Talk:Major depressive disorder/Archive 13

Semi-protected edit request on 22 June 2020

Could someone update the global incidence/frequency (listed as reference 6)? There's not an edit option for me on this page , but I found the same source as previously used (updated for 2017). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext Arkit.joy (talk) 13:22, 22 June 2020 (UTC)

 Done – Thanks for your contribution! — Tartan357  ^(Talk) 00:51, 23 June 2020 (UTC)

Emotional detachment reverted

Hi, Wikimeedian. I have reverted this edit for several reasons. One of the most important is that you should become familiar with copying within Wikipedia to provide attribution required by Wikipedia's licensing.

The next is that MDD is a broad overview article that summarizes the most relevant concepts as mentioned in the most recent high-quality reviews, as required for a Featured article. I suspect that something can be said about emotional detachment in this article, if a proper source is found, but it is unlikely to warrant a full section and more than a sentence with a link. Also, emotional detachment is not necessarily as sign of MDD, as it is a factor in many conditions, so how and where to work in the term needs discussion. I can find no reviews within the last five years that mentioned emotional detachment as a factor of major depressive disorder, while PubMed does produce mention in conjunction with many other conditions. As far as I know, emotional detachment is not mentioned normally as a particular sign of MDD.

Please have a look at WP:MEDMOS to understand how Wikipedia medical articles are structured, and perhaps other editors (@Casliber, Eyoungstrom, and Iztwoz:) can help decide if emotional detachment warrants a sentence here somewhere.

A separate question is if major depressive disorder (and other conditions) should be mentioned at emotional detachment. SandyGeorgia (Talk) 17:46, 15 September 2020 (UTC)

Yes I'd agree with it not being here. Associated yes but not intrinsic enough to warrant a paragraph here. Cas Liber (talk · contribs) 20:49, 15 September 2020 (UTC)

Seems that emotional detachment could be redirected to reduced affect display aka emotional blunting which is what is being referred to. ? --Iztwoz (talk) 08:31, 16 September 2020 (UTC)

There is no mention of emotional detachment or blunting in DSM5 listing of MDD.--Iztwoz (talk) 09:03, 16 September 2020 (UTC)

Found a reference to this as emotional blunting on a site which mentions it as a side effect of medication in MDD; some argue it could be a feature of the disorder.[1]--Iztwoz (talk) 22:19, 19 September 2020 (UTC)

Not a great source for a featured article ... SandyGeorgia (Talk) 23:54, 19 September 2020 (UTC)

That's why it wasn't used here - added some to Emotional detachment. --Iztwoz (talk) 07:29, 20 September 2020 (UTC)

External links

@Knownnotknown has suggested adding an Wikipedia:External link to an online depression screening tool. Do we think that this article would benefit from a link to a (scientifically based) screening tool? WhatamIdoing (talk) 02:01, 17 May 2021 (UTC)

No, the link to a tool belongs in an article about the tool if the tool meets notability ... imagine if we added links to every diagnostic tool for every condition? What we say about diagnostic tools in this article is based on what sources about this condition say about them. WP:ELNO and UNDUE come to mind, SandyGeorgia (Talk) 02:53, 17 May 2021 (UTC)

SandyGeorgia you make 2 very good points:

#1. "the link to a tool belongs in an article about the tool": I agree but does that stop the link to that tool from being given at the disease page.

For e.g. over here: https://en.wikipedia.org/wiki/Wikipedia_talk:WikiProject_Medicine#Should_disease_pages_have_a_link_to_diagnostic_tool_if_one_exists

Some quotes

"On the other hand there is surely no problem linking such a site if it is, as suggested above, "scientifically validated" - and that I suggest would mean it was at least uncritically referred-to in some WP:MEDRS."

"doesn't mean we can't link to diagnostic tools like you describe, "

#2. "imagine if we added links to every diagnostic tool for every condition?" I agree that would be the absolutely wrong policy.

