Talk:Major depressive disorder/Archive 6

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To-do List

I just updated the list (anything else we should add?), and I imagine that once that's all done (shouldn't take very long), this article will be a very strong WP:FAC candidate, if it isn't one already. Cosmic Latte (talk) 08:26, 22 August 2008 (UTC)

  • Ah, yes. Anyone have a suicide stat for a population of non-depressed folks that's comparable to the 3.4% for depressed people? What population is that 3.4% referring to, anyway? Cosmic Latte (talk) 19:40, 22 August 2008 (UTC)
Gah..need to go back an' read it now...Cheers, Casliber (talk · contribs) 22:17, 22 August 2008 (UTC)
The Treatment section here should be summarized, and new editing about treatments should be made in Treatment of depression. --Ronz (talk) 15:50, 23 August 2008 (UTC)
As per the comment about lead cites, I've covered the associated points in the prognosis section. As I understand it the intro should just summarize what's alredy covered in each section of the article. Probably should get a mention of melancholia into it, and I'd say the endogenous issue should be mentioned more historically since it has been "officially" deprecated for some time. EverSince (talk) 11:25, 26 August 2008 (UTC)
Agreed - edogenous removed...now to fit melancholia in somehow...Cheers, Casliber (talk · contribs) 13:23, 26 August 2008 (UTC)

Psychotherapy for under 18th - style issues

I believe that the fact that psychotherapy is recommended as the first line treatment for the under 18th should be placed into the psychotherapy section, not into the introduction to the treatment section. This is purely stylistic point. Paul Gene (talk) 21:28, 7 September 2008 (UTC)
  • I disagree that this is simply a matter of style. This introduction is important to the reader in directing them through the long section on different treatments which follows. Since psychotherapy is preferred for this age group, it is good to say this at this point. The detail regarding parental pathology seems less important and might reasonably be buried below. I shall make a new version accordingly. Colonel Warden (talk) 21:50, 7 September 2008 (UTC)
The recommendation "Furthermore, pathology in the parents may need to be looked for and addressed in parallel." is not notable enough. I would recommend skipping it. It is not clear why it is singled out from three treatment considerations recommended by NICE. The other two are arguably more important.

"Treatment considerations in all settings ● Psychological therapies used in the treatment of children and young people should be provided by therapists who are also trained child and adolescent mental healthcare professionals. ● Comorbid diagnoses and developmental, social and educational problems should be assessed and managed, either in sequence or in parallel, with the treatment for depression. Where appropriate this should be done through consultation and alliance with a wider network of education and social care. ● Attention should be paid to the possible need for parents’ own psychiatric problems (particularly depression) to be treated in parallel, if the child or young person’s mental health is to improve. If such a need is identified, then a plan for obtaining such treatment should be made, bearing in mind the availability of adult mental health provision and other services." Paul Gene (talk) 21:28, 7 September 2008 (UTC)

Yes and no. I am frustrated by how often familial environment and possible abuse are glossed over or not sufficiently ruled out, and child abuse is a predictor of future psychopathology. Assessing and treating kids is quite different - they can be quite unusual historians indeed. Cheers, Casliber (talk · contribs) 21:42, 7 September 2008 (UTC)

I have tothink about it some more.Cheers, Casliber (talk · contribs) 21:43, 7 September 2008 (UTC)

That more "assessment" than "therapy" and I am not sure it belongs to that chapter. Besides, it does not say "abuse by parents, it says "particularly depression". Or are you talking about the second point "social and educational problems should be assessed

and managed", I presume abuse goes under social problems? Paul Gene (talk) 21:58, 7 September 2008 (UTC)

Aargh. Its cmplicated. Listen, I am typing on the run here, its monday am and I am getting ready to run out into the daily grind. I will read over it again and see how it flows. I just need a bit of time to really figure it out (will get onto it in a few hours) leave it how you want and I will look at the diffs etc. Cheers, Casliber (talk · contribs) 22:06, 7 September 2008 (UTC)

Do not worry. It is an extremely minor point, and CW removed that anyways. Paul Gene (talk) 10:50, 8 September 2008 (UTC)

Diagnosis

I've added a citation to support the physical investigations but took out the references to syphilis, HIV. If you have a citation that supports these investigations in routine practice, please put it in. Same goes for the sentence about CT and EEG. I disagree with :"If no such cause is found, a psychiatric assessment may be done by the physician, or by referral to a psychiatrist or psychologist". I think a psychiatric assessment will still be done even if there are lab abnormalities. And I'm adding a subheading "Physical investigations" because at a glance it looks like the heading "Diagnosis" refers only to this paragraph.Anonymaus (talk) 20:25, 19 August 2008 (UTC)

Can I add that if "commonly ordered" is staying, can it give an idea of how commonly and if the source is specific to some countries or services? It's not common at all in many cases. Also when it says that assessment "will" include "complete" such and such - realistically, in many general services at least, would it be fair to say that it's often more cursory than that implies? EverSince (talk) 11:39, 26 August 2008 (UTC)
The citation (a UK study) that comes after "a physician generally performs a medical examination and selected investigations" (and a list of tests) says "A recent survey has suggested that the majority of patients with severe mental illness are not offered routine physical examinations and appropriate investigations in primary care (Spotlight, 2005)" and concludes from its own findings that "psychiatrists are not ensuring that appropriate routine physical examinations and haematological investigations are being performed for newly referred patients" ("80% of the inpatients had routine haematological investigations performed compared with 6% of the outpatients. 62% of the inpatients had a full physical examination compared with 0% of the outpatient group.")
The citation for "Two commonly ordered investigations are EEG to exclude epilepsy, and a CT scan of the head to exclude brain lesions" is a book Kaplan & Sadock's Synopsis of Psychiatry, can anyone clarify what it says about "commonly" in this context? EverSince (talk) 23:47, 16 September 2008 (UTC)
I need to eat something. Agree that patients often miss out on routine ruling out of organic diagnoses. I will double check this afternoon (I have K&S). While we're on books, eversince do you have any page numbers to add? Who else added book refs? Cheers, Casliber (talk · contribs) 01:27, 17 September 2008 (UTC)
You're right to call me on that; 'commonly' is vague and indefinable, so I ditched it. I have looked around for criteria/algorithms on routine investigations and it is not as dogmatic/routine as I thought (although somewhat vague). I have reworded it to be more specific to depression (i.e EEG with dementia (vs pseudodementia) shows up slow waves. Our own criteria (Australian Clinical Practice Guidelines) are also somewhat coy on the subject! The article above is a good one for the (at times) poor follow-through with outpatients WRT examinations etc. I am thinking of how to incorporate it. On second thoughts, it is a fairly general observation, and it is ususally the GP who does this before or after review by psych services separately. Worhtwhile in an article on community psychiatry though. Cheers, Casliber (talk · contribs) 12:14, 17 September 2008 (UTC)
Yeah the article above isn't really specific to depression either (nearest it comes is the number with "affective disorder" - 40% inpatient and 78% outpatient). The issue I wanted to raise really was that it doesn't seem to support the claim that "physicians generally" perform these tests; it shows that psychiatrists often don't, and suggests that community physicians may not either (and that no one really checks). Maybe for now it could just be reworded to "physicians may" perform those tests? By the way the more I read that article the more damning an indictment of services (in the UK at least) it appears, e.g. "Of particular interest was the high number of patients commenced on atypical antipsychotics (24%). Following recent publicity regarding the link between atypical antipsychotics and diabetes and guidelines for monitoring patients on these drugs, it is surprising that less than half of these patients had a baseline glucose test performed." EverSince (talk) 16:58, 18 September 2008 (UTC)

What?

The article says "Around 3.4% of people with major depression commit suicide, and there is also a higher rate of dying from other causes". It is not clear what that means.Kaiwhakahaere (talk) 21:22, 7 September 2008 (UTC)

I've given that line a copy-edit. Hopefully it's a bit clearer now. Cosmic Latte (talk) 13:31, 8 September 2008 (UTC)
Well, the new sentence says "Around 3.4% of people with major depression commit suicide, and depressed people also have a higher rate of dying from other causes than do the non-depressed." Question. Excluding suicides, how exactly do people with major depression achieve a higher rate of dying from other causes than non depressed. Don't we all have exactly the same rate of 100 percent? Kaiwhakahaere (talk) 22:32, 8 September 2008 (UTC)
It means that people with depression are more likely to get conditions like heart disease and they are more likely to die from them. i.e. they have a shortened life expectancy from illnesses even with suicide removed. Cheers, Casliber (talk · contribs) 01:01, 9 September 2008 (UTC)
OK, I changed it to reflect that. However, there's still a niggle. It says 60 per cent of the suicides have a mood disorder. Don't 100 percent of the people with major depression who commit suicide have a mood disorder? Kaiwhakahaere (talk) 01:22, 9 September 2008 (UTC)
No, many people commit suicide don't have a mood disorder (i.e. 60% of all suicides have mood disorder). Cheers, Casliber (talk · contribs) 01:26, 9 September 2008 (UTC)
Exactly--some folks who commit suicide are already going to die soon, and other folks have their own, peculiar reasons. Still, others do it for social-psychological reasons. Cosmic Latte (talk) 03:38, 9 September 2008 (UTC)

Review by delldot talk

Very clear article, a pleasure to read. Very close, so these are very minor details. Some comments, requested on my talk by Casliber:

  • (not addressed) I noticed verify Epidemiology section in the to do list. Has this been done?

