Talk:Major depressive disorder/Archive 8

Change and needed formatting

I took the intiative to replace a bit of text that was a original research concern to me.[1] I used an on-topic source and followed the indications regarding the subtopic in that reference. I also moved the text to the opening of the paragraph to contextualize the statements that follow. If this is a problem, please feel free to revert and let me know why it is problematic.

Also, the references need to placed into a single standardized format. I recommend using {{harvnb}} for the footnotes and the various "cite" templates (such as {{cite book}}) for the "cited texts" list. The texts list should also be alphabetized or placed in chronological order. If I can find the time and energy over the next day, I will begin updating the references in such a fashion myself, barring any significant objections. Vassyana (talk) 17:50, 6 November 2008 (UTC)

I wouldn't recommend that, Vassyana. Harvnbs seem to be standard to some other topic areas (like literature), while the cite journal format used in this article is actually very typical of other medical articles, and if the format is changed, it becomes hard to move citations between articles (something I learned while working on Samuel Johnson, where the format used by the literary types forced me to rewrite all citations used in other medical articles in order to transport them). I found a couple of sources that weren't in alphabetical order, but other than that, I'm not seeing a problem here. The "Cited texts" section already used standardized Cite book templates, and cite xxx is used throughout, with shortened footnotes linking to the texts—it's a very standard format for medical articles. SandyGeorgia (Talk) 18:03, 6 November 2008 (UTC)

Would it be reasonable to have all book citations use the harvnb/cite book format? (For example, coverting citations like this to said format.) Vassyana (talk) 18:43, 6 November 2008 (UTC)

It would just add clunk to the text: it's really fine to use shortened notes for repeat book citations. And if you introduce Harvnbs, you have to convert the entire article to the citation template, which isn't used in almost any medical articles. With other work to be done, ... SandyGeorgia (Talk) 18:50, 6 November 2008 (UTC)

I'm fine with the actual edit to the text. It makes sense and flows well for me. Cosmic Latte (talk) 18:10, 6 November 2008 (UTC)

Good with the changes - WRT citation format, I inserted some code before which allowed the harvard referncing to work with cite book rather than citation...Cheers, Casliber (talk · contribs) 23:27, 6 November 2008 (UTC)

That is good because there are some harvard references in article, I noticed. —Mattisse (Talk) 23:38, 6 November 2008 (UTC)

Since the Harvard style is not used throughout the article, and is generally only used for reused references, I intend to standardize the citations. I would use the standard convention for repeated citations to the same material: The first citation using the full publication information and following references to the same source using the Author Name, op. cit., page number(s) format. It just seems better to use the same citation style throughout the article. Are there any objections to this? Vassyana (talk) 13:05, 7 November 2008 (UTC)

See WP:CITE and WP:FN (op cit aren't used on Wiki); also, the shortened format used here helps lower the article size and load time (it's already a large article, at around 9,000 words). No objection if you prefer that longer style, other than the effect it may have on load time, as long as op cit isn't introduced, as explained at MOS. SandyGeorgia (Talk) 16:06, 7 November 2008 (UTC)

Black Dog Institute and "black dog" - not world wide

Image:BlackLab.jpg. Caption: A black dog. Not to be confused with Major depressive disorder. There appears to me that there is an undue emphasis on "black dog", including singling out the "Black Dog Institute" for mention as a major research institution on the subject of this article, when no others are mentioned. The reference link given says the Black Dog Institute activities include "depression" but does not mention "Major depressive disorder". Are there some references that Black Dog Institute is a major institute world wide on the subject of Major depressive disorder and worthy of inclusion when others in the world are not? Is it more major that the National Institute for Mental Health, for example? The reference to "black dog" appears to be English/Australian in interest and not world wide. —Mattisse (Talk) 19:17, 6 November 2008 (UTC)

"English/Australian" does cover two continents (and four hemispheres). The Black Dog Institute is, if i recall correctly, headed by Gordon Parker, an extremely well-published researcher on depression/MDD/whatever you'd like to call it. Cosmic Latte (talk) 19:24, 6 November 2008 (UTC)

England is not a continent, as far as I know. I believe if is part of an island. I realize this article is mainly "English/Australian". That is evident throughout the article. But why is this Institute mentioned when no others are? Is "black dog" of interest outside of "English/Australian" editors? Considering the title of this article is of American derivation from an American diagnostic manual , there is nothing on the American Psychiatric Association who developed DSM, or important American research institutions like the National Institute of Mental Health or others in the world. France, Germany, Switzerland etc. have none. None on the other six continents in the world besides Australia?

"Is 'black dog' of interest outside of "English/Australian" editors?" Well, given that I'm neither English nor Australian, yet nonetheless fascinated by the concept, I'd say it's a distinct possibility. Cosmic Latte (talk) 19:47, 6 November 2008 (UTC)

Provide references that the Australian Gordon Parker is "an extremely well-published researcher on depression/MDD/" and worthy of mention over other well-published researchers world wide and of note to a world wide readership. Why not strive for more variety is content and sourcing, instead of so much emphasis on "English/Australian". —Mattisse (Talk) 19:36, 6 November 2008 (UTC)

Casliber is more familiar with Parker than I am, so I'll have to defer to him on that, but see here. And here, for that matter. I don't think anyone would object to some more variety, but the black dog idea is certainly interesting enough to mention in a sociocultural aspects section. Cosmic Latte (talk) 19:47, 6 November 2008 (UTC)

• Those are just references to Casliber's statements on a talk page, and he is Australian. Do a Google search of many researchers that publish a lot and you will get many results. Give a secondary source that he is important. —Mattisse (Talk) 20:17, 6 November 2008 (UTC)

• Methinks this is overkill. The article does not assert his importance (so I don't think we need a citation saying, "Gordon Parker is important, folks"), even if it implies it (which is where common sense comes in, and, based on the fact that he heads a major research/education institute and has published oodles of papers, I'd say there's enough of a common-sense reason to include him). Of course, this doesn't mean that someone else with a comparably interesting perspective should be excluded, but I'd say the onus of inclusion is upon whomever would like to diversify the section more. Cosmic Latte (talk) 20:27, 6 November 2008 (UTC)

Except that to be mentioned at all in the article , Gordon Parker needs a reference from a reliable source. —Mattisse (Talk) 02:22, 7 November 2008 (UTC)

Cosmic Latte, would you mind formatting citations that you add, per 2c of WP:WIAFA? Introducing raw URLs and unformatted citations to an article under consideration at FAC work against the nomination. Alternately, you could suggest the citation on talk and wait for others to format and add it. Thanks, SandyGeorgia (Talk) 19:53, 6 November 2008 (UTC)

Thought I fixed that here... Cosmic Latte (talk) 19:52, 6 November 2008 (UTC)

• Re "black dog". Perhaps you could explain what is fascinating about it, Cosmic Latte? I don't get it. It seems like fluff in an article that sorely needs credibility via statements that are well sourced and of interest to a world wide readership. What is fascinating about "black dog"? —Mattisse (Talk) 20:09, 6 November 2008 (UTC)

• What's fascinating is that, of all that has been written about depression, "black dog" seems to be the most enduring metaphor. The fact that Johnson's term has been kept alive by the disparate likes of Churchill and Parker is fascinating, as is its presence in several disparate facets of culture. Cosmic Latte (talk) 20:19, 6 November 2008 (UTC)

• Fascinating why? You could find many things in a culture that are "kept alive" in that culture. That is what culture is. My point is that it is a narrow reference in an article that is supposed to be relevant to a world wide readership. Also, regarding your google search for Gordon Parker, here is one for Robert Spitzer [2] who actually is important in the development of DSM and more known world wide than Gordon Parker. But he is not Australian or British/English. —Mattisse (Talk) 20:57, 6 November 2008 (UTC)

• I don't think anyone would object to saying something about Spitzer, if he has said something about depression that could fit into the article. Cosmic Latte (talk) 21:10, 6 November 2008 (UTC)
• There is, by the way, a legitimate field of study devoted to understanding the survival of certain ideas in a culture. Cosmic Latte (talk) 21:14, 6 November 2008 (UTC)

I have heard of "black dog" depression, because of Churchill. I have not heard of "Black Dog Institute" ever being mentioned in the UK. This is a bit anecdotal. Are there references about "Black Dog Institute" having relevance in the UK? Snowman (talk) 21:37, 6 November 2008 (UTC)

This is hopeless. I have repeatedly complained about this issue of "Black Dog Institute" and other mentions of material without sources that confirm its importance to the article topic in general. Posting on this talk page is useless and frustrating. —Mattisse (Talk) 21:46, 6 November 2008 (UTC)

There are two separate issues, black dog expression and the institute. Parker has been published in British and American Journals; sometimes biographies of living people written independently can be tricky to find online. More than happy for refernece to Spitzer to be embellished. Cheers, Casliber (talk · contribs) 23:31, 6 November 2008 (UTC)

We realize that, if you read the above. The question is if the "Black Dog Institute" has any relevance outside of Australia, as a UK editor above says he has never heard of it and feels it is a trivial mention, as do I. The only reference is to the institute's own web site, and it really doesn't make it sound very important to this article. However, I feel very frustrated by this article and very sick of black dog. Actually, I don't know what it means, other than a black anything can be associated with depression, "a black depression", "a black mood", "a black dog", "a black _____". It is not particularly enlightening to the degree it is mentioned in this article. —Mattisse (Talk) 23:51, 6 November 2008 (UTC)