Let me restate the initial sentence of WhatamIdoing -->

@Knownnotknown has suggested adding an Wikipedia:External link to an online depression screening scientifically validated tool. This tool is the gold standard of measuring depression worldwide.

Knownnotknown (talk) 05:12, 17 May 2021 (UTC)

If “this tool is the gold standard for measuring depression worldwide”, then a) find sources that say that, and b) write the Wikipedia article about the tool, then c) add sourced text to this article about the tool by d) linking to the Wikipedia article about the tool using MEDRS sources to cite the text, not an offwiki page about the tool. Again, try to imagine if every condition linked to external links about every diagnostic tool. This entire line of questioning shows a failure to understand how wikipedia articles are written, with a desire to get an external link to a non-MEDRS source into articles inappropriately, rather than writing a sourced article about the tool which can be wikilinked if and only if MEDRS sources and due weight support it. See Tourette syndrome#Assessment and screening for other conditions and Dementia with Lewy bodies#Clinical history and testing. Please digest WP:ELNO and spend some time understanding wikilinks; this question has already been answered enough times and is based on advocacy editing. SandyGeorgia (Talk) 05:34, 17 May 2021 (UTC)

Here are responses to the valid points you raise.

a) "find sources that say that" There are 15 references here: https://en.wikipedia.org/wiki/PHQ-9

b) "write the Wikipedia article about the tool" Please see: https://en.wikipedia.org/wiki/PHQ-9

c) "add sourced text to this article about the tool" Okay!!

"shows a failure to understand how wikipedia articles are written" I have learnt a lot and the robot still has the learning mode on.

"desire to get an external link to a non-MEDRS source into articles inappropriately" I assure you there is no bad intent.

Does this create conditions for giving a link to the tool in the EL?

Knownnotknown (talk) 10:55, 17 May 2021 (UTC)

The external link does not belong in this article; please stop pushing that idea as it breaches WP:ELNO and this is a featured article which must conform to guidelines and policy. Text including a Wikilink to the Wikipedia article PHQ-9 could be added to this article (see examples given above at Dementia with Lewy bodies and Tourette syndrome) if a) it can be cited to a very high quality MEDRS source as required by WP:WIAFA, and b) the text is accorded due weight. Whatever 15 sources you may have used at the PHQ-9 article wouldn't necessarily be used here, as whatever is used here should be a broad and very high quality overview of major depressive disorder rather than the specific tool. A link to the tool belongs at the article about the tool. DID YOU LOOK at the examples I gave? SandyGeorgia (Talk) 11:57, 17 May 2021 (UTC)

Semi-protected edit request on 31 May 2021

Add information on the benefit of psychological interventions specifically aiming to reduce the risk of relapse to Management --> Taking Therapies --> Variants. A possible addition could be:

Psychological interventions aiming to reduce the risk for relapse are particularly effective for patients who wish to stop antidepressant medication use. Preventive Cognitive Therapy and Mindfulness-based Cognitive Therapy were found to be equally effective as continued medication use in these patients, and even superior to medication use alone when combined with antidepressant treatment. Poschfeld (talk) 12:50, 31 May 2021 (UTC)

References

Comment: I've removed one of the sources, since it was obviously (just from the title) a trial (i.e. a primary source), hence not appropriate per MEDRS and common sourcing policies which suggest avoiding WP:PRIMARY sources in general. RandomCanadian (talk / contribs) 01:10, 11 June 2021 (UTC)

 Not done for now: please establish a consensus for this alteration before using the {{edit semi-protected}} template. ScottishFinnishRadish (talk) 10:47, 18 June 2021 (UTC)

Semi-protected edit request on 11 July 2021

Section 7.3 should be "expectancy" instead of "expectency". Seattcat (talk) 20:45, 11 July 2021 (UTC)

 Done Largoplazo (talk) 21:18, 11 July 2021 (UTC)

“ Some people have periods of depression separated by years, while others nearly always have symptoms present.”