Lead

  • pervasive low mood, and loss of interest or pleasure in usual activities - is the comma necessary? Seems like fewer commas in this sentence might be better.  Done
  • two separate conditions, namely a biological and a reactive depression, - is the namely necessary? Maybe it could be removed, or turned to two separate conditions, one biological and one reactive...  Done
  • (not yet dealt with, but also not a big deal) Major depression can be a serious and often disabling condition that can significantly affect a person's work, family and school life, sleeping and eating habits, and general health. - this sentence seems out of place in this paragraph, and it seems like it should come before the sentence about needing to be hospitalized for self-neglect. Maybe it should go in the first paragraph, to kind of establish the seriousness?
  • However, some maintain that it is overdiagnosed... - WP:WEASEL, and this is vague. If there's a significant controversy within the medical or psychological professions, this could be stated. (I put the name in of a leading Australian professor and expert/historian on mood disorders to validate it, but I do worry about wordiness. what do you think?)
I agree that this might be too wordy or detailed for the lead, and it still doesn't give me an idea of how big this group is. Is it a few radicals, or a significant group of respected psychologists? Too bad there's not a name for this camp, or you could say something like "those who advocate the blah hypothesis". I'll let you know if I think of a way to convey it. delldot talk 21:03, 27 August 2008 (UTC)
(I'd hazard a guess at maybe a third of the psychiatric community, some civil libertarians, scientologists, maybe some antispychiatry (?), essentially quite a disparate group, but that would not be based on any scientific material, only anecdotal)
Parker is obviously notable, so I don't think the mere inclusion of his name amounts to wordiness, but I think that, thanks to wikilinks, the introduction can be tightened. We could simply say, "However, psychiatrist Gordon Parker and others argue..."--and if folks want to know Parker's nationality or anything else about him, then they can simply click on the link. How does that sound? Cosmic Latte (talk) 11:41, 29 August 2008 (UTC)
Good idea
I think it could be a bit OTT singling out one person in the lead, and I'm not sure he can really be representative of the range of perspectives from within and without psychiatry. Isn't it ok to just summarize the diagnostic/boundary difficulties and other points as outlined in the sociocultural section? EverSince (talk) 19:42, 4 September 2008 (UTC)
Yeah, I'm with you EverSince. I agree that it's a problem to bring up one guy in the lead unless he's uber notable or acknowledged as the head of that camp. And it doesn't help give an idea of how big this camp is anyway. Maybe something general like "may be overdiagnosed" in the lead, and a more detailed description in the appropriate section. Really the only reason I brought this up was the awkward, vague use of some. delldot talk 21:27, 4 September 2008 (UTC)
Then how about, "However, it may be overdiagnosed, and current diagnostic standards arguably have the effect of medicalising sadness or misery"? Cosmic Latte (talk) 13:07, 5 September 2008 (UTC)
I've gone ahead and changed it to this. Feel free to modify if there are still concerns. Cosmic Latte (talk) 15:47, 6 September 2008 (UTC)
  • This article's hook is unsourced or too long or there are other content issues (not dealt with) Up to 60% of those who commit suicide have a mood disorder, such as depression, and their risk may be especially high if they feel a marked sense of hopelessness or have both depression and borderline personality disorder - this may be too much detail for the lead. Maybe remove it and integrate the rest of the para elsewhere, e.g. after the other mention of suicide or the discussion of course.
  • (not addressed) 60% of those who commit suicide have a mood disorder, such as depression could you get rid of this comma? (i.e. 60% of those who commit suicide have a mood disorder such as depression) but see above.

S/S

  • A person suffering a major depressive episode almost always reports a pervasive low mood, and loss of interest or pleasure in favorite activities. - maybe mention that it manifests as irritability in children. tricky as kids material is mentioned two paras down. If I put it here it is mentioned twice.
(not addressed) How about Almost all adults suffering a major depressive episode report a pervasive low mood...? Of course, that leaves out adolescents. I was just concerned about whether that was an inaccuracy to say "almost everyone" when it doesn't apply for children. delldot talk 22:31, 30 August 2008 (UTC)
  • Hypersomnia, or oversleeping, is less common. - This makes it sound like it's uncommon--how common is it? (not common at all in this condition really, though one does see it quite a bit in bipolar depressed phase, and in adjustment disorder etc.)
Lower down it says it is characteristic of the atypical subtype, which is the most common one. Maybe a statistic would be good to clarify how common it is.
  • Others may report the person appears agitated or slowed down. Maybe observers may report? The others in this context makes me think I'm about to read about other depressed people.

I tried "Family or friends"...(as this who it usually is), as observers makes me think of some neighbourhood voyeurs or something.

  • (not addressed) The risk is increased in the first year after childbirth (post-natal depression), and after cardiovascular and neurological illnesses such as stroke,[4] Parkinson's disease,[4] and multiple sclerosis.[4] - does the one ref endorse this whole sentence? Then why not one citation at the end of the sentence? If not, you need to cite another source too. Also, is this s/s info, or epidemiology?

Now placed in epidemiology, and ref is for all examples in sentence and hence placed at the end

  • The children para should mention when it switches from child to adult symptoms (e.g. from irritability to misery)--usually adolescence, right? Sort of. Truth is, you see alot of overlap really. I have not seen a reference for age of overlap, though assume it is around 18.

Comorbidity

  • Eubulides once mentioned to me that Comorbidity belongs as a subsection of Epidemiology.
  • Who is Ellen Frank? If she's someone important, maybe "Psychologist Ellen Frank ..." if not, probably just say "one study" or just mention the finding. I just think a person should have a bit of an introduction on the first mention of their name. (agree. She is a professor of psychiatry.)
  • Is it one-third or one third? (the latter)

General

  • Someone once suggested going through an article and looking for all unnecessary uses of may and can to tighten up the wording. [edit: e.g. I think one-third of individuals diagnosed with attention-deficit hyperactivity disorder (ADHD) may develop comorbid depression would be better as one third develop.]  Done

Just curious: why aren't you going to GAN before FAC? I'm gonna stop here for now, I'll have more later. Give me a poke if you're ready for more comments and I dont' notice. delldot talk 20:13, 26 August 2008 (UTC)

More

General

  • No need for accessdates for journal and pubmed sites. am removing as I go. thx  Done I believe delldot talk 15:45, 4 September 2008 (UTC)
  • Use en dashes (–) rather than hyphens (-) for number ranges per WP:DASH. thought I got most of 'em. thx again

Refs

  • May want to make refs consistent for author's name (e.g. Last First, Last F., Last F). [I've taken the liberty] Similarly, some page numbers have p. in front and some don't, some have "volume" spelled out and some don't, some use abbreviations for journal titles and some don't, etc. Decide on a consistent citation style.
  • Some refs are missing publisher, date or page numbers. Some need to be fleshed out, e.g. "FDA > CDRH > CFR Title 21 Database Search", bare urls.
    • This article's hook is unsourced or too long or there are other content issues Examples of books missing page numbers:
      • Overcoming Depression: A Self-Help Guide Using Cognitive Behavioral Techniques (2nd rev. ed.),
      • Escape from Freedom,
      • Comprehensive Guide to Interpersonal Psychotherapy. New York,
      • Abnormal psychology: An integrative approach
      • Depression: causes and treatment
    • Example of refs needing more info:
      • Biologic, Syndromic, Social, and Personal Damage - Psychiatric Times,
      • Skirmish or Siege? Is depression primarily a recurring disease? Can you ever really be cured? I can mark these in the article with hidden comments if you think it'd help.
  • Use PMID to link to pubmed abstracts; reserve hyperlinking the ref's title for when the full text is available. Done I think delldot ∇. 17:04, 15 September 2008 (UTC)
  • Chapter and article titles only use caps for proper nouns and the first letter and letters after periods and colons.  Done I think delldot ∇. 17:04, 15 September 2008 (UTC)
  • The book An Introduction to the History of Psychology is cited twice under references--maybe it should be moved to the cited texts section.  Done

Dx

  • Maybe define hypogonadism in the sentence. this is trick as it would require repeating discussion of testosterone. I prefer the use of bluelinks alone at times if explanation is gong to be a real can of worms, which I fear it would be here
  • No biological tests are used to confirm major depression as such. - citation would be nice.  Done
  • Investigations are not generally repeated for a subsequent episode unless there is a specific medical indication. These may include measuring serum sodium to rule out hyponatremia (low sodium) if the person presents with polyuria and has been taking a selective serotonin reuptake inhibitor (SSRI). - lost me there. So hyponatremia has depressive symptoms? Perhaps a note about what SSRIs have to do with polyuria and sodium? hyponatraemia can present with dyphoria and fatigue, as well as delirium and seizures when more severe. It is often asymptomatic as well. I will think about now much more info to place in.