"Black dog" was/has been singled out as a specifically notable black something to describe depression yes. I will look a bit later to see about third party refs. I am doing other stuff at the momnet off-wiki so involved searching is a bit tricky for a few hours. Cheers, Casliber (talk · contribs) 00:16, 7 November 2008 (UTC)

PS: Another reason why alot of this is tricky to establish notability is that often (but not always) the work (as it should be I guess) is focursed on ideas, theories and studies, rather than emphasising who did them (they are listed as authors obviously but often not much more is given), so sometimes a person's contribution to a field can be somewhat hard to define with sources. Just a thought. Cheers, Casliber (talk · contribs) 00:25, 7 November 2008 (UTC)

It is interesting, reading through the article, that the British are not mentioned as having contributed much of note to the field, except the literary/political/black dog references that are so emphasized. So maybe that is why the black dog stuff is clung to with such tenacity? Just asking, as it is striking when the article is read, how it diverts when the reader gets to the mushy "social and cultural" part where suddenly the Brit literary types, like Samuel Johnson, are repeatedly mentioned. Are there some real content providers from Britain who are being left out? There are Americans (Lincoln, Styron) who wrote vividly of depression, but no quotes from them. The black dog stuff I find empty without further elaboration. It is just a phrase repeated over and over, unless something meaningful can be added. —Mattisse (Talk) 02:18, 7 November 2008 (UTC)

?The metaphor is mentioned once in the text and once in a textbox, and once (referring to the institute again) again. This is hardly "over and over". Mapother is English, and a brief not on English pracitce in the next sentence. We could easily write an article double or triple the size, the key is to sifting out the most notable. I was waiting for Awadewit to add something too. Cheers, Casliber (talk · contribs) 03:03, 7 November 2008 (UTC)

That is over and over to me, for a reference that has little meaning to others than UK/Austrialians. It is not clarified or amplified so that others from a non UK/Austrialian culture would understand. It is not linked to anything. It is just repeated over and over. Other than Samuel Johnson, who similarly is repeated, is there anything else in the article that is repeated, pardon me, so repetitiously? —Mattisse (Talk) 03:18, 7 November 2008 (UTC)

Addendum: Perhaps you should include the picture of the black dog, as for some reason I always think it is an alcoholic beverage when I see "black dog". —Mattisse (Talk) 03:26, 7 November 2008 (UTC)

Your comment about Brits & depression reminded me of an article that I just managed to find again - doctors realized he wasn't depressed at all…..........only Scottish (the English of course just have Stiff Upper Lip) EverSince (talk) 03:30, 7 November 2008 (UTC)

ROFL Cheers, Casliber (talk · contribs) 05:09, 7 November 2008 (UTC)

Can we use this in the "differential diagnosis" section? :-) /skagedal^... 08:47, 7 November 2008 (UTC)

• I think that the bit about Samuel Johnson and his "black dog" serves as a nice illustration of the topic, made more relevant by the subsequent use by Winston Churchill. It is a bit arbitrary of course, as any illustration will be. I do agree with Mattisse on that "the term lives on in the Black Dog Institute, an Australian facility for research and education into mood disorders such as major depression and bipolar disorder" is undue. There are many such facilities, it is not clear why this one is special, and also this sentence strays away from the topic in the secion.
• As for a general English/Australian bias, I don't really see this problem; I think a much greater problem with the section is the gender bias that was previously mentioned. /skagedal^... 08:47, 7 November 2008 (UTC)

• That also. It has been mentioned many times previously. The article's major editors says this reflects the fact that the article editors are male. I have given up on this point, as I cannot manage to get it to be seriously considered. —Mattisse (Talk) 16:32, 7 November 2008 (UTC)
• Agree with both Mattisse and Skagedal that the reasons for mentioning the Black Dog Institute link are pretty lame. It's a metaphor. Somebody, somewhere on the other side of the world from me repeated a metaphor that was coined and popularised by two notable individuals. Big deal. Colin°^Talk 17:00, 7 November 2008 (UTC)

• Except that this "somebody, somewhere on the other side of the world" is also notable. But since there doesn't seem to be consensus either way, and since this is a medicine-related article, perhaps we can default to the Hippocratic position that, hey, it's not doing any harm. *G* Cosmic Latte (talk) 10:03, 8 November 2008 (UTC)

Erm, the fact that he is part of a feature discussing diagnosis here in the British Medical Journal and holds a professorial position and chairs a unit specialising in mood disorders suggests his opinion is valued by some. I suspect the peer-reviewed BMJ know what they are doing when they have a debate like this on in their journal. Nevertheless I do know what folks are getting at with the use of teh metaphor WRT an australian institute and am rereading teh section again given we have so many bits and pieces jostling for a ghuenrsey as it were. Cheers, Casliber (talk · contribs) 06:29, 9 November 2008 (UTC)

PS: Did think, and ultimately we have so much valuable material jostling for spots in teh article that the 'colour' I added about the institute I have removed; ultmiately would I be mentioning it if it were not called "Black Dog"? Answer, very unlikely, hence removed. Cheers, Casliber (talk · contribs) 06:42, 9 November 2008 (UTC)

Use of boldface

Under "Subtypes" and "Differential diagnoses", the entries in the bullet lists start with a bolded term. Is this really supported by MOS:BOLD? Can they be considered "definition lists"? /skagedal^... 10:05, 7 November 2008 (UTC)

The emboldened blue links (as headings) seem to be inconsistent with the rest of the formatting, and probably should be unemboldened, pending on what MOS says. Snowman (talk) 10:42, 7 November 2008 (UTC)

I suppose they are follwed by a definition of sorts afterwards (?) Cheers, Casliber (talk · contribs) 11:27, 7 November 2008 (UTC)

WP:MOSBOLD treats lists like that in bold (before, they were in italics, which is incorrect); it's very common throughout Wiki. Although the bolding is not incorrect, removing it wouldn't raise any eyebrows (I don't think): the italics were incorrect, though. SandyGeorgia (Talk) 16:03, 7 November 2008 (UTC)

Biopsychosocial model vs. Diathesis-stress model

Under "causes": In the biopsychosocial model, both biological and psychological (including social) factors play a role in causing depression. I find the second link to be problematic: first, it's somewhat easter-eggish; second, it's a very long link; third, it seems to explain the biopsychosocial model by referring to the diathesis-stress model. The reader wonders, are they the same model? If so, why two different articles? (The two articles, while covering two very similar topics, do not even refer to each other... I think I'll at least add some "see also" links.) I'm not sure I know enough about the theoretical differences to suggest a good alternative. /skagedal^...

Yes that phrasing is problematic and I was planning to change it back when I next edited that section, because they are two different models (though sometimes complimentary) and one shouldn't be explained as if it's the other (esp. by wrongly subordinating social causes to parentheses). EverSince (talk) 16:59, 7 November 2008 (UTC)

Also, the article never explains what psychosocial means, although it mentions the term at least twice, once under "Evolutionary hypothesis" and once under "Social". I suggested on the FAC page that perhaps there could be a psychosocial section, since there are several social psychologists and social learning theorists mentioned under "Psychological". A separate section could then explain the term. (Or, failing than, move the social psychologist to be under "Social"). —Mattisse (Talk) 22:19, 7 November 2008 (UTC)

I've reworded the causes section a bit. Hopefully that'll resolve most of these concerns. See what you think. Cosmic Latte (talk) 19:04, 8 November 2008 (UTC)

Good, I like it! Also, there probably should be some sources for the two models... /skagedal^... 19:19, 8 November 2008 (UTC)

Incomplete citations

Some of the citations are incomplete. Some are missing page numbers. Others are missing ISBN/ISSN/OCI/PMID/etc numbers. Could someone more familiar with the source material and citations correct this? Vassyana (talk) 13:06, 7 November 2008 (UTC)

Which ones? Not all journals are indexed by PubMed... /skagedal^... 13:19, 7 November 2008 (UTC)

While not all journals have PMIDs available, it would be exceedingly unusual for the article itself (or the journal issue, depending on which identifier is used) to not have an ISBN, SICI, DOI and/or similar identifier used. At the very least, the journal itself should have an ISSN available. Also, some books cited in the article lack ISBN numbers. Vassyana (talk) 14:41, 7 November 2008 (UTC)

Be careful...

