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Tryptophan

Interestingly, tryptophan is prescribed in the UK and it has a licence as adjunctive therapy for resistant depression and used only under specialist supervision - there is risk of eosinophilia-myalgia syndrome and some drug interactions (again ref is the BNF). Snowman (talk) 14:56, 4 December 2008 (UTC)

Where's this BNF reference? The Cochrane review notes that no eosinophilia-myalgia syndrome occurrences have happened since the last incident in 1989, which was traced to a contaminated supply. The full-text also says the "link remains unproven". Given that all of these substances have major side-effects and drug problems, a vague warning about long-term safety and link to the article page is probably sufficient. Going into detail on a speculative condition seems a little undue, especially when similarly dangerous things side effects occur with conventional pharmaceuticals. II | (t - c) 21:09, 4 December 2008 (UTC)
BNF(56) page 213 "...it has been associated with eosinophilia-myalgia syndromve." Snowman (talk) 22:01, 4 December 2008 (UTC)

Rating scales

I would agree on creating a separate article with a title similar to rating scales (medicine); since it does not exist right now. We would have the info on depression rating scales for the moment and I could easily add some info on the use of cognitive perception deficits questionnaires. We would eliminate one further section which could be easily sumarized into the clinical assessment section. Best regards.

Additionally: is the use of bold and bullets correct in the subtypes section? I don't think bold is needed. Would not italics be more correct?

Finally: I think that the reduction of the history section is a good one: The new article is quite complete. Best regards.--Garrondo (talk) 14:25, 4 December 2008 (UTC)

It is good that there are several people keen to make a new article on rating scales. Rating scales (medicine) would make a great article. Snowman (talk) 15:01, 4 December 2008 (UTC)
Agree. I was dismayd as I ruminated over summarising scales section somehow. Still think it is more notable than some other material. Cheers, Casliber (talk · contribs) 00:17, 5 December 2008 (UTC)
Article size now 467 kB. Snowman (talk) 15:21, 4 December 2008 (UTC)

St John's wort

From my point of view if a treatment is worth a cochrane review it should be included per notability: I would at least leave a line such as: There is inconsistent evidence on the effect of St John's wort extract on major depression.[1] either in the medication or other subsections

Best regards. --Garrondo (talk) 14:52, 4 December 2008 (UTC)

I run too much in writting this. It has been done already.--Garrondo (talk) 15:02, 4 December 2008 (UTC)
Is these info needed?: St John's wort interacts with a number of prescribed medicines including other antidepressants, oestrogens and progesterones, and can reduce the effectiveness of oral contraceptive pills.[151]: I believe it should appear in the St John's article and not depression.--Garrondo (talk) 15:05, 4 December 2008 (UTC)
Absolutely yes, there is a need, as it is potentially harmful. In the UK St John's Wart in not licensed for depression (I can provide a ref in the BNF), so there is a need to be careful about describing it. In time I hope to check the articles refs and check that it is prescribed in Europe. Snowman (talk) 15:10, 4 December 2008 (UTC)
I do not say that info is not important; only that I feel that it is not in the scope of an article in depression; no info on interactions or side effects is given for any other medication. I believe it should appear in the secondary article on treatments and also in the St. Jonhs article.Nevertheless I do not have too strong feelings about it.--Garrondo (talk) 15:31, 4 December 2008 (UTC)
These are quite well known hazards of St John's Wart. About SSRI, the article says "relatively mild side effects, and because they are less toxic in overdose than other antidepressants." It also refers to safety issues of venlafaxine, and a specific risk of hyponatraemia in SSRI. "Monoamine oxidase inhibitors, an older class of antidepressants, have been plagued by potentially life-threatening dietary and drug interactions". Snowman (talk) 15:37, 4 December 2008 (UTC)
OK, I accept your point in part, and have shortened it keeping it to essentials only. Snowman (talk) 16:18, 4 December 2008 (UTC)
Sounds better: I would still eliminate the info on contraceptive pills since I believe it is not very related to this article. But it is only my opinion. Best regards.--Garrondo (talk) 16:39, 4 December 2008 (UTC)
I believe it is highly related to this article where St John's wort is mentioned. Interactions and side effects are mentioned with other drugs, and are a consistent theme of the drug medication sections. As it is an OTC medicine in some parts of the world, I think that is is very important to mention drug interacions as one of the complications of taking St John's wort. I have just checked the ref, and I believe it to be any sort of hormonal contraception, so have have made an appropriate wikilink. The interactions are only a few essential words. It increases drug metabolism and these are some of the effects of that. Snowman (talk) 17:01, 4 December 2008 (UTC)

Depression and culture

I would create this subsection in the history section to include the 3 par more historically orientated (historical figures, relation with creativity, and literature as a relief). These 3 paragraphs could be simplified in main article. --Garrondo (talk) 14:57, 4 December 2008 (UTC)

References

Can someone please explain why we are using two different kind of citations styles? I see the typical citet versions, sprinkled with Harvard style. It's messy. If we're concerned about page numbers, then convert all of the references to Harvard style. I personally believe that these articles should never use books as citations, because they are several years out of date upon publication. It's so easy to find secondary sources, oftentimes with full text available, that are far superior to the books. Real science researchers don't use books. OrangeMarlin Talk• Contributions 17:31, 4 December 2008 (UTC)

Apparently it is ok to use two types of citations as used in this article. There is discussion above, on the talk page. I cannot explain it. Also, I agree with you about the books, as well as out-of-date reviews and primary sources. If you could convince Casliber of that, it would be wonderful. —Mattisse (Talk) 20:28, 4 December 2008 (UTC)
Do you really want to rule out DSM-IV as a source? Or the Letters of William James? This may need a little bit of qualification… Looie496 (talk) 20:58, 4 December 2008 (UTC)
I have tried to use them judiciously. DSM IV TR will not be outdated until DSM V. Some basic material that I referenced with Sadock is too basic to appear in journals. Everyone is welcome to find review articles. (man tehre was some action overnight!) Cheers, Casliber (talk · contribs) 23:20, 4 December 2008 (UTC)
I think OrangeMarlin is referring to textbooks, not references to the source you are actually using, like someone's letters or a version of DSM. —Mattisse (Talk) 00:44, 5 December 2008 (UTC)
I'm referring to general textbooks. DSM IV is kind of like the Bible--it would be difficult to discuss this article without it, as much as it would be difficult to discuss JC without the Bible. I'm talking about some of the books used in the Harvard references--I already deleted one. But just to rant, I never liked the Harvard references, since it takes two clicks to get to the citation (and one more to go out of Wikipedia to actually read the reference), whereas CITET is a one click. The problem, I realize, is the page issue. I wish CITET handled that better. OrangeMarlin Talk• Contributions 00:51, 5 December 2008 (UTC)

Expanding 'Other Treatments' Section

I am a therapist and researcher who specializes in non-pharmaceutical treatments for depression. There are several treatments not included in this section that have been shown to treat depression effectively. Some include volunteering, negative ion generators, and multiple nutritional supplements. Please review www.depressiontreatmentworks.org to see if you agree there are several treatments on that site that warrent inclusion. That site is fully referenced. Thank you Postcrypto (talk) 21:31, 4 December 2008 (UTC)

That's actually a pretty nice site in some ways, but the documentation for most of the "alternative" methods don't seem to meet Wikipedia's standards. Generally in a Wikipedia article it's not appropriate to cite "primary sources", i.e., reports of individual studies, because it is almost impossible to avoid imposing an original interpretation on them (also known as "cherrypicking"). As a rule, if there isn't a review article in one of the leading medical publications, we probably don't want to go there. That doesn't mean it isn't correct, just that it isn't ready for Wikipedia. (Some the stuff in your "Reviews of Specific Depression Treatments" does meet Wikipedia standards, and some of them are actually used in the current article.) Looie496 (talk) 22:04, 4 December 2008 (UTC)
In any event, this article is not meant to cover all treatments of depression. The topic is a specific diagnosis, not depression in general. There is an article, Treatment of depression, that is meant to be a more in depth exploration of treatments. —Mattisse (Talk) 22:21, 4 December 2008 (UTC)
Postcrypto is a CAM pusher obviously. Nothing there warrants any further analysis. OrangeMarlin Talk• Contributions 00:53, 5 December 2008 (UTC)

Omega-3 fatty acids

"Evidence for omega-3 fatty acids is too mixed and limited to make a strong conclusion, although the available evidence does not support their use.[155]". Does this say it is not used for MDD? Can it be removed? Snowman (talk) 22:25, 4 December 2008 (UTC)

Sounds like a very wishy-washy statement that is not worth keeping ("too mixed and limited"). Stating the negative (the world is not square) for no reason! —Mattisse (Talk) 23:03, 4 December 2008 (UTC)
The article is freely available.[1] The evidence isn't great, but I feel it should be included, because n-3 fatty acids are popularly known for this association, and there is some epidemiology and biochemical theory behind it. Basically a bunch of small trials found positive results, and one large trial found that they are not (graph). The negative trial to which they accorded nearly half the weight basically told 452 people to eat more fish,[2] rather than giving a fish oil pill to one group and a placebo pill to the other. But if other people want to take it out I'm certainly not going to fight that move. II | (t - c) 23:10, 4 December 2008 (UTC)
It is acknowledged in the article that SSRI's may not have antidepressant effects beyond placebo. I believe that holding other treatments to higher standards than pharmacotherapy would not be fair or honest. I vote to keep omega-3's Postcrypto (talk) 23:25, 4 December 2008 (UTC)
The exact quote is "A large 2008 meta-analysis of past studies reported that the response to antidepressant treatment in moderate depression were not shown to exceed that of placebo;[115]". This is why they are used for severe depression. It seems that you have not understood the text, so would you like to reconsider your vote? Snowman (talk) 23:42, 4 December 2008 (UTC)
Another factor is how widespread a particular treatment is used and or talked about. Hence St Johns wart (and some others) needs discussion Cheers, Casliber (talk · contribs) 23:53, 4 December 2008 (UTC)
One line on omega-3 fatty acids is not much discussion. Snowman (talk) 00:20, 5 December 2008 (UTC)
Perhaps the sentence on SSRI and placebo should be rewritten to help people understand it. It could be explained better. Snowman (talk) 00:26, 5 December 2008 (UTC)
I removed the fatty acid sentence, since it did not say anything one way or another. Where is the sentence on SSRI and placedbo? I couldn't find it. I did notice that placebo is linked, so that might help. Also, I changed "Other" to "Alternative" but change if you want. Anything just seems better to me than "Other"! —Mattisse (Talk) 00:41, 5 December 2008 (UTC)
We cannot put in therapies that just aren't proven. I'm glad it was removed. As for St. John's Wort, there isn't a speck of reliable evidence that has any effect on MDD. I've never been in favor of including information in these articles just because it's in popular use. MDD sufferers who treat themselves with SJW are idiots. And we're enabling idiots by not being clear about what these compounds can and cannot do. The research is very very very weak. OrangeMarlin Talk• Contributions 00:47, 5 December 2008 (UTC)
I believe the wikipedia quote is understated and would like to reaffirm my objection to deleting omega-3s. To quote from the reference "Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication." This should set the standard for what kinds of treatments are presented (those that clearly beat a wait-list but have small and debatable effects beyond placebo.) I believe that having such a large section on drugs and such a small one on alternative treatments with equitable evidence paints a misleading picture for people who are trying to make an informed choice about their treatment. Postcrypto (talk) 01:14, 5 December 2008 (UTC)
Well, I urge OrangeMarlin to make the changes you see fit. There are a bunch of uncritical "Supports" so this article is going to become a FA in any case, so it would be great if it were also a decent article. I think I would agree with any changes you made. (I have that feeling.)
Also, the article is too long (having download problems), has an irrelevant image that is hefty (Caption: Overview of the human "circadian biological clock" showing the chronotype of someone who arises early in the morning and goes to sleep at 10:00 pm, with some physiological parameters) and is not crisply focused. At least a huge "History" section has been pared down. And the "Causes" > "Psychological" no longer wanders on about existentialism — improvements from my point of view. —Mattisse (Talk) 01:18, 5 December 2008 (UTC)
To postcrypto, alternative treatments exist because they lack proof, in terms of real research, in their efficacy. In addition, most of their safety is suspect. Real medicine and science are required here. OrangeMarlin Talk• Contributions 01:19, 5 December 2008 (UTC)
More of a philosophical point, but I despise the omega oil industry because of what it's doing to the ocean ecosystem, especially coastal environments on the Atlantic and Gulf Coasts of North America. And given the raping of our ocean environment to provide little pills for a useless product, I am going to stand up to its inclusion in articles, unless there is overwhelming evidence.OrangeMarlin Talk• Contributions 01:22, 5 December 2008 (UTC)
Postcrypto, this article is not supposed to be giving information "for people who are trying to make an informed choice about their treatment." This is an encyclopedia article, not a medical advice source. —Mattisse (Talk) 01:24, 5 December 2008 (UTC)
SSRI misunderstanding has ref 115 at the end of its line, at least that is where I thought the quote came from, but the second placebo quote does not appear to be in the article.Snowman (talk) 01:26, 5 December 2008 (UTC)
I think "and/or mention" added (this edit) after the strike by Casliber above appears to change the meaning of what he said, and hence the sense of my reply. It is bad practice to change edits after people have commented on it, so I would be grateful if the extra words added after my reply (after the strike) could now be removed. Reformating that improves the layout or improving the readability is allowed, but changing what you said is not good practice. If you like, say this is what you meant as a separate edit, but you should not make my reply look odd, by changing your edit retrospective to such an extent that the meaning is changed. Snowman (talk) 02:10, 5 December 2008 (UTC)

OK, pages taking a long time to load where I am. Can you see what I meant though? also, I have removed some more from history now. The version of IE on the computer I am at won't let me do Dr PDAs tool properly for some reason. Cheers, Casliber (talk · contribs) 02:25, 5 December 2008 (UTC)

Fine, I see you have removed the late addition. Using the tool the file size is now 457 kB. Snowman (talk) 02:32, 5 December 2008 (UTC)

ECT

The ECT section has also deterioriated into more typos & bad sentences. And in the meantime more recent RCTs and surveys have been removed (which happened to show that nearly everyone relapes and even initial remission rates are much lower in practice) in favor of older more positive reviews. And a vital point that some authorities don't recommend maintenance ECT 'cos not evidence-based & may be harmful, was also removed. And then going the other way, critical factual claims added sourced to unreliable Breggin quotes... EverSince (talk) 00:10, 8 November 2008 (UTC)

Gosh, when did that happen? Oh well...time to clean up..Cheers, Casliber (talk · contribs) 01:33, 8 November 2008 (UTC)
Well some of the changes could no doubt be argued & there's advantages to some of the new sources...just difficult when other reliable soruces removed without discussion. EverSince (talk) 02:00, 8 November 2008 (UTC)
Yeah, a fly-by person with a strong point of view too..(in Hx)Cheers, Casliber (talk · contribs) 03:51, 8 November 2008 (UTC)
Thank you for making comments on the ECT section. I am sure that the article would benefit from more new people reading the article for the first time and offering their comments, and I hope that your comment will inspire further improvement to the article. It is an enormous task checking this article with over 200 refs and problems are still turning up every day, so if you see anything odd please provide comments on your observations, and I hope you will find participating in the discussion interesting. Snowman (talk) 10:42, 5 December 2008 (UTC)

Strange ref?

Purves, D., Augustine, G. J. et al. "Molecular Mechanisms of Biological Clocks". www.ncbi.nlm.nih.gov. Retrieved on 2008-12-05.

