “treating” even Virginia Woolf. It’s exactly what it sounds like, but more barbaric. Picture not being permitted to move, even your hands, for up to four or five weeks, while also being separated from loved ones and friends. “Forced feedings, rectal enemas, and even lashings were used,” Riley said. I also was not surprised that one of the longest running “cures” for any ailment, bloodletting, was also used to “treat” those thought manic and depressed, stemming from Galen’s (Greek physician and philosopher) notion of “black bile” in the body. When anatomists ultimately found no such bile in the body, bloodletting persisted because there was “no other alternative yet proposed.” The lobotomy is only rivaled by ECT for being the most notorious treatment to the general public, thanks to movies and books, and of course, the brutal reality of how it was practiced in its early days. Walter Freeman popularized the lobotomy in America in the 1940s. I find it rather unconscionable that a “doctor” would perform this procedure without any actual expertise about what they were quite literally poking the brain with and its effects. Indeed, 10 percent of patients were killed by the lobotomy, which is likely a conservative estimate. Rosemary Kennedy, sister of future President John F. Kennedy, was someone who was rendered forever incapacitated by the lobotomy performed by Freeman. ECT, a very brief burst of electricity into the brain, on the other hand, while not performed with the best of practices after its introduction in fascist Italy in 1938 (marring it from the get-go and to this day in Italy), ECT in its modern form is done with anesthesia and at least for the psychotic form of depression (when one experiences delusions), the third category of depression, is superior to drugs as a treatment option. I admittedly did not know much about ECT prior to Riley’s book other than the two broad sweeps: that it was maligned after much use, including of people who didn’t actually need it, and that contrary to conventional wisdom, its not only still in use, but it’s safe. In fact, I didn’t realize, despite its name, that ECT is inducing epilepsy, a disease, as a mitigator of another disease (depression), similar, I suppose, to how some vaccines, are created from a disease, to mitigate a disease.

But, as evidenced by the good ECT does, psychiatry is also replete with wonders and life-saving advancements. Nathan Klein, probably a bastard in his private life, is an example, thanks to his boisterous support of drug treatments for millions of people suffering from depression, which at the time, was abhorred by the dominant, Freudian-influenced, strain of depression treatment: psychoanalysts. Riley talked about the introduction of antipsychotic drugs in the 1950s due to Klein’s efforts, as a game-changer. Instead of patients rotting away in mental hospitals, they could actually leave after being treated with such drugs, a revolutionary concept. Aaron Beck is another great example, thanks to his pioneering work that also pushed back against Freudian psychoanalysis, with cognitive behavioral therapy, or CBT. CBT was as instrumental in my recovery as venlafaxine. While psychoanalysis was focused on sexual repression and inward-facing anger, Beck saw that it was more about self-hatred and magnifying the little things in life that then became insurmountable. The behaviorists, like B.F. Skinner, also pushed back against CBT, thinking it was just a subset of what they had already established. Skinner saw CBT as dangerous because he viewed depression as a conditioned response to the environment. “By ignoring this external element, Skinner feared, there would be no political pressure to change, say, unemployment, poverty, poor housing, or diseases that take their toll on the mental health of a population,” Riley said. Of course, as the name would indicate, these rivalrous factions ultimately fused into what CBT is today. In other words, behavioral changes are used to promote cognitive change, according to Marjorie Weishaar, a cognitive therapist. What differentiates CBT from SSRIs, for example, as Riley noted and then experienced himself, is that CBT is effective at preventing relapse long-term, whereas taking a SSRI is only effective as long as you take it. At one point, Riley was prescribed what I take, venlafaxine, but decided against it due to its severe withdrawal effects. I can attest to that. One time in between shipments, I didn’t have any pills, so I went a day without venlafaxine. It was brutal, and then within literal minutes of taking it again, I was well. But since I have no plans of stopping, I’m not worried about such withdrawal issues. Finally, I’d be remiss if I didn’t mention Myrna Weissman, another person I think who made important contributions to our understanding of depression because she quite literally endeavored to understand how many people were depressed and who it was affecting. In other words, she approached depression from an epidemiological standpoint.