Clinical assessment

Sociocultural aspects

  • ref name="Mill" should have the real publisher and date of the book.
  • Is the Black Dog Institute important enough to mention in this basic article? It is pretty preeminent here, but I see your point. Have to think on this one

DSM and ICD

Subtypes

  • Lots of bulleted lists in this article. I'm not sure a table would be better here, but one advantage would be you could divide symptoms into physical, emotional, and behavioral or something.
  • Maybe define leaden paralysis. ?? - gosh, that shouldn't be there...done Cheers, Casliber (talk · contribs) 14:55, 8 September 2008 (UTC)

Dif dx

  • Pedantic moment: this is not technically the correct way to use a colon: Some potential diagnoses that may be considered before diagnosing MDD include: You'd need a "the following" or something.
  • People with clinical depression can develop RBD, and vice versa, and both illnesses have similar risks - similar risk factors, or they present similar risks to the patient? Is gpnotebook a reliable source?
  • Awkward sentence: the name given for a psychological response from identifiable stress that causes significant emotional or behavioral symptoms that does not meet criteria for more specific disorders tried to flesh it out a bit and clarify and make it relevant to depressed mood/depression. Cheers, Casliber (talk · contribs) 14:34, 10 September 2008 (UTC)

More to follow. delldot talk 21:03, 27 August 2008 (UTC)

Next installment

General

  • Not to keep focusing on the very minor stuff, but another way to make the refs consistent would be to decide on a page number format: 672-679 vs. 672-9. they are all supposed to be 2 digits acc. to MOS, but there are so many....:(
No worries, I can do some of these (it's exactly the kind of repetitive task I enjoy :P) delldot talk 07:01, 29 August 2008 (UTC)  Done I think delldot ∇. 23:33, 7 September 2008 (UTC)
  • Abnormal psychology: An integrative approach (5th ed.) is also cited several times with different page numbers under references--maybe it should be moved to the cited texts section.  Done
  • (still a number of these, also not a big deal) Only three (or six) authors needed for citing a journal article--you can use et al. thereafter.

Psychological

  • (not addressed) Events such as the death of a parent, issues with biological development, school related problems, - what are 'issues with biological development'? Also, I think school related should be school-related.
  • More names to introduce: S. B. Patten, Martin Seligman, Julian Rotter, Albert Bandura, Aaron T. Beck. May be difficult if they're all psychologists and you don't want to keep saying 'psychologist'. I guess the wikilinked ones are less important, but I'd still think it'd be better with short introductions.  Done-ish. Cosmic Latte (talk) 10:57, 30 August 2008 (UTC)

Existential, humanistic, and evolutionary psychology perspectives

  • Not clear why evolutionary is discussed in the same section as existential, humanistic; the former seems very different.
  • That happened in [1], [2], and [3], although I never followed up on it and don't quite understand the rationale for setting any of these schools apart from the rest. Cosmic Latte (talk) 08:15, 29 August 2008 (UTC)
  • I've gone ahead and removed the heading here, and I'd hope for a response to my edit summary in the event that anyone re-adds it. Cosmic Latte (talk) 08:23, 29 August 2008 (UTC)
  • The reader doesn't get an impression of how widely accepted each camp is. e.g. psychoanalysis is presented right there with cognitive behaviorism, but doesn't it have less acceptance nowadays?
  • Good point, and one that is discussed at quite some length in the talk archives. In short, the "psychotherapy" section makes clear that psychoanalysis proper has largely been superseded in psychiatric circles by the more eclectic "psychodynamic psychotherapy"; however, psychoanalysis as theory has had an impact on just about everything, especially in the humanities vs., say, the sciences. If this distinction can be made clear without causing WP:SS or WP:NPOV problems for the article, then I'd be all for it. Cosmic Latte (talk) 07:19, 29 August 2008 (UTC)

Biological

  • some components of depression are adaptations. - can you provide an example? The change of subject in the next para comes as a surprise.
Bit tricky 'cos is also covered in other subsection, 'cos of the top-level split into bio vs psych. What about losing that vaguely outdated dualistic split and having more mid-level headings as in schizophrenia article? EverSince (talk) 19:57, 4 September 2008 (UTC) p.s. I'd suggest that some of the causes listed under "psychological" should really be under a separate "social" causes heading... EverSince (talk) 19:10, 5 September 2008 (UTC)
  • Although the precise relationship between sleep and depression is mysterious, it appears to be particularly strong among those whose depressive episodes are not precipitated by unusual stress. - what is it? I suggest integrating the first part of the sentence into the para's first sentence and elaborating on it. Such cases is similarly not defined.  Done

Psychotherapy

  • Is it cognitive-behavioral therapy or Cognitive behavioral therapy? Make consistent for hyphen and capitalization. no hyphen, need to check on caps for it Cheers, Casliber (talk · contribs) 22:16, 29 August 2008 (UTC)
  • Like the thing about introducing unfamiliar people, maybe a short description of fluoxetine would be good, e.g. "the antidepressant fluoxetine". Done
  • (not addressed) Can the short para about CBT trials in adolescents be integrated into the previous one?

More to follow if you're still interested. delldot talk 19:46, 28 August 2008 (UTC)

  • Bring it on, this is all invaluable and mightily necessary if it is to get through FAC.

Another section

Psychotherapy

  • Here again I would think it would be useful to give an idea of how widely practiced and accepted each technique is. As I understood it, it's been found that the psychoanalysis doesn't work, am I wrong?
  • It all depends on how you define "work." Psychoanalysis isn't going to make MDD disappear overnight, but that was never its goal. It works insofar as it provides a very influential type of insight to folks who are more or less receptive to it. There's already a cited meta-analysis regarding psychodynamic psychotherapy, so I'm not sure how much more we can elaborate until size or WP:SS become concerns. But if it can be reasonably done, then...sure, why not? Cosmic Latte (talk) 14:06, 2 September 2008 (UTC)
  • That's fine, so long as the article's representing the consensus in the scientific and psychological communities, I'm happy. :-) delldot talk 02:02, 3 September 2008 (UTC)
  • Several clinical trials have shown that CBT is as effective as antidepressant medications, even among more severely depressed people. -- citation needed.  Done
  • Ref 86 "Psychiatry and Behavioral Neurosciences - Outpatient Psychotherapy Groups" -- Is this a reliable source? How about a review paper, or at least something indexed in PubMed? I don't see where this sentence is endorsed in this ref anyway.  Done

Medication

  • I think it'd be good to have a sentence of introduction or transition here, maybe the sentence about combining psychotherapy and medication; the first sentence kind of launches into the topic.
  • Their adverse side effect profile and toxicity in overdose limit their use. - Could the wording be simplified? What's a side effect profile? Could this sentence be moved to before the previous one? e.g. Tricyclic antidepressants have [many? severe?] side effects, are toxic in overdose, and are not tolerated as well as SSRIs; thus they are usually reserved for the treatment of inpatients. You'd need to make sure the refs used endorse the integrated sentence, or find another ref for a mid-sentence ref. Poorly tolerated and lotsa side effects are synonymous here, so fused. The other bit, that they are highly lethal in overdose (a somewhat common problem in depressed people) is important but I am finding it hard to squeeze in. I know Paul Gene wasn't too fussed about me putting it in and we have to summarise somewhere so I may just leave it out. I can reinsert (and ref) it if the consensus is it is important enough. I think the side effects are the more salient issue of why TCAs aren't used so much.Cheers, Casliber (talk · contribs) 14:23, 2 September 2008 (UTC)
  • Are monoamine oxidase inhibitors a type of tricyclic antidepressant? If so, maybe make it explicit so it's clear why we're now discussing them. If not, maybe they don't belong in this para, or maybe the para needs a new lead sentence.
  • Nope, MAO inhibitors and tricyclics are two separate classes of drugs. Feel free, of course, to edit accordingly. Cosmic Latte (talk) 14:12, 2 September 2008 (UTC)
  • hopefully the introductory few words clears that up.
  • In a meta-analysis of 35 clinical trials of four newer antidepressants - which ones? What type are they? If they're tricyclic, maybe this sentence should be integrated into the previous para.
  • Nope, they were fluoxetine, paroxetine (i.e. 2 SSRIs), venlafaxine (SNRI)

and nefazodone, (medication not used anymore anyway as it had adverse effects on the liver).