Earlier the intro had a statement about neurotransmitters being implicated in depression. Someone changed that to state that they are involved, but I changed that back to something like the original wording. Be careful not to commit the treatment-aetiology fallacy (the Latin name escapes me), inferring from a (more or less) successful treatment (e.g., raising serotonin levels in the synapses) that the cause of the problem is the opposite of the treatment (e.g., low serotonin levels in the synapses). I'm saying this, partially because it's fun to point out, but more importantly as a deterrant to anyone who might feel tempted to simplify the language so as to say that neurotransmitters are aetiologically involved. Cosmic Latte (talk) 15:42, 7 November 2008 (UTC)

I think your edit is ok, and as far as I can see the meaning has not been changed by your edit. It did not say that they are "aetiologically involved" it said "neurotransmitters are involved in depression". which is very similar to "implicated in depression"? Snowman (talk) 17:31, 7 November 2008 (UTC)

I guess the difference is subtle, but still important. "Implicated" suggests that there's evidence of their involvement (just like if you're implicated in a crime, then there's evidence that connects you to it, but still doesn't prove your guilt). Cosmic Latte (talk) 18:05, 7 November 2008 (UTC)

Suicide numbers

Those in the opening paragraphs don't have a references. There are some numbers further below, but whoever added them did not read the papers carefully. For instance, the 15% is historical number used in 1970, and the 2000 AJP paper cited (http://ajp.psychiatryonline.org/cgi/content/full/157/12/1925) simply uses it in the abstract as basis of discussion, but finds different numbers, namely:

There was a hierarchy in suicide risk among patients with affective disorders. The estimate of the lifetime prevalence of suicide in those ever hospitalized for suicidality was 8.6%. For affective disorder patients hospitalized without specification of suicidality, the lifetime risk of suicide was 4.0%. The lifetime suicide prevalence for mixed inpatient/outpatient populations was 2.2%, and for the nonaffectively ill population, it was less than 0.5% —Preceding unsigned comment added by Psychotropic sentence (talk • contribs) 17:38, 7 November 2008 (UTC)

Too many edit conflicts, but agree that the text about suicide numbers doesn't seem supported by the citation given, and now the lead also disagrees with the numbers cited in the body. SandyGeorgia (Talk) 18:54, 7 November 2008 (UTC)

Hopefully that's all fixed now. Cosmic Latte (talk) 19:58, 7 November 2008 (UTC)

(edit conflict, afraid not fixed) There were two citations (also PMID 11437805) and the wording was changed since I'd added them - the first as mentioned above was the paper that showed that the old 15% hospital figure was being wrongly generalized in textbooks (and still crops up around the place), and the second paper gave updated population figures specific to modern major depression dx (the first covered a jumble of affective disorders). Needs staightening out. I'll also add the previously mentioned differnet gender picture that emerges from the stats on attempts and non-suicidal self-harm. EverSince (talk) 20:23, 7 November 2008 (UTC)

Three people editing this, and we still have an uncited 2.2% in the lead, but 3.4% in the text. Many cooks in the kitchen :-) Additionally complicated by the fact that PMID 11437805 is not a review; it would be best to get a recent, authoritative review for one set of data. SandyGeorgia (Talk) 22:49, 7 November 2008 (UTC)

I've finished some editing now (still not formatted ref ideally), is at least consistent again. There are several problems still... that article isn't technically a review but it is a summary, but a more recnet broader & international review would definitely be better, prob is they tend to be on suicide generally and not enough detail on depression or come from a different angle, or if on dep not enough on suicide stats. Also the baseline suicide rate varies substantially by country, so is difficult to compare; not sure how much it varies re depression specifically. EverSince (talk) 23:34, 7 November 2008 (UTC)

Thx btw for fixing the new citation, had tried unsuccessfully to use full text link in Diberri thing EverSince (talk) 05:34, 8 November 2008 (UTC)

Can't remember if I left this here (how to search PubMed for free, full-text reviews, and how to use Diberri): Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. SandyGeorgia (Talk) 05:44, 8 November 2008 (UTC)

Oh I know yeah, it's just Diberri seems to only work with via a PMID number rather than a URL... EverSince (talk) 06:22, 8 November 2008 (UTC)

Subtypes

Earlier versions didn't refer to DSM at all,[3] but the current version specifically refers to the DSM, yet contains text and a citation referencing ICD,[4] so I'm not sure what's up there. Since I don't have any of the full-text of the sources, I can't verify the text: just asking. SandyGeorgia (Talk) 21:19, 7 November 2008 (UTC)

I would be happy if DSM were removed from the article entirely, as the article misrepresents its category of Major depressive disorder. The article tries to straddle both justifying its title by referencing DSM and its focus on general depression, since almost none of its references include mention of Major depressive disorder. Further, there is still no reference that DSM is lingua franca around the globe. Having been trained very strictly to follow DSM criteria, as I think most US practitioners are, this is very distressing. —Mattisse (Talk) 22:06, 7 November 2008 (UTC)

All that section does refer to classification within DSM IV TR yes. Cheers, Casliber (talk · contribs) 23:30, 7 November 2008 (UTC)

Comorbidity section

Comorbidity with depression is not an unusual topic. The section came in to the FAC looking like this, but now has typos and grammatical errors, and is straying from the topic of comorbidity. Besides the need for a copyedit (that has been introduced by changes made during the FAC), I'm unclear why the focus is straying to individual researchers and their background and primary studies, rather than citing text to recent peer-reviewed secondary sources. Perhaps a rewrite can be sourced to a high-quality secondary review. SandyGeorgia (Talk) 23:35, 7 November 2008 (UTC)

I would be happy if the whole reference to Ellen Frank were removed, as the reference [5] does not add to the article and I am puzzled why it is there. —Mattisse (Talk) 00:17, 8 November 2008 (UTC)

Also I added tags as I was surprised that most of the statements were unsourced. Perhaps that was wrong of me, but I have found that complaining on the talk page or on the FAC has no effect. So I decided to interfere. —Mattisse (Talk) 00:20, 8 November 2008 (UTC)

Perhaps a more organized approach would make it easier on all: the FAC is one of the messiest seen in months, with multiple sections saying the same thing. Prose errors are now complicating the other matters:

American psychiatrist Ellen Frank, developer of Interpersonal and social rhythm therapy, in a study the c onceptualization and rationale in the definition major depressive disorders, concluded that research on depression needed more consistency in the "definition change points in the course of illness".

SandyGeorgia (Talk) 00:54, 8 November 2008 (UTC)

This article would be better off if it did not rely on so many primary sources for general statements. —Mattisse (Talk) 00:22, 8 November 2008 (UTC)

I still don't understand why the text is chunked up with extra detail on personalities. For example:

• American psychiatrist Ellen Frank, developer of Interpersonal and social rhythm therapy, in a study on the conceptualization and rationale in the definition of major depressive disorders, concluded that research on depression needed more consistency in the "definition change points in the course of illness".

could be:

• A study on the definition of major depressive disorders concluded that research on depression needed more consistency in the "definition change points in the course of illness".

There are names mentioned throughout: perhaps an article on the History of depression or History of the DSM needs to look at individuals, but does this article need so much mention of personalities ? For that matter, I'm unclear why any of the text above is needed, as it relates to comorbidity. There is so much to be said about comorbidity and depression, that I'm not clear what that convoluted construct is adding. The earlier version made more sense to me. SandyGeorgia (Talk) 04:08, 8 November 2008 (UTC)

Remove reference to Ellen Frank's article, remove her. That is what I recommend. Her article disagrees with what is being advocated here anyway. —Mattisse (Talk) 04:13, 8 November 2008 (UTC)

Glad you said that as I was about to as well :) Cheers, Casliber (talk · contribs) 04:24, 8 November 2008 (UTC)

Rating scales section

The prose in the Rating scales section has also noticeably deteriorated: each time I check back in here, I'm finding new prose errors introduced. Text that was copyedited at the initiation of the FAC now has errors. When I checked prose yesterday, the Rating scales section looked like this. (I'm unclear why this article is going in to so much detail about personalities involved: those details should be in the rating instrument articles, but I guess that's a choice made in this article.) The last version I checked has grammatical and prose errors and snakes for chopping. Beck is introduced after it's discussed. MADRS is found to be the equivalent of MADRS. The Inventory is a tools (plural). Although clauses abound.

The two most commonly used rating scales completed by clinicians are the highly regarded Hamilton Depression Rating Scale (HRSD-21) designed by psychiatrist Max Hamilton in 1960, although there is increased criticism that it is flawed both as a test instrument and in its conceptual basis, and the Montgomery-Åsberg Depression Rating Scale (MADRS), found to be the equivalent of the Beck Depression Inventory and the MADRS. The Beck Depression Inventory is the most commonly used tools which is completed by the patients themselves, although scales completed by observers are more common. Originally designed by American psychiatrist Aaron T. Beck in 1961, it is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex and thoughts including feelings of guilt, hopelessness or of being punished.

I've not seen another article at FAC deteriorate quite this dramatically; perhaps the editing pace here can slow down, with a better organized list of changes needed (the FAC is a shotgun blast at best) and more discussion before changes are introduced ? I suggest a thorough review of the daily diff to pick up prose errors. SandyGeorgia (Talk) 00:41, 8 November 2008 (UTC)

(ec) The trouble is that primary sources are used in misleading statements. This has been a constant problem throughout the article. But the rating scales section is particularly bad in this regard. Or maybe I have just noted it because I have been complaining about it since the beginning. The sources simple do not support the statements. Since I have complained endless about this, to no effect, I modified the statements to fit the sources. I do not know what else to do to draw attention to the problem. I am very frustrated. Making comments on the FAC and endless talk page discussions have no effect. Nada. —Mattisse (Talk) 00:54, 8 November 2008 (UTC)

There's no need for frustration, as there aren't really deadlines on Wiki. Casliber has stated several times that he's getting to things as fast as he's able, but with this much deterioration, it's become a moving target. Now the article has 1) copyedit errors that need attention, and 2) a FAC that is so convoluted it's hard to see what remains to be done. It would help if reviewers struck and cap items as they are completed, kept comments to one section, and took a more organized approach to presenting issues. SandyGeorgia (Talk) 01:01, 8 November 2008 (UTC)

Something is off here as well:

• Existential and humanistic approaches are generally grouped together, representing a forceful affirmation of individualism, as does phenomenological approach pioneered by American psychologist Carl Rogers.