Then are three areas of treatment for depression that are relatively new and/or still need to break through due to limitations or legal issues Riley covered in the book. First, is deep brain stimulation, or DBS, primarily used on patients who have been proven to have treatment-resistant depression. An electrode is implanted in the patient’s brain at a specifically important region (area 25), which is controlled by a pacemaker in their chest. Researchers then documented eight years of stimulation. It seemed to be effective for some of the research group, where by the second year, 30 percent were in full remission from their depression. So far, DBS is still considered experimental. Second is the relationship between our gut bacteria, or the microbiome, and depression. Is depression more a factor of the gut than the mind? Is treating low-inflammation the pathway to treating depression? Does depression cause the inflammation or does inflammation cause the depression? There at least appears to be a link between those with depression and high levels of inflammation in their blood (it could even be a predictor of depression later in life). Third is the cocaine of it all. I jest, but it is rather amusing that more than 100 years after Freud was slurping cocaine, we’re back to the struggle with drugs deemed “illicit” and thus, unable to be used for medicinal purposes or even to be researched in a way that isn’t cost prohibitive. In the modern context, drugs like LSD, which contains psilocybin, could have medicinal uses for treating depression. Psilocybin seemed to shut down the overactive part of a depressed person’s brain, according to one study Riley mentioned. The drug disrupted the negative inner-thought process those with depression experience. Ketamine is another one, which made me chuckle given its negative connotation right now, owing to its connection to Elon Musk. The reason researchers started looking into LSD and ketamine is because we still don’t quite know why SSRIs have lag time, i.e., the multiple weeks it takes for a SSRI to be effective once ingested. Riley rightly pointed out how dangerous of a time that is as a suicide-risk for people. Certainly, I would think the next frontier in pharmacology is finding an effective drug without such a lag time.

Finally, there are the two treatments that Riley and I both used because we can do them ourselves: diet and exercise. He embraced the Mediterranean diet and running. Both diet and regular exercise were also crucial to my recovery from depression and suicidal ideation. Therefore, to overcome the scourge of depression, I needed venlafaxine, CBT, diet and exercise, and that sneaky fifth item that is also vital: support from family and friends. Riley credits his significant other in the Acknowledgements for her support.

The throughline for all these treatments, established or experimental, at our disposal or not, is that fundamentally, we still have a long way to go to not only understanding the brain and the role of the microbiome, but depression itself. Only then, once we have a more complete understanding of depression, as one doctor Riley quoted said, can we truly work toward a cure.

Riley’s thesis is that we do not need to let depression kill us, but his call-to-action underpinning that is for psychiatry and governments the world over to overcome the obstacle of getting preventive treatments for depression to the people who need them, no matter where they live. Obviously, much of the world’s poorest do not have access to such treatments. Worse still, they face a different form of barrier to treatment than those in the West do in terms of stigma: racism and misguided assumptions about the global poor. Whether it’s scientists of old, or even some on the far-left these days talk like this, there’s a racist assumption that those facing extreme poverty, brutish conditions, war, famine, and the like, are not depressed because “they don’t know any different.” As Riley noted, it goes back to the Swiss philosopher Jean-Jacques Rousseau’s ideas about civilization being a “scourge” and it being better to be outside of it, i.e., that one would be happier without the trappings of civilization. Which is to say, again, even today, people see depression as a modern disease, a product of civilization, the Industrial Revolution. Of course, depression has been around for as long as humans have been recording reflections on society; it has just gone by different names, like melancholia. Similarly, it isn’t that those in developing countries, like Zimbabwe, which also had to deal with colonization and decolonization, don’t suffer from depression. They absolutely do! They just call it something else in their culture, and it’s up to us and the doctors looking to treat depression to understand the culture around it. Riley said 90 percent of people living in low-income countries do not have access to evidence-based therapies, such as antidepressants and psychotherapy (for high-income countries, the figure is 60 percent). To that point then, perhaps the most salient, profound quote of the book comes from Shekhar Saxena, the former director of the Department of Mental Health and Substance Abuse at the World Health Organization, “[W]hen it comes to mental health, we are all developing countries.”

If psychiatry approached depression the same way Riley does, with an open mind and a holistic approach aimed at treating depression and in a globally accessible way, then I do believe we could save and heal a lot of lives. I also look forward to a day when we understand depression and its machinations (along with the brain and the microbiome) better.