In this sentence, it is said that some patients may have chronic symptoms. This in not true, as major depression is episodic. Chronic depression may suggest other illness such as schizophrenia or Persistent Depressive Disorder. 184.19.96.157 (talk) 20:22, 27 August 2021 (UTC)

I just thought, is this referring to the way that symptoms “remain in the background” after episodes? If so, it should be clarified. 184.19.96.157 (talk) 20:24, 27 August 2021 (UTC)

Please correct a typo

Hi, this is an anonymous person from a public library. I noticed a typo on the page: "who" is misspelled as "whp" in the Pathophysiology section. Can someone please fix it? Thank you! 65.88.88.200 (talk) 20:36, 13 September 2021 (UTC)

Well that's embarrassing. Thanks, it's been fixed.--Megaman en m (talk) 20:43, 13 September 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 January 2019 and 1 May 2019. Further details are available on the course page. Student editor(s): Tpsx.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:26, 18 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 26 August 2019 and 16 December 2019. Further details are available on the course page. Student editor(s): Priscilla.mtz330.

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Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 25 October 2020 and 12 December 2020. Further details are available on the course page. Student editor(s): Mengyurui. Peer reviewers: Iceblue458, Natgorman.

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This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Alyssakubs.

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Special populations

WP:MEDORDER suggests separate sections at the bottom for special populations, such as geriatrics or pregnancy or children. At Tourette syndrome, I found it more useful to work Pregnancy in to the Management section. Whatever is decided here, the article is currently inconsistent in its treatment of special populations. Pregnancy and children are spread throughout (my preference), while the elderly are in a separate section at the bottom. I suspect that happened because it was all added by one editor (and cited to one less than FA-standard source, now old).[2]

Do we want to merge the elderly content in to the body of the article, in the appropriate sections, or move all info relative to pregnancy and children to separate sections, as is done with elderly ? I am indifferent, but the article should be consistent. SandyGeorgia (Talk) 19:08, 27 February 2022 (UTC)

Multiple issues

@Casliber and Cosmic Latte: multiple problems have been introduced in recent edits:

• DSM-5 etc are acronyms, not books; they should not be italicized. Since removing all of those italics will require considerable work, I hope Cosmic Latte will do it.
• Long ref names are unhelpful on refs that aren't reused; they just clog up the text.
• There is no reason to add new text that is cited to very old sources; if the text is still relevant, more recent reviews will have covered it.
• Some UNDUE text and sources not suitable for a Featured article are being added, samples: [3] [4]

I haven't checked everything, but this is enough to mean more scrutiny is needed. SandyGeorgia (Talk) 02:30, 27 February 2022 (UTC)

This should also be examined. SandyGeorgia (Talk) 02:31, 27 February 2022 (UTC)

I responded on SandyGeorgia's user talk before I noticed her post here. Anyway, for the record, this is what I said: "Hi, I see that you removed my sentence about Aaron Beck from major depressive disorder, calling it "undue and poorly sourced". I would argue that Beck's contribution to the understanding of MDD is certainly due somewhere in the article, considering that Beck is regarded as the father of the most prominent treatment for it (cognitive behavioral therapy). I'm wondering if you felt that doesn't quite belong in the "Cause" section, though? That Beck's cognitive triad may be more effect than cause, more of a description than an explanation? I'm open to disagreement and/or compromise, but I would argue that it does indeed belong in that section, due to the cognitive-behavioral premise that cognition precedes emotion. I agree with you, though, that the source I borrowed from the cognitive-triad article is not the best, especially for a former featured article, so would you be open to the re-inclusion of the material if attributed to a more reliable source? Again, I would argue that Beck, as the father of CBT, holds more due weight than perhaps anyone else in this article." Cosmic Latte (talk) 02:53, 27 February 2022 (UTC)

This is a featured article, and the source provided for Beck's triad would not be adequate even if the article was not featured. If the content belongs here, it should be cited to a WP:MEDRS source, and one that is recent and high quality, as this is a featured article. SandyGeorgia (Talk) 02:55, 27 February 2022 (UTC)

I've removed the italics, and I'll look