  • As much as I hate to say it, that does indeed look like a potential WP:SPS. Cosmic Latte (talk) 13:43, 3 September 2008 (UTC)
  • So the question is, has Merkel been published in sufficient WP:RS's (I'm guessing he has)? If so, then we can probably let it slide. Cosmic Latte (talk) 13:46, 3 September 2008 (UTC)
  • I'd say there's a difference, though, between passing WP:V and representing the best work of Wikipedia, don't you? I mean, when you're aiming for FA, even if it's admissible, if it's not the best source you might want to replace it with a solid review article. If you're having trouble finding a good source to back up the info, maybe it's too specific for this general a subject; tons and tons of stuff has been published on depression. delldot talk 17:37, 3 September 2008 (UTC)
  • Well, I agree that it's not ideal. Hmmm... Merkel is cited alongside the Kent and Daly sources, so I wonder if the latter sources can patch up what would be missing if the former were removed. I haven't read either Kent or Daly, though, so I don't exactly know. In any case, it doesn't look like a whole lot of content would disappear were Merkel to be omitted. But I think it's helpful to state why the demons were alleged to enter the body, and that's what the Merkel source really contributes. I guess we have a balancing act between ideal sources (omit Merkel) and ideal substance (keep Merkel, or find another source that says something comparable). Either way, I think the section will be all right. Cosmic Latte (talk) 12:44, 4 September 2008 (UTC)

Other conventional methods of treatment

  • Are the bullets really needed here, or could these be regular paragraphs? Either way, a sentence to introduce the section might be helpful here.
  • Paul's edit here might be helpful in generating an intro sentence. I'd prefer regular paragraphs over bullets, generally speaking, but are the blurbs long enough to look good in paragraph form? Cosmic Latte (talk) 13:38, 3 September 2008 (UTC)
  • Yeah, I see what you're saying. For me the length wouldn't be as much of a problem as the flow--it hops from one topic to the next, and the bullets give it a kind of cohesiveness (i.e. "these are all parts of a list"). I don't know if it would transition well without the bullets, especially in the alternative treatments section (and the two should probably be the same format for consistency). So I guess leave it as bullets for now unless we can think of another approach. delldot talk 18:36, 3 September 2008 (UTC)

Alternative treatment methods

  • (not addressed) Chromium picolinate was found to be equivalent to placebo for atypical depression overall but possibly efficacious in the sub-group of patients with severe carbohydrate craving. - More info needed here. What were the other subgroups? - Clarified Paul Gene (talk) 01:52, 20 September 2008 (UTC)

Prognosis

  • (not addressed) The reason for recurrence in these cases is poorly understood and could be a "true pharmacologic failure or a worsening of the disease, a relapse that overrides medication." - citation and attribution needed. - The citation is at the end of the paragraph. I formatted it properly. Paul Gene (talk) 02:08, 20 September 2008 (UTC)

Epidemiology

  • (not addressed) Awkward sentence: Lifetime prevalence estimates in community epidemiological surveys carried out by the World Health Organization in ten countries varied widely, from 3% in Japan to 16.9% in the US, with the majority between 8% to 12%. - Re-worded. Paul Gene (talk) 01:52, 20 September 2008 (UTC)

More to come, sorry to be so picky. delldot talk 04:21, 2 September 2008 (UTC)

  • The epidemiology section's a little sparse, I bet it could be fleshed out. I noticed there was some epidemiology in the signs and symptoms section, I think it should be moved down here (the second para and the suicide map). More info on ages (incidence, prevalence) would be good. If you can point me to a source with info about incidence in different age ranges, I'll make a graph like this one. I think something like that would add a lot to the article, especially with the fact that the incidence peaks at different age ranges.
    Had a go at moving down what seemed like epidemiology (some other about risk factors, also seems like it belongs to some other section). Wasn't sure how to get the map tidy (by the way the graph is great but it doesn't appear to be specific to major depression, is that a problem?). Re. age of onset - Epidemiology of Major Depressive Disorder is saying (2005) that it "provides the most comprehensive information on the epidemiology of MDD among US adults to date" and gives a nice odds ratio graphs (can we use that if we cite it?) and some tabulated data (incl. on other sociodemographic variables too). I'm not sure whether epidemiological studies in europe or elsewhere have necessarily found the same shift to older age groups...
    Great job with the reorganization. I don't think it's a problem with the map not being specific to major depression, but one could be made with the more specific info if it's available. Just curious, what is un-tidy about the map?
    Good find with that article. We can't directly lift their graph but we can make one of our own using their info (which we can make prettier anyway). I was thinking of making a bar graph from the info in Table 1, what do you think? (I'm busy in real life all this week so it'll be a bit before I can). Too bad it's just the US though, it'd be better to find a source with worldwide relevance. delldot on a public computer ∇. 13:01, 20 September 2008 (UTC)
    There's also the international 2003 The epidemiology of major depressive episodes which has a paragraph and graph on age of onset. The problem is that the tabulated data is not the data used for the graphs, is tricky in terms of whether giving prevalence rates (as in table 1 in the 05 article) vs incidence & hazard rates for first onset as per the graphs. Incidentally the stats already in this wiki article on age of onset cite 1997 The Baltimore Epidemiologic Catchment Area follow-up which is too old to access online via the journal website, but links to their 2008 Population-Based Study of First Onset and Chronicity in Major Depressive Disorder (cited in prognosis already), which gives some (slightly different seeming) tabulated age of onset data. I'm lost anyway, good luck to you :) EverSince (talk) 22:58, 20 September 2008 (UTC) (p.s. re. the map, only meant my formatting of the text around it).

History

  • Passages of the Hebrew Bible/Old Testament - I believe MOS discourages slashes, and there's got to be a more graceful way of putting this.
  • Changed to parentheses around "Old Testament." Cosmic Latte (talk) 12:49, 4 September 2008 (UTC)
  • This article's hook is unsourced or too long or there are other content issues (Source still missing. Wikipedia is not the source. There's no source in the deleted image on en WP.) Image:Emil Kraepelin.png is missing a source. Also, this is so minor it's silly, but he is looking off the page. Might want to left align it or flip the image for artistic effect.
  • Fixed position. :-) Cosmic Latte (talk) 16:03, 6 September 2008 (UTC)
  • I'm not having much luck figuring out the source, although there's an image here with a date of ca. 1900, so definitely public domain, at least in the U.S. Cosmic Latte (talk) 13:37, 18 September 2008 (UTC)

Sociocultural aspects

  • The quote is good, but the text should explain who it's by and give a little info before launching into it.  Done

Other

  • Haven't I heard somewhere that you're not supposed to use both {{citation}} and {{cite journal}} (etc.) templates? Ideally we could get them all to {{cite journal}}, they have the most info and it's easy to make them uniform. I've been working on this with the help of Diberri's wonderful tool.
The only issue is that I need the ones at the bottom to be in {{citation}} fro Harvard refs to work with them. So is it ok do you think for those ones to be in that format? Cheers, Casliber (talk · contribs) 06:58, 3 September 2008 (UTC)
To be honest I'm not actually sure what the objection is to mixing {{citaiton}} and {{cite journal}}. I think it's just a cosmetic thing -- the citation styles are different. So no big deal. But if you do want to have consistency in the format, couldn't you use WP:REFGROUP?Ignore me, I'm an idiot delldot talk 17:37, 3 September 2008 (UTC)

Images

  • (citation needed in article and on image page) Image:SuicideRates.PNG needs a citation or citations for the statistics. Done
  • Sorry to continue to be a pain about this, I'm not seeing this info in the source: there's per 100,000 info for each age group and there's pure numbers info for overall population, but I don't see a total population statistic per 100,000? Am I missing the info? Or are you doing something with math and populations here? I've left a note for the uploader. delldot ∇. 13:16, 18 September 2008 (UTC)
  • Done by uploader. delldot ∇. 01:03, 26 September 2008 (UTC)
  • If this image remains an issue, we could probably substitute an image of an existentialist philosopher, keep a general caption about the existential psychology view, and add something like, "Shown here is X [probably Nietzsche or Kierkegaard], whose philosophy influenced Rollo May and other existentialist thinkers."  Done
  • This article's hook is unsourced or too long or there are other content issues (not addressed) Image:Albert Ellis 2003 emocionalmente sentado.jpg is improperly tagged as the uploader being the copyright holder, may need OTRS confirmation.
  • (not addressed) Image:Wm james.jpg missing a source, tagged with generic {{PD}} instead of more specific {{PD-old}} (at least I assume that's why it's PD).  Done
    Maybe I'm missing the obvious here, but I think there is still no source on the image page. The image page needs to say where the image is from (e.g. a book). delldot ∇. 13:16, 18 September 2008 (UTC)

Refs

  • Not sure these are reliable sources:
    • [4] - definitely not

I have removed this, this fact splashed around the internet all dates from a 1998 Neiremberg Study which I can't find. Certainly not consensus anyway and I seldom use the term anyway for a number of reasons, and certainly don't recall hearing it was the most common.

    • [5] - ok, but not the best source available
Removed. This bit could be reworded and bits added or subtracted
replaced with better ref
changed for PR journals etc. Not sure whether this diagnosis should stay in anyway
NAMI web page authored by Aaron Temkin Beck, so yes I think we can say it is Reliable

More to come. delldot talk 02:02, 3 September 2008 (UTC)

  • Dead links in refs
formatted ref so glitch doesn't occur
glitch in ref formatted

Well, I'm done reading through the text but I'm available for further discussion and I may have more comments later. delldot talk 02:55, 3 September 2008 (UTC)

Hey delldot, many thanks for the thorough review. Now as there are at least two of us going through it, do you want to strike points which have been done, or you feel have been explained adequately as why not done etc. Or are you happy for us to do it (as there is so much it is making my head spin and I am trying to get a handle on it :) ) Cheers, Casliber (talk · contribs) 06:57, 3 September 2008 (UTC)
Heh, yeah, it's a lot... I'm not really excited about striking them all. How about we assume it's been dealt with if someone has left a comment or a tick, unless someone else (e.g. me) follows up with another objection? delldot talk 17:37, 3 September 2008 (UTC)
Of course, you should feel free to strike or cap anything you want if it helps you stay organized, I'll say if I don't think something's been dealt with. delldot talk 18:36, 3 September 2008 (UTC)
Another broken link: [12]
removed. we have the pmid so unnecessary anyway

What do we all want to do now?