Riley's book is a wonderful addition to my thinking around my own depression, both through Riley's vulnerable personal experience and his scientific and historical run through depression, as well as offering fascinating insights into treatment options and addressing the inaccessibility issue. I highly recommend A Cure for Darkness to everyone.

[Destiny · Rating 5 out of 5]

This book is a history and science book first and foremost, so if you're looking for a self-help book, then this book likely isn't for you.

A Cure For Darkness by Alex Riley is the history of depression, both the diagnosis and the treatment of it. Our understanding, and lack thereof, of this disease has changed greatly over the past 2000 years (and longer!). Alex Riley breaks all this information down while including his bits of his own journey with depression and his skepticism of antidepressants but inevitable need of them.

The scientific understand (and public understanding!) of depression has changed a lot throughout the history of mankind. Just the name itself has gone through a litany of changes, but not quite so much as the different branches of science that have argued over the cause: anatomy, genetics, gut microbiome, synapses, subconscious, consciousness, and the list goes on. Many scientists have had their fingers in the psychology pie over the years, and funnily enough, no one knows for sure what it is yet. Perhaps it's simply different strokes for different folks.

The way these scientists have treated the disease has changed to. We've gone from bloodletting to "forced rest" to cocaine to electroconvulsive therapy to talk therapy (a multitude of different kinds: psychoanalysis, interpersonal therapy, behavioral therapy, cognitive therapy, psychedelic therapy), to experimental drugs, and peer counseling. Perhaps we've gotten better at it over the years, but one thing is for certain we can do more.

Alex Riley touches on all of things, including the biggest things preventing broader steps forward in the psychology world: poor government funding and the outlaw of treatments that work(!) but are feared due to past abuse and poor regulation (hello electroconvulsive therapy and LSD treatments). These outlaws means studies and treatments are hard to come by, so what of the people who have gotten help through these practices when nothing else worked? And why do allow ad agencies to circumvent the FDA and tout something as a miracle drug when it isn't better than the next thing, and sometimes performs worse, like Prozac?

All of this summary to say that this was a great read for someone who is always interested in psychology and isn't afraid of a bit of medical jargon in their bedtime stories. Definitely recommend!

[Kelsey · Rating 4 out of 5]

The length in which it took me to finish this book should indicate that this was challenging for me to get through. However, I found it insightful and full of historical and detailed information about mental health, particularly depression, and all the treatments studied over the past years.

When I first requested this book, I thought I was getting more of a memoir approach to depression. However, it is more of a historical textbook transpiring the years studying depression. What works, what does not, how does it happen, and what medications have been fruitful. The author discusses his own experiences with different SSRIs, which I related to, and I think it was also something that helped me connect with the author more.

I liked learning about the different treatments (past, present, and future) and was excited to learn more about psychedelics to treat depression. Throughout the book, the author makes it clear, through no opinion, just facts, that depression and mental health is very complex. There is not a "quick fix" or a "one size fits all" solution. I found that it gave me validation as I struggle with anxiety and depression. It is complicated, it takes time, and I am not alone.

I also liked the discussion between inflammation and depression. I enjoyed seeing that what my doctors say about eating right and exercising is based on scientific evidence (why I didn't think so before is asinine). It was never fully explained, just that "it's good for you and will help with anxiety and depression." That was extremely helpful for me.

I will note for those looking for a self-help book; this is not it. As others have said, it definitely leans more textbook. I enjoyed it from the scientific and historical aspects. If you are interested in more factual and data-driven information on depression, then I would highly recommend this book.

Thank you to NetGalley and Scribner for this ARC in exchange for my honest review.

[Chris Demer · Rating 4 out of 5]

This is a very interesting, well-researched history of mental illness and its treatment. While it is scientifically and historically rich, there is also a personal element as the author has suffered from depression.

Riley focuses in the beginning, with the "anatomists"(who hoped to find structural abnormalities in the brains of the afflicted) through a thorough review of Freud. He discusses the callous treatment of the insane and the more helpful "cottage retreats" which stressed peaceful surroundings, good nutrition and empathic conversation.

He reviews the development of anti-depressants, their usefulness and problems, including side effects.