Grammar error, and no idea what it says or how it relates. SandyGeorgia (Talk) 00:49, 8 November 2008 (UTC)

Sorry about that. I was going to improve the section but I decided it wasn't worth it. Sorry to have left that in. I was annoyed at the seemingly random way they describe this section as humanistic and existential are not exactly related and Carl Rogers, the "father" of humanism was actually important. Far more so that that Gordon Parker who they insist on promoting, without any references, other than primary, as to his general importance. But who cares about another "father" and who cares if that section is the jumble it has been all this time or whether it actually says something meaningful. I am very frustrated. Sorry. You can just delete my attempts as I will not bother with that section. —Mattisse (Talk) 00:59, 8 November 2008 (UTC)

Actually, what is there without my addition doesn't relate. However, if you allow the name of this article to change, I will cease having any investment in what it says. It is only that it is so misleading that I am involved. I have worked on other diagnositic articles without this problem of insistence on using a DSM category in a misleading way. —Mattisse (Talk) 01:02, 8 November 2008 (UTC)

Well, we're running into another issue: with this pace of frenzied editing, I'm pretty sure everyone here has passed 3RR many times a day for many days. I'm no longer sure who can correct what, but I suggest a slower and more deliberative approach to addressing issues would be helpful. SandyGeorgia (Talk) 01:04, 8 November 2008 (UTC)

I am not sure of what constitutes a 3RRR, but I am not aware of anyone changing what I have done or visa versa. I have made edits to relatively confined areas. I am not responsible for the rest of the deterioration. Perhaps others are growing frustrated also. The talk page is useless. There is no way to get a response. And when a response is given, it is often misleading. Now, I feel I have to second check everything. Sorry. —Mattisse (Talk) 01:08, 8 November 2008 (UTC)

Except for some wikilinking, I have not edited the article for a long time, until today. This afternoon I edited the article. But, as I said, to relatively confined areas. And I have never edited the lead, the ETC section or anything to do with suicide. Mostly rating scales, except for ill fated desire to fix the psychology section.

I have added nationality and occupation to names over the days, but that was agree to on FAC. —Mattisse (Talk) 01:12, 8 November 2008 (UTC)

No-one has actually reverted in the 3RR sense, but there is an aligning going on between sources and prose which needs fine tuning and some substitution of references for better ones, and some comprehensiveness issues addressed. I looked at the changes between when I went to bed and this morning and I initially thought it was going to be massive when I looked at the history, but it wasn't that extensive and the fine tuning was ok. Snowman has done a great job at reducing some jargon which until he came along all of us had missed as we were/are all familiar with many of the words. I will have another look now. Cheers, Casliber (talk · contribs) 01:26, 8 November 2008 (UTC)

I recommend a solid review by all editors here of WP:3RR to avoid confusion, noting the limited exceptions, and recalling that bad faith 3RR reports are easily filed, and editors have been blocked. There's no exception for "we were all discussing in an open and collaborative manner and working together on a FAC": the page is clear, and I've seen bad faith reports filed, and editors blocked. Of course, I would come out of my skin if I saw it happen to someone working on a FAC, and I'd protest, but sometimes that doesn't help, and based on other 3RR reports I've seen, I wouldn't be surprised at anything anymore. I recommend caution. For the record. SandyGeorgia (Talk) 03:51, 8 November 2008 (UTC)

PS: Yes, the changes have been discussed in an open and collaborative manner, the nationality/occupation prefixes are the only actual reverts I vcan think of. Cheers, Casliber (talk · contribs) 01:43, 8 November 2008 (UTC)

Could you make sure that primary sources are not used as much as they are, and if they are used (there are a lot of them) that they do not misstate what the source actually says? That is a problem with this article in that regard. For example, a source states that a rating scale is out of date and has construct validity problems, and that source is used as a reference to say the rating scale is a "gold standard" just because the source intro says the scale was long considered a "gold standard" but goes on to say there are this and that problem with the scale and says, in essence, that it is not a "gold standard". Do you not think that is misleading? —Mattisse (Talk) 02:01, 8 November 2008 (UTC)

The more I look at that the more I am thinking that this is better relegated to the Hamilton scale page, as it is difficult to explain succinctly and is possibly in too much depth, as it requires more elaboration that the parent article can give, and anyway these are more research than clinical tools, so just touching on things is better. Cheers, Casliber (talk · contribs) 03:28, 8 November 2008 (UTC)

Agree, as I don't think rating scales are important to primary diagnosis as much as is the clinical interview, and so much mention of individual ones is just more unclarified verbiage for the general reader, however preoccupied professionals may be with them. —Mattisse (Talk) 03:37, 8 November 2008 (UTC)

Btw Major Depression Inventory is another one, is also interesting regarding the naming issue since designed to cover both DSM & ICD EverSince (talk) 03:42, 8 November 2008 (UTC)

Can someone rearrange that paragraph now to minimize the snakes, and get the flow corrected (Beck discussed before it's mentioned in passing, and lowering all the although clauses and disclaimers)? The flow in the original version (linked above) was pretty good. SandyGeorgia (Talk) 03:53, 8 November 2008 (UTC)

OK - I am thinking of removing

Originally designed by American psychiatrist Aaron T. Beck in 1961, it is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex and thoughts including feelings of guilt, hopelessness or of being punished.

as it is pretty obvious, I would have thoguht, what questions are going to be asked (they ain't going to ask about shoe size are they...) Cheers, Casliber (talk · contribs) 04:35, 8 November 2008 (UTC)

Too much detail throughout: that level of detail can come from the Beck link. This article should stay tightly focused on the condition (not the people, not the instruments, not the history of the DSM, and so on). SandyGeorgia (Talk) 04:37, 8 November 2008 (UTC)

Done. Cheers, Casliber (talk · contribs) 05:14, 8 November 2008 (UTC)

Recent epidemiology reviews

Here are some recent reviews that might be helpful in improving Major depressive disorder #Epidemiology.

• Patten SB, Bilsker D, Goldner E (2008). "The evolving understanding of major depression epidemiology: implications for practice and policy" (PDF). Can J Psychiatry. 53 (10): 689–95. PMID 18940037.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Patten SB (2008). "Major depression prevalence is very high, but the syndrome is a poor proxy for community populations' clinical treatment needs" (PDF). Can J Psychiatry. 53 (7): 411–9. PMID 18674395.
• Andrews G (2008). "Reducing the burden of depression" (PDF). Can J Psychiatry. 53 (7): 420–7. PMID 18674396.

Someone also asked about depression in women: here's a reliable review (though not as recent):

• Kessler RC (2006). "The epidemiology of depression among women". In Keyes CLM, Goodman SH (eds.) (ed.). Women and Depression: A Handbook for the Social, Behavioral, and Biomedical Sciences. Cambridge University Press. pp. 22–40. ISBN 0-521-83157-1. {{cite book}}: |editor= has generic name (help)

Eubulides (talk) 09:12, 8 November 2008 (UTC)

Thanks for that; will have a look. Cheers, Casliber (talk · contribs) 12:38, 8 November 2008 (UTC)

Carl Rogers

I generally like Carl Rogers (as I do Carl Jung), but I'm worried that the reference to him may be a bit tangential (just as I was worried about the image of Jung proposed earlier). If we're going to mention Rogers, then we should probably say something about what he thought about depression. Unfortunately, I'm not aware of his views on depression specifically. Is anyone else? If not, then do we really need to mention him? (As it stands, when I see his name in the beginning of the paragraph, I'm naturally expecting to read something about his theories before the paragraph is over.) Cosmic Latte (talk) 10:26, 8 November 2008 (UTC)

By the way, he said plenty about "psychopathology" in general (see Carl_Rogers#Psychopathology), and although I'm fine with using melancholia/depression/MDD more or less interchangeably, "psychopathology" is just too broad. So again, does anyone know his views about the relatively specific type of psychopathology that we're discussing in this article? Cosmic Latte (talk) 10:31, 8 November 2008 (UTC)

Only mention Rogers if he said something specific re depression, otherwise not; we could mention loads of people in that case. I think we have plenty in the article already and wouldn't be hunting out Rogers references. Cheers, Casliber (talk · contribs) 12:16, 8 November 2008 (UTC)

Agreed and fixed. Cosmic Latte (talk) 14:39, 8 November 2008 (UTC)

Why is Heidegger mentioned in footnotes? Has he "said something specific re depression"? If so, it should be referenced. —Mattisse (Talk) 21:40, 8 November 2008 (UTC)

Treatment

The section mentions medication and psychotherapy as if it was one or the other. Generally, if it was for severe depression, then both might run simultaneously to make the outcome quicker. Years ago, I am sure I have heard of papers showing the quicker effectiveness of medication with psychotherapy than with psychotherapy by itself. Combined treatment is an omission. Snowman (talk) 13:06, 8 November 2008 (UTC)

Slaps hand on forehead) I thought it we had it in (?) ...ok, off to find it. Cheers, Casliber (talk · contribs) 19:04, 8 November 2008 (UTC)

Combined treatment is in the second sentence of the Psychotherapy section, but another account in the next section, the medication section, just mentions medication or treatment. It is in but it is spread over two sections. Snowman (talk) 19:48, 8 November 2008 (UTC)

Fonagy and Roth's 1996 book What Works for Whom was a definitive text on effectiveness and evidence to date; I read it yesterday afternoon and info was surpirislingy sparse and vague on the point. I did recall seeing something else somewhere...Cheers, Casliber (talk · contribs) 18:54, 9 November 2008 (UTC)

