Rivers are central to debate about the Anthropocene because many human activities from antiquity focused on channels and floodplains. A literature compilation for the onset of human modification of rivers identifies six stages that represent key innovations focused in the Near East and adjoining areas: (1) minimal effects before about 15,000 cal yr BP, with the use of fire and gathering of plants and aquatic resources; (2) minor effects from increased cultivation after about 15,000 cal yr BP, with plant and animal domestication after about 10,700 cal yr BP; (3) agricultural era after about 9800 cal yr BP, with legacy sediments, widespread fire use, the first dams and irrigation, and mud-brick manufacture; (4) irrigation era from about 6500 cal yr BP, with large-scale irrigation, major cities, the first large dam, urban water supplies, expanded groundwater use, river fleets, and alluvial mining; (5) engineering era with embankments, dams, and watermills after about 3000 cal yr BP, especially in the Chinese and Roman empires; and (6) technological era after about 1800 CE. Anthropogenic river effects were more varied and intense than commonly has been recognised, and they should be considered routinely in interpreting Late Pleistocene and Holocene fluvial archives.