I found the section on the newest drugs and their combination with supportive therapies interesting.
Also fascinating: the newest ideas related to the microbiome and its contribution to health and disease. Those organisms in our gut, produce some of the most important neurotransmitters, such as serotonin, dopamine and GABA, chemicals that are known to affect brain function.

To his credit, he also reports on the state of global mental health services (not good!) and the need to provide access to therapies. Interestingly, there has been a range of strategies that are inexpensive and productive and can be used in underdeveloped countries. Case in point: Developed in Africa -the training of respected elders. These members of the community can sit and listen to those with depression, calming them and making useful suggestions. These connections have shown great promise.

This is an informative book and I highly recommend it.

[Lauren Geier · Rating 3 out of 5]

I express my gratitude both to NetGalley and the publisher for providing a free e-copy in exchange for an honest opinion.

I was eager to read “A Cure For Darkness” by Alex Riley. An estimated 322 million people worldwide are living with depression. While the most common mental health diagnosis, there is still much to be learned about this illness. Riley’s exploration is not meant to be an introduction to depression and the fields of treatment but is, instead, a deep dive into many considerations. He weaves his own experiences throughout the book but also relies heavily on scientific research and treatments. If the reader is looking for a definitintive solution to depression, this is not to be found within these pages, as it doesn’t exist. Riley approaches the subject as journalist and not a medical or psychological practitioner. However, sometimes the best content comes from outside the field.

I recommend “A Cure For Darkness” to professionals in the field looking to have a deeper understanding of the disease and treatment trends and options. For the American reader, it is noteworthy that Riley lives in Europe and some of the treatments he mentions are not readily available in the states. My only complaint with this book is that it doesn’t explore cultural expressions of depression as much as I would have liked. For that reason, I prefer “Noonday Demon” as a resource on depression but this is a clear companion option.

[Ann Vallimaa · Rating 4 out of 5]

You only get 4 out of 5 because I disagree with some of the stuff you say. And that is ok. Agree to disagree. I go with Janna's side that psychedelic mushrooms enhance your psychic ability. (From another book I read.)

The grandma parts were good and the bench and being someone's friend. And the history. The point really is that we all do recover in our own way. And we should respect each other. And if you really do it for yourselves , it feels good and you learn that these other people saying and doing stuff to you shouldn't matter. It effects you less if you care for yourselves. My favorite post on FB is "Make sure your not surrounded by assholes!"

Tranquilizers because we don't know how to deal with these behaviors. I think America has been improving on that . I won't talk about the pill part because I don't take them. Sorry. Music and reading and gaming and I have been slacking on the exercise.

I started with goals. I want to stay sober for a year. I want to get married. I want to have kids. A dog. And you just keep adding to it and enjoy your life. And it starts becoming about you taking care of yourself. And who cares what other people think then.

Good luck to you!

[Nicole · Rating 2 out of 5]

I found this hard to follow at times with so much jumping around between eras (at times that didn't really make sense). It read more like a Sparknotes version of a textbook than anything, which wasn't necessarily a bad thing, but not what I was expecting.

[Noelle · Rating 3 out of 5]

A lot of this was quite dry and slow. Some of the historic “cures” were surprising (cocaine, LSD). Best takeaway: two proven remedies with no side effects are a clean diet and regular moderate exercise.

Listened to this on my phone from the library.

[Rebecca · Rating 4 out of 5]

Engagingly written, taking care to discuss the history, epidemiology, and potential treatments in a human way. While a book on this topic could easily be impenetrably academic and dull, this book is not; it is informative and well-researched, yet accessible and easy to read. The book particularly shines in regards to discussing the history of depression and society's various interpretations of what it was caused by and how to treat it. As someone more well-versed in the psychopharmacology of depression, learning about its history over the years was new for me.

The book's strength was definitely in the history of depression. It explores (among other things) early conceptualizations of depression and mental illness and the evolution of psychiatry in Europe, taking particular care to explore the rich, interconnected academic world of European psychiatry and how different major figures (Kraepelin, Freud, Aaron Beck, etc.) learned from and influenced one another. I also particularly enjoyed the discussion of depression in other cultures, particularly in Africa; I've definitely read research to indicate depression is _less_ common in developing countries, but the author makes it clear some of this is just due to poor cultural translations--depression does exist, but you have to know how to ask about it.

I do wish he had explored the rising rates of depression in the Western World more, but can't win 'em all.