Illness

Note that the term "condition" is being used deliberately rather than "illness" in the intro. I often say "mental illness" myself, but if we really want to be WP:NPOV, we've gotta acknowledge that medical-model terminology is a matter of debate. Note that even mental illness is a redirect to mental disorder. Cosmic Latte (talk) 14:30, 8 November 2008 (UTC)

"Affliction" might work, though, if "condition" sounds too bland. Cosmic Latte (talk) 14:46, 8 November 2008 (UTC)

But the article "mental disorder" implies that "mental illness is a synonym. This indicates that MDD is an illness, and there is no POV issue. Snowman (talk) 17:18, 8 November 2008 (UTC)

My mention of the redirect was sort of a side note, as WP isn't really supposed to be self-referential. See the external link for my main point. Cosmic Latte (talk) 17:26, 8 November 2008 (UTC)

Unwatch

I'm going to unwatch now that things seem to be somewhat on track, but I hope the comprehensive issues will be addressed soon (the gender bias section above, how to work in more about women, I left a link there to a recent full-text review, and Eubulides left some reviews on epidemiology, I suspect Comorbidity needs a new look), use of primary sources should be reviewed and replaced with high-quality secondary source reviews where indicated, and I hope the FAC will stay on track now ... rather than massive multiple repeat sections on the FAC page, it would be helpful if someone would generate a succint list of remaining work so the FAC can stay somewhat readable. SandyGeorgia (Talk) 15:47, 8 November 2008 (UTC)

Images

I've added a few more images--all properly sourced, as far as I can tell--and I hope that the extra colour is a welcome addition to the article. But please feel free to modify or remove them if they look too clunky. Cosmic Latte (talk) 16:51, 8 November 2008 (UTC)

I'd vote for the picture of the hippocampus going away. I'm a hippocampus specialist myself (I created the image you added, from a Gray's Anatomy picture), and I think the case for it playing a major role in depression is pretty weak -- the discussion in the article is okay, but adding the picture gives it too much weight in my opinion. A picture of the Raphe nuclei and their projections would be more appropriate -- I'm not aware of a usable one, though. The other pictures look good to me. looie496 (talk) 17:02, 8 November 2008 (UTC)

I like it, except for the Maslow "hierarchy of needs" triangle. It seems to take over that whole section, and frankly isn't all that relevant. /skagedal^... 17:04, 8 November 2008 (UTC)

Thanks for the input, both of you. I went ahead and removed those two images. Cosmic Latte (talk) 17:08, 8 November 2008 (UTC)

I managed to find and add a much smaller version of Maslow's hierarchy. The original one didn't like to display properly unless it was set at precisely a whopping 400px. But if you still feel that relevance is an issue, I'll understand. Cosmic Latte (talk) 19:31, 8 November 2008 (UTC)

More images of molecular structures of drugs and neurotransmitters could be added. Some illustrations are made to have the 3D appearance. Snowman (talk) 20:00, 9 November 2008 (UTC)

Fluoxetine (Prozac) is probably the most famous antidepressant, is the most prescribed, and was (I think) the first FDA-approved SSRI. I added a 3-D image of fluoxetine a while back, but Paul replaced it with the Isoniazid picture that's now in History. I like visual aids (can you tell?), though I hope we don't get too carried away, as there are already two chemical-structure images on the page. Cosmic Latte (talk) 20:54, 9 November 2008 (UTC)

On seeing the 3D image, it is not as informative (to me anyway) as the molecular structure. Snowman (talk) 22:56, 9 November 2008 (UTC)

New image on page

Is there a personality rights issue with using the image of poor street children in this article? Snowman (talk) 17:27, 8 November 2008 (UTC)

Probably not any more than there is with any of the countless other pics of living folks that are on WP. Cosmic Latte (talk) 18:29, 8 November 2008 (UTC)

I think that there is a problem here, as the children might not want their images to be reproduced on such a page as this. They are minors. The image needs immediate unlinking in my opinion. Snowman (talk) 19:29, 8 November 2008 (UTC)

That's a bit of a stretch IMO. Lots of people do/don't want their pictures taken, and if anything, children are probably more enthusiastic about seeing themselves on film than self-conscious adults are. The image is properly sourced. If there are genuine legal concerns with it, which somehow don't apply to other pictures of living people, then I'd be open to removing it. Cosmic Latte (talk) 19:45, 8 November 2008 (UTC)

I wonder what Anne Geddes would think about all of this... Cosmic Latte (talk) 19:51, 8 November 2008 (UTC)

They look too young to understand the consequences and give consent themselves. Do you have their parents permission? Snowman (talk) 19:52, 8 November 2008 (UTC)

I didn't take the picture. Whether or not it was morally proper for this photograph to have been taken and uploaded to Commons is a matter for the photographer's conscience to contend with. But as editors, the facts before us are: It's on Commons, it's perectly legal (as far as I am aware), and it's germane to the article. Cosmic Latte (talk) 19:59, 8 November 2008 (UTC)

I would leave it out pending an experts opinion on what "Personality rights" are as applied to images of young children possibly taken without their parents consent. See Personality rights. Snowman (talk) 20:20, 8 November 2008 (UTC)

(deindent) Don't want to put another spanner in the works 'cos I personally never have any luck finding appropriate images, but need to be careful about the difference between findings on relative socioeconomic disadvantage in Western societies, vs poverty in other parts of the world; rates of Western-defined Depression probably do'nt show the same associations to both. EverSince (talk) 04:41, 9 November 2008 (UTC)

I have to add I also feel uncomfortable with the image - very tricky to link a pic of kids to an article on a mental illness. We just had a discussion on the schizophrenia talk page with this image Image:The Schizophrenic House.jpg to illustrate delusions. Cheers, Casliber (talk · contribs) 10:18, 9 November 2008 (UTC)

Update: user Cosmic Latte has unlinked this image of children. Snowman (talk) 18:48, 9 November 2008 (UTC)

Source

Would this be sufficient for the tag regarding Feighner and the RDC in 20/21st century? Its by Spitzer (who did the RDC) saying they based it on Feighner and the DSM built on RDC.Fainites ^barley 18:08, 8 November 2008 (UTC)

Looks good to me! Cosmic Latte (talk) 18:30, 8 November 2008 (UTC)

OK. I'll stick it in when I get a proper turn on the computer. Fainites ^barley 18:44, 8 November 2008 (UTC)

According to that source, at least one of the authors of the Feighner criteria (sic) - otherwise known as the Feighner Criteria, was a psychologist, and psychologists and research by psychologists was part of the process of developing DSM, so that fact should be added if this informal source is used, per Spitzer. —Mattisse (Talk) 18:51, 8 November 2008 (UTC)

That source doesn't say psychologists plural played a significant role developing the DSM-III - it says they (& probably referring primariy to Rosenhan) were instrumental in showing "the sorry state of pscyhiatric diagnosis". It explicitly says "a small group of psychiatrists developed the Feighner criteria" (a load of artifically medicalized criteria to artifically improve inter-rater reliability, regardless of validity). It only mentions one psychologist, Jean Endicott, as having a role in modifying some of them for the RDC (incidentally, by the way, she is described elsewhere as an academic in a psychiatry dept, who has long pushed for some forms of premenstrual distress to be classed as a psychiatric disorder, and worked with the pharmaceutical company Eli Lilly to* help them rebrand Prozac (just as its patent was running out) as Sarafem in order to* "treat" it). Anyway, perhaps there's other sources on involvement of psychologists, but for now I think the new wording in the section obscures the fact that virtually all were (research-oriented) psychiatrists (male, white etc, which almost goes without saying I guess) EverSince (talk) 22:37, 12 November 2008 (UTC) (*& to get the diagnosis voted in by committee in the first place) EverSince (talk) 23:11, 12 November 2008 (UTC)

How about supplying some sources before getting into a POV rant? —Mattisse (Talk) 00:01, 13 November 2008 (UTC)

Sources for what? I've pointed out that the source doesn't support the word change (my "rant" presumably being the one sentence in parantheses). EverSince (talk) 00:18, 13 November 2008 (UTC)

I suggested the word "clinicians" as a safe altenative, as a variety of researchers were/have been inolved. Cheers, Casliber (talk · contribs) 00:28, 13 November 2008 (UTC)

I can appreciate that, but it was basically a group of research-oriented psychiatrists. Btw I also now notice wording has been changed so it incorrectly states (while still citing a source I added on concepts of major depression) that the term "major depressive disorder" was incorporated into DSM-III - in fact the DSM-III and DSM-III-R used "major depression" EverSince (talk) 01:32, 13 November 2008 (UTC)

O.K. Just supply a reference. At the beginning of DSM-II, the names of two M.D.s and one Sc.D. are given, saying they served as "consultants to the APA Medical Director and approved the final form of the Manual before publication" in 1967. I can't find my DSM-III, but you are probably right about the diagnostic label, showing the evolution of the term into its current fixed state did not occur until DSM-IV. (Suppose it is changed again! What will Wikipedia do?) —Mattisse (Talk) 01:55, 13 November 2008 (UTC)

This is'nt to do with the DSM-II. Reference for what, it states in the one above that it was psychiatrists with odd exception. EverSince (talk) 03:54, 13 November 2008 (UTC)

Philosopher Heidegger used as reference under "Causes - Psychological " is inappropriate

Presumably we are seeking to provide scientifically validated data in this section. However interesting a philosopher's opinion is, it does not provided support for psychological data for the causes of Major depressive disorder. Perhaps he could go under cultural influences or somewhere. I have objected to this but my objections have been removed. —Mattisse (Talk) 19:17, 8 November 2008 (UTC)