Clicking on this ref, presently #34, takes one to another title with other authors. - Hordaland (talk) 18:01, 5 December 2008 (UTC)

I fixed the link and the rest of the cite. Don't know who added it -- there's so many changes to this article they're hard to track. It actually isn't a very good link for the assertion, and the paragraph it's in is sort of "hanging" -- it doesn't establish any relevance to MDD. I'm going to assume this is work in progress and leave it alone for the moment. Looie496 (talk) 18:19, 5 December 2008 (UTC)

Biological clock human image

1. Does this image describe the circadian rhythm of males only? There is an image of a male in the middle of the clock and testosterone levels are mentioned on the perimeter. Snowman (talk) 20:35, 27 November 2008 (UTC)

2. This diagram appears to be providing a lot of information sourced from a book by Michael Smolensky and Lynne Lamberg (2000). called "The Body Clock Guide to Better Health", as indicated by the image description. Since the image description will not appear on a print out of the page, should this reference appear as an inline ref in the caption? Have there been any changes since 2000? Snowman (talk) 21:04, 27 November 2008 (UTC)

3. I think that this image should be removed. Instead, the text could explain what the commonest sorts of disruption of the circadian rhythm are. Snowman (talk) 13:58, 28 November 2008 (UTC)

Replies - it is a da vinci man, so I guess can be interpreted as human rather than male man in a 15th century sorta way. Still, I do see that it is a little tangential to the text. I do like it more than some other stuff we have found but can see it is not an exact 'fit' to the article. Happy to see what others think. I won't fuss too much if the consensus is to remove. Cheers, Casliber (talk · contribs) 14:21, 28 November 2008 (UTC)
I guess that interpretations of the 15th century man may vary, and not everyone will interpret it as meaning humans in general. The perimeter with testosterone levels combined with the male image may tend to indicate that the chart is for men only. Does anyone know what the reference says about testosterone changes in women? Snowman (talk) 14:45, 28 November 2008 (UTC)
Yeah, it's a bit like using the word "mankind" to refer to everybody--easy to make a fuss over if you're feeling obstinant, but otherwise no biggie. This is a difficult article to illustrate, and I never imagined that the circadian rhythm could be illustrated so beautifully. Also, research seems to indicate a strong relationship between circadian rhythm and depression, so I'd say that the image works on both an aesthetic and a scientific level. I say let it be. Cosmic Latte (talk) 14:48, 28 November 2008 (UTC)
And if the testosterone changes apply only to men, then this could just be noted in the caption. Cosmic Latte (talk) 14:50, 28 November 2008 (UTC)
Also, does "greatest muscle strength 17.00pm" apply to women? Are "bowel movements suppressed at 10.30pm" and "are bowel movements likely at 8.30am"? Interpreting it literally, it appears to me to suggest that it is not possible to have a bowel movement at 11.00pm. Snowman (talk) 15:07, 28 November 2008 (UTC)
It is a prototype, a generalization. If I draw a diagram of the worker's day, I might have the shift begin at 9 am and end at 5 pm. This doesn't mean that you can't go to work earlier or leave later (or vice versa), but it implies a likelihood that if you go to work at 8, you'll come home at 4. Cosmic Latte (talk) 15:49, 28 November 2008 (UTC)
It is on the linked "circadian rhythm" page where anyone can see it, and I think that with a image width of 400px it has too much prominence on this page. Snowman (talk) 17:40, 28 November 2008 (UTC)
It's that big only for readability. Feel free to resize it if you'd like. Complete removal seems too drastic, though, given that the research link to depression is so strong. Cosmic Latte (talk) 19:58, 28 November 2008 (UTC)
  • Seems like "biological clock" or "circadian rhythm" is a general concept and not specific to depression. Most of what is in the image, and takes out the most space, is not addressed in this article, eg bowel movement likelihood, fastest reaction time, greatest cardiovascular efficiency, bowel movement suppressed. There is only a one sentence mention in the text.

Major depression may also be caused in part by an overactive hypothalamic-pituitary-adrenal axis (HPA axis) that is similar to the neuro-endocrine response to stress. Investigations reveal increased levels of the hormone cortisol, enlarged pituitary and adrenal glands, and a blunted circadian rhythm.

The image seems irrelevant to the statement in the article. Does this image convey enough information relevant to this article on Major depressive disorder? —Mattisse (Talk) 20:18, 28 November 2008 (UTC)

Nearly the entire paragraph is about the circadian rhythm: "Oversecretion of corticotropin-releasing hormone from the hypothalamus is thought to drive this, and is implicated in the cognitive and arousal symptoms.[2] The REM stage of sleep, in which dreaming occurs, tends to be especially quick to arrive, and especially intense, in depressed people. Although the precise relationship between sleep and depression is unclear, it appears to be particularly strong among those whose depressive episodes are not precipitated by stress. In such cases, patients may be especially unaffected by therapeutic intervention.[3]" Cosmic Latte (talk) 20:22, 28 November 2008 (UTC)
The same thing could be said about the synapse. Or the suicide stats. Or Freud. Or Lincoln. Or, perhaps, about most images in most articles. The point is to make the article visually interesting in relevant ways. There is no picture of "major depressive disorder" per se, as it is difficult to illustrate an abstraction. Cosmic Latte (talk) 20:11, 28 November 2008 (UTC)
I've shrunk both images in the biological section a bit, so as to make them less unwieldy. Cosmic Latte (talk) 20:16, 28 November 2008 (UTC)
  • But the specific information in the image is not referenced in the article. Are the timings of the bowel movements correct, for example? Is the information in the image scientifically validated? Or is it just someone's compilation? Is the information in the image specific to the issues raised in that section in the article? It is a pretty familiar image, as someone notes, dating back to da Vinci. —Mattisse (Talk) 20:29, 28 November 2008 (UTC)
  • The information in the image is referenced on the image page itself: "Informations were provided from 'The Body Clock Guide to Better Health' by Michael Smolensky and Lynne Lamberg; Henry Holt and Company, Publishers (2000)." Cosmic Latte (talk) 20:41, 28 November 2008 (UTC)
  • I see no reason to assume so; women have testosterone, too. But, for the sake of argument, let's say that it applies only to men. In that case, an image including women as well would be unnecessarily complex for this article. Maybe it applies only to adults, too. Should we therefore desire an image pertaining to children, as well? Things could easily get out-of-hand in the name of comprehensiveness and/or political correctness. Concepts like "circadian rhythm" and even "biological clock" may strike some readers as extremely vague, and the image does a nice job of schematizing and simplifying things. In other words, it does precisely what an illustration ought to do: it illustrates. Cosmic Latte (talk) 21:30, 28 November 2008 (UTC)
  • Circadian rhythm also includes a reduction of urine output at night, but this is omitted from the chart. Why is this? Another major omission is that is does not provide the times of starting and beginning sleep. Snowman (talk) 21:39, 28 November 2008 (UTC)
  • The citations you give are are all to popular book reviews. The last one says it is "about a new area of medicine called "chronomedicine" and a new approach to treatment called "chronotherapy". Do you have evidence that chronomedicine and chronotherapy are valid, and researched-based? Quote from one of the book reviews:

    "Whether it's arthritis or asthma, diabetes or depression, heart disease or ulcers, breakthroughs in chronomedicine can revolutionize your care. To help you assess your own chronobiological status, the book provides many fill-in diaries that let you track when symptoms worsen or diminish, how medication affects them, how long relief lasts, and whether and when side effects occur."

It sounds more like a self-help book. It gives "tips" on how to get a good night's sleep. The article on chronotherapy is not very convincing. —Mattisse (Talk) 23:54, 28 November 2008 (UTC)

  • It did not take me long to find a ref that appears to contradict the diagram. This ref says that there is a secondary period of sleepiness in the mid afternoon, which appears to indicate that the diagram is wrong as this can not be expected to be consistent with the best coordination and fastest reaction times. Snowman (talk) 10:22, 29 November 2008 (UTC)
Damn, you're right Snowman, this material I should have remembered...oh dear, not so good :( Cheers, Casliber (talk · contribs) 10:34, 29 November 2008 (UTC)
I would be grateful for clarification of what this is saying or not saying about the image. Snowman (talk) 12:12, 29 November 2008 (UTC)
The person in the illustration is obviously a (Chronotype) lark who gets up fairly early in the morning. Lowest core body temperature is usually said to be at about 5 a.m., here it's 4:30. If this person feels a need for a nap, it will be closer to 1 p.m. By 2:30 the circadian 'drive for wakefulness' will have kicked in, consistent with the best coordination and fastest reaction times. --Hordaland (talk) 12:55, 29 November 2008 (UTC)
The Wikipedia article Chronotherapy specifically states at the top: "This article is about treatment for circadian rhythm sleep disorders. The term "chronotherapy" can also refer to the optimization of schedules for administering medication." Timing of cancer treatments etc relative to a person's circadian rhythms is not included in that article. The article is about a treatment, not about the timing of sundry other treatments.
"Timing of medical treatment in coordination with the body clock" is mentioned in the Circadian rhythm article, though briefly. - Hordaland (talk) 12:25, 29 November 2008 (UTC)
But the section of the article this image illustrates has to do with the biology of depression, not timing of medical treatment in coordination with the "body clock". The article section does not mention the "body clock", nor treatment of sleep disorders, nor any kind of treatment. It is for a human who arises early in the morning, according to the image description. Is it for humans worldwide or for Americans or what. What is early in the morning? This is a nonscientific image for a selfhelp book aimed at Americans. —Mattisse (Talk) 16:19, 29 November 2008 (UTC)
It is an illustration, intended to illustrate. To give people some idea as to what might be meant by "circadian rhythm" or "biological clock." To supplement the text. Pretty simple, really. Cosmic Latte (talk) 16:25, 29 November 2008 (UTC)
There appears to be some uncertainty regarding what the illustration says about testosterone levels in a woman, or if the illustration is only for a man. Could you double check what the book says? Snowman (talk) 17:11, 29 November 2008 (UTC)
The book is not a reliable reference anyway. It suggests how to schedule sleep and other daily behaviors in order to remedy a variety of disorders, but primarily sleep disorders. Anything the books says about testosterone in women would have to be verified by a reliable source. This is a self help book written for lay persons in the US. The info in the diagram needs to be referenced to a reliable source. If the image came from a reliable source, that source should be given. As it unlabeled, the image is WP:Original research. The article only mentions circadian rhythm once, and that once is linked in the article. If further explanation is needed, which I doubt, the wording can be changed in the article to "daily physiological rhythms in the body are reduced in amplitude" or something. But I don't think the statement in the article section is that important, as it is only suggested as a hypothesis anyway. The image is being used to illustrate this article in the section.[6] —Mattisse (Talk) 20:26, 29 November 2008 (UTC)
Has anyone who has edited the page within the last three months (or more) seen this book? It is rather difficult to put a {{cn}} statements on the peripheral of the clock, but verification (perhaps page numbers) has been requested here about the validity of statements on the chart. Usually page numbers from the book are needed so that facts can be verified easily. Verification (perhaps the page numbers on the book) is needed for:
1. To establish if the chart is for a man, or a woman, or either Resolved
1a.To verify the testosterone changes in a woman in the morning, if the chart is for a woman Resolved
2. To verify the times of bowel times stated on the chart
3. To verify if there is more sleepiness in the afternoon, as indicated in a reference provided above
4. To verify the times and nature of maximum CVS efficiency and muscle strength
5. To establish why changes in urine output are not included, and why of a lot of detail of other functions was included. Snowman (talk) 23:17, 29 November 2008 (UTC)

I presume that if page numbers or alternative verification is not provided, then the questioned material can be removed, as is usual on the wiki. Snowman (talk) 23:36, 29 November 2008 (UTC)

If I can get ahold of a copy of the book, I'll be happy to check this stuff, but I see no reason not to trust the creator of the image. Once again, the point of the image is to provide a general visual overview of the circadian rhythm, not to turn the reader into an expert on all of its details. Lots of questions remain about lots of things in life (hence the "further research" sections of academic reports), but unless something in the image is demonstrably false, this seems like too exacting a critique of something whose main purpose is to convey not detail or exactness, but generality. If it turns out that further qualifications can be made to the image, then they can be made in the caption. It does not seem to me that the reader will be severely misinformed upon reading, "circadian rhythm" and then seeing the (reasonably well-sourced) circular "biological clock" image and then going, "Aha! I get the idea now." Cosmic Latte (talk) 09:59, 30 November 2008 (UTC)
I think I could modify the image to remove the bits that are in question. Snowman (talk) 10:45, 30 November 2008 (UTC)
That would be wonderful and much appreciated. I like the diagram but would be good to have all checked etc. Cheers, Casliber (talk · contribs) 11:35, 30 November 2008 (UTC)
  • But wait. Cosmic Latte refers above to the difficulty of illustrating this article nicely – yet SandyGeorgia seems to be saying (below) that there are too many pictures, affecting load time? What do the guidelines say on this...? Because if some picture should be removed, I'd vote for this one. My main problem with it is that in it's current size, the text on it is not readable; you have to follow the link to the real picture. And if size is increased so that the text is readable, it takes up too much space. This, plus that I don't find the illustration really that relevant to the text, I'm for removing it, if we need to cut down on images. /skagedaltalk 11:51, 30 November 2008 (UTC)
It is a toss up between this one and Abe Lincoln for me...I think this is more relevant but agree with the logistical challenges noted. Cheers, Casliber (talk · contribs) 12:01, 30 November 2008 (UTC)
I would go with Lincoln, who doesn't seem any more or any less relevant than Samuel Johnson, whose (equally harmless) picture was removed. (However, on the majority of computers that are available these days, and on the majority of ISP's, I'd think that this page would load in a flash, images and all.) Cosmic Latte (talk) 14:41, 30 November 2008 (UTC)
Support to Cosmic Latte here. How many readers of en: Wikipedia already know what Honest Abe looks like, and how many have a general idea of the many functions of our circadian rhythms? (And which is more important?) The colorful and IMO very attractive image Biological clock human can't show all the specifics nor all the normal variations, but I think it gives a good general idea. And while Wikipedia isn't supposed to predict the future, I feel sure that the 'body clock(s)' and depression will be more, rather than less, connected in near future.
To one specific question raised above about testosterone and women, I've found here the following: "Ideally blood should be drawn between 8:00am and 10:00am as testosterone levels are usually higher in the early morning and lower in the afternoon6. In premenopausal women, testosterone levels are lowest during the first week of the menstrual cycle (i.e. during a woman’s period or the early follicular phase) with small but less significant variation across the rest of the cycle7,8. Thus, blood should be drawn after day eight of the cycle, and preferably before day 20." While the image may not apply to infants and children, it does apply to human adults of both sexes.--Hordaland (talk) 15:28, 30 November 2008 (UTC)
Thank you for providing corroboration for the elevation of testosterone in the mornings in women. That is helpful. I suppose the image of the man in the middle of the clock can be removed now, because it tends to suggest that the schematic is for a man. Snowman (talk) 18:19, 30 November 2008 (UTC)
I'd agree with whomever it was above who said that most people would see the da vinci man as a symbol for mankind, rather than just for males, but whatever.
It sounds like you may be considering making some changes to the image. A suggestion. It is unlikely that melatonin secretion continues clear 'til 07:30 in this clearly morningness-chronotype person. What was likely meant is that melatonin levels have returned to their daytime (undetectable) low by 07:30. Its half-life is less than an hour, so this would make more sense. Thanks, - Hordaland (talk) 21:05, 30 November 2008 (UTC)
May I interpret this that you are saying that this detail on the clock is wrong? I think you are saying that it should say that melatonin secretion stops about 6.30 am and the levels have substantially declined by 7.30 am. I might be able to make the changes to the image, or it might be necessary to ask for assistance, but there is not a consensus about this as yet. Snowman (talk) 21:43, 30 November 2008 (UTC)
  • Not that it "matters" but SandyGeorgia has complained about too many images in the article, [7] as it slows down load time too much. So how about removing Lincoln and/or Samuel Johnson to make way for this one? As you say, they have little if any more relevance to Major depressive disorder than this one. (Testosterone levels in women isn't mentioned in the article, anyway, so it's relevance to women is unknown from the article's point of view.) —Mattisse (Talk) 17:10, 30 November 2008 (UTC)
  • The Samuel Johnson image was removed by Casliber several days ago, with an edit summary refering to long page load times. It seems to be a balance between load times and the number of images, and I do not know what the effect will be of removing one or more images, despite the information given in the external site about load times for each part of the page. Another option might be to put the history stuff in a separate wikilinked offshoot page, leaving short summaries here. See section below for discussion about what can be done about the length and load times of this page. Snowman (talk) 18:39, 30 November 2008 (UTC)
Recent discussion on the "biological clock image" (above) has revealed a additional problem with the wording of "melatonin secretion" rather than "melatonin levels", so I do not think it can be kept in without modification. Perhaps a modified and corrected body clock image with bigger more readable text can be used instead, and without a lot of the colour to reduce its size. Snowman (talk) 15:15, 1 December 2008 (UTC)
While most of the objections in this section seem reasonable, they also seem too minor to warrant the complete removal of the image, although it'd be great if Snowman would like to tweak the image so that it's even better. The objection that stands out as a bit over-the-top is the objection to the picture of the man. It's a classic image, it adds aesthetically to the picture (so that the biological "clock" has "hands"--get it?), it's no different than using "mankind" to refer to everyone--and objecting to it seems almost as absurd as objecting to the picture in Human#Habitat_and_population on the grounds that not everyone is a hunter-gatherer. Cosmic Latte (talk) 17:05, 1 December 2008 (UTC)
I downloaded the body clock png and tried to edit it with GIMP, but it is not like editing an jpg image. In order to have the body clock image modified, may I suggest that you ask at the graphics improvement page on the wiki, and I expect the people there will know how to change it. Snowman (talk) 23:28, 1 December 2008 (UTC)
I will be grateful if you provide an update on the progress or lack of progress on modifications to correct the schematic. Snowman (talk) 17:27, 3 December 2008 (UTC)
Update: I note that the body clock image was removed as an experiment to see how download times were affected. I can not workout what page size reduction resulted, because the change was overnight here. If you are not organising having the image corrected, then I think it should be removed. Snowman (talk) 10:52, 5 December 2008 (UTC)
Update: I have asked for help from a Dutch medical student, who has made some very good diagrams for medical articles, but he might be busy. Snowman (talk) 14:56, 6 December 2008 (UTC)

Black box warning

I suspect "black box warning" is incomprehensible outside the USA. Snowman (talk) 11:48, 4 December 2008 (UTC)