I gave this book four stars, however, because I felt the book was more comprehensive in _history_, rather than _treatment_, which is why I picked the book up. Much time was spent discussing, say, Freud's personal life, than new non-SSRI upcoming treatments. While I think overall the coverage of treatment options was good, some aspects of the field that I would consider important weren't mentioned at all, or got just a drive-by mention. For instance, the research on SSRIs is fairly discouraging, with efficacy not much better than placebo effect; while this was mentioned, this wasn't particularly emphasized, and instead SSRIs were discussed very positively (I suspect this might be because sertraline was so effective for the author). The author is clearly very enamored with ECT and spends a good deal of time discussing it, yet, surprisingly, he doesn't even mention transcranial magnetic stimulation (TMS). The biology of ketamine was not discussed at all, and genetic testing for SSRI metabolization (or lack thereof) wasn't mentioned either. All of it seemed like kind of odd omissions, given that treatment-resistant depression is discussed so much. I suppose I felt like the history section was very well-written, but the treatment section was rushed somehow?

I'd also have liked to have seen more discussion about the different types of depression. Seasonal Affective Disorder and dysthymia are not mentioned at all. Depression in the context of schizoaffective disorder and bipolar disorder isn't really explored either. While unipolar disorder is distinctly different from both of those disorders, it's also at the same time related (indeed, there is a nascent theory that unipolar depression is another form of bipolar disorder).

All in all, a well-written book, though.

[Lori · Rating 3 out of 5]

I had high hopes of insight into depression and maybe enlightenment of my struggles in the past, even a tidbit to take away to help guide or assist others with this oppressive illness. This book was more like a textbook on the history and hit and miss treatments over the years by professionals. Some extremely dangerous. Some successful. I did learn a lot but it wasn’t what I was looking for. I came to understand how far reaching this illness is and the vast volume of people who suffer from it. The professionals struggle to understand how depression differs from one person to the next and is to this day still being explored.
I made it through, (it’s not a book to breeze through) however, I’m glad I read it for a new understanding of how relatively new many treatments and medications really are. A new understanding that there is not one fix all answer, it’s a constantly evolving quest to help with differing theories and methods. I’m impressed with the research Mr. Riley needed to do to write this even during his own daily oppressive struggle with depression. The ups and downs, the search, for answers, and now the reason to keep fighting through this illness.
Thank you NetGalley, Alex Riley and Simon & Schuster publishers for allowing me to read this eARC this is my honest opinion.

[Angela · Rating 5 out of 5]

I wasn't sure what to expect when I started this book. And just coming off of a multi-year depression myself, I wasn't sure how I would respond. The author, Alex Riley, has his own struggles with depression, but that is not the focus of the book. But from the small glimpses he gives us into his own history, I found myself wanting to know more about his personal journey, and also rooting for him to overcome his struggles.

The book basically recounts the history of depression and how it has been a thorn in society for thousands of years ... from the struggles of philosophers to Cary Grant's battle with darkness. And how a cure has been elusive during this time. It gets into modern pharmaceuticals and touches on the most recent treatments.

Somehow, in reading this book, I didn't feel as broken as I have in the past. Depression has vexed humans since the beginning of time, and it's complicated. Surprisingly, I found some comfort in reading about how complex this illness is. It reinforced that this is an illness, and the struggles are real, and we are not alone in dealing with it. I appreciated how straightforward the author writes. The history of treatment isn't always pretty, but the book discusses these matter-of-factly. Reading all of this helped me realize I'm not as weak as I thought I was. Thank you Alex.

[David · Rating 5 out of 5]

A very expansive history of the identification and treatment of depression coupled with the author's memoirs of his journey dealing with this malady.

This book explores the bio, pscyho, social and environmental factors affecting depression and then looks at treatments through the ages. From lobotomies to pharma interventions to talk therapy, there is a lot to unpack.

I particularly found the coverage on Electroconvulsive Therapy (ECT) (described as electric shock therapy in the past) to be very helpful.

The author also provides a nuanced analysis of the research on the use of psychedelics for the treatment of depression.

My takeaways:
1. Talk therapy (especially CBT) is preferable to begin with as a longer-term strategy.
2. Drugs can be helpful in the short-term but not all drugs are created equal.
3. For severe cases that cannot be helped by the above two interventions, ECT is worth exploring.