If we're seeking "scientifically validated data," then we'll have to eliminate the entire sections on psychoanalysis and existentialism and humanism. If one wants fully to appreciate this stuff, one must head to the library, not the laboratory. The bias towards positivism--itself a philosophy--is discussed at length in the talk archives, and I think it's safe to say that we came to at least a rough consensus that both scientific and literary/philosophical views merit mention here. Cosmic Latte (talk) 19:26, 8 November 2008 (UTC)

I should again point out that all of these folks are discussed in the Hergenhahn source, which explores the history of psychology. Cosmic Latte (talk) 19:26, 8 November 2008 (UTC)

Those are provided in the context of the history of psychology and the history of depression. The article discusses the importance of historical figures predating the current status of depression. Heidegger is not mentioned in this section, in fact, he is not mentioned at all. He is give as a reference in a section of the article "Causes - Psychological", in which all the other references are to scientific data and follow WP:MEDRS. The fact is, any references Heidegger made to these concepts do not belong in this section. If you or others have problems with positivism, they should be discussed in the article. Your objections do not belong in this section, disguised in footnotes. —Mattisse (Talk) 20:00, 8 November 2008 (UTC)

Heidegger's contributions to our understanding of what is now known as depression make the most sense in the general context of existential psychology. I'm not sure what you mean by "scientific data." If the writings of Freud, Maslow, and even Rogers can now be acceptably referred to as "scientific," then I'll be a monkey's uncle. There is variation in the degree to which psychologists/philosophers-of-psychological-relevance are positivistically oriented. If we are going to be WP:NPOV, then we need to reflect this variation. Cosmic Latte (talk) 20:09, 8 November 2008 (UTC)

Please see WP:MEDRS for explanation of scientific data. The point is that you do not discuss Heidegger at all in the article. You have hidden him in footnote references in a section that otherwise attempt to follow WP:MEDRS. Please provide some evidence that Heidegger is an expert to reference Rollo May's statement that "lack of awareness leads to neurotic anxiety ... inauthentic living,[50][51] guilt,[50][51] and depression." Two references to Heidegger is being used as reference in each example here. If Heidegger is important to the article discussion, please explain openly in article, and not hidden in disguised references. —Mattisse (Talk) 21:05, 8 November 2008 (UTC)

P.S. Has Heidegger addressed depression? The lack of the provision of specific references to depression was the reason for excluding some relevant psychologists. —Mattisse (Talk) 21:38, 8 November 2008 (UTC)

Heidegger discusses what happens when people "fail to construct a future" (to paraphrase May, who echoes Heidegger on this point), which is exactly what the article says. Further discussion of Heidegger in the article probably would be undue, because he was not addressing "depression" per se; May, who happened to be echoing Heidegger, addressed depression more explicitly--hence the mention of May, and not Heidegger, by name in the article. Cosmic Latte (talk) 21:49, 8 November 2008 (UTC)

If he was not addressing "depression" per se, then he certainly should not be used as a reference. That seems obvious. —Mattisse (Talk) 22:14, 8 November 2008 (UTC)

It all depends on what is being said. Nowhere is it said that Heidegger is talking about "depression." But maybe that is what he was talking about, after all--see the book link that I provided below. Cosmic Latte (talk) 22:19, 8 November 2008 (UTC)

(outdent) The issue is if there is a reference, you know very well from the quotation below from this article talk page re Carl Rogers:

Only mention Rogers if he said something specific re depression, otherwise not; we could mention loads of people in that case. I think we have plenty in the article already and wouldn't be hunting out Rogers references. Cheers, Casliber (talk · contribs) 12:16, 8 November 2008 (UTC)

Agreed and fixed. Cosmic Latte (talk) 14:39, 8 November 2008 (UTC)

So, please apply standards evenly. —Mattisse (Talk) 22:12, 8 November 2008 (UTC)

I agree that Rogers shouldn't be mentioned if he's not saying something about depression. The same does indeed go for Heidegger, who is not mentioned at all, but is simply cited in passing, in an attempt to elaborate on what May is saying about depression. By the way, for an interesting equation of Heideggerian "existential anxiety" and depression, see p. 149 of this book. Cosmic Latte (talk) 22:16, 8 November 2008 (UTC)

He has said plenty about depression. I just did not supply an article. If Heidegger is important to the history and study of Major depressive disorder, then mention him with proper referencing in the article. Do not disguise him by hiding him in a footnote, under the pretense that you are following WP:MEDRS. And please use edit summaries, as it is rude not to. —Mattisse (Talk) 22:34, 8 November 2008 (UTC)

WP:AGF... EverSince (talk) 05:06, 9 November 2008 (UTC)

Btw actually, re presumably scientifically validated data in this section...WP is also of course about representing notable points of view on subjects, right or wrong (but they should be noted as points of view not facts of course)... EverSince (talk) 05:11, 9 November 2008 (UTC)

Heideggerian existentialism and social work practice with death and survivor bereavement (2006):

One example of application of Heideggerian existentialism in clinical social work practice can be found in the treatment of depression due to unresolved bereavement. Although the client may seek assistance from a social worker for the depression, bereavement issues may come to the surface through the manifestation of the client's depression. The presenting problem of facing one's own death or the death of a loved one can be addressed by Heideggerian existentialism through viewing the client's depression from the total perspective of the client's environment. Therefore, the client can see that the immediate problem of depression, for which the client initially sought help from the social worker, is only the characteristic of unresolved grief. Also, clients may not have dealt with specific life issues, such as relationship difficulties, that often become accentuated when confronted with bereavement issues. The death of a loved one is very representative of the types of problems that can be addressed through the application of such Heideggerian existential concepts as totality and remembering, which will be discussed later.

EverSince (talk) 05:21, 9 November 2008 (UTC)

• Primary source reference from abstract of the article you source:

Heideggerian existentialism has not been applied on a widespread basis to the Generalist Social Work Practice Model. This paper explores the relationship between social work practice with bereavement issues and Heideggerian existentialism. Applications of Heideggerian existentialism in the social work profession with clients and families experiencing bereavement are examined. Conceptual applications also address future utilization of Heideggerian existentialism.

Suggest if you want to use Heidegger, you bring him up in a legitamite way in article content with reliable sources, not in disguised footnote purporting to follow WP:MEDRS. —Mattisse (Talk) 06:11, 9 November 2008 (UTC)

I assume that suggestion is being addressed to Cosmic Latte, seems a fair point though I don't see where s/he purported it followed MEDRS EverSince (talk) 06:23, 9 November 2008 (UTC)

Heidegger is not mentioned more than he is because that would probably be overkill, at least without a separate "Philosophy" subsection; he is not mentioned less than he is because he gives colour to what fellow existentialist Rollo May (who was strongly influenced by Heidegger, and who is discussed in the same chapter in the same tertiary source [Hergenhahn, 2005] as Heidegger) is saying. This is called balance--i.e., a careful consideration of weight, as in "WP:WEIGHT." I've yet to see which part of WP:MEDRS this balance conflicts with, nor have I seen how the good ol' citation process has suddenly transformed into a method of "hiding" POVs in "footnotes." And even if there were a conflict with WP:MEDRS, it would be easy to overstate the point, because this article does not fall strictly under the scope of WP:MED; it is also covered by WP:PSY, and a fair amount of psychology--including the Rogerian approach that you tried to introduce--is not especially congruous with the medical model. Even some psychiatrists, such as R. D. Laing and Thomas Szasz, have taken issue with this model. I'm not going to give my own opinion about the model here, as it is irrelevant, but I do support WP:NPOV. Psychology and psychiatry share boundaries with both medicine and philosophy; indeed, science itself was once a branch of philosophy, known as natural philosophy. To dismiss the philosophical boundary arbitrarily is to defy WP:NPOV, even if to acknowledge it is somehow to conflict with some absolutistic reading of WP:MEDRS that no one else appears to share. Cosmic Latte (talk) 10:27, 9 November 2008 (UTC)

• It does according to Sandy. That is the sole justification of the title of this article, "Major depressive disorder". And Sandy has mentioned WP:MEDRS many times. Again, I advocate changing the title so you can put into the article what you want. —Mattisse (Talk) 02:26, 13 November 2008 (UTC)

Dream interpretation

Although this is neglected in the West somewhat, dreams themes that depressed people get in their dreams could make a very interesting section and fill an omission. Snowman (talk) 12:54, 9 November 2008 (UTC)

Psychiatry has massively moved away from things like dream interpretation with the swing away from psychoanalysis and toward a more biologicla model between the mid 1960s and 1980. I guess the dream article would be a first point of call with some boosting of material from Jung and Freud really. Dreaming was more a part of analysis and thus detached from diagnosis somewhat. Fascinating topic :) Cheers, Casliber (talk · contribs) 13:20, 9 November 2008 (UTC)

OK, perhaps dream interpretation as part of psychoanalysis is beyond the scope of the page. However, it might be worth mentioning something about the themes of dreams depressed people get, as a feature of depression. Just to make something up to illustrate the point - a depressed person is unlikely to dream about flying admiring the view, but might dream about running in quicksand uphill and finding the going difficult. The article would need actual examples of dream themes and not this example I made up. Snowman (talk) 13:31, 9 November 2008 (UTC)