I don't know about England, but it got a fair bit of press here in Oz. Cheers, Casliber (talk · contribs) 12:35, 4 December 2008 (UTC)
But is it called "black box warning" in Australia? It has no meaning in UK. I think it is called "Committee on Safety of Medicine" advice in UK. Snowman (talk) 13:32, 4 December 2008 (UTC)
It is nearly 1 am and I need to get up early. If you have a good ref for the UK for a similar practice, you are welcome to pop in that and reword to Safety warnings have been introduced in the US and UK... (to make it more global). I have one other idea I want to post before sleeping. Cheers, Casliber (talk · contribs) 13:40, 4 December 2008 (UTC)
May I interpret this that you are saying it is not called a "black box warning" in Australia. As far as I am aware, in the UK there is advice on prescribing for children and young adults under the age of 18 years, but not 24 years as in the USA black box warning what ever that is. Snowman (talk) 22:46, 4 December 2008 (UTC)
Funny, we don't have any here in Oz - I went and checked on all the antidepressant boxes I could find. Just general info inside. The black box issue was definitely discussed alot though I recall...Cheers, Casliber (talk · contribs) 04:11, 5 December 2008 (UTC)
The black box comes out of no where in the para in the article. As it doesn't seem to be related to anything, it doesn't flow. It is an interesting point, but so what? It either should be elaborated on or dropped, in my opinion. —Mattisse (Talk) 04:25, 5 December 2008 (UTC)
It was added during the FAC in response to issues raised by the psychotropic account. It was notable and in the news but if the consensus it is undue depth for the article and should be left on the treatment of depression page or elsewhere that is fine with me. Cheers, Casliber (talk · contribs) 04:35, 5 December 2008 (UTC)

There is significant concern with the increased risk for suicidality with some of these drugs among adolescents. This references that suicidality by noting something which demonstrates its undeniably major notablity -- the addition of a black box warning on the antidepressants in the major pharmaceutical country of the world. My vote is to keep it in. If people don't understand it, there's the wikilink. II | (t - c) 04:41, 5 December 2008 (UTC)

I believe it should be in secondary article.--Garrondo (talk) 08:10, 5 December 2008 (UTC)
I think that readers should be able to read it without having to click on a wikilink to find out what black box means. Snowman (talk) 21:57, 5 December 2008 (UTC)
So given that, snowman do you want to relegate it to daughter page or expand here? Cheers, Casliber (talk · contribs) 13:26, 6 December 2008 (UTC)
I think there is no need to mention "black box" if other parts of the section were written a bit more clearly. I am interested that the black box warning is for those under 24 years old. What seems much clearer is the suicidal risks of antidepressants under 18 years of age, and this could be mentioned earlier in the section where treatment of children and under 18s is mentioned and the black box removed. I can not see this under 24 year warning in the BNF (for the UK), but that is not to say that it is not stated in the USA or elsewhere. Snowman (talk) 15:13, 6 December 2008 (UTC)

light therapy

Currently in the "Alternative treatments" section (was called the "Other" section). I thought this was established treatment for SAD, so it could have its own sub-heading in the treatment section. Snowman (talk) 01:53, 5 December 2008 (UTC)

Is there a better name for that section? Really, if light therapy doesn't work for MDD, is this another "the world is not square" statement? That whole section is a hodge podge of questionable to no effect treatments. Or "this has a major effect, but the only study done showed no effect" statements. Is it meaningful to the general reader to have such brief, equivocal statements? —Mattisse (Talk) 02:59, 5 December 2008 (UTC)
The more I thought about it, the more I only see it in relation to SAD, so I am happy to leave it in the treatment subarticle only. Cheers, Casliber (talk · contribs) 10:19, 5 December 2008 (UTC)

And done. Cheers, Casliber (talk · contribs) 10:20, 5 December 2008 (UTC)

The image of a bright light can be removed as well? Snowman (talk) 11:00, 5 December 2008 (UTC)
oops. thought i got it. Cheers, Casliber (talk · contribs) 11:06, 5 December 2008 (U
Whoops, yes you did get it, I probably saw the image in a browser tab with an older page. File size now 448 kB. Do you know what effect on file size removal of the body clock image had? It was removed overnight here. Snowman (talk) 11:34, 5 December 2008 (UTC)
I have added 7 words to the subtypes section about light therapy where SAD is mentioned to provide this key feature of SAD somewhere on the page. I have not got access to the ref that is given for SAD, so a have put it after the ref. Snowman (talk) 11:54, 5 December 2008 (UTC)
Update: light therapy removed by someone. Snowman (talk) 15:00, 6 December 2008 (UTC)

Subtypes (2)

SAD and postpartum depression are in the "Subtypes" section to say that they are not subtypes of MDD. I think it would be more logical to put these in the "Differential diagnosis" section, if I am not mistaken. Snowman (talk) 10:19, 5 December 2008 (UTC)

Under DSM IV - postpartum onset bears the ungainly name of a modifier, I need to double check where SAD is. Differential Diagnosis is something which is similar but distinct. Cheers, Casliber (talk · contribs) 10:21, 5 December 2008 (UTC)
If it is not MDD then it should be in the "DD" secion. If it is a subtype of MDD, then it should be in the "Subtype" section. The current layout is illogical where is is in the subtype section where it is under a heading that says; "not categorized as Major depressive disorder". Snowman (talk) 10:58, 5 December 2008 (UTC)
The specifier With Seasonal Pattern can be applied to the pattern of Major Depressive Episodes In Bipolar I Disorder, Bipolar II Disorder, or Major Depressive Disorder, Recurrent. —Mattisse (Talk) 16:39, 5 December 2008 (UTC)

Matisse is right, I just looked it up - so the answer is "yes, no, maybe" - it is classified as a longitudinal course modifier. I have to think - the first thing that comes to mind is changing this line:

Other types of depression, not categorized as major depressive disorder, are recognized by the DSM-IV-TR:

to something that encapsulates these two sub-entities are diagnosed/classified on their timing. I need to think. Cheers, Casliber (talk · contribs) 22:10, 5 December 2008 (UTC)

First attempt:

Two types of depression are recognized by the DSM-IV-TR on the basis of the timing of episodes:

bit clunky - feel free to change if you feel you can make it sound better. Cheers, Casliber (talk · contribs) 22:13, 5 December 2008 (UTC)

I am pleased that grotesque error has been repaired. Snowman (talk) 22:27, 5 December 2008 (UTC)
I think there should be a one or two line explanation of specifiers and subtypes under the "Subtypes" heading, in preference to non-science parts of the page (which are being reduced). This is essential MDD stuff. The current line after the "Subtypes" heading says "there are several specifies" and then five are listed. Could is say "there are five specifiers"? or are there any extra ones not listed. Snowman (talk) 22:31, 5 December 2008 (UTC)

:::OK, I will get onto it a bit later today. Cheers, Casliber (talk · contribs) 22:49, 5 December 2008 (UTC)

OK, done (mostly). I may need to reword SAD Cheers, Casliber (talk · contribs) 11:53, 6 December 2008 (UTC)

"List of rating scales for depression" subarticle proposal

I have been thinking: rating scales would be a great article; however is a big task in scope; since there are specific rating scales for almost any symptom and any specific disorder; so it would not have sense to put in it each specific test used in depression. I have created a possible list of rating scales for depression. What does people think?. We could move all info and sumarize it in the clinical section. --Garrondo (talk) 13:52, 5 December 2008 (UTC)


Depression rating scales are not used to diagnose depression, but they provide an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis.[4] Several rating scales are used for this purpose.[4] Screening programs have been advocated to improve detection of depression, but there is evidence that they do not improve detection rates, treatment, or outcome.[5]

I think that is an excellent idea. The current article on rating scales is very rudimentary and ignores rating scales for depression. Plus the rating scale section does not add to the MDD article. Since we need to cut down the size of the MDD article, removing the rating scale info to a new article would be an excellent plan. —Mattisse (Talk) 16:17, 5 December 2008 (UTC)
P.S. Casliber has already mentioned removing the rating scale info in a discussion on talk page above, so perhaps there is general support for this idea. —Mattisse (Talk) 16:20, 5 December 2008 (UTC)
I proceed to create the subarticle; but I won't eliminate info from this article: As soon as I am finished I will say it here. Best regards.--Garrondo (talk) 17:05, 5 December 2008 (UTC)
I have created List of rating scales for depression‎. The info in the article can be sumarized if there is consensus. Best regards.--Garrondo (talk) 17:29, 5 December 2008 (UTC)

A would include the following between the second and third paragraph of the clinical assessment subsection: Rating scales are not used to diagnose depression, but they provide an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis.[4] Several rating scales are used for this purpose.[4] Screening programs have been advocated to improve detection of depression, but there is evidence that they do not improve detection rates, treatment, or outcome.[13]. I would also add a further info line for the subarticle.

I am open to it if (a) the consensus is the page is still too large, and (b) this would be the next segment of material to be placed in a daughter article. I really liked having the material here but in reality it is research/epidemiology based and somewhat separate from day-to-day clinical practice. However it is important as well. Cheers, Casliber (talk · contribs) 02:35, 6 December 2008 (UTC)
Matisse agrees, I also do, and Casliber is neutral. Is anybody against it? Does anybody want to say anything?--Garrondo (talk) 09:39, 6 December 2008 (UTC)
One more thing: I have already placed all info in a daughter article in list-form.--Garrondo (talk) 09:52, 6 December 2008 (UTC)
(sigh) I think you may as well do it; Sandy and Snowman both agree the article is still too big as well, and I can see it makes sense. If I reframe my own perspective that the article isn't losing material but it is being redistributed, then I don't feel so miserable about it....Cheers, Casliber (talk · contribs) 10:56, 6 December 2008 (UTC)
Do not feel at all miserable: this is how wikipedia grows: What was a great article is going to continue being it; but it will also bring new articles which somebody in the future may also improve. For example I believe the history article is great and could even become a good article with some work in the introduction. Do you know any encyclopedia which has an article as good as the one you created about history of depression? Best regards. I will do the paragraph reduction. --Garrondo (talk) 11:47, 6 December 2008 (UTC)
thanks, (sniff, blows nose in handkerchief) Cheers, Casliber (talk · contribs) 12:59, 6 December 2008 (UTC)
OK, the rating scales section (and more) are in the offshoot article, and I think that the signpost link under the heading and the link in the text are easy to find. I am pleased that the wiki has a new page that can be expanded on rating scales. I guess that the "History of depression" could become a good article in its own right too, but but do not take my word for it. As well as providing details about MDD, I suppose this MDD page has similarities to a portal for depression, with many offshoot pages which is beneficial for "big articles" if well organised, I think. Incidentally, the link in the template at the bottom of the page still says "clinical depression". Snowman (talk) 13:19, 6 December 2008 (UTC)
Aha! well spotted and duly dealt with. OK the article is now 444kb, Snowman, how do you feel about the size now? Cheers, Casliber (talk · contribs) 13:22, 6 December 2008 (UTC)
Or more to the point, what does MOS say about article size? Snowman (talk) 14:00, 6 December 2008 (UTC)
Well, the rule_of_thumb has >60kb as a "probably" and 30-60 as a "may" need splitting, and we're on 49kb now. Sandy has given a ceiling of 60 kb (which I had in my head as 50 before). I am happy with the size as is now. Cheers, Casliber (talk · contribs) 14:05, 6 December 2008 (UTC)
You are using the prose size, which is one way of looking at it. Another way of looking at it is to consider total size of all the separate parts of the page, which should be less than 400 kB. I guess the article should not excess any of the page size limits. What was the size reduction achieved by removing the "body clock" image experimentally? Anyway, downloading the body clock image from the article to the desktop and looking at its properties show that its size is 51915 bytes. I am sure that the body clock schematic can be redesigned without all the colour images to cut down its kB size, and still retain its key points. Snowman (talk) 14:16, 6 December 2008 (UTC)
If it is taking long for a 50-kilobyte pic to load, then it might be time for a new (or, should I say, new?) computer. I took the initiative of saving every pic from both this article and our friend Primate, and found that the primate pics total out to 233 kb, which is more than twice the total size (106 kb) of MDD pics. Primate passed FAC, and the overwhelming consensus is for MDD to pass, as well; this pic-size thing appears to be a rather esoteric ideosyncrasy of at most two people. Given that the research on MDD/circadian rhythm is so extensive--not to mention that the paragraphs on it take up a third of the "biological" subsection--this seems like a reasonable idea to illustrate, and to illustrate well. A ton of images have already been moved to a subarticle: Just how plain do we want things to be? Cosmic Latte (talk) 15:50, 6 December 2008 (UTC)
"Primate" has a total file size of about 319 kB, which is well within the wiki guidelines. Snowman (talk) 16:40, 6 December 2008 (UTC)
Then have a look at Lion, another FA. I'm too much of a luddite to know how one would go about determining the exact size of everything in there, and I'm too much of a mergist to care, but some reasonably advanced optical equipment shows that it's even longer than MDD and has considerably more images. Yet it does not appear to have caused any widespread technological doom. Cosmic Latte (talk) 18:29, 6 December 2008 (UTC)
"Lion" has a total file size of about 339 kB, which is well within the wiki guidelines. There is a big difference in the References (including all HTML code): 133 kB for lion and 284 kB for MDD. Some parts of the page are hidden, so you can not tell exactly by looking at a page. Snowman (talk) 18:41, 6 December 2008 (UTC)
What are these "wiki guidelines" you're referring to? Cosmic Latte (talk) 18:44, 6 December 2008 (UTC)
I do not know how you missed that point because WP:page size has been quoted here several times. Snowman (talk) 18:59, 6 December 2008 (UTC)
(edit conflict) I checked out WP:SIZE and came across the astoundingly vague, "With some web browsers with certain plug-ins running in certain environments, articles over 400 KB may not render properly or at all." I don't know how many people this applies to, but, judging by all of the FAC support, I wouldn't think it applies to a very large fraction of the wiki-population. 444 kb is also not exceedingly larger than 400. Okay, so maybe the removal of the image would make the page more accessible to certain people who do certain things in certain ways (to echo the precision of WP:SIZE), and the removal of a work of art from an exhibit might make admission tickets more affordable (I'm too tired to think of a better analogy), but there are aesthetic concerns as well, not the least of which, in this case, is the notion that the image makes the circadian rhythm more (conceptually) available to the lay reader. Cosmic Latte (talk) 19:06, 6 December 2008 (UTC)
  • Well, don't overinterpret my post :-) It is well known that when I was reviewing at FAC/FAR, I opposed every one of those extra-long articles, and my personal views on article size and summary style are on display at Tourette syndrome. As FAC delegate, my job is to look at consensus wrt WIAFA. I don't fully understand why some articles have load time issues worse than others, but I suspect the answers are to be found here. SandyGeorgia (Talk) 19:43, 6 December 2008 (UTC)
  • The "Campaign history of the Roman military" seems to me to be more like a list of battles, and "WP:page size" guidelines are different for lists, it is says that it is best to get the whole list on one page. I have not found the Dynasty articles yet, but I do not think I will interfere. If those pages are too big for some to view easily perhaps they will view the downloadable pages somewhere else, perhaps even wiki science pages. Snowman (talk) 20:42, 6 December 2008 (UTC)

note - expanded/new material on depression and sleep

I got a surprise but upon reading remembered this is all quite new and very important material. Also a good compromise in it places light therapy in context (still an experimental treatment). So all good, just might need to tweak for flow (but keeping faithful to sources.) Cheers, Casliber (talk · contribs) 00:40, 6 December 2008 (UTC)

I think the Adrien article is perhaps not the best possible source -- falling into the category of "speculative review" -- and suggest making use of this review, which is recent, comprehensive, and written by one of the top researchers in the field. Looie496 (talk) 01:48, 6 December 2008 (UTC)
That is a great article. The only problem is that it has not been published yet, if the disclaimer on the article is true: Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. —Mattisse (Talk) 02:01, 6 December 2008 (UTC)
It's published -- Pharmacol Ther. 2007 May; 114(2): 222–232, pmid=17395264 -- I just linked you to the free "preprint" at Pubmed Central; should have mentioned that. Looie496 (talk) 02:40, 6 December 2008 (UTC)

Tricky, certainly I have seen plenty of journals referencing something that is in press....has anyone seen anything on WP:RS about this sort of situation thus far? Cheers, Casliber (talk · contribs) 02:10, 6 December 2008 (UTC)

As I read the article, it basically agrees with the articles already cited. Apparently this is fairly well established information, all pointing to the same system in the brain, linking these disparate elements. Very nice. —Mattisse (Talk) 03:14, 6 December 2008 (UTC)

Cicradian rhythm paradox

"The serotonergic system is least active during sleep and most active during wakefulness. Because of this relationship of sleep to the synaptic levels of serotonin, compounds that decrease serotonin levels impair sleep." Well, if the serotonergic system is least active during sleep, then, logically speaking, shouldn't decreased serotonin levels be associated with increased sleep? Or is "this relationship" a compensatory relationship--i.e., decreased serotonin levels trigger the serotonergic system to go into action for homeostatic purposes, thereby resulting in wakefulness and insomnia? I've long been aware of both the association between insomnia and depression, and the association between sleep deprivation and increased mood, but not until re-encountering these associations in the article did I find them paradoxical. In any event, it might help to clarify the wording a bit, as I didn't quite catch the logic in, "Because of this relationship of sleep to the synaptic levels of serotonin." Cosmic Latte (talk) 09:51, 6 December 2008 (UTC)

This is a puzzle. There's massive literature saying that serotonin levels drop during slow wave sleep and fall to near zero during REM, and there's substantial literature saying that serotonin levels rise during sleep deprivation. But there is no broadly accepted story of how these things fit together. I agree with you that the logic of that sentence is questionable: that's one of the reasons I suggest not relying on the Adrien paper, which doesn't really reflect mainstream opinion in this respect (it was written as a speculative review, i.e. proposing new ideas, so that isn't a criticism). Looie496 (talk) 17:59, 6 December 2008 (UTC)

Old reference or not?