[Jessica Mason · Rating 5 out of 5]

This is a phenomenal book! It is written similarly to “The Case of the Murderous Dr. Cream.” Both books have scores of references and deliver the facts. “A Cure for Darkness” particularly focused on what we know about depression, what has been done to treat it, and where we can go from here. Despite the grim reality depression imposes, this book details the efforts of individuals trying to treat it, and it gave me a little hope to know that there are so many people around the world trying to figure i outt.

This book also does a great job at arguing that depression is a natural disorder instead of a moral failing. It provides and describes studies (some from the last 10 ten years) as to why this is the case. Thus it is a perfect read for people trying to wrap their heads around depression.

[Meg Gramer · Rating 3 out of 5]

This book is well researched and written. If you’re looking for a cure for your darkness, you won’t find it in this book. This book is about the history of mental illness (specifically depression) and how it has been treated over the years. I learned quite a bit about the medications I’m currently taking (lol) and found the chapters about hysteria and the gendered misconceptions surrounding depression really really super interesting.
So why did I give it 3 stars? My answer is kind of lame—I just wasn’t feeling it. I believe in the literary beauty of narrative nonfiction, and this book had the potential to be an engaging read. Instead, I found myself counting down the pages.
Again, if you’re looking for something that extensively covers the history of depression and provides loads of reputable data, this is your book.
It just wasn’t the right book for me right now!

[Ian Partridge · Rating 3 out of 5]

I was drawn to the book by a personal interest in understanding more about depression in terms of the evolution of the condition and its treatments.

The book neatly summarised the evolution of the two schools of psychiatry and the corresponding development of new treatments for the condition. I found this very helpful in that the writers prose made the material very accessible.

What lifted the book from the style of an historical narrative charting characters, events and progress in the science of the condition, was the inclusion of the writers own experiences of the condition. It turned what might on the face of it appear a dry narrative into a highly engrossing and vivid portrayal of a very personal journey.

[Nuno · Rating 5 out of 5]

I decided to read this book because in the course of my life, I ended up suffering for a long time with the harmful effects of depression, and I wanted to learn more about the topic. And this book did not disappoint. It is not at all a self-help book, nor does it present any strategies on how to deal with depression. But it clarifies how this illness has been understood and treated over time and, the part that perhaps surprised me the most, how there are still so many unknown facets and so much to discover. In the middle of the book, I seriously wondered if in 100 years we will not be looking at current treatments for depression and not have the same opinion that we currently have about prefrontal lobotomies that the book explains so well. For those, like me, who are avidly curious about mental health, this book is a must-read, especially because it is exquisitely written.

[Nilla Sivakumar · Rating 4 out of 5]

Exhaustively researched and fascinating stuff. The weaving of the personal narrative with the historical one is a little clunky, but that's to be expected; it's not like Riley himself went through the earliest forms of treatment that he discusses, so his connections to those were tenuous at best. He does a good job objectively presenting ideas and treatments as they were perceived in their time, without projecting his own opinions much.

A little Baader-Meinhof: immediately after reading the chapter that begins discussing MAOIs, I watched an episode of House, MD in which MAOIs were thrown out as a treatment option and briefly felt like a genius among men.

[Delia Turner · Rating 4 out of 5]

A history of the many ways we have tried to treat depression in the last century and a half, including talk therapy, lobotomy, medication, ECT, and hallucinogens. One the way, the author talks about the various ways he has tried to approach treating his own depression. Thoroughly researched, with short chapters dealing with many of the people, factions, and systems that have emerged to battle with a common and persistent human condition, the book is sometimes slow going but is thoroughly enlightening. I finished thinking that it seems as if we are still feeling our way in the dark when it comes to understanding mental illness.

[Cjkemp · Rating 2 out of 5]

Just sort of boring in places.

Worthwhile, but I'm frustrated at the lack of specificity. Just throw absolutely everything in. It's harder to write with brevity but, holy cow, some of this material needed brevity. I don't understand why people don't write tight,
well-edited 80k-word-long books anymore. Ideas/theories that could have been covered in two good sentences got, literally, 20 pages sometimes. Which is fine, but it means they seem as important as other concepts that deserved 20 pages.