If you can find any good sources that discuss this topic, it might be worth thinking about further. I'm not aware of any myself, but the literature is vast, so who knows? You could try hunting around on Google Scholar to see if you find anything. looie496 (talk) 16:26, 9 November 2008 (UTC)

This paper, by Aaron T. Beck and another author, most certainly looks interesting to me: "The obtained differences between the depressed group and the control group are statistically significant and clear-cut. On the basis of these results the hypothesis that the depressed patients show a greater incidence of dreams with 'masochistic' content than the nondepressed patients appears to be clearly confirmed" (p. 53). Cosmic Latte (talk) 21:13, 9 November 2008 (UTC)

Published in 1958. —Mattisse (Talk) 22:31, 9 November 2008 (UTC)

Suppression of scientific evidence by Looie496

How much are you getting paid for this spin job Looie? I bet you're cheaper than Charles Nemeroff. —Preceding unsigned comment added by Psychotropic sentence (talk • contribs) 01:21, 10 November 2008 (UTC)

I'm sure I'm a lot cheaper than Charles Nemeroff. I reverted your changes for three reasons: (1) they need discussing, (2) you used news items as sources, which is not desirable, (3) this article is struggling to stay short enough for FA and you added a substantial amount of material. I won't revert them again, because I restrict myself to one revert per article per day, but given your apparent determination to push your point of view regardless of the opinions of other editors, I perceive that you're going to run into difficulties. looie496 (talk) 01:37, 10 November 2008 (UTC)

Psychotropic, several editors have been working in collaboration to improve this article. If you have some input, I encourage you to work with them by discussing changes here on the talk page. Please don't let their hard work degenerate into an edit war. I'm sure they will take your proposals for changes seriously if they are well argued. --GraemeL ^(talk) 01:42, 10 November 2008 (UTC)

I acknowledge the issue about moderate depression is worth raising (we discussed it above). I will see how we can do it in a succicnt manner, but not in hte detail as just added. Cheers, Casliber (talk · contribs) 02:13, 10 November 2008 (UTC)

I've replied on my talk page, I won't repeat myself here. Psychotropic sentence (talk) 02:17, 10 November 2008 (UTC)

Essentuially it is a tricky subject to do justice in a brief manner - unfortunately there is some issue over interpretation of response rates in moderate episodes, and yet more issues on how patients are selected for trials (many used to have to rule out people with suicidal thoughts (often, not surprisingly, more serious cases) which make up a fair proportion of psychiatric pracitice, and often the duration of illness is shorter in trial patients than it is in patients seen in psychiatric practice, hence regression to the mean probably plays a role. On the other side there is publication bias and I have wondered what they do actually use as a placebo to make the studies blind at times. I do recall all these issues and more being discussed at length in literature. The idea of an overview article is that it has subarticles - hence there is treatment of depression which should go into more detail on these subejcts too. Cheers, Casliber (talk · contribs) 03:12, 10 November 2008 (UTC)

Psychotropic sentence: See this section of the talk page for further discussion about drug efficacy. Treatment for depression might be the appropriate place to go into some depth about the Kirsch study. It's a fascinating study, and one of the authors was a professor of mine, so I'm certainly not biased against elaboration. But the topic probably merits more elaboration than we can give it in an article as long as this one, especially while it's in the FAC process. Cosmic Latte (talk) 10:05, 10 November 2008 (UTC)

Verdict on Maslow image

Should we keep or nix the diagram of Maslow's hierarchy of needs? It gives some colour (literally) to the humanism paragraph, but, apart from the caption, it doesn't address depression directly and isn't usually used for that purpose. I'm rather ambivalent about it; Casliber seems ambivalent, too; and Skagedal objected to an earlier, larger version of the image, although partially due to its size, which isn't as much of an issue with the current version. I just wanted to see what the consensus is here. Cosmic Latte (talk) 10:28, 10 November 2008 (UTC)

The hierarchy itself never mentions depression. Maslow is not noted for his contributions to the theoretical conceptualizations of depression. It certainly was not a major focus of his writings. This article on depression only has one sentence on Maslow and that sentence does not even mention the hierarchy: "American psychologist Abraham Maslow theorized that depression is especially likely to arise when the world precludes a sense of "richness" or "totality" for the self-actualizer." I submit that this sentence makes no sense to a reader not already familiar with Maslow and his hierarchy. The concepts are very Western world biased. The caption on the hierarchy image contains more accurate information than does the article text. The hierarchy itself is not explained in the article text, so why such prominence pictorially, other than that it is pretty? —Mattisse (Talk) 17:29, 10 November 2008 (UTC)

This time I agree with Mattisse: Although its a beautiful image I do not feel it is really relevant. I would remove it.--Garrondo (talk) 11:30, 11 November 2008 (UTC)

Yes I am ambivalent too, and would remove if the consensus were to do so, which it looks like it is...Cheers, Casliber (talk · contribs) 13:32, 11 November 2008 (UTC)

Opinions about the image seem to be ranging from negative to neutral, so I went ahead and removed it. Cosmic Latte (talk) 14:23, 11 November 2008 (UTC)

Heads up - US spelling

Hi all, I am busy for a few hours. mattise has (rightfully) pointed out US/UK spelling inconsistencies (not surprising given the speed of editing). I would be grateful if anyone could convert UK --> US spelling. Also, I need consensus on best ref for discussion of 'black box' as upon consideration this was an important development. It got alot of press outside the US incl. here in Oz. if some folks can do these, then I can get stuck into other issues (groan). Cheers, Casliber (talk · contribs) 23:56, 10 November 2008 (UTC)

Depression and the elderly

In discussing Major depressive disorder with a USA psychiatrist today, he said that by far Major depressive disorder in the elderly was the biggest problem and accounted for the most diagnoses. Other than mentioning that the diagnosis is primary one of older persons and peaks between 50 and 60 years old, you do not address the issues of depression in the elderly. Is it that you do not see this group has having unique issues? Is there a reason that Major depressive disorder tends to occur and "peak" in older persons? Are there special treatment issues regarding the elderly patient? —Mattisse (Talk) 23:26, 11 November 2008 (UTC)

Absolutely, I was just musing on this as much of the review material with Burden of Disease/etc and epidemiology seems to not really address this. My first find was this note which is leading me off looking for some Review Material to include/look at. I did start an article on pseudodementia some time ago. Give us a few mnutes...Cheers, Casliber (talk · contribs) 02:52, 12 November 2008 (UTC)

PS: Just retrieving the fulltext of this Cheers, Casliber (talk · contribs) 02:54, 12 November 2008 (UTC)

PPS: hmmm..interesting. Cheers, Casliber (talk · contribs) 02:59, 12 November 2008 (UTC)

This topic reminds me of Erik Erikson's notion of "integrity vs. despair" (the latter having something to do with depression) among the elderly. See, for example, here. Cosmic Latte (talk) 03:40, 12 November 2008 (UTC)

Humm, those articles contradict what is in the article already. The lead statement states about the incidence of Major depressive disorder: "The most common time of onset is between the ages of 30 and 40 years, with a later peak between 50 and 60 years." So, that is not true, but there is a decreasing incidence? Also, article(s) have been quoted in the article that say exercise has no proven effect on depression, yet one of your sources above says the opposite. Are "truths" different for the elderly? —Mattisse (Talk) 04:04, 12 November 2008 (UTC)

Elderly these days is often over 70, but usually 65 is the minimum. The two articles are not mutually exclusive. I haven't looked deeply into articles on exercise, and not for the elderly although...Cheers, Casliber (talk · contribs) 06:41, 12 November 2008 (UTC)

I keep forgetting I was involved in doing the Hamiltons for this one... :) Cheers, Casliber (talk · contribs) 06:42, 12 November 2008 (UTC)

Even funnier, the first two of these are me, no idea who the third is...[Author&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVCitation]...Cheers, Casliber (talk · contribs) 06:44, 12 November 2008 (UTC)

Perhaps this issue should be clarified in article with appropriate explanations/hypotheses as to why the elderly (65 >) get happier, with some references. Biological? Psychological? What? Also, common definition of elderly is needed, also referenced. —Mattisse (Talk) 13:58, 12 November 2008 (UTC)

It isn't necessarily true that the elderly get happier. It could be that the unhappiest people die at younger ages, leaving a happier remnant. No individual person needs to get happier to produce the statistics. looie496 (talk) 03:59, 13 November 2008 (UTC)

• These are the kind of things I am wondering about. What accounts for this belief or effect that Major depression is an affliction of older people? —Mattisse (Talk) 04:16, 13 November 2008 (UTC)

It is undoubtedly a common affliction in old age, and I was musing on its prevalence before as it was not mentioned specifically in many of the general review articles on depression, and was intrigued to find what I did when I looked into it. Cheers, Casliber (talk · contribs) 10:09, 13 November 2008 (UTC)

Here is a meta analysis that found positive results for treatment of depression in the elderly, finding a variety of treatments to be equally effective (PMID 16955421). —Mattisse (Talk) 00:04, 14 November 2008 (UTC)

That looks a good one, i will have a read of the full-text and add (gotta jump off the keyboard for a bit, so you are welcome to add beforehand otherwise in a few hours I will look). Cheers, Casliber (talk · contribs) 00:19, 14 November 2008 (UTC)

PS: I note there is a cochrane review as well linked to the right. Cheers, Casliber (talk · contribs) 00:22, 14 November 2008 (UTC)

 Done The more I thought about it the more important it is, as I would assume it may be a misconception among readers that psychotherapy may be of limited use in old age. Cheers, Casliber (talk · contribs) 03:48, 14 November 2008 (UTC)