Is the book, Jorm AF, Angermeyer M, Katschnig H (2000), out-of-date to be commenting on the views of the public on mental health in a 2008 wiki article? Snowman (talk) 21:18, 6 December 2008 (UTC)

I don't know (in response to the original "in 2008" wording), but if it is, then this looks like an extraordinarily minor copy-editing issue: "Public opinions on treatment differ markedly to those of health professionals; alternative treatments are held to be more helpful than pharmacological ones, which are viewed poorly" ---> "Public opinions on treatment have differed markedly to those of health professionals; alternative treatments have been held to be more helpful than pharmacological ones, which have been viewed poorly." Cosmic Latte (talk) 21:31, 6 December 2008 (UTC)
And what are the up-to-date opinions? Snowman (talk) 22:05, 6 December 2008 (UTC)

Like an aging hunter in humans' foraging past, an alienated member of today's society !

Cosmic Latte, how is an alienated member of today's society like an aging hunter in humans' foraging past? What is the connection to Major depressive disorder? Please explain what that sentence means in the article, as it makes no sense to me! —Mattisse (Talk) 01:36, 5 December 2008 (UTC)

The aging hunter would have been an alientated member of his society: "Of course, if our ageing hunter had been in error in assessing himself as of no further use to the tribe, his comrades would probably have quickly responded to his mood and inappropriate perception with reassurance and possibly a suggestion of a modified role compatible with his physical abilities, thereby nipping his depression in the bud before it had reached deeper stages...In today’s world, it is all too easy for individuals, isolated from the supportive network of an extended family, to become locked into a distorted and undeserved sense of uselessness or rejection...Lacking corrective re-assurance of their value to significant others, the triggering of severe depression in such circumstances becomes a significant risk" (Carey, p. 217). Cosmic Latte (talk) 01:49, 5 December 2008 (UTC)
I missed the point as well. Snowman (talk) 01:57, 5 December 2008 (UTC)
It is a very strange sentence. It sounds like something out of a science fiction novel. Do our theories of evolution contain information about an alienated ageing hunter in the foraging past? Where do you get this information of what occurred in that period of human evolution? —Mattisse (Talk) 02:53, 5 December 2008 (UTC)
I'm not sure I understand the question. I get this idea from the Carey source, which I block-quoted above. Cosmic Latte (talk) 10:02, 5 December 2008 (UTC)
The "aging hunter" as similar to an "alienated person" today makes no sense.Snowman (above) agreed. Please explain the logic behind such a statement. How is an aging hunter in a human foraging past relate to today's human behavior. It would be helpful to know who you are referring to when you say "alienated" persons today. Are you referring to racial alienation, third-world country alienation from first world, handicapped person's alienation, or what? The alienation of youth is no longer the factor it was in the last century, unless you have data showing otherswide.
The fact you got the "idea" from a block quote is not an explanation. Rather than quoting the paragraph, it might be better to clarify the meaning and reference some scientific data supporting that view. Also, a newspaper is not an acceptable reference for any statement in this section, unless you are specifically referencing a news event, or information not presented in the scientific literature, such as legal issues, current events, etc. Please try to maintain the quality of the article. View of counseling therapists should not be included in the "Causes" section, unless this counseling therapist has research findings to support his view. —Mattisse (Talk) 16:39, 7 December 2008 (UTC)
"depression may be seen as 'a species-wide evolved suite of emotional programmes that are mostly activated by a perception, almost always over-negative, of a major decline in personal usefulness, that can sometimes be linked to guilt, shame or perceived rejection'" -- so, a person who feels useless in today's society possesses the same "suite of emotional programmes" that the aging hunter possessed: the suite (aka depression) has evolved. And our benchmark here is WP:V: information on Wikipedia must be verifiable, not necessarily "scientific" or even "true." Of course, some views are disfavoured per WP:FRINGE, but evolutionary psychology is hardly a fringe approach. And mainstream news articles are allowed per WP:RS (I mistakenly called this a policy in an edit summary; it's a guideline, but it has a strong affinity with the WP:V policy). You do not have to like this allowance, and you're welcome to challenge it at Wikipedia talk:RS, but nonetheless it exists. Cosmic Latte (talk) 16:55, 7 December 2008 (UTC)
Perhaps this quoted section of yours should go under another section. Perhaps if you put the quote in your own words so that it made sense, it would have more meaning. In the "Causes" section, the statements must follow WP:MEDRS. Novelistic impressions do not satisfy this criteria, nor do references from popular newspapers, as these are specifically mentioned in the guidelines as unreliable. Further, none of the evidence on evolution (archeological evidence etc.) support any statements about "aging hunters" nor how humans handed the problem of aging persons. Perhaps, since they were in a "foraging society" the "aging hunter" could "forage" instead of hunt. Perhaps everyone died young anyway. There is no data on human attitudes toward aging persons in that period. Perhaps members of societies left their "aging hunters" to die alone, as Eskimos did. Information in this section should be written clearly and based on scientific findings. —Mattisse (Talk) 17:57, 7 December 2008 (UTC)
1) Nothing must follow MEDRS; that is a guideline, meant to be used with discretion and common sense. In fact, the popular-press section of MEDRS even says, "As the quality of press coverage of medicine ranges from excellent to irresponsible, common sense and the general guidelines presented in the verifiability policy and general reliable sources guideline should be considered in determining whether a popular press source is suitable for these purposes." 2) Do I really need to point out again that this is not strictly a "medical article," and that it also falls under WP:PSY, and that a good portion of psychology is related only loosely to medicine? Evolutionary psychology is a legitimate, growing, and non-fringe branch of psychology. This is where WP:UCS (policy) comes in to put MEDRS (esoteric guideline) in perspective. 3) There is plenty of data on hunter-gatherer (aka foraging) societies, given that plenty of such societies exist today. While we are limited in the inferences we can make about such societies in the past, our inferences are based on more than idle speculation. 4) For what it's worth, the notion that Eskimos were left alone to die on ice floes is one of many unsupported myths that are floating around (no pun intended) about hunter-gatherers. Not that it never happened (can't prove a null hypothesis), but it's basically an overblown stereotype. 5) Hunter-gatherers are, and presumably were, incredibly diverse. Admittedly, this fact stands at odds with some evolutionary explanations of human behaviour. But it allows for tremendous variation in the possibilities of hunter-gatherer life. Surely Carey's hypothesis applied to at least some group, and depression may have proven adaptive. The argument ultimately stands on its inductive merits, and therefore complements the deductive-nomological reasoning used in laboratory, or what you have been calling "scientific," research. 6) "Forage" simply means to search for food. Hunters are foragers; "foraging society" and "hunting-gathering society" are synonymous. 7) Because it's probably worth saying again, MEDRS is a guideline meant to be used with editorial discretion, and considerable discretion is appropriate when we're dealing with a topic that is not exclusively "medical" in the first place. Cosmic Latte (talk) 19:31, 7 December 2008 (UTC)
Please give some references for what you consider "common knowledge". For example, the statement "Hunters are foragers" needs some context and finding of fact besides your say so. You seem to be using what you know to be true rather than providing references. What you write is "the story we were all told" before recent archeological data altered much commonly held to be fact. There is a lot on evolution, the history of evolution etc. that is well referenced. Please stick to that rather than what you may think is the case, or someone's personal opinions in writing. A counselling therapist is not an authority on evolution or evolutionary theory. If you want to place something about a therapist's use of an evolutionary analogy in his therapeutic practice in the article, put it under the "History" section which is more allowing of fuzzy data. —Mattisse (Talk) 19:44, 7 December 2008 (UTC)
It would be swell to trust us every now and then, rather than demanding a source for every fraction of an assertion that anyone dares to make. Look up "forage" in a dictionary or, if you insist, read this fascinating book cover-to-cover. "History" is not a synonym for "fuzzy," nor does it imply a repository for everything that fails to live up to the expectations of positivism (which, speaking of "history," dates back to Auguste Comte in the 19th century). I don't have a problem with the "from a counseling therapy viewpoint" introduction, but trying to move or remove it because it comes from that perspective seems like yet another overreaction. Cosmic Latte (talk) 20:01, 7 December 2008 (UTC)
Anyway, reworded here. Cosmic Latte (talk) 20:11, 7 December 2008 (UTC)

Stigma

"In the UK, the Royal College of Psychiatrists and the Royal College of General Practitioners conducted a joint Five-year Defeat Depression campaign to educate and reduce stigma from 1992 to 1996." and the next sentence on the Mori poll. Have these sort of campaigns been held anywhere else, and can a more general statement be made without it just referring to the UK. It is a in the current psychiatry service framework to work to reduce stigma in the UK, and this is more up-to-date. Snowman (talk) 15:23, 6 December 2008 (UTC)

The Canadian Mental Health Association is about to launch an anti-stigma campaign, but it is not focussed on depression, and instead is targeting attitudes towards all mental health issues. I'm afraid I don't have a link to the campaign as I heard about it at a workshop and it does not yet appear on their website --Vannin (talk) 06:45, 7 December 2008 (UTC)

Prose again

I have no idea what this sentence is trying to say:

Successful psychotherapy appears to prevent the recurrence of depression even after it has been terminated or replaced by occasional booster sessions; the same degree of prevention can be achieved by continuing antidepressant treatment, although bias from unpublished medication studies may be responsible for this effect.

How is bias from unpublished studies about medication affecting psychotherapy? SandyGeorgia (Talk) 20:45, 6 December 2008 (UTC)

I think it's trying to say something like, "Successful psychotherapy appears to prevent the recurrence of depression even after it has been terminated or replaced by occasional booster sessions. Published studies suggest that the same degree of prevention can be achieved by continuing antidepressant treatment, although literature not submitted for publication may indicate otherwise"--i.e., drug companies aren't going to submit unimpressive reports for publication (and journals wouldn't accept them--why would they, when there's basically nothing to report?), even if they've submitted them for review to, say, the FDA. Cosmic Latte (talk) 21:21, 6 December 2008 (UTC)
Ah, I see. Perhaps that be made more clear in the text. I've promoted the article, and am encouraged to see that most parties seem to be working favorably towards resolving the remaining (small) issues, but I feel that the larger issues wrt WP:WIAFA have now been addressed. SandyGeorgia (Talk) 21:55, 6 December 2008 (UTC)
One of the referenced articles is on the effect of unpublished drug studies - studies that show no effect of the drug and are therefore withheld from publication by the drug company or those funded by them, for example. The article estimates that 33% of studies are withheld from publication. This is a significant problem in evaluating evidence for the effectiveness of a drug. —Mattisse (Talk) 23:02, 6 December 2008 (UTC)
I understand now, but that's not what the (muddled) sentence says, so hopefully y'all can patch it up. SandyGeorgia (Talk) 23:12, 6 December 2008 (UTC)
I have removed the second part of the sentence, because it's a non sequiter here: the source says nothing about psychotherapy as far as I could see. If I'm missing the point, please rewrite in a more understandable way. Looie496 (talk) 18:52, 7 December 2008 (UTC)

Promoted!

Yeeha! Congrats to Casliber and everybody else. The next step is Perfect Article status… Looie496 (talk) 22:31, 6 December 2008 (UTC)

The REM paragraph

"The REM stage of sleep is produced by decreased serotonin levels in the brain stem.[29] The REM sleep stage, the one in which dreaming occurs, may be to be quick to arrive, and intense, in depressed people. Although the relationship between sleep and depression is unclear, it appears to be particularly strong among those whose depressive episodes are not precipitated by any obvious factors. In such cases, patients may be unaffected by therapeutic intervention.[32]"

I wonder if this paragraph can be deleted. Beyond the first sentence, it doesn't say anything, IMO. While there may well be a particularly strong relationship between sleep and depression, it's undefined here. And the last sentence seems to say that unless depressive episodes are precipitated by obvious factors, they will not respond to therapeutic intervention. There can't be many psychiatrists who will agree with that?

If the bit about REM (the first two sentences) is important, it can likely be incorporated into an earlier paragraph. Then the last two sentences can just quietly disappear. Any objections? - Hordaland (talk) 06:45, 26 December 2008 (UTC)

See also: Telephone counseling

Is it relevant to the article?: if it has been reviewed in some reference it should be included (maybe not really here, but in the treatments subarticle), if it has not, it should be eliminated per manual of style. I quick search in pubmed only found 1 review relevant article (PMID 16638233). I do not have access to full article but abstract says: Although these studies provide evidence that telephone interventions can be effective, the few studies conducted, small sample sizes and lack of randomized controlled trial methodology prevent firm conclusions from being drawn. I believe it should be eliminated per manual of style and WP:weight.--Garrondo (talk) 14:41, 8 January 2009 (UTC)

Agree. Looie496 (talk) 18:04, 8 January 2009 (UTC)

Rating scales

I feel that the article deemphasizes rating scales a bit too much. In research settings this is practially the only instrument used to asses improvement or lack thereof. There are some papers which argue that functioning in real life should be used as the ultimate indicator (can't give you refs off the top of my head), but this is currently in the realm of opinion. Xasodfuih (talk) 15:17, 19 January 2009 (UTC)

Circadian rhythm

I'm glad that this section has become as thorough as it has, because it's an active and exciting area of research. However, it should probably be be proofread and revised--perhaps even trimmed a bit--by someone with expert knowledge on the topic. Because the gist of it seems to be, "serotonin down, sleep impairment/insomnia up," but "wakefulness up, serotonin up"--quite a contradiction that isn't adequately explained. Note, however, that I tried to fix some of the most ambiguous wording here, by...well, being somewhat explicit about the fact that ambiguity exists. Cosmic Latte (talk) 00:44, 28 January 2009 (UTC)

Not claiming to be the expert you need, but my reading of the source says that the word 'decrease' in that sentence should have been 'increase', so I've changed it. I base that on this quote from the source (abstract): In particular, the production of rapid eye movement (REM) sleep depends on the decrease of serotoninergic tone in brain stem structures. Thus, serotoninergic compounds which increase this tone (such as antidepressants) induce inhibition of REM sleep. If I've misinterpreted, someone will change it back. If I'm right, perhaps that sentence shouldn't begin with 'however'?? - Hordaland (talk) 04:09, 28 January 2009 (UTC)
There is a previous discussion of this buried in the archives somewhere. It isn't really a contradiction, but it is definitely weird. Unfortunately, the literature has to rule, even if it seems weird. Looie496 (talk) 05:03, 28 January 2009 (UTC)
That's why I hope someone will look at what I changed. It now says the opposite of what it said before. Maybe less weird? Hopefully correct? - Hordaland (talk) 08:35, 28 January 2009 (UTC)
It certainly makes more sense to me now, at least. I've rearranged the paragraph a little bit ([8], [9], [10]) to accommodate the logical flow. Cosmic Latte (talk) 09:23, 30 January 2009 (UTC)
Excellent, thanks. Reads much better, and I think it's correct. Collaboration is fun. - Hordaland (talk) 14:49, 30 January 2009 (UTC)
I made another slight change, because the wording was slightly misleading. REM depends on decreased serotonin, but decreased serotonin is not sufficient to produce REM, it also depends on decreased norepinephrine and probably other factors as well---so it isn't quite right to imply that decreased serotonin is "the cause" of REM. Looie496 (talk) 17:46, 30 January 2009 (UTC)
And I shortened it more, finding "the production of sleep" unnecessary, even tho it's in the source. Now: REM sleep depends on decreased serotonin... - Hordaland (talk) 02:04, 31 January 2009 (UTC)

World Health Organization now says "depression is the leading cause of years lost due to disability."

I am very surprised not to see this mentioned in the article. The World Health Organization's study "The global burden of disease: 2004 update" is cited in this article here as stating that "depression is the leading cause of years lost due to disability."

http://blogs.psychologytoday.com/blog/in-practice/200901/the-major-scourge-humankind

any comments? Brian Fenton (talk) 21:32, 29 January 2009 (UTC)

Done. See section Epidemiology. - Hordaland (talk) 02:19, 30 January 2009 (UTC)

Psychoanalytic understanding of depression

I think it's really important to get the general understanding of depression according to psychoanalysis into this article. There is a substantial body of work on depression there, and while psychoanalysis is mentioned, it's theories of depression are not featured. Here's a summary, it could do with some work and references. I might come back and develop this again before adding it to the article. Any comments?

Psychoanalytic understandings of depression are based in the ideas first advanced by Freud in "Mourning and Melancholia", later developed by Klein in the object relations school of thought. In this paper, Freud discusses the process of grieving the loss of a loved one and working through the personal impact of their absence from the world. Unhindered, this process eventually results in the mourner coming to possess a reliable and loving "inner voice" of their lost love, which Klein would call a "good object". In everyday terms, we might imagine a widow having come to terms with their grief and being able to think fondly of their former partner, remembering them in a warm and affectionate way and thinking how they might respond and comment on the widow's life in the present.