OK folks, any more issues before FAC? AFAICT we have either dealt with or explained why we haven't WRT delldot's very thorough review. I am still musing on the mention of Minor depressive disorder and Recurrent brief depression in the article, both of which are not in the main section of DSM IVTR but hived off in some research section at the back. One could argue as we are trying to talk a bout a clinical condition, these two aren't worht discussing as they are not clinical diagnoses as such. I have begun revamping mood disorder as it is more of a classification type article. My feeling is on removing them, but not strongly, and I am happy to leave them in if others want to do so. Anything else? Cheers, Casliber (talk · contribs) 06:23, 13 September 2008 (UTC)

(sound of crickets chirping...) hmmm..awfully quiet 'round here....Cheers, Casliber (talk · contribs) 13:58, 15 September 2008 (UTC)
There are still a number of concerns I don't think have been addressed. I'll go through and mark them: the ones I still have questions about are marked and the ones I still think are definitely problems are marked This article's hook is unsourced or too long or there are other content issues. I can point stuff out further or in a different way if you think it would be helpful, just let me know.
The most important things that need to get dealt with before FAC are the improperly licensed and sourceless images (which really should be dealt with ASAP even for a B-class article) and the epidemiology info in the signs and symptoms section. delldot ∇. 17:04, 15 September 2008 (UTC)
I'm done tagging the ones I thought hadn't been addressed. Not all of them are important, and if you don't want to deal with them you can just say so and/or remove the tag yourself (of course, if the ones I think are important aren't dealt with I'm going to bring them up at the FAC, but there are not many of those). delldot ∇. 17:28, 15 September 2008 (UTC)
thanks for reminding me, large chunks of the article I didn't have much to do with as it has been a true collaboration. (I hate articles this size....) Cheers, Casliber (talk · contribs) 20:05, 15 September 2008 (UTC)
Fixed the issues in the parts I wrote. Paul Gene (talk) 02:10, 20 September 2008 (UTC)
Great, those pesky page numbers etc. Just alot of little things. You don't mind if we try to summarise the alternative and complementary treatments bits in paras? Cheers, Casliber (talk · contribs) 03:49, 20 September 2008 (UTC)
Last time when somebody tried, it looked awful. But if you can make paragraphs that look better and read easier than the bullet points, by all means do it. Guidelines kinda say that you may have lists if it helps the reader, so there is no imperative to remove them. Paul Gene (talk) 04:50, 20 September 2008 (UTC)
It was just a suggestion, do whatever you think is best for the article. delldot on a public computer ∇. 12:51, 20 September 2008 (UTC)
I know that this will become an issue at FAC. So if it possible, it would be nice to get rid of the bullet points. But is it possible without sacrificing readability? Paul Gene (talk) 13:24, 20 September 2008 (UTC)
I think I could probably do this, but I would like to do a bit of modification in the process, including combining the "other conventional" and "alternative" sections into one (the difference between, say, St. John's Wort and 5HTP is not obvious, and I don't see why exercise is unconventional), and dropping a couple of things with really minimal support, such as zinc. Looie496 (talk) 16:48, 20 September 2008 (UTC)

(undent) No, mixing up Other and Alternative would have been wrong. Other methods have support of regulatory authorities, and generally much larger volume of supporting evidence. Thus SJW has been officially approved as prescription antidepressant in Germany and Ireland, and has 35 good quality trials on which the positive meta-analysis was based. 5HTP has no support of authorities and only two trials to prove its efficacy. I am of two minds about zinc and chromium. They have very little supporting evidence. You could remove zinc and chromium, but we write for the readers. So, if one of them reads some wild claims and then checks the depression article, it would be good for him to find references that Cr is ineffective. Level of evidence for exercise is poor, but if you could find an official guideline which recommends it as a specific treatment for depression, then why not move it to conventional. Go ahead, make the changes that you think could make the article better. I promise to consider them on merits, without pre-conceived notions. Paul Gene (talk) 02:51, 21 September 2008 (UTC)

I've taken a shot at the "other conventional methods" section. (Ended up adding a bit of material that calls for a couple more refs, which I haven't yet looked up.) If you think the approach is reasonable, I'll do the "alternative" section as well. Looie496 (talk) 04:13, 21 September 2008 (UTC)
Thank you for doing it. It looks very good. I made some minor changes and removed any references to the mechanisms of action. They are not undisputed, and should not concern us here, since we give only a brief summary of the method. Paul Gene (talk) 00:31, 22 September 2008 (UTC)
Now also taken a shot at the "alternative" section, with somewhat more extensive revisions. I'm afraid I couldn't resist talking about reasons and mechanisms again, largely because it seems likely to make things more interesting to readers. I dropped the part about nerve stimulating devices on the grounds that it is too fringey to belong (I had never heard of it), but if it really is widely used, it probably deserves to come back. Looie496 (talk) 04:51, 23 September 2008 (UTC)
Well done - it is a tricky subject area. Might have to change the first sentence "sanctioned" is odd here; I do know hwat you mean, though it sin't a word I'd think of using WRT health, but anyway. My energy levels with this article on the long haul to FAC were low, but this has buoyed me :) Cheers, Casliber (talk · contribs) 05:08, 23 September 2008 (UTC)

Subtypes

I think the section on "Subtypes" needs to be redone -- it is confusing and even partly wrong. DSM-IV distinguishes three main subtypes: melancholic, atypical, and undifferentiated. SAD is not a subtype of major depressive disorder, and biologically may have more in common with bipolar disorder; it should be listed as a differential diagnosis, and bipolar disorder too. Course specifiers really should be handled separately from subtypes. I'm willing to do some work on this, but thought it would be good to bring up here before plunging in. Looie496 (talk) 16:05, 23 September 2008 (UTC)

Definitely, go for it. EverSince (talk) 16:38, 23 September 2008 (UTC)
Yeah, you are right. I have been a bit sloppy there and should have picked the glitches up myself. I did spruce up Mood disorder which was in pretty poor shape, so we had somewhere a bit more polished to place other disorders....actually that could be a Good Article with not a huge amount more work. Cheers, Casliber (talk · contribs) 01:12, 24 September 2008 (UTC)
Erm, there is no undifferentiated as such (unlike schizophrenia), and catatonic is a specifier as well, actually they are all called specifiers in DSM IV TR (luckily, all the segment on mood disorders can be seen on google books as DSM-IV-TR is there and the mood disorders bit is searchable. Cheers, Casliber (talk · contribs) 01:47, 24 September 2008 (UTC)

This reminds me that I haven't yet added to diagnosis the brief points and sources I raised back in archive 4 - the notable views and research findings that depression is better conceptualized as a continuum, both in terms of it merging into "normal" mood variation and merging into the rest of the mood disorder category. This will include mentioning (briefly - I agree with the paragraphs on them having been taken out of the types section) brief recurrent & minor depression as part of the spectrum. I'll get round to this in due course. EverSince (talk) 23:05, 25 September 2008 (UTC) (just remembered I added some very briefly & separately to history...but as they are current notable issues and views on diagnosis, should be covered there). EverSince (talk) 23:13, 25 September 2008 (UTC)

The Dreaded Pruning Time...

Righto (I hate this part), this article now stands at 58 kB (8951 words) "readable prose size" using Dr PDAs tool. We goofed in that the tool did not pick up bulleted text and hence the article looked smaller than it really was :(

Anyway, we need to prune a bit. Luckily, we have some subarticles, so that content is not lost as such but relegated to a daughter article.

These are:

Also, I am loth to make the orthodox treatments section smaller than alternative section from undue weight concerns.

I am thinking, rather than removing text straightaway, maybe we should be careful and examine what may be the best to remove - list the bits below and argue underneath. Cheers, Casliber (talk · contribs) 12:21, 24 September 2008 (UTC)

I'm not really familiar with the FA process -- what's the target length? Looie496 (talk) 15:53, 24 September 2008 (UTC)
50 kb of prose is the ceiling. The way to tell is to get Dr PDAs tool and add it to one's monobook. After this, a 'pages size' tab will appear on hte left of the screen in hte column which starts with 'toolbox' Cheers, Casliber (talk · contribs) 20:20, 24 September 2008 (UTC)
This might be a good time to go along with Ronz's suggestion to trim the treatment section. However, because psychotherapy + medication is the "standard" response to MDD, I'd try to leave those sections as-is, but it might be good to trim ECT and beyond. Cosmic Latte (talk) 09:05, 25 September 2008 (UTC)
That's what I was thinking. Will have a think about which to trim. Cheers, Casliber (talk · contribs) 10:12, 25 September 2008 (UTC)

OK, if I think about what is used commonly and what is rare, the following are rare and could be relegated to the Treatment for depression article IMHO:

S-Adenosyl methionine (never heard of it being used, so pretty rare), Vagus nerve stimulation (pretty experimental and very rarely seen in practice), And everything from (DHEA) downwards in the Alternative treatment methods section as they are all rare. I am undecided about Omega-3 fatty acid, and light therapy which is much more for SAD anyway.