Mindfulness-based Cognitive Therapy

According to the references, Mindfulness-based Cognitive Therapy is not psychotherapy, but an 8-week class-based therapy. Therefore, it should not be included in the "Psychotherapy" section. —Mattisse (Talk) 02:22, 13 November 2008 (UTC)

Eh? The Mindfulness-based Cognitive Therapy article describes it as a form of psychotherapy in the very first sentence. Could you explain your point a bit more, please? looie496 (talk) 03:50, 13 November 2008 (UTC)

That when I looked at the full text cited as reference for Mindfulness-based Cognitive Therapy, it said the study was confounded by the fact that "usual care" that the subject received did not incude antidepressant or psychotherapy. —Mattisse (Talk) 04:22, 13 November 2008 (UTC)

I don't see any specific mention at all of "psychotherapy" in the cited article (PMID 18085916)..? But I see the point, I'm not very familiar with MBCT but it seems to be mostly an educational approach. One solution would be to use the more general heading "Psycho-social treatments". But also, it depends on your definition of "psychotherapy" – this term seems to often be used rather broadly, encompassing many different kinds of psychological treatments. /skagedal^... 09:02, 13 November 2008 (UTC)

It definitely is a form of psychotherapy. I need to look up some definitions..(psychotherapy is a broad def)Cheers, Casliber (talk · contribs) 10:07, 13 November 2008 (UTC)

This is an educational approach. It does not involve forming a "therapeutic relationship". —Mattisse (Talk) 14:49, 13 November 2008 (UTC)

"Some of the key ideas in mindfulness based psychotherapy and research are radically different from our cultural (and perhaps human) assumptions". Cosmic Latte (talk) 20:19, 13 November 2008 (UTC)

• Again, that does address Mindfulness-based Cognitive Therapy (MBCT) which is a class-based program per [6]:

• "The MBCT programme takes the form of 8 weekly classes, plus an all-day session held at around week 6. A set of 5 CDs accompany the programme, so that participants can practise at home once a day throughout the course."
• Per [7], MBCT classes: "In MBCT programmes, participants meet together as a class (with a mindfulness teacher) two hours a week for eight weeks, plus one all day session between weeks 5 and 7. The main ‘work’ is done at home between classes. There is a set of CDs to accompany the programme, which you use to practise on your own at home once a day. In the classes, there is an opportunity to talk about your experiences with the home practices, the obstacles that inevitably arise, and how to deal with them skilfully."

• A "teacher" is not a psychotherapist. —Mattisse (Talk) 20:27, 13 November 2008 (UTC)

• Says who? Cosmic Latte (talk) 20:35, 13 November 2008 (UTC)

• I don't know what that diff is supposed to prove. The fact is that Mindfulness-based Cognitive Therapy (MBCT) describes itself as a class-based program. Psychotherapy is not class-based. —Mattisse (Talk) 21:03, 13 November 2008 (UTC)

• Further, the reference you gave[8] does not say MBCT is psychotherapy. After examining four studies (all that could be found), all it says regarding psychotherapy is: "The researchers are trying to say, look, we think the research that has looked at MBCT has found some positive results (for those 3 or more depressive episodes — in other words, people with more chronic, treatment resistant type of depression). But none of the research could say it was the MBCT or some non-specific general therapeutic effects often found in psychotherapy treatment studies." It also says "So the answer of its effectiveness remains elusive, but people will continue to pursue MBCT regardless." Not a ringing endorsement. —Mattisse (Talk) 21:14, 13 November 2008 (UTC)

May I humbly suggest that this discussion is kept on one place, preferrably this? There have been repeated requests of keeping the FAC page short and to the point, and keeping lengthy discussions on this page. Mattisse asked on FAC: Where does it say that Mindfulness-based Cognitive Therapy (MBCT) is Cognitive behavioral therapy + meditation?. I'd point to this passage in the text: The 8-week, class-based MBCT program combines mindfulness training (Kabat-Zinn, 1990) with elements of cognitive–behavioral therapy for depression (Beck, Rush, Shaw, & Emery, 1979), and teaches patients to recognize and disengage from modes of mind characterized by negative and ruminative thinking and to access and use a new mode of mind characterized by acceptance and “being” (Segal et al., 2002). So while it takes an educational approach, it includes components of CBT, which makes it topically close enough to be under this heading, if it should be in the article, IMHO.

I do think that the available research on MBCT is a bit lacking (four studies?) to justify inclusion here, though. The article mentions nothing about purely behavioral treatments, which have a long history, with modern approaches such as behavioral activation that have received good support. (e.g., PMID 17184887) /skagedal^... 21:19, 13 November 2008 (UTC)

Agree. There are a bunch of "alternative" therapies if you want to mention "mindfulness". Why not mention Acceptance and Commitment Therapy (ACT) which says "ACT is sometimes grouped together with Dialectical behavior therapy, Functional Analytic Psychotherapy, and Mindfulness-based Cognitive Therapy as The Third Wave of Behavior Therapy." I also suggest Behavioral activation as an alternative. —Mattisse (Talk) 21:14, 13 November 2008 (UTC)

• Albert Ellis's Rational Emotive Behavior Therapy should be mentioned since has a long history and was one of the first Cognitive behavioral therapy to gain wide recognition and is still practiced today. It had a huge impact on the field of psychology, and specifically the practice of psychotherapy. —Mattisse (Talk) 22:02, 13 November 2008 (UTC)

• Certainly nothing wrong with mentioning REBT, although it's already noted in the caption to "Albert Ellis 2003 emocionalmente sentado.jpg," which is currently commented out due to copyright concerns. As for mentioning more alternative therapies, I normally wouldn't object, except that article length and WP:DUE might be issues in this article's case. As with the Heidegger issue, though, there's no WP:ABSOLUTISM; we don't need to say either everything or nothing about a given topic, and one or two alternative approaches should suffice. And I still see no problem with referring to MBCT as "psychotherapy," and I find the attempt to distinguish between "teachers" and "psychotherapists" somewhat contrived. Let me put it this way: What adjective would you use to describe MBCT teachers? Primary? No. Postsecondary? No. Financial? No. Dietary? No. Spiritual? Eh, maybe to an extent. How about "psychotherapeutic"? It seems a decent fit. Besides, in the US at least, the word "psychotherapist" (unlike "psychologist" and "psychiatrist") is not officially regulated. If what you do can, within reason, be construed as therapy for the psyche, then you have every legal and semantic right to call yourself a psychotherapist. Why not give MBCT practitioners their moment in the sun? After all, she would, and I'd be willing to bet that he would, too. Cosmic Latte (talk) 09:52, 14 November 2008 (UTC)

• Again, that does address Mindfulness-based Cognitive Therapy (MBCT) which is a class-based program per [9]: "The MBCT programme takes the form of 8 weekly classes, plus an all-day session held at around week 6. A set of 5 CDs accompany the programme, so that participants can practise at home once a day throughout the course." Per [10], MBCT classes: "In MBCT programmes, participants meet together as a class (with a mindfulness teacher) two hours a week for eight weeks, plus one all day session between weeks 5 and 7. The main ‘work’ is done at home between classes. There is a set of CDs to accompany the programme, which you use to practise on your own at home once a day. In the classes, there is an opportunity to talk about your experiences with the home practices, the obstacles that inevitably arise, and how to deal with them skilfully."

Albert Ellis should be in article The Daniel Goleman [http://www.mbct.co.uk/ "glowing review" repeatedly mentioned by Cosmic Latte is at the MBCT company website. The article he mentions above [http://psychology.berkeley.edu/faculty/profiles/erosch2007.pdf does not mention MBCT but talks of mindfulness as a general approach. Cosmic Latte states, "Why not give MBCT practitioners their moment in the sun?". This article is not the place to give a scantly research packaged program with "dubious" effectiveness advertising space as an example of "mindfulness" therapy. Why not mention Acceptance and Commitment Therapy (ACT) which says "ACT is sometimes grouped together with Dialectical behavior therapy, Functional Analytic Psychotherapy, and Mindfulness-based Cognitive Therapy as The Third Wave of Behavior Therapy." As /skagedal said above:

"I do think that the available research on MBCT is a bit lacking (four studies?) to justify inclusion here, though. The article mentions nothing about purely behavioral treatments, which have a long history, with modern approaches such as behavioral activation that have received good support."

If Albert Ellis is commented out in the article, then he is not in the article. He is one of the pioneers of Cognitive behavior therapy. His Rational Emotive Behavior Therapy has had a huge impact on the field of psychotherapy. He is a psychologist and a psychotherapist. His omission from this article is glaring. —Mattisse (Talk) 15:03, 14 November 2008 (UTC)

Did you even read the Rosch paper? Here are some lines from this article that, you say, "does not mention MBCT": "These systems are: Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002; Teasdale & Barnard, 1993), Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b), and Acceptance and Commitment Therapy (ACT; Hays, Strosahl, & Wilson, 1999)" (p. 5). "MBSR and MBCT incorporate actual meditation sessions as part of the practice" (p. 5). "Facilitators in MBSR and MBCT are required to have had mindfulness meditation experience in formal settings for good reason; early MBSR groups led by individuals who lacked personal experience tended to be ineffective. MBCT, DBT, and ACT are actual therapies" (pp. 5-6). And no one is objecting to mentioning Ellis or REBT. Cosmic Latte (talk) 15:18, 14 November 2008 (UTC)