Melancholia, which we would now call depression, shares the initial trajectory of the loss of a love but leads instead to a pathological, deadening grief. Freud and Klein argue that depression is brought about by a combination of hostility toward the lost object and an inability to let it go. For example, a child of an emotionally unresponsive and threatening father may feel inadequate and afraid around them. If the father then leaves, the child may be left with unexpressed anger and disappointment. This hostility cannot be directed at the actual father, who is now absent, so instead becomes directed at the "bad object" of the father, the inner memories and "voice" of that parent internalised and carried by the child. Thus the anger intended for the other becomes directed at the self, accounting for the depressive's tendency to deride and denigrate themselves ("I'm worthless" etc.).

This also explains why other people around the depressive person cannot argue them out of their self-hatred ("I'm worthless", "No you're not", "Yes I am" etc.), as the derisive remarks are not really directed at the depressive them self, and the irritation others can feel when trying to do so.

N.b. I think this should include some words on counter-transference (this is my aim in the third paragraph), some better words succinctly explaining the idea of an object, a note that the lost object could also be an ideal, a country etc., and some explanation of the gap between how the depressed person understands (or doesn't understand) their condition and this theory, i.e. some brief notes on the details of the loss being unconscious.

—Preceding unsigned comment added by 78.105.159.2 (talk) 03:00, 19 February 2009 (UTC)

Hi and thanks for commenting. Much of this was in an older version of the article but had to be reduced due to the article's huge size....I was frustrated too. I cna't remember if we kept it on a daughter page. We were going to make a causes of depression page at some point. Casliber (talk · contribs) 05:39, 19 February 2009 (UTC)
Hi, thanks for that. I'm interested to see the material and how that was decided, I'll have a look through the archives. Whitespace (talk) 16:33, 19 February 2009 (UTC)
Eek, the dreaded archives! Feel free to read them, but here's a summary of the situation: Freud's contribution is discussed at Major_depressive_disorder#History; it's also in History of depression. I was among those who felt that it belonged in Major_depressive_disorder#Psychological, but agreed (still against my overall inclination, however) to moving it only following much debate and after Casliber made the very valid point that psychodynamic thinking has a rich post-Freudian history. So I eventually added a much-condensed version of Freud's theory to "Psychological causes," attributing it specifically to Freud's "classical psychoanalytic perspective." However, if you can improve any of the three places in which psychoanalytic theory is mentioned--Major_depressive_disorder#Psychological, Major_depressive_disorder#History, or History of depression--then please, by all means, feel free to do so. Cosmic Latte (talk) 17:31, 19 February 2009 (UTC)
Thank you for your summary. I've been intending to edit and write the above paragraphs into the Major_depressive_disorder#Psychological section but I haven't done so yet. I am very keen to get Freud's explanation in there somewhere (basically: lost love object + hostility / ambivalence + regression of libido into the ego = bad object stored in ego + hostility towards self). It's readily understandable in everyday language and opens the door for the reader to learn more if they wish, ie. it seems at exactly the right level for a general encyclopaedia article. In response to the work since Freud, I'd argue that this framework from his Mourning and Melancholia paper is a crucial part of the psychoanalytic canon of thought on depression. There have been significant later developments (Klein and Bowlby come to mind), certainly, but it remains a cornerstone of the work on this subject. Perhaps it would be a good idea to collate all of the material so far into a new Psychological approaches to depression article, where we can work the finer points out in detail? Whitespace (talk) 00:49, 26 February 2009 (UTC)
Yep - spinning out into daughter articles is a good idea. Orignal material is here. Note the box above has more too. Casliber (talk · contribs) 01:43, 26 February 2009 (UTC)

Cannabis

WP:UNDUE, POV, uncited text removed. SandyGeorgia (Talk) 03:39, 9 January 2009 (UTC)

Over the years cannabis has come to be demonized by misinformed and selfish people, so much so that propaganda (Above the Influence) are spread about its effects and by a combination of lies and scare-tactics this wonderful plant has been made and kept illegal in the US. Sensible people are now learning of the plants medical value, and more and more people are being prescribed medical Marijuana (as it's now called so that it sounds more friendly) every day. Cannabis has virtually no side affects, is much much more affective than any pain pill or anti-depressant, and is %100 natural.

Read a paper a while back about how THC increases ones risk of both anxiety and depression over baseline.--Doc James (talk · contribs · email) 22:10, 9 January 2009 (UTC)
I've read that paper. Correlation does not equal causality. Unless you have some other evidence? 219.89.98.127 (talk) 10:53, 27 February 2009 (UTC)
Correlation may not be causality, but that doesn't look like a very promising correlation. I agree that marijuana has been irrationally demonized, but where's the evidence--correlational or otherwise--that it's a helpful medication for depression? Cosmic Latte (talk) 14:21, 27 February 2009 (UTC)

Transcraneal magnetic stimulation

This treatment has been approved recently in USA and Europe, has a well proven efficacy, and its likely to be increansingly used. It does not seem logical to have it under a "other" subsection, side by side to an "over the counter herbal remedy" or a recommendation on physical exercise non proved by reviews; it may also confuse its importance the fact that just under the subsection title there is a "see also:self medication"; when nobody can use TMS by their own... I believe these are all reasons for it to have its own subsection just after ECT (since it says that it is used as an alternative to it). Best regards.--Garrondo (talk) 08:30, 6 March 2009 (UTC)

I've removed the "self-medication" bit from that section because neither rTMS nor VNS can be considered self-medication. As for the placement in an "other" subsection, that is probably okay given that these treatments are newer and less well established. Xasodfuih (talk) 19:59, 8 March 2009 (UTC)

Cause -> Bad sleep?

The article Are bad sleeping habits driving us mad? in New Scientist states:"TAKE anyone with a psychiatric disorder and the chances are they don't sleep well. The result of their illness, you might think. Now this long-standing assumption is being turned on its head, with the radical suggestion that poor sleep might actually cause some psychiatric illnesses or lead people to behave in ways that doctors mistake for mental problems. The good news is that sleep treatments could help or even cure some of these patients. Shockingly, it also means that many people, including children, could be taking psychoactive drugs that cannot help them and might even be harmful.". In short, sleeping disordes may cause deperssive disorders. I couldn't find it in the article. Maybe I just overlooked it, if not shouldn't it be in here? regards --Cyrus Grisham (talk) 18:28, 6 March 2009 (UTC)

It actually is here, in Major depressive disorder#Other theories: "Depression may be related to abnormalities in the circadian rhythm…". We've talked about discussing this more extensively, but there really isn't space. Still, if you have suggestions for getting the message across more clearly, feel free to make them. Looie496 (talk) 00:19, 7 March 2009 (UTC)
Well, it is there an it is there not. The Chronobiology (circadian rhythm/Circadian rhythm sleep disorders) part is there (at least partly, but how different wavelengths of the "light" affects our body clocks is another story), but not quality of sleep part (see also Sleep disorder), for example sleep-disordered breathing like sleep apnoea or Insomnia (well, I can't see the part). I qoute the article: "Adults with depression, for instance, are five times as likely as the average person to have difficulty breathing when asleep, while between a quarter and a half of children with attention-deficit hyperactivity disorder (ADHD) suffer from sleep complaints, compared with just 7 per cent of other children.. Normally, like in the Insomnia article:"Poor sleep quality can occur as a result of sleep apnea or clinical depression.", but what if sleep apnea could cause poor sleep quality and clinical depression? Thats what the weblink from New Scientist suggests: that sleep disorders may lead to the depression, and not "just" However, certainly not every depressed person has a sleep disorder, but this should be thought of!
This leads to the question how this could be included. Well thats not so easy, but first we should agree that this part is not in and then how we can implement it to fit nicely into the article. --Cyrus Grisham (talk) 14:54, 7 March 2009 (UTC)
I agree that it's not in there, and it should be. I do have a feeling (like you?) that research and time will show that sleep disorders cause depression more often than the opposite. They cause "ADHD", too. - Hordaland (talk) 18:59, 8 March 2009 (UTC)
I have the same opinion, but unfortunately the psychiatric community as a whole doesn't seem to be fully convinced yet, so there's a limit to how much weight the article can give these ideas. We gotta follow the mainstream even if we think they're behind the times. Looie496 (talk) 19:51, 8 March 2009 (UTC)
Well, this is not the psychiatric community, this is wikipedia. The Peptic ulcer is one example were the psychiatric community told the people it is just "stress" (bad childhood, stressful job, etc), which is causing this. They were wrong! Stress might be a factor (maybe even an importend or the one), but then what is stress? When were are answering this question, we also have to think about stress hormones! Here the problem begins, because when are these hormons released into the body and where are those produced? Here the psychiatric community gives some answers, but is it the full picture? I don't think so. Why? Scientific evidience shows that stress hormons can also be released, when you have a sleeping disorder or when you're on nightshift(?)! Thats a measurable fact. I have no idea what happends, when the organs which is producing these hormones is not working as it should, for whatever reason. Therefore, I believe that this should be included into the article under a section like "Depression and sleep", where both possibilities should be fairly weighted (depression->bad sleep, bad sleep->depression or better depression <-> bad sleep). There is from my point of view a lot from the psychiatric community, so why not add this stuff? The source is there and I think that New Scientist is a realiable one, don't you? What do you think? Best regards! --Cyrus Grisham (talk) 20:32, 8 March 2009 (UTC)

That article in New Scientist relies almost entirely on this paper for the link with depression. If anything, that study should be cited directly, and the New Scientist article be cited with the "laysummary=" param. I've not read the paper carefully, so no comment on it right now. Xasodfuih (talk) 20:44, 8 March 2009 (UTC)

Here are some other links:
  • Regarding the comment above that the psychiatric community seeks to attribute medical conditions diseases to psychiatric disorders, the example give is peptic ulcer. My experience is the opposite, that is, the general medical community attributes to psychological disorders diseases for which the etiology is unclear e.g. currently Fibromyalgia and Chronic fatigue syndrome and often pain in general. —Mattisse (Talk) 22:15, 8 March 2009 (UTC)
Yup, including mine (DSPS) until quite recently. Progress is slow, but remember that homosexuality was a disorder to be treated according to the DSM. Now it's not, though transsexuality still is. Circadian rhythm disorders were mental disorders until recently. Now they're not, except for SAD which got left behind. There are certainly still a lot of unknowns. - Hordaland (talk) 01:25, 9 March 2009 (UTC)
All I am saying is that misinformation/misdiagnoisis is not a feature of the psychiatric/psychological community seeking to "cover" more diseases/disorders under their umbrella, but rather a reflection of the general medical consciousness of the times. —Mattisse (Talk) 02:21, 9 March 2009 (UTC)

Here are some more studys (some were from mentioned in the New Scientist article, but I couldn't find them all):

By the way, there are far more studys out there between the connection sleep and depression/psychiatric disorders. Quite interesting... --Cyrus Grisham (talk) 12:12, 9 March 2009 (UTC) <-Here's a suggestion: I think a specific article on Role of sleep disturbances in mood disorders would be fully appropriate, and having such an article would make it easier to extract out the gist for the top-level article. If you would like to use your sources to start such an article, I would be supportive. Looie496 (talk) 16:47, 9 March 2009 (UTC)

Thanks Looie496, thats an good idea. I would even suggest an article like sleep and health (Maybe thats too general, and quite a lot of things are in other articles, but there is no article in wikipedia, which gives a quick overview, what might happen when someone has sleep disturbances). However, first I'd like to hear what others are thinking and then we can decide what to do. So I'll be back in this discussion in a few days, I have lots of work to do (and I'm not an expert in this area). Best regards! --Cyrus Grisham (talk) 21:22, 10 March 2009 (UTC)
  • You might look through
For sure :-)
One approach might be Sleep disorder as a list, showing a hierarchy. F.ex. shift work, DSPS and Non-24 are all circadian rhythm sleep disorders, as are ASPS and even Jet lag. One section of Sleep disorder is already in list form. As is:
This almost should be a project. In fact, I think I proposed it as a task force once upon a time!
(This whole discussion should be moved someplace more appropriate.) - Hordaland (talk) 00:55, 11 March 2009 (UTC)
Until then: There is an article on sleep medicine, which could be of use.--Garrondo (talk) 08:33, 11 March 2009 (UTC)
Task force: found it! I did indeed suggest a task force for Sleep medicine here last June. (That was before I wrote the article Sleep medicine referred to above.) Only one other person (user:Medicellis) ever expressed an interest. As this discussion shows, some clean-up and reorganizing is needed. Might there be enough interest now for a Task Force? - Hordaland (talk) 12:22, 11 March 2009 (UTC)
Insomnia got redirected to Sleep medicine (from my point of view, an annoying redirect.) I don't know much about wikipedia projects, but I wonder if "Sleep" could be a "Topic", or is that what it is in the template above? Not sure. Does a project deal with a topic? How does a task force operate? I agree that the subject of sleep is very important and has relevance to many issues/subjects/conditions. —Mattisse (Talk) 12:59, 11 March 2009 (UTC)

Undue weight? to the exclusion of other causes?

There seems to be a big focus on psychological and biological causes of depression which definitely should be included in the article and are relevant but there is zero mention of drug induced depression, which is a common cause of depressive disorder, such as chronic alcohol misuse and chronic sedative hypnotic use. I am not talking about someone getting drunk and "feeling depressed", that is depression the symptom but I am talking about major chronic depression associated with suicide etc caused by chronic use of certain drugs of dependence, specifically alcohol and other sedative hypnotics. I am not talking about self medicating either but the dependency and the chemical imbalances caused by the dependence either directly causing the major and chronic depression or worsening depression. I am not saying that we need a huge section on this but even just a short paragraph or two would do. I can't see why these factors have been totally excluded but a huge amount of text is used on the biological/genetic/chemical imbalance and social factors but nothing on chemical induced depressive disorder. Here is one paper, a 25 year follow-up study.[11] Certain drugs can cause chemical imbalances in serotonin, dopamine etc which leads to depression. I can provide more references but as this is a featured article I did not want to "dive in" and start editing and pulling up refs without discussing first.--Literaturegeek | T@1k? 21:22, 11 March 2009 (UTC)

The new cause section chemical imbalance should be renamed from my point of view drug use. BTW, alc has both an effect on sleep and mood, I qoute from this article [12]: "Alcohol-use disorders are associated with depressive episodes, severe anxiety, insomnia, suicide, and abuse of other drugs." and this [13] "How alcohol produces disturbed sleep remains unknown.". I just rename it. Greetings Cyrus Grisham (talk) 19:29, 14 March 2009 (UTC)
A fairly glaring problem with "chemical" is that everything composed of matter is a chemical. I guess it has a colloquial meaning akin to "noxious substance," but really, all of the neurotransmitters discussed in Biological Causes are chemicals. The entire body is made of chemicals, especially the scary-sounding dihydrogen monoxide--which is, indeed, lethal in certain doses. The main idea of this section appears to be that foreign, psychoactive chemicals can induce depression. And because another name for a foreign, psychoactive chemical is a drug, "drug use" would appear to be the clearest heading. I just wonder if all these headings have led the Causes section slightly astray from the trifurcate "biopsychosocial" theme. Cosmic Latte (talk) 20:11, 14 March 2009 (UTC)

Thanks for the comments. I was unsure about the best name for that section when I chose it. Yea I know alcohol can cause anxiety and sleep disorders. I didn't mention anxiety or sleep in the article as I didn't want to veer off the article topic of major depression too much. Your points are good and I am happy with the sub section name change.--Literaturegeek | T@1k? 00:28, 15 March 2009 (UTC)

In my opinion you need better sources. PMID 19014977 is not a very strong source per MEDRS, and I know from my own experience that the sort of tricky statistical methods it uses are prone to produce spurious results. Most of the evidence I've seen indicates that alcoholism tends to follow depression rather than vice versa -- not sure of the story for other drugs. Looie496 (talk) 00:44, 15 March 2009 (UTC)

Hi Looie. The rat study Cosmic suggested is not necessary anyway. There are lots of authoritative sources for the sleep disturbances of alcohol and also info on sleep disturbances is not relevant to this article I don't think.--Literaturegeek | T@1k? 02:10, 15 March 2009 (UTC)

I deleted the section, mainly because I think we're giving too much weight to unclear causal relationship. Please see WP:MEDRS. You need consensus here first, and I'm not seeing it. OrangeMarlin Talk• Contributions 03:10, 15 March 2009 (UTC)
I suggested a rat study? Cosmic Latte (talk) 09:21, 15 March 2009 (UTC)

There was no opposition if you read above about that section, so I don't know why you say that you are not seeing consensus. I know in the mental health field sedative hypnotics, especially alcohol are well known as causes of depression and psychiatrists will often screen for alcohol misuse when making a diagnosis of depression. Furthermore sedative hypnotics decrease serotonin and noradrenaline which is inline with antidepressants which increase those neurotransmitters having therapeutic effect and those neurotransmitters being involved in depression.--Literaturegeek | T@1k? 07:19, 15 March 2009 (UTC)