The history section I am torn about, as it looks heaps better and is nice and coherent and relevant, but if the above doesn't bring it down to under 50 kb, then I would lose para 2 of Medieval to Renaissance eras. Very tricky. I will try to coyedit a bit...Cheers, Casliber (talk · contribs) 14:10, 25 September 2008 (UTC)

Agree about the rare/experimental treatments, although wouldn't be averse to them all being mentioned as such within one sentence. The history, I think the first two sentences of para 2 (the book & acedia being notable & relevant) and last sentence of the para before it. Also agree that ECT can be trimmed, while keeping the balance.
I think in the causes section, the overarching psychological theories could be edited down slightly, e.g. Freud's writings on "libidinal cathexis of the ego" etc (could go in history). And some types of cause (abuse, trauma, poverty etc) moved into a "social" subsection, with the section intro reworded to indicate the prevailing "biopsychosocial" model rather than just bio-psych. EverSince (talk) 23:22, 25 September 2008 (UTC)
Well spotted on the ECT, agree about one sentence maybe. I had another idea in that instead of the standard
Main article: Treatment of depression
link, maybe a slightly more elaborative one saying "For a fuller discussion of standard and more experimental or less common treatments see...." or somesuch. Cheers, Casliber (talk · contribs) 23:59, 25 September 2008 (UTC)
I think that would help give it some more representation. And actually looking at it again I think there should probably be a summary paragraph rather than just one sentence. EverSince (talk) 00:45, 26 September 2008 (UTC)
I try and think (when pruning), which bits are more important/interesting to more people. Thus ranking a piece of history vs a rare treatment etc. Cheers, Casliber (talk · contribs) 03:33, 27 September 2008 (UTC)

(undent) I will prune my part (treatments). As for the general issue of the article size, I can only wish that Depression article was the same size as Schizophrenia. Unfortunately, the disorder has a much longer history than schizophrenia, is wider spread and attracts more attention. Given all this, I would hope that the folks at FAC would be receptive to the [WP:IAR] argument - ignore all rules if it makes the article better. Of course the less relevant and marginal stuff should be cut. But lets not cut something essential only to meet the set limit. Paul Gene (talk) 22:08, 27 September 2008 (UTC)

Good point. I will ask a few others soon :) Cheers, Casliber (talk · contribs) 23:07, 27 September 2008 (UTC)

Causes, Biological

Hmm, hmm. On one hand, the section as written leaves out a lot of interesting things we know about what happens to the brain in depression. On the other hand, it devotes a good bit of space to at least a couple of things that few people take seriously any more, such as the monoamine hypothesis. I have a temptation to rework this, but it would be pretty intrusive, so I took at shot at sketching my understanding of what we know as a separate article, biology of depression. I'd be interested in reactions, particularly relating to whether any of the material there would be appropriate here (once properly referenced, of course). Looie496 (talk) 04:24, 26 September 2008 (UTC)

Others added more info than me in this section. There is alot of conjecture in this area. I will have a look at both. By all means expand and reference the daugher article as we can link it to the section. Once it is bigger, we can figure out what to keep in and what to prune. Cheers, Casliber (talk · contribs) 04:52, 26 September 2008 (UTC)

Well I'm quite amazed how that article's escaped having all kinds of sourcing and formatting tags slapped on it within about a quarter of a second...maybe 'cos it's neuro stuff & not something like, say, human rights :)

I'm gonna add a chunk of stuff here on social causes; might have to move that & all the causation/patho off into its own article too & only summarize here, like there is a Causes of the Great Depression article ;) EverSince (talk) 08:30, 26 September 2008 (UTC)

I am not sure that biological causes is the section that needs most trimming. The history section is by far the longest one. Do we need to go back to pre-history to outline the modern concept of MDD, which began with DSM III? At the most we need to go back only to Kraepelin who began the modern era of psychiatry. The antique concepts of humors, melancholia, etc should be moved to History of psychiatry, Melancholia or putative history of depression articles. Paul Gene (talk) 11:34, 26 September 2008 (UTC)
Biological causes of depression have been discussed in thousands of publications so the place they take in the article is well-deserved. For the record, my POV is that the relative contribution of biological and psychological causes to the development of MDD is 50:50. I believe that neither of existing biological theories explains the disorder well; moreover, all of them are inadequate and mostly wrong. That is why I think that I can be objective when comparing them.
The monoamine theory is still by far the predominant biological explanation among drug developers and psychiatrists (Cas, correct me if I am wrong). That is why it takes the most place. Its criticisms and the most recent formulation (Nutt, 2006) is reflected in the article. The new and rising one is the neurogenesis hypothesis. The HPA axis hypothesis is used sometimes; although IMHO, HPA dysfunction is a consequence not the reason of MDD. Circadian rhythm hypothesis is not commonly accepted or widely discussed and should be trimmed.
Please feel free to tag the parts you think are not impartial and explain your tagging here. I will address all of your concerns. Paul Gene (talk) 11:58, 26 September 2008 (UTC)
I don't think the bio section was being singled out for editing down. And when I mentioned tagging I was referring to the creation of the offshoot article (& speaking from unrelated personal experiences of creating articles). The only issue I see is that when there's a proper full-length social causes subsection, and Looie496 has sourced and merged in what seems to be very good additional bio stuff, the whole causes section will be very large. EverSince (talk) 12:46, 26 September 2008 (UTC)
(groan) I have edited out some more reduplication and material which is really esoteric, but I really need to sleep now. I suspect some more rejigging may reduce repetition elsewhere but I am too tired to look at it properly. adios. Cheers, Casliber (talk · contribs) 13:40, 26 September 2008 (UTC)
The potential for largeness is the main reason I avoided trying to put this stuff into the top-level article; also the fact that it might have too much neuroscience for the audience this article aims at. What I really miss mostly in the current article is a fuller description of the importance of circadian rhythm disruptions in depression, which is a theme that has developed tremendously in recent years. I agree with Paul that the history section is the obvious place to make cuts, even though it is quite well-written. I don't necessarily agree about the monoamine hypothesis: historically, once an idea has made it into the textbooks, the knowledge that most investigators have abandoned it takes many years to work its way into general awareness. I'm not saying that it shouldn't be discussed, just that it might not need as much space as it currently gets. Looie496 (talk) 16:16, 26 September 2008 (UTC)
My problem with trimming the history section is that it's difficult to draw the phenomenological line between melancholia and depression--as though the experience of MDD really arose with DSM III, much as the experience of turning on a light bulb originated with Thomas Edison. My problem with trimming the monoamine hypothesis is that it's just too darned famous. The average reader will probably be familiar with the old cliche, "chemical imbalance in the brain," and deserves an adequate treatment of that idea, however antiquated. I'd still opt for trimming the treatment section. Indeed, when "alternative treatment methods" is longer than "psychotherapy," we might have some WP:WEIGHT concerns. Cosmic Latte (talk) 19:55, 26 September 2008 (UTC)
Agree with CL about alternative treatments, agree about monoamine hypothesis. Casliber, please give us the view from the trenches as to the relative significance of biological theories - Re: monoamine vs. neurogenesis vs. MAO A vs. HPA axis vs. circadian rhythms. Paul Gene (talk) 09:48, 27 September 2008 (UTC)

I was musing on this today - have been busy off keyboard. I will ask the more neuropsychiatrically-minded of my colleagues. When this bit started being developed, it reminded me of just how unclear biological basis of depression is compared with schizophrenia, and even some interesting stuff by Allan Schore and others with borderline personality disorder or more specifically early trauma really. I have been a bit lazy WRT this area IRL, but my impression is that some nebulous feeling it is to do with the monoamine pathway is what most psychiatrists still feel, especially when they see the antidepressants working. The anatomical material about the anterior cingulate cortex I had heard little, and the HPA I had thought was outdated, though many theories come and go and come into vogue again. An interesting take on the circadian rhythm was (I recall) a study which showed some good response by people with insomnia to either forced wakefulness or being awaken just after falling asleep. Must check this out. Looie's biology of depression page strikes me as very anatomical, but a good start nonetheless. Not sure whether there has been an anatomical swing I haven't noticed. I have had a bit of a cold/light head and sore throat so haven't edited much. Will ask my colleagues on our email group. Cheers, Casliber (talk · contribs) 13:17, 27 September 2008 (UTC)

PS: I did think of one thing - that is the theory of a vascular depression arising in old age - need to go hunting for material though. Cheers, Casliber (talk · contribs) 13:21, 27 September 2008 (UTC)