IMHO, the alcohol and drug abuse should go into co-morbidities as the causality is tenuous. In addition, we have to mind the undue weight issue. For example, the co-morbidity with drug abuse should not take more room than the whole antidepressant treatment chapter. It deserves, at the most, one or two sentences. The Sceptical Chymist (talk) 12:31, 15 March 2009 (UTC)

Hi Sceptical, The references were not talking about comorbidities but major depression induced by alcohol misuse or chronic use of other sedative hypnotics. They cause an increased risk of major depression, probably due to depletion of serotonergic and noradrenergic function. Your suggestion would be misrepresenting the references.--Literaturegeek | T@1k? 23:10, 15 March 2009 (UTC)

Sorry Cosmic I meant to say Cyrus, I got you two mixed up.--Literaturegeek | T@1k? 23:10, 15 March 2009 (UTC)

Your point is well taken. Indeed, the authors of PMID 19255375 suggest that alcoholism causes depression. However, such a causation is far from being clear-cut. For example PMID 16917682 suggests that the association of alcoholism with depression disappears if the cases with bipolar symptoms correctly assigned to BP-II disorder and not to MDD. Furthermore, "in the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years." To the contrary, PMID 18215474 finds that the onset of alcohol abuse tended to precede the onset of major depression. And PMID 17960298, which you recommended, maintains that it may go both ways: "Major depressive episodes with an onset before the development of alcohol dependence ... were observed in 15.2% of the alcoholics, while 26.4% reported at least one substance-induced depressive episode."
We have to mind the weight issue, too. And write as concise as possible. What about something like this: "Major depression is associated with alcohol abuse. Alcohol abuse often precedes major depression and a recent meta-analysis suggested that it may cause depression. At the same time, in many cases mood disorders precede drinking problems." And I am not sure if the depression caused by benzodiazepine withdrawal can be classified as a bona fide MDD. Is there an MD who could help? The Sceptical Chymist (talk) 00:54, 16 March 2009 (UTC)

The 2nd ref uses the "broadest" criteria for BP II. They use very broad criteria outside of the accepted DSM, so I think their paper is more of a theory hypothesis based paper, rather than a traditional paper. If you use very broad criteria outside of the DSM you can end up distorting data. So I wouldn't say that they are "correctly" assigning cases to bipolar, if anything they are incorrectly doing so in my opinion and by their own admission the DSM's opinion. When using very broad criteria outside of the DSM you can end up diagnosing mild to moderate paranoia as schizophrenia and double or treble the amount of people diagnosed for example. Same with ADHD, insomnia and other disorders you could end up with figures like 30% or more of the population having those or other disorders if you use the broadest of criteria outside of and or in addition to the DSM. Infact that paper seems to be doing some synthesis or original research by using DSM but then adding in more broad diagnosis criteria, which is not universally accepted like the DSM which itself has even been criticised by some as being too broad. Self medicating with alcohol in bipolar patients (the sedative effect of alcohol reducing the manic symptoms) is very common and do agree that self medicating for bipolar is common but this would be relevant for the bipolar article.--Literaturegeek | T@1k? 03:13, 17 March 2009 (UTC)

You already included the following good sentence into the causes of depression chapter: "Long term drug use or abuse or withdrawal of certain sedative and hypnotic drugs eg. alcohol or benzodiazepines can also cause a chemical imbalance which may result in major depressive disorder.[14][15]" Minding the due weight issue, is there need for more? If yes, for how much more? Ref [15] (name=ashman>{{cite web | author= Professor Heather Ashton | year= 2002 | url= http://www.benzo.org.uk/manual/bzcha03.htm | title= Benzodiazepines: How They Work and How to Withdraw) is probably not very reliable. How about replacing it with some of the discussed above? changing eg to for example for the lay reader?The Sceptical Chymist (talk) 10:30, 17 March 2009 (UTC)

Prof Ashton is a world expert on benzodiazepines and The Ashton Manual is often referenced in medical publications, on google scholar. I don't think that the text that I added was undue weight if you look at the size devoted to biological chemical imbalances, although I guess that I could shorten it a bit. I have found a medical text book which speaks about protracted withdrawal symptoms including depression so I can certainly improve the quality of the references if necessary.--Literaturegeek | T@1k? 13:19, 17 March 2009 (UTC)

I added back the data and included an oxford text book reference. I am trying to get a hold of another oxford text book for reference.--Literaturegeek | T@1k? 14:09, 19 March 2009 (UTC)

I just reverted mwalla on this page who has now decided to follow my edits around because I "dared" to revert their vandalism to the paroxetine talk page. They were deleting parts of comments Sceptical Chymist made and inserting their own comments to make sceptical say things that he didn't on the paroxetine page so because I reverted mwalla he is now adding their voice to talk page discussions like here to annoy me.--Literaturegeek | T@1k? 17:01, 19 March 2009 (UTC)

the claim of vandalism by literaturegeek today is unfounded. the changes made by mwalla appear to be' good faith. Apart from the slight wording times that may reflect different points of view (cause vs associated with")- the remainder of the edits by Mwalla improved the article. someone is gaming the system. Have reverted Earlypsychosis (talk) 18:26, 19 March 2009 (UTC)

Appearances can be deceptive is all that I can say. I explained in the edit summary that mwalla was being malicious. An administer has investigated them and they are currently blocked for 1 week for editing so I am NOT being biased. Mwalla is also under investigation for using sock puppets. Their edits were just nuscience edits. I really don't appreciate people jumping to conclusions and accusing myself of "gaming the system" when I am the innocent one here. Mwalla is the one who got blocked for a week. Actually I reverted vandalism to edits of another user on am article talk page. The revert of their vandalism didn't even involve me but involved another editor on another talk page. For being a good wikipedian, I am now getting my name slammed into the ground.--Literaturegeek | T@1k? 18:32, 19 March 2009 (UTC)


I didnt accuse you, I accused both of you. I stand by that. the claim of vandalism was unfounded and your revert edits made the article on depression worse. Please keep discussion to the depression talk page. Earlypsychosis (talk) 18:32, 19 March 2009 (UTC)

I copied the above from your talk page. The edits were vandalism or malicious because,,,, they followed my edits immediately after I had reverted vandalism they had done on another page. They did something similar when I voted on an article for deletion (as did 90% of other people) and they then attacked my recent edits to other articles. This is what they always do to multiple editors. They do things like harrass other editors like edit their comments on talk page to make them say the opposite of what they mean without signing posts to annoy them or win arguments. Like imagine if I edited comments you made all over wikipedia to say the opposite of what you actually said. This si what they do and why I reported them and why they got blocked and why they attacked this page, albeit subtly and you said on "appearance they seemed to being good faith".--Literaturegeek | T@1k? 18:38, 19 March 2009 (UTC)

It is not your fault and I am not annoyed because you don't know the background of this editor mwalla. Sceptical has more problems and run ins with mwalla by the looks of things and mwalla goes all over trying to smear him as well as other productive editors. I am NOT opposed to people coming up with suggestions on how to reword paragraphs or tweaking edits that I make or even challenging them, I simply reverted this one individual because they distorted what ref says and only did it for malicious reasons to annoy me.--Literaturegeek | T@1k? 18:43, 19 March 2009 (UTC)

As for my revert of Mwalla's malicious edits making the article worse, how would misrepresenting the refs make the article better? The refs are on benzodiazepine dependence and benzodiazepine withdrawal in prescribed users, not abuse.--Literaturegeek | T@1k? 18:47, 19 March 2009 (UTC)

My undo was in good faith. I have no history here. I read the changes and looked at your claim that the article was being vandalised. It was not. This is a conflict between POV. I stand by my edit. Please dont undo it Earlypsychosis (talk) 19:11, 19 March 2009 (UTC)

I understand that your revert was in good faith. But you did not look at the references, my edits are references are accurate reflections of the references. Your reverts back to the vandalised version is inaccurate. My edits reflect the references so how is it POV? I cannot believe I am still arguing over fake data here. The terminology that I used was "long term use" which actually includes misuse as well as prescribed use, although the articles were on prescribed users so if anything I am being overly neutral.--Literaturegeek | T@1k? 20:03, 19 March 2009 (UTC)

It is clear that you have NOT read the references and you are doing original research and denouncing me based on your POV. The only POV that I am using is a POV of the references.--Literaturegeek | T@1k? 20:07, 19 March 2009 (UTC)

I'm not sure what you are referring to in regards to original research and my POV, but I am open to your challenge (ie using good referencs that I have read). In addition, I will continue to edit in good faith and NPOV. Cheers Earlypsychosis (talk) 09:25, 21 March 2009 (UTC)

As explained the refs are not on drug abusers but on prescribed users. I did not challenge you to anything. All I requested was that the text be kept to what the refs said is all. If you have a ref which talks about benzo drug abuse being correlated with increased levels of major depression please do cite those. By the way I have not claimed that you are a bad editor. I have seen some of your edits to wikipedia and can see that you are a productive contributer to wikipedia, so please don't take this dispute on this article personally.--Literaturegeek | T@1k? 09:39, 21 March 2009 (UTC)

Freerangeraider is a sock puppet of Mwalla who are now trying to make me look like I am using sockpuppets by editing this article. An independent wiki BOT detected it as a suspected BOT and added it to the growing list of sockpuppets of Mwalla.--Literaturegeek | T@1k? 10:36, 21 March 2009 (UTC)

Regarding the efficacy of dietary oils in depression

Header edited to comply with WP:TALK#New_topics_and_headings_on_talk_pages, which indicates that headers should indicate the topic, but no specific view on that topic. Original header preserved in an anchor tag. --Scray (talk) 06:31, 15 March 2009 (UTC)

Regarding these edits [14] [15] [16] by OrangeMarlin: (clarification added after topic was renamed)

  • Metaanalysis1: (PMID 17194275) "CONCLUSIONS: The preponderance of epidemiologic and tissue compositional studies supports a protective effect of omega-3 EFA intake, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mood disorders. Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02)."
  • Metaanalysis2 (PMID 17877810): "A meta-analysis of trials involving patients with major depressive disorder and bipolar disorder provided evidence that omega-3 PUFA supplementation reduces symptoms of depression. Furthermore, meta-regression analysis suggests that supplementation with eicosapentaenoic acid may be more beneficial in mood disorders than with docosahexaenoic acid, although several confounding factors prevented a definitive conclusion being made regarding which species of omega-3 PUFA is most beneficial."
  • Metaanalysis3 (PMID 17158410): "Meta-regression provided some evidence that the effect was stronger in trials involving populations with major depression-the difference in the effect size estimates was 0.73 (95% CI: 0.05, 1.41; P = 0.04), but there was still considerable heterogeneity when trials that involved populations with major depression were pooled separately (I2 = 72%, P < 0.001). CONCLUSIONS: Trial evidence that examines the effects of n-3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity."
  • Editorial (PMID 17919344): "The evidence supporting the use of EPA+DHA in the management of psychiatric disorder appears strongest for conditions involving disturbances of mood/anxiety and/or impulse control. Thus in addition to the benefits for major depression and bipolar disorder highlighted by the APA's meta-analysis, ..."

OrangeMarlin, you are in gross violation of WP:V and WP:MEDRS trying to debunk 3 metanalysis with one negative study done in a different population PMID 17956647 (read the editorial in Br. J. Nutr. carefully). You are also stating the exact opposite of what metaanalyses cited say; presumably you need a refresher in statistics. Desist at once! Xasodfuih (talk) 05:45, 15 March 2009 (UTC)

Please see WP:NPA. Each one of your citations quote mines. In fact, none of them support your statements, and most of them say "you know, we see some variability, maybe it might do something, but really, we're not seeing it." I'm paraphrasing for effect. Any further personal attacks about my intelligence, fields of study, etc. will be dealt with quite radically. Otherwise, YAWN. OrangeMarlin Talk• Contributions 06:01, 15 March 2009 (UTC)

(out-dent) From what I see presented here (I am not an expert on this subject), it appears that no randomized, placebo-controlled clinical trial has shown a clear protective or therapeutic benefit for omega-3 or other dietary oils. Meta-analysis (a less-compelling form of evidence because it is not a direct comparison and is subject to publication bias and other limitations) has suggested a modest effect tempered by heterogeneity among trials (worrisome in a meta-analysis). Let's see how others weigh in, but I would attempt to write soft language that captures the limited support these data provide. The gold standard remains randomized placebo-controlled study, and to date those have not shown a clear benefit. --Scray (talk) 06:30, 15 March 2009 (UTC)

There's too much happening to this article too quickly. OM's wording is far more negative than the wording that was in the article a couple of days ago, which was a result of a lot of careful editing. There are a couple of dozen other dubious new changes too. For an FA this sort of thing is really unacceptable. I would like to revert back to the version of March 13 and then take things one at a time, discussing on the talk page and reaching consensus before making changes to the article. Looie496 (talk) 06:32, 15 March 2009 (UTC)
I agree with your concern about the rapid succession of edits, but it's not obvious where to draw the line. I'll defer to others on how exactly to get there, but part of the message is that we need consensus in a situation like this, not rash action. This is not an emergency. --Scray (talk) 06:41, 15 March 2009 (UTC)
Taking PMID 17158410 as example (the other metaanalyses are also on RCTs): "Eighteen randomized controlled trials were identified; 12 were included in a meta-analysis. [...] The pooled standardized difference in mean outcome (fixed-effects model) was 0.13 SDs (95% CI: 0.01, 0.25) in those receiving n–3 PUFAs compared with placebo." Please read what a metaanalysis is, and also what WP:MEDRS recommends wrt. to them (hint: they're the best level of evidence. Xasodfuih (talk) 06:44, 15 March 2009 (UTC)
I assure you that I am well-versed in meta-analyses, and they do have serious weaknesses to which I specifically alluded. They are certainly not simply the best level of evidence - they can be very useful, but their accuracy depends on many factors. --Scray (talk) 06:54, 15 March 2009 (UTC)
"not simply the best level of evidence" WP:MEDRS disagrees with you; take that discussion there. Yes, heterogeneity is a concern for the validity of the results, hence the careful wording I proposed "meta-analyses of controlled studies showing positive results but also high heterogeneity and small effect size". Xasodfuih (talk) 06:58, 15 March 2009 (UTC)
(after edit conflict, and relevant to this comment) The specific example chosen (PMID 17158410) it is remarkable that the exact sentence quoted above actually continued, "with strong evidence of heterogeneity (I2 = 79%, P < 0.001)". This is exactly the sort of problem that plagues meta-analysis. Also, I don't dispute that meta-analysis can be an excellent form of evidence, but it is not simply the best form - there are many bad meta-analyses. --Scray (talk) 07:05, 15 March 2009 (UTC)
So? The wording I used "meta-analyses of controlled studies showing positive results but also high heterogeneity and small effect size" captures this finding which was common to all three metaanalyses. Compare with OM's "with controlled studies and meta-analyses showing negative results exclusively." which is clearly a false statement given the sources. Xasodfuih (talk) 08:12, 15 March 2009 (UTC)

I saw request for comments on wiki medicine. I read the edit summary and the reason for deleting was "CAM pushing". I don't think diet and nutrition is CAM pushing. It is basic biology that certain nutrients have effects on brain function, essential effects on brain function. I think that the scientific literature does seem to suggest that there is some benefit all be it small benefit from taking omega 3. Furthermore omega 3 is deficient in western diets. HOWEVER, like I say the effect size appears to be small and to effect only a small proportion of those with major depressive disorder. Basically my stance is as the literature seems to suggest a small effect size, it is an issue of accurately wording the conclusions and not giving undue weight. I do not think that it should have been deleted and I don't think that it can be compared to alternative medicine as explained in this post. It is certainly not like kinesiology or something, the body needs nutrients to function and that is fact.--Literaturegeek | T@1k? 07:01, 15 March 2009 (UTC)

Scray you are correct meta-analysis have their weaknesses although it depends on what they are assessing. If they are being used to assess a paradoxical effect for example of a medication they are useless as all they prove is you are more likely to have a therapeutic effect than a paradoxical effect (I am recalling a debate I had on another talk page :)). Unfortunately authors then commit scientific fraud by then misusing meta-analysis to debunk uncommon paradoxical effects. I am sure they have other weaknesses to, but I think that there does appear to be enough evidence of a small effect size on omega 3. By the way, I don't have a strong view point on omega 3 and don't want to get in an edit war over it. I am merely commenting on this because it was raised on the medicine talk page for comments, so whatever the decision is on this so be it but these are my views.--Literaturegeek | T@1k? 07:07, 15 March 2009 (UTC)

I came here for the same reason (the appeal on wikimed; my very first visit to this page was just minutes ago), and agree with the tone of your comments. We need a moderate position - the data are very imperfect. --Scray (talk) 07:12, 15 March 2009 (UTC)
(copied from above) The wording I used "meta-analyses of controlled studies showing positive results but also high heterogeneity and small effect size" is a moderate statement that captures the common findings from all three metaanalyses. Compare with OM's "with controlled studies and meta-analyses showing negative results exclusively." which is clearly a false statement given the sources cited. Xasodfuih (talk) 08:12, 15 March 2009 (UTC)
WP:MEDRS is only a guideline, so editors can override its general advice if they have good reason. However, before the meta-analyses are dismissed, I ask what would be used instead? If the best published attempts to review the literature are imperfect, are we to replace them with some wikipedian's own attempts to review the literature? Or do we have other reviews to consult? The article should reflect what our best sources have to say on the subject, and that is best done by consulting those who have already reviewed the research and had their conclusions published in a respectable journal. WP:V policy is "verifiability, not truth" so this article should reflect their conclusions, whether we think they are strong founded or not, subject to publication bias or not. There are biases and flaws in all source types and the real world is messy. BTW: don't interpret this as leaning towards one side or another -- I haven't read those sources and am not qualified to judge here. Colin°Talk 08:39, 15 March 2009 (UTC)

Regarding the efficacy of dietary oils in depression (arbitrary break)

Let's avoid selective citation and look at the CONCLUSION part in the abstract of each meta-analysis:

Metaanalysis1 PMID 17194275) positive but not quite conclusive: "Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02). The results were highly heterogeneous, indicating that it is important to examine the characteristics of each individual study to note the differences in design and execution... EPA and DHA appear to have negligible risks and some potential benefit in major depressive disorder and bipolar disorder, but results remain inconclusive in most areas of interest in psychiatry."

Metaanalysis2 PMID 17877810 inconclusive, further studies needed: "While it is not currently possible to recommend omega-3 PUFA as either a mono- or adjunctive-therapy in any mental illness, the available evidence is strong enough to justify continued study, especially with regard to attentional, anxiety and mood disorders."

Metaanalysis3 PMID 17158410 negative, further studies needed: "Trial evidence that examines the effects of n-3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity. The evidence available provides little support for the use of n-3 PUFAs to improve depressed mood. Larger trials with adequate power to detect clinically important benefits are required."

Study and meta-analysis4 PMID 17956647 negative: "In conclusion, substantially increasing EPA+DHA intake for 3 months was found not to have beneficial or harmful effects on mood in mild to moderate depression. Adding the present result to a meta-analysis of previous relevant randomised controlled trial results confirmed an overall negligible benefit of n-3 LCPUFA supplementation for depressed mood."

Opinion PMID 17919344 controversy: One of the authors of Metaanalysis1 slams authors of metaanalyses 3 and 4 for poor methodology. "Their choice of a new population to study makes good sense. But pooling their results with those of other trials involving very different populations does not. This all encompassing approach to meta-analysis was used in an earlier publication from the same group12, and it is repeated in the current paper, with the inclusion of this latest trial. What have males with angina, chronic patients with schizophrenia, and mothers who choose to breastfeed got in common?" However, the author of this opinion notes a very important detail that the abstract of his own meta analysis1 did not mention. "It was strongly emphasised [in metaanalysis1] that these recommendations are not intended as a substitute for standard treatments for psychiatric disorders, as most trials to date have used n-3 fatty acids adjunctively."

So why not return to the balanced version: "The issue of efficacy of omega-3 fatty acids for major depression is controversial,[14] with controlled studies and meta-analyses supporting both positive[15][16] and negative conclusions.[17][18]" The Sceptical Chymist (talk) 11:50, 15 March 2009 (UTC)

I largely agree with the version you restored, which preceded OM's edits. An observation: metaanalysis3 PMID 17158410 and Study and meta-analysis4 PMID 17956647 are pretty much one and the same as the authors list overlaps significantly, and meta-analysis4 added one study to metaanalysis3. As for caveats, authors of Metaanalysis2 also wrote a similar caveat that authors of Metaanalysis1 in a reply to a letter to the editor. Regardless of metaanalysis and the spin given in the conclusion section, the statistical results of metaanalyses are in the same ballpark in terms of heterogeneity and effect size. Even though Metaanalysis2 puts a different sticker on its conclusions than Metaanalysis1, their statistical findings agree: "The magnitude of that effectiveness is approximately 0.91 standard deviations of improvement, given the characteristics of the populations studied to date and noted above. Such a finding is in line with a previously reported meta-analysis which analysed a smaller number of trials [89]. There was, however, significant heterogeneity between the studies." Also metaanalysis3, when restricted to MDD patients, gave a similar result. That's why I thought we should report on their actual statistics, which they actually agree upon, rather than whatever spin they put on them, which is where they disagree. But I'm fine with taking the spin from the horse's mouth, even when it makes little sense to me to present this as controversy over "positive" and "negative" findings when the statistics are pretty much the same, just the spin differs. Xasodfuih (talk) 13:29, 15 March 2009 (UTC)
X, on such a controversial topic we have to stick closely to the original interpretations, the more it is controversial the less editorial discretion we have. As omega-3 is an unproven treatment (all the analyses call for more research), it does not deserve more than a short mention. Please also note that the efficacy was suggested only for adding omega-3 to the antidepressant treatment, the fact that your version missed. With all the caveats this can be explained in the article on omega-3 themselves or in the article on the treatment for depression. The Sceptical Chymist (talk) 19:02, 15 March 2009 (UTC)
Agree (in part) with preceding, in that omega-3s also aren't actually used in psych wards or prescribed by any psychaitrists that I know of. The treatment for depression is an ideal page for a greater in depth summary. I have only very briefly scanned over the material and will look into it a bit further to see what is out there. Casliber (talk · contribs) 20:14, 15 March 2009 (UTC)
Maybe they should start prescribing omega-3s. Omega-3s are harmless and the placebo effect is a powerful thing. :) The Sceptical Chymist (talk) 01:26, 16 March 2009 (UTC)

I think that returning to the balanced version that Sceptical suggested is a good idea.--Literaturegeek | T@1k? 23:36, 15 March 2009 (UTC)

I don't. —Preceding unsigned comment added by Mwalla (talk • contribs) 16:56, 19 March 2009 (UTC)

Exercise

The section on "somatic treatments" did not accurately reflect the results of a recent Cochrane review (see note 160) on the impact of exercise. A detailed reading of this review reveals that 1) the 23 studies that were originally selected show a "large clinical effect." 2) this conclusion is qualified by a statement that three of these studies "with adequate allocation concealment, intention to treat analysis, and blinded outcome assessment" are inconclusive. As far as I can see the secondary selection of this small subgrouping is (puzzlingly) not mentioned at the outset of the study and so should not be considered as a major finding, but only as a qualification, at best. The scale and rigor of many of these studies as well as the main conclusion of the Cochrane review indicates that a separate section on exercise is merited, and so I have created one. The new section obviously needs beefing up, and we have a plentiful supply of serious studies to facilitate this. —Preceding unsigned comment added by Blissblog (talk • contribs) 21:33, 15 March 2009 (UTC)

Substance-induced mood disorder

In my opinion, the recent addition of drug abuse or withdrawal as a cause of Major Depressive Disorder is questionable. By definition, if drug abuse or withdrawal is a cause of depression it is not MDD but Substance-Induced Mood Disorder. According to DSM IV-TR criterion B for Substance-Induced Mood Disorder "there is evidence from the history, physical examination, or laboratory findings of either (1) or (2): 1) the symptoms in Criterion A [eg depression] developed during, or within 1 month of, Substance Intoxication or Withdrawal (2) medication use is etiologically related to the disturbance [emphasis mine]." Apparently, there is a confusion in the literature as to the differential diagnosis of these two disorders. Particularly unreliable is a diagnosis of MDD which begins and continues on the background of alcohol abuse/dependence. But this diagnosis is often used in the literature supporting causal relationships of drug abuse and MDD. What should we do? The Sceptical Chymist (talk) 23:25, 19 March 2009 (UTC)

I would agree that a substance-induced mood disorder theoretically has a difference etiology than a non substance-induced disorder. I have not noticed the confusion in the literature as much as in real life. There may be an assumption of a "predisposition" for a case that is not clearly substance-induced, or a belief the the substance abuse is secondary to the depression, a self medication for MDD. —Mattisse (Talk) 00:01, 20 March 2009 (UTC)
Agree that it is problematic given the exlcusion criteria of MDD. A better place would be including it on the mood disorder article as it pertains to them as a group. Casliber (talk · contribs) 00:35, 20 March 2009 (UTC)

Mwalla changed it to say drug abuse. The refs on benzos are talking about long term use in prescribed users, but yes it is still substance induced mood disorder. There isn't a wikipedia article on substance induced mood disorder. The literature still ascribes substance induced major depression to major depressive disorder. I think MDD can have a range of causes, genetic, social/environmental, childhood, post traumatic, substance related or perhaps often a mixture of 2 or more factors. The literature seems to suggest that some I think it is about a 3rd had pre-existing major depression but 2 thirds or so develop it as a result of drinking or the drinking worsens it. It might be an idea moving the bulk of the material to the mood disorder article but I still think if we did that that we should leave a short summary on this article of say only a few sentences, I don't think readers should be left completely without the information on alcohol and benzos as a risk factor for increased risk of MDD as alcohol misuse and chronic sedative hypnotic use is so common. How about that for an idea?--Literaturegeek | T@1k? 06:26, 20 March 2009 (UTC)

For what it's worth...

According to the DSM, in order for a major depressive episode to be diagnosed, "The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication)." I'm unfamiliar with the branch of research being discussed here (not to mention unimpressed by DSM arbitrariness), but are you sure that these researchers have in mind the same "major depressive disorder" that others in the psychological/psychiatric community talk about? Cosmic Latte (talk) 10:00, 21 March 2009 (UTC)

What do you think about moving the bulk of the material to mood disorder. See my suggestion in above comment. I might do that actually now.--Literaturegeek | T@1k? 10:21, 21 March 2009 (UTC)
yes +++ Casliber (talk · contribs) 10:34, 21 March 2009 (UTC)
[edit conflict] That sounds like a good idea to me--moving most of it to mood disorder but leaving a general summary of it in here. I wouldn't omit it entirely, because something relevant is clearly going on, but I think there might be WP:Undue weight issues if it's given extensive treatment here while in some conflict with DSM-defined depression. Cosmic Latte (talk) 10:35, 21 March 2009 (UTC)

Freerangeraider by the way is trying to impersonate, trying to make it look like I am using socks. A wiki BOT detected them independently and added it to an investigation list, just incase anyone thought that it was me.--Literaturegeek | T@1k? 10:40, 21 March 2009 (UTC)

Glad we seem to have agreement. I agree with the suggestions here, ie leave a brief summary here with some citations and move the bulk of the material in mood disorder.--Literaturegeek | T@1k? 10:40, 21 March 2009 (UTC)

 Done--Literaturegeek | T@1k? 12:03, 21 March 2009 (UTC)

Causes/Other theories --> Possible role of the endocannabinoid signaling system?

I think it might be worth mentioning under the "other causes" heading about the possible role of the endocannabinoid signaling system in the etiology and/or possible treatments for depression. It's a theory that seems to be gaining ground especially as it seems to pick up where the monoaminergic theory falls short. The role of cannabinoids seems to make sense as the psychoactive component of cannabis (marijuana), which has been reported to have anti-anxiety and mood-elevating properties, is an agonist to the cannabinoid receptor. Rimonabant, which is the first pharmacuetically developed cannabinoid receptor antagonist used to treat obesity, was recently pulled off the market because of the prevalent side-effects of depression and suicide. [17] Recent articles highlighting endocannabinoids in depression:Kpstewart (talk) 05:57, 29 April 2009 (UTC)

Role of Vitamin D? Where is the best place to add?

I think it is also worth mentioning the possible role of vitamin D in the etiology or treatment of depression, especially as the theory fits in with the development of SAD and the use of light therapy as a treatment. Reason being the evidence shown in these articles, among others:

  • Gloth, F.M. 3rd; , Alam W, Hollis B. (1999). "Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.". J Nutr Health Aging 3 (1): 5–7. PMID 10888476. http://www.ncbi.nlm.nih.gov/pubmed/10888476.
  • Lansdowne, AT and Provost SC (1998)."Vitamin D3 enhances mood in healthy subjects during winter." Psychopharmacology 135:319-23. pmid:9539254
  • Vitamin D and Depression

I can think of 5 possible places to add this, and I'm asking for input as for where the best place would be:

  • Option 1: as a separate paragraph under "other theories"
  • Option 2: add to the "light therapy" paragraph under "other theories" heading
  • Option 3: add the paragraph mentioning vitamins A and B12 at the end of "other theories" heading
  • Option 4: as a new paragraph under "Treatments/Over-the-counter compounds"
  • Option 5: as a new heading under "Treatments"

I think the vitamin D story is a viable, intriguing, noteworthy theory, and I'm surprised that it isn't mentioned in any of the "depression" related pages I've found on wikipedia. I think it's best to mention under both the "other theories" and "treatments", but I hesitate to add too much because I feel the entire "depression" article is getting overwhelmingly large for most readers. (I do plan to add more in depth info on Vitamin D to Treatment for depression and possibly Biology of depression pages when I have the time) Beyond that I think the "other theories" topic is getting far too large and I suggest that it might be broken up under separate headings to make it easier to read. However, the only idea I would be to split it in two, possibly as headings such as "other theories of central nervous system origin" and "other theories of peripheral origin" (but hopefully using more layman friendly wording).Kpstewart (talk) 06:58, 29 April 2009 (UTC)

Perhaps relevant to seasonal affective disorder. I don't think that it should be added to this article as it is not addressing Major depressive disorder.--Literaturegeek | T@1k? 13:30, 29 April 2009 (UTC)

Pathological laughing and crying ,crying and depression Where is the best place to add?

Symptoms of depression Crying easily or crying for no reason at all Zenhabit (talk) 11:36, 10 May 2009 (UTC)

Crying could (and probably should) be mentioned in Major_depressive_disorder#Symptoms_and_signs. I'm surprised that it isn't already there. I'm not familiar with PLC, but something should probably be done about the contradictory-sounding claims in that article that, on the one hand, "These episodes are not manifestations of a mood disorder such as major depression or mania, where laughing and crying are expressed in tandem with feelings of happiness or sadness" and, on the other hand, "Studies have reported an inconsistent pattern of association between PLC and major depression. Sometimes an association is found, other studies find none." If PLC isn't a "manifestation" of MDD, then what is the association between the two that is sometimes found? Cosmic Latte (talk) 22:04, 11 May 2009 (UTC)
Most likely indirect, i.e. they share causal variables. Guido den Broeder (talk, visit) 22:20, 28 May 2009 (UTC)

Learning theory

The aritcle contains the following sentence:

Psychological treatments are based on theories of personality, interpersonal communication, and learning theory.

But learning theory is a disambiguation page. Please clarify in this article what kind of learning theory is intented. - 75.145.87.233 (talk) 01:53, 23 June 2009 (UTC)

Done, thanks for the pointer. Looie496 (talk) 04:10, 23 June 2009 (UTC)

Causes - monoamine hypothesis

The text says "The medications tianeptine and opipramol have long been known to have antidepressant properties despite lacking any effect on the monoamine system". From what I can tell, although tianeptine indeed is known to have antidepressant properties, it definitely does affect the monoamine system, since it is a selective serotonin reuptake enhancer (SSRE). (The other drug mentioned, opipramol, is indeed "lacking any effect on the monoamine system"). I think that the sentence should be rephrased, but I hesitate to do so myself because of my lack of expertise in the field. Perhaps what should be said is simply that the clinical efficacy of tianeptine and opipramol is a counterargument to the monoamine hypothesis.--PloniAlmoni (talk) 09:40, 23 June 2009 (UTC)

Suicide statistics

I suggest to re-check the sources for the sentence 'Major depression is reported about twice as frequently in women as in men, although men are at higher risk for suicide.' and to rephrase the second part if necessary. To my knowledge, the number of suicide attemps is higher in women, who frequently fail when using sleeping drugs, whereas the 'success rate' is higher in men that 'prefer' weapons and other hard ways to leave earth. --Emil Bild (talk) 11:46, 23 June 2009 (UTC)

Yes, that's an important point. See [18] and [19]. Cosmic Latte (talk) 12:10, 23 June 2009 (UTC)


The section about genetics of major depressive disorder needs to be expanded and completed. There are hundreds of scientific papers about it and it is a topic of high interest for a lot of people. — Preceding unsigned comment added by 81.241.188.220 (talk) 21:26, 23 June 2009 (UTC)

Causes

"For example, a prospective, longitudinal study uncovered a moderating effect of the serotonin transporter (5-HTT) gene on stressful life events in predicting depression." I've read this sentence over several times and I STILL don't understand what it means, mainly the predicting depression part at the other end. Can this be reworded? Icemuon (talk) 12:02, 23 June 2009 (UTC)

I guess that might have been a little too much jargon for the wikilinks to counterbalance. Simplified here; tweaked further here and here and here. Cosmic Latte (talk) 12:52, 23 June 2009 (UTC)
Tweaked here now, too, and hopefully for the better. Cosmic Latte (talk) 15:20, 23 June 2009 (UTC)

I think this was meant to be a new thread...