PPS: Have fired off an email to colleagues' discussion group. We'll see what happens, I'd guess by tommorow arvo our time I'll have some more info. Cheers, Casliber (talk · contribs) 13:23, 27 September 2008 (UTC)

I'm not sure it is fair to say that schizophrenia is any better understood than depression, but let's not go there. One should not confuse the "monoamine hypothesis" with the claim that "depression involves alterations in monoamine transmission", which is surely correct. The monoamine hypothesis basically says that "depression is an alteration in monoamine transmission", and that is surely wrong. The fact that refutes it is that antidepressants normalize monoamine levels almost immediately, but don't usually alleviate depression until many days later.
The HPA hypothesis, in the sense of HPA abnormalities being the root cause of depression, has as you say been discredited. However, HPA abnormalities are very commonly seen and undoubtedly contribute to the symptoms.
Concerning circadian rhythms, their role in bipolar disorder and SAD has been established, I would say, pretty solidly, but their significance as a causal factor in unipolar depression is not as well established. You might take a look at [13] and perhaps [14] Looie496 (talk) 17:56, 27 September 2008 (UTC)
Agree on most points there; should have clarified that schizophrenia not better understood as such, but that there is more cohesive discussion on the theories (i.e. what people suspect is involved is somewhat more cohesive). Nice fulltext article to read too and a bit on Alaskan/Siberian incidence or depression to red and slot into epidemiology...and look at wording of  :) Cheers, Casliber (talk · contribs) 21:12, 27 September 2008 (UTC)
You would be surprised but look at the psychiatric establishment view of the mechanisms of depression in the NEJM 2008 review PMID 18172175. It is mostly monoamine and monoamine-related theories. The second one is HPA hypothesis. The neurogenesis hypothesis is tucked at the end of HPA chapter, with the explanation that excess of cortisol causes hippocampal shrinkage and stops neurogenesis (I am not kidding!). All other hypotheses are relegated to a Table. In that light we certainly need more support for the circadian rhythms theory. Unfortunately, even the 2005 edition of Barlow is quite outdated. Are there better reviews in journals? Paul Gene (talk) 00:28, 28 September 2008 (UTC)

edits

  • Cas, ECT is perfect now.
  • I don't see why historical origin should affect the engvar issue now: it should be in the overall variety. Tony (talk) 13:25, 3 October 2008 (UTC)
Thanks - main issue now is how aggressively to reduce down to 50 kb ceiling of prose for FAC, and if so, what else to lose. There is some copyediting and some page numbers to get but otherwise...Cheers, Casliber (talk · contribs) 13:31, 3 October 2008 (UTC)
Is it a deal-breaker to get it down? I've seen FACs pass with as much info as this. I'd worry about that later. More important to address these micro-issues (well, not so micro). Tony (talk) 13:51, 3 October 2008 (UTC)
  • Yes, older people are more likely to have those symptoms - should it be changed to "are more likely to..."? Cheers, Casliber (talk · contribs) 13:36, 3 October 2008 (UTC)
Yes, I think it's clear enough; too wordy to spell out "than .... RETHINK: no, I think it does need to be spelt out. See what you think of my attempt now. PS I meant to say that I'm delighted you're branching into this area; great use of your expertise. Because I'm in the know, it's easy to see the slight hospital bias, but I don't think it matters. Tony (talk) 13:51, 3 October 2008 (UTC)
(ec) To clarify, the term investigation refers to blood tests, ecgs, CT scans, ultrasounds etc. and is not used for a physical examination, hence the use of both terms. Cheers, Casliber (talk · contribs) 14:02, 3 October 2008 (UTC)
  • I'm slightly concerned that it's very centred on the western world. I wonder whether you might cover yourselves by adding to the lead the cultural/historical/non-western context. I was particularly concerned in reading "Clinical assessment", where it seems to assume that the neat divisions between generalists, psychiatrists and psychologists are universal. Here, "in the developed world" might cover you (if indeed that is accurate (Japan?)), after the acknowledgement of the importance of cultural construction to the disorder and its professional treatment. I know this is hard, but it's necessary, don't you think? Tony (talk) 14:01, 3 October 2008 (UTC)
  • I am pretty sure the profiles of the three clinicians are similar worldwide, though would imagine more general medial doctors in less developed areas (true in Oz as well). Agree regarding getting a sense of place/context in the worldwide milieu. Will have to think on how best to do it. Cheers, Casliber (talk · contribs) 14:05, 3 October 2008 (UTC)

Cas, some MoS notes: I see incorrect use of WP:ITALICS in lots of places, and left-aligned images under third-level section headings (review WP:ACCESS and WP:MOS#Images). Something wrong here: This tendency is characteristic of a "depressive attributional style," or "pessimistic explanatory style,".[70] Incorrect use of logical punctuation, see WP:PUNC, sample: ... things leads to "neurotic anxiety,"[82] "self-alienation,"[83] ... Citation placement, why not put it after the "or", ... additional benefit[108][109] or, ... Lots of WP:DASH problems in the citations; you can ask User:Brighterorange to run his script. Don't forget WP:ALLCAPS: WOULD HONEST ABE HAVE WRITTEN THE GETTYSBURG ADDRESS ON PROZAC?". Retrieved on October 3, 2008. I assume this formatting and quality of sourcing won't be staying: <http://webspace.ship.edu/cgboer/maslow.html> I also saw some punctuation issues and WP:OVERLINKing, so you might want to review for that. I'm unsure why you don't create a History of article (Colin and I have been intending to work on History of Tourette syndrome for a year.) That was just a scan; I didn't actually read anything, and don't want to engage much deeper so I won't have to recuse at FAC. SandyGeorgia (Talk) 07:26, 5 October 2008 (UTC)

Good pickups, have reduced overlinking now and fixed the caps and image issues, Will look at other style stuff. Cheers, Casliber (talk · contribs) 20:44, 5 October 2008 (UTC)

Working on incorporating a worldwide view

I have read the above articles which are fascinating - question is, how to incorporate in a succinct manner; clearly a few sentences on the paucity of resources will fit very well in the treatment top section, but how much should go above it under diagnosis? I was musing on removing the subheadings of Physical investigations and Clinical assessment, as what to add there would be relevant for both, or just a statement on this being a usual pracitce in developed countries (is enough?). Cheers, Casliber (talk · contribs) 21:27, 4 October 2008 (UTC)

Rumination

I came across an interesting bit of news about the relationship between depression (explicitly, both unipolar and bipolar--finally!) and creativity (i.e., an inclination to ruminate seems to be the common variable). I've already incorporated this into "Sociocultural aspects," but feel free to work with it further if it interests you. Cosmic Latte (talk) 08:39, 8 October 2008 (UTC)

Aaargh! just when we're trying to shorten the article, but seriously, it is interesting. One could argue that if it is general/inclusive, then it being placed on mood disorder may be more appropriate. I guess I am a little skeptical as many people with personality disorder somehow end up with the label of a mood disorder, from what I have seen, and just from looking at bookstores and popular literature, trauma and adverse events do prompt alot of soul-searching and what could be construed as rumination, but I digress. The connection of bipolar and depressive illnesses in highly creative people could be due to a large number of reasons (the whole chicken-or-egg conundrum comes to mind here). Anyway, the article is a bit of a hotchpotch, but seems to foucs more on bipolar more than depression, even though the latter is mentioned - would you mind if we moved it to mood disorder? That article is rather slim and there is ample room there for discussion. Cheers, Casliber (talk · contribs) 12:47, 8 October 2008 (UTC)
Sure, it'd be fine to move it over to mood disorder--but to what section? Without a comparable section on sociocultural aspects, it might be a bit of a challenge to fit it in. Maybe a new section needs to be made on that article? Cosmic Latte (talk) 13:34, 8 October 2008 (UTC)
Absolutely, and this can be the first bit in it. Cheers, Casliber (talk · contribs) 13:40, 8 October 2008 (UTC)
Done! :-) Also moved the bit about female poets to mood disorder. After all, this finding--the Sylvia Plath effect--was named after a bipolar poet, so it's probably more appropriate there. Cosmic Latte (talk) 14:25, 8 October 2008 (UTC)
Was Sylvia Plath bipolar? I thought she was purely depressive. (Her poetry is purely depressing, for sure.) Looie496 (talk) 15:47, 8 October 2008 (UTC)
This is a tricky one, as is apparent on Plath's own talk page, but Barlow and Durand (2005, p. 223) cite a study in which they remark in a footnote, "Plath, although not treated for mania, was probably bipolar II"--so I figure mood disorder is probably a safe spot to allude to her. Cosmic Latte (talk) 16:46, 8 October 2008 (UTC)
I'd be careful, the label bipolar II is getting splashed around an awful lot these days. Issues such as personalty disorder and PTSD are often mistaken. Cheers, Casliber (talk · contribs) 21:08, 8 October 2008 (UTC)

Psychotherapy section

Since CBT is by far the most frequently used approach, perhaps the others could be dealt with in the sub-article. More iportantly, I have issues with the paragraph that starts, "For the treatment of adolescent depression..." It relies on primary sources, which is not good, and a search on Google Scholar shows that later secondary sources are available that don't draw the same conclusions, for example this. Looie496 (talk) 16:26, 25 September 2008 (UTC)

Well spotted. I didn't add that bit. I have FOnagy and Roth's book, and that is an interesting link too. I agree we need to address that. I stuck back in the one-liner linking to treatment-resistant depression as it is a common problem and a challenging one. Disagree about CBT being the most universal by far - not sure how it goes in the US with Managed Care but here in Oz many therapists end up being pragmatic and adopting measures from IPT, CBT and psychodynamic lore, not to mention what is now called Supposrtive Therapy in difficult periods. Furthermore, CBT is generally more often used with anxiety (and there is a more clear preponderance for its use than in depression). WRT cutting down, patients get alot more psychotherapy than they do vagal nerve stimulation, which is I guess the point we're trying to get to in the previous section above. There is a push in practice to relegate use of antidepressants to second choice behind psychotherapy, which is why I had that mentioned about "treatment of choice", and it has been a controversial issue here in Oz too, not sure about the US - agree your version is more succinct and am reading it a couple of times to see if the message is conserved (I think its ok :)) Cheers, Casliber (talk · contribs) 21:09, 25 September 2008 (UTC)

Update

Fonagy and Roth was a bit vague but there is alot of review material that suggests effectiveness, so I replaced. Cheers, Casliber (talk · contribs) 12:44, 12 October 2008 (UTC)

Plea for page numbers of books used

can anyone who reffed a book who hasn't done so already please add page numbers if possible? There are a few left which I can list if we like. we are nearly ready to nominate methinks. Any last issues jot here too. Cheers, Casliber (talk · contribs) 22:59, 12 October 2008 (UTC)

  • As far as article size, we are only just over the ceiling of 50k prose size [ 54 kB (8299 words)]. I thought of actually throwing this up at FAC and letting that be the forum for consensus on further pruning. What do we think, as I am stumped as to what to prune next. Cheers, Casliber (talk · contribs) 14:50, 13 October 2008 (UTC)
I'm doing one more round of copy-editing, and so far the article looks very good. The boldest thing I've felt a need to do was to remove the sentence about Gordon Parker from the item about the melancholic subtype, because it jumped out at me as glaringly out of place there. Could belong in a discussion of the validity of the DSM-IV criteria somewhere, but it doesn't belong where it was. Looie496 (talk) 16:45, 13 October 2008 (UTC)
Follow-up: I've swapped the first two paragraphs under "Medication". This might not be the ideal solution, but if you want to swap it back, the first paragraph needs something to introduce it. Looie496 (talk) 17:02, 13 October 2008 (UTC)
Okay, done with that. I do have one suggestion that I'm not quite bold enough to implement: that the "Sociocultural aspects" section be retitled "The experience of depression" and moved up near the top, below "Signs and Symptoms" and above "Diagnosis". This is material of broad interest, and really should be shown to the reader before the technical stuff. In any case, this article looks ready for FA to me. Looie496 (talk) 17:33, 13 October 2008 (UTC)
Hmm. I know what you're getting at, but I think calling it "The experience of depression" strikes me as somewhat vague and overencompassing. "Sociocultural" defines it as different from "clinical" in some ways and places it in a "bigger picture" scenario after discussion of the syndrome in a clinical (or some would say reductionistic) way. I am musing on it and will have a further look. Cheers, Casliber (talk · contribs) 20:35, 13 October 2008 (UTC)
I have a personal policy in editing that if it's in a book, it's really old (even if published this year). We can always find the proper source for anything in a book. The DSM-IV criteria probably needs a page number, but even then, it's not necessary. This is all IMHO, and if you choose to flog me, I'll cry. OrangeMarlin Talk• Contributions 21:17, 13 October 2008 (UTC)
Erm, yeah, but I think I can sort the wheat from the, er, chaff. Cheers, Casliber (talk · contribs) 22:33, 13 October 2008 (UTC)

Other methods of treatment

I think this section gives too much weight to either placebo effects, discredited methods, or other stuff. I think it should be digested into one paragraph, similar to what is done in either the treatment or prevention sections of Alzheimer's disease. Sadly, people come here for there medical information. I don't want anyone to get the impression that there's any chance of treating Major depressive disorder with acupuncture or some other off-the-wall treatment. For example, St. John's wort has no effect on MJD, and worse yet, the dosage required to actually have any effect is so large, that we should consider the safety vs. efficacy of the herb. So, should we cut this section down to one paragraph or so per WP:WEIGHT?? OrangeMarlin Talk• Contributions 21:21, 13 October 2008 (UTC)

Agree. Given it duplicates Treatment for depression, there's no reason to go into much detail in this article. --Ronz (talk) 21:41, 13 October 2008 (UTC)
Yeah, good point. we did a bit but should do some more. Cheers, Casliber (talk · contribs) 22:35, 13 October 2008 (UTC)
Let me take a pass. I need to work on a real article for awhile. OrangeMarlin Talk• Contributions 22:46, 13 October 2008 (UTC)
Go for it (sigh of relief) - bit busy off keyboard..Cheers, Casliber (talk · contribs) 23:05, 13 October 2008 (UTC)
I'm always suspicious of the CAM sections of any medical article. Most of us ignore it, so it just is filled with stuff. I reviewed each of the citations, and few, if any, supported the statement in the article. In fact, there is no evidence that Omega-3 or tryptophan have any effect on any type of depression. Light therapy has an effect on seasonal disorder, but not on depression, specifically because they couldn't do any trials long enough to determine if it could work. St John's wort may work for major depression, but the pharmaceutical quality of the herb in your local store is so variable, that it probably shouldn't be used. I deleted the stuff that obviously doesn't work. OrangeMarlin Talk• Contributions 23:32, 13 October 2008 (UTC)
(Back again for a sec)..where I am the connection is so damn slow, just what I need when trying to look at a )^*$&)#(#%( large article....Cheers, Casliber (talk · contribs) 23:51, 13 October 2008 (UTC)
What do you have down there for internet connection, a tin can and string? OrangeMarlin Talk• Contributions 00:00, 14 October 2008 (UTC)
Nice bit of pruning there; article now at 51 kb readable prose...any other problems?Cheers, Casliber (talk · contribs) 09:24, 14 October 2008 (UTC)

←I wasn't happy about the changes to the section. They were weasel-worded and often outside of what was written in the citations. I reverted. I'm doing some copy editing--I'm finding some redundant prose, that need some work. I think it will help out. OrangeMarlin Talk• Contributions 17:15, 14 October 2008 (UTC)

I certainly don't want an edit war, but I'm a bit puzzled at OrangeMarlin's changes. He is insisting on, "Other supplements such as omega-3 fatty acids,[161] tryptophan, and 5-hydroxytryptophan (5-HTP),[162] no effect beyond placebo." And yet reference [162] states in the abstract, "Available evidence does suggest these substances are better than placebo at alleviating depression", referring to Trypt and 5-HTP. And again, he is insisting on, "Exercise has shown to have moderate, but not statistically significant, effects in reducing the symptoms of depression.[168]" Reference [168] states in the abstract, "Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant." In short, the sources are drawing the conclusion that there probably are effects but that more studies are needed, whereas the current wording is drawing the conclusion that there probably are not effects. Looie496 (talk) 17:22, 14 October 2008 (UTC)
Dude, I have no patience for this type of discussion. Abstracts are useless. The conclusion states clearly that they have no effect beyond placebo. OrangeMarlin Talk• Contributions 17:35, 14 October 2008 (UTC)
What you're saying in effect is, the way that the authors summarized their findings is useless, I can summarize them better myself. Anyway, I'm going to leave it there until Casliber can express an opinion on this. Looie496 (talk) 17:51, 14 October 2008 (UTC)
The writer's conclusions are what I used. OrangeMarlin Talk• Contributions 17:53, 14 October 2008 (UTC)
Just to further waste my valuable time, here's what the authors say about Omega 3 in their conclusions: "The evidence available provides little support for the use of n-3 PUFAs to improve depressed mood." I believe that summarizes it perfectly. Using non-weasel wording, with clear writing, as I have done, Omega 3 is useless for MDD. OrangeMarlin Talk• Contributions 17:56, 14 October 2008 (UTC)
OM has a point - we always forget abot effects like placebo effect and regression to the mean etc. so caution is advised. I will have a look myself a bit later but need to hop off again - brekfast/coffee/dog walk beckon...Cheers, Casliber (talk · contribs) 20:26, 14 October 2008 (UTC)
Looie, stuff like The presence of funnel plot asymmetry suggested that publication bias was the likely source of heterogeneity. doesn't look good (i.e. the studies which showed no benefit weren't published)....still looking. Cheers, Casliber (talk · contribs) 13:43, 15 October 2008 (UTC)

I think have shown no effect beyond placebo is best solution as it states exactly that. The omega 3 does say they are of little use and then leaves the door open a little (tantalizingly or annoyingly I guess, depending on how you look at it) WRT more data required yada yada yada. FWIW - the whole shebang can be read from a link here. Cheers, Casliber (talk · contribs) 14:07, 15 October 2008 (UTC)

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