DISGUST - SURGERY AND DRUGS, DRUGS AND SURGERY - we am aware this is an encyclopedia, but this article reflects so strongly the american style of medicine that it is disturbing. the history of the DSM is clearly fraught with highly documented payola in schools, research, and the dsm itself. for the latest/upcoming version, almost all authors were receiving money or had direct connections to drug companies, as reported in major newspapers. WHEN ORIGINS OF SOCIAL PHENOMINA ARE FORGOTTEN AND PEOPLE PERPETUATE THEIR OWN PROPOGANDA ISN'T THIS THE ULTIMATE FORM OF BRAIN-WASHING. we leave you with perhaps the most famous quote of the english psychologist r.d. lang: "psychology is the science of becoming well adjusted to an insane world." 208.125.126.250 (talk) 15:53, 23 June 2009 (UTC)grumpy- wikimessage#2

Did you survive the article long enough to reach the Major_depressive_disorder#Sociocultural_aspects section at the end? We are well aware that there are those who depart from DSM-style understanding. Heck, some of us might even be among them. But since the concept of "major depressive disorder" originated with the DSM, ought we not to put it in its native frame of reference? If we focus on the likes of Laing and Szasz (both of whom, incidentally, fascinate and challenge me), then we might be able to write an interesting article about what MDD is not, and then we could go over to Wiktionary and explain how things are not defined; and then we might like to go outside and ask the neighbour how he's not doing today. But if we wanna get at what we've not got, then first we've gotta get what we've got. And what we've got is a prominent system of belief and practice--a system without which this article could not exist, could not inform aspiring critics of just what it is they are about to criticize. In a nutshell, of course this article is going to reflect a lot of DSM understanding, given that the article's subject is a direct product of that understanding. In contrast, Depression (mood), having predated that understanding, is not so much a product of it; Diagnostic and Statistical Manual of Mental Disorders and Descriptive psychiatry are less predicated upon it than equivalent to it; even Major_depressive_disorder#Sociocultural_aspects implies areas of reduced contingency upon the mainstream. You might enjoy editing on these topics; you might even expand Major_depressive_disorder#Sociocultural_aspects into an article of its own. But if an American-style concept is not first presented in its American-style context, it might not amount to a very solid ground from which one can coherently diverge. Cosmic Latte (talk) 17:03, 23 June 2009 (UTC)
Or, if you'd prefer, I'll approach this from a slightly different angle: Well, okay. So, what do you suggest? Cosmic Latte (talk) 17:32, 23 June 2009 (UTC)

melatonin & light sensitivity

Possibly of interest here. In the book 'Biology of Depressive Disorders: Subtypes of depression and comorbid disorders', pg 48, they're discussing some study of healthy young people (age 15-25), comparing the sensitivity to light of children of healthy parents & children with 1 bipolar parent & children with 2 parents with major depressive disorder. Google book preview

Those with 2 well parents were most likely to suppress melatonin at the relatively low level of 500 lux. Those with 1 ill parent were intermediate, and those with 2 ill parents were least likely to suppress melatonin at that light level at 2-4 a.m.

"Therefore, this marker, supersensitivity to light suppression of melatonin, may be a "trait" marker for development of bipolar depression in adolescents and young adults." - Hordaland (talk) 07:21, 24 July 2009 (UTC)

Wouldn't this be more relevant to the bipolar disorder or melatonin pages? MichaelExe (talk) 15:26, 25 July 2009 (UTC)
Not melatonin, I think. That would be backwards; it's the mental illness they're researching, not the hormone. But bipolar, probably, yes. I came here because of the book's title, I think. - Hordaland (talk) 18:56, 25 July 2009 (UTC)

It seems that nobody mentioned here that a number of insect born diseases can affect the nervous system and create depression, bipolar syndrome, anxiety attacks, bouts of rage, as well as sensitivity to light and migraines. They are not well known and therefore the psychologists or psychiatrists rarely suspect these causes. For more information one might research Lyme disease, bartonella, babesia, spirochetes , etc infections... See Pubmed for references.

When it comes to most mental disorders (except innate disorders, often autism or retardation), disease never actually CAUSE the disorder. Disease can create a biological vulnerability to the disorder (biopsychosocial model and diathesis-stress model suggest this). If anything, the psychosocial factors and stress weigh the most in mental disorders. MichaelExe (talk) 15:28, 23 August 2009 (UTC)

Dorothy Rowe

has been given too much prominence here, IMO, especially considering that the article about her lacks citations... - Hordaland (talk) 11:33, 30 August 2009 (UTC)

Interesting - how'd that get there. Need to look into it. I have never heard of her. I have not seen the name in peer-reviewed literature anywhere before now. Casliber (talk · contribs) 13:29, 30 August 2009 (UTC)
she is well known in UK psychology [20] Earlypsychosis (talk) 20:36, 30 August 2009 (UTC)

Picture relevent/meaning?

The picture of Van Gogh's painting seems suitable but when I looked it up I could find nothing on it. I thought it'd have all sorts of sites. Can it's pertainence be ensured? It seems more a near-death time thing as the old man is just that, very old; Death being an eternity. More apropriate to fear of death than depression, perhaps; as it draws nearer and is inevitable. Daniel Christensen (talk) 03:47, 16 September 2009 (UTC)

Fortunately Wikipedia's rules don't require pictures to have reliable sources, or we'd be completely screwed. The pose is strongly associated with grief, and I don't see that anything more is needed to justify it. Looie496 (talk) 21:14, 16 September 2009 (UTC)
I don't think it's appropriate, a lot of people with depression do their best to hide it and present a cheerful/normal attitude outwards. Instead this might help spread the incorrect notion that you can easily see that someone is depressed (perhaps you can see physical signs, but that is nothing like the picture). Anyway, i feel it could give the wrong idea.
—Apis (talk) 23:57, 2 October 2009 (UTC)

Diet and depression

An interesting paper on the association between the two http://archpsyc.ama-assn.org/cgi/content/short/66/10/1090 Doc James (talk · contribs · email) 17:11, 6 October 2009 (UTC)

Recurrence/Relapse and Chronic

"Approximately 80% of the patients who have a first episode of major depression will have at least one more. The lifetime average is 4 episodes." and "Approximately eight out of ten people experiencing a major depressive episode will have one or more further episodes during their lifetime: a recurrent major depressive disorder." PMID 17555914 and PMID 17144786

Currently, the article assumes a recurrence rate of 35% (from PMID 18458203). Should we try to use both (i.e. "some studies have shown", "so-and-so's review has shown", etc.)? Or, try to find which of the two rates is used the most? I just went through all of the reviews on PubMed with "depression" and "recurrent"/"recurrence"/"relapse" in their titles, and the two above were the only to offer a rate in their abstracts.

As for chronic depression, PMID 12858430 (20%), PMID 11310815 (up to 35%) and PMID 8354502 ("Reported prevalence rates of chronic depression range from 3 to 5 percent in community samples and from 9 to 31 percent in clinical samples.") Also, PMID 12117622 may be useful: "This review focuses on six putative determinants of chronic depression: developmental factors, personality and personality disorders, psychosocial stressors, comorbid disorders, biological factors and cognitive factors."

All of these considered, is there enough to start a new section focused on the recurrent and chronic depressions? MichaelExe (talk) 05:18, 17 October 2009 (UTC)


I think it is a good idea to expand the discussion of recurrence/relapse, and I am glad you have taken the time to further investigate this. The recurrence rate of 35% given in article (cited by PMID 18458203) is misstated. That article says, and I quote:
"Major depressive disorder is unremitting in 15% of cases and recurrent in 35%. About half of those with a first-onset episode recover and have no further episodes."
Based on this, the article should state that recurrence is 50% because 35% plus 15% (since "unremitting" is a form of "recurrent") is equal to 50%. I am not sure if there is enough text to warrant a new section, but it could be a subsection under "Prognosis". I think all that is necessary is a citation that the recurrence is estimated to be between 50 to 80%, and perhaps a clarification of "recurrent" vs. "unremitting". I think we should avoid overwhelming readers with a confusing barrage of battling statistics.
Relating to this, I think the section "Prevention" should be placed between "Management" and "Prognosis" since the idea of preventing depression is on preventing a recurrence (not an initial episode), and prevention is part of the goal of managing depression.--Tea with toast (talk) 15:36, 17 October 2009 (UTC)
Thank you for clarifying.
Also, I understand your logic for moving Prevention, but typically, this is the order in which they appear on Wikipedia (based on Wikipedia:Manual_of_Style_(medicine-related_articles)#Diseases.2Fdisorders.2Fsyndromes). I think we'd be better to shift the focus from therapies (because most people don't go to therapy before they've every had a major depressive episode) to "psychoeducational interventions" (more or less universal prevention) like "Coping with Depression". MichaelExe (talk) 16:44, 17 October 2009 (UTC)
Finally, a table with lifetime prevalences (for the Epidemiology section) per country would be a great addition (to this and perhaps Mental_disorder#Prevalence/Prevalence_of_mental_disorders). MichaelExe (talk) 16:44, 17 October 2009 (UTC)
For Prevention, PMID 17355898 and PMID 14594912 look promising (the full texts can be found here and here, respectively, for free]). I may expand the section, citing those sources, later tonight, if I can find the time.
Also, as for causes, PMID 17716089 should be of some help, but the full article is not free (and I'm not going to buy it XD). The last two lines of the abstract could be used, however. MichaelExe (talk) 18:10, 17 October 2009 (UTC)

Reporting Bias

This whole section makes it sound like reporting bias is exclusive to antidepressants or something. There are literally hundreds of studies and reviews on reporting bias. Here's just a few: http://www.ncbi.nlm.nih.gov/pubmed/19584207?ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=jama&resid=291/20/2457 http://www.ncbi.nlm.nih.gov/pubmed/3576013?dopt=Abstract —Preceding unsigned comment added by Skrewler (talk • contribs) 23:15, 17 October 2009 (UTC)

Those are interesting sources; but I've read, re-read, and re-re-read that section, and for the life of me I can't figure out where it's suggesting that nothing else is biased. Are there particular words or phrases that you find problematic? Cosmic Latte (talk) 15:32, 18 October 2009 (UTC)
Also, do the first or third of those sources (I currently can access the full text of only the second) actually mention antidepressant studies and note that publication bias extends beyond these studies? If not, then while your point here may be perfectly valid, it could turn out to be an original synthesis that falls outside the scope of an encyclopedia. Cosmic Latte (talk) 17:18, 18 October 2009 (UTC)
The three studies do not discriminate in what drugs were included in their meta analysis. Perhaps my comment was out of line if I can't find a source for that specific comment -- although I haven't really looked. I think there should be a link to a separate page and maybe include a special section for specific classes of drugs that may be more biased than others (if there are credible sources of course). I don't see why antidepressants (does not even differentiate the type) include this special section while other drugs do not? No clue on the policy for that. Skrewler (talk) 00:36, 19 October 2009 (UTC)
Antidepressant: "An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia." It makes sense that they're used most commonly to treat depression. MichaelExe (talk) 01:13, 19 October 2009 (UTC)
Your comment is not germane to any point made in this discussion. Skrewler (talk) 01:17, 19 October 2009 (UTC)
Doh. I thought you were asking why antidepressants would have their own section, and not other less frequently used drugs used for the treatment of depression (some antipsychotics). PMID 18514154, PMID 19666685 and PMID 11229783 might be useful for the Antidepressants section as a whole. MichaelExe (talk) 01:47, 19 October 2009 (UTC)

depression rates / suicide

The article says that 60% of people who commit suicide have depression. Surely, it is closer to 100% at the moment of suicide? I think this is supposed to read that 60% of patients had already been diagnosed with depression before killing themselves. I think this is an important distinction to make. Can someone who has access to the reliable source cited ("Barlow 2005"?) please check that this is what was meant by the source? Thank you! Gregcaletta (talk) 06:47, 21 October 2009 (UTC)

Psychosis (hallucinations and delusions), drugs ("Over fifty percent of suicides are related to alcohol or drug dependence. In adolescents alcohol or drug misuse playing a role in up to 70 percent of suicides"), having a reaaaaalllly bad day (so you can't say they had depression, because there are minimum durations for every type). "Suicide may occur for a number of reasons, including depression, shame, guilt, desperation, physical pain, emotional pressure, anxiety, financial difficulties, or other undesirable situations." Also, "Studies show a high incidence of mental disorders in suicide victims at the time of their death with the total figure ranging from 98% to 87.3% with mood disorders and substance abuse being the two most common." MichaelExe (talk) 11:19, 21 October 2009 (UTC)
I'd also add bipolar disorder and borderline personality disorder. Somewhat counterintuitively, there are folks who look forward to suicide, seeing it as an escape from whatever maladies are plaguing them. And these maladies don't even have to be depression of any sort: Samurai commit seppuku out of shame; a friend of mine thought suicide was kind of cool, and could talk about hurting herself with a smile on her face; George Sanders killed himself out of boredom; and Hunter S. Thompson (I don't think anyone will ever really figure that guy out) did so because "football season is over". Cosmic Latte (talk) 09:43, 23 October 2009 (UTC)
As an afterthought, I'd suggest that many suicides are better explained in social-psychological, sociological, philosophical, or literary terms than in clinical ones. We have the kamikaze and other suicide attackers; we've got prisoners who hang themselves in order to regain from the state some control over their destiny; but there's also Socrates, who (among other reasons) felt he had no right to do so. And then there are various people who (according to Albert Camus) remain unreconciled with existential reality (i.e., the Absurd), or (according to Émile Durkheim) with social facts (i.e., integration and regulation). There's even the Shakespearean suicide of "star-crossed love"; nobody says, "Well, Romeo and Juliet just had MDD. So did Antony and Cleopatra." And, last but not least, let us not forget the mass suicide by a group that (quite understandably) could find no other logical way to board the flying saucer that was following a comet (social psychologists had a field day with that one). In fact, come to think of it, even though I'm the one who added that 60% statistic, I actually find it surprisingly high. In any case, the reasons people kill themselves are probably as varied as the reasons they do anything else. Cosmic Latte (talk) 08:23, 24 October 2009 (UTC)
  1. ^ Linde K, Mulrow CD, Berner M, Egger M (2005). "St John's wort for depression". Cochrane Database Systematic Reviews (2): CD000448. doi:10.1002/14651858.CD000448.pub2. PMID 15846605.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Monteleone P (2001). (abstract) "Endocrine disturbances and psychiatric disorders". Current Opinion in Psychiatry. 14 (6). Lippincott Williams & Wilkins, Inc.: 605–10. ISSN 0951–7367. {{cite journal}}: Check |issn= value (help); Check |url= value (help)
  3. ^ Barlow 2005, pp. 227–28
  4. ^ a b c d Sharp LK, Lipsky MS (2002). "Screening for depression across the lifespan: a review of measures for use in primary care settings". American family physician. 66 (6): 1001–8. PMID 12358212. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ Gilbody S, House AO, Sheldon TA (2005). "Screening and case finding instruments for depression". Cochrane Database of Systematic Reviews (4). doi:10.1002/14651858.CD002792.pub2.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ "Beck Depression Inventory - 2nd Edition". Nova Southeastern University Center for Center for Psychological Studies. Retrieved 2008-10-17.
  7. ^ Hamilton M (1960). "A rating scale for depression". Journal of Neurology, Neurosurgery and Psychiatry. 23: 56–62. PMID 14399272.
  8. ^ a b Demyttenaere K, De Fruyt J (2003). "Getting what you ask for: on the selectivity of depression rating scales". Psychotherapy and psychosomatics. 72: 61–70. doi:10.1159/000068690. PMID 12601223.
  9. ^ Montgomery SA, Asberg M (1979). "A new depression scale designed to be sensitive to change". British Journal of Psychiatry. 134: 382–9. doi:10.1192/bjp.134.4.382. PMID 444788. {{cite journal}}: Unknown parameter |month= ignored (help)
  10. ^ Yesavage JA (1988). "Geriatric Depression Scale". Psychopharmacology Bulletin. 24 (4): 709–11. PMID 3249773.
  11. ^ Katz IR (1998). "Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias". The Journal of clinical psychiatry. 59 Suppl 9: 38–44. PMID 9720486.
  12. ^ a b Spitzer RL, Kroenke K, Williams JB (1999). "Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire". Journal of the American Medical Association. 282 (18): 1737–44. doi:10.1001/jama.282.18.1737. PMID 10568646. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. ^ Gilbody S, House AO, Sheldon TA (2005). "Screening and case finding instruments for depression". Cochrane Database of Systematic Reviews (4). doi:10.1002/14651858.CD002792.pub2.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Richardson AJ (2008). "n-3 Fatty acids and mood: the devil is in the detail". Br. J. Nutr. 99 (2): 221–3. doi:10.1017/S0007114507824123. PMID 17919344. {{cite journal}}: Unknown parameter |month= ignored (help)
  15. ^ Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, Keck PE, Marangell LB, Richardson AJ, Lake J, Stoll AL (2006). "Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry". Journal of Clinical Psychiatry. 67 (12): 1954–67. PMID 17194275.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ Ross BM, Seguin J, Sieswerda LE (2007). "Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?". Lipids Health Dis. 6: 21. doi:10.1186/1476-511X-6-21. PMC 2071911. PMID 17877810.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  17. ^ Appleton KM, Hayward RC, Gunnell D; et al. (2006). "Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials". Am. J. Clin. Nutr. 84 (6): 1308–16. PMID 17158410. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  18. ^ Rogers PJ, Appleton KM, Kessler D; et al. (2008). "No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial". Br. J. Nutr. 99 (2): 421–31. doi:10.1017/S0007114507801097. PMID 17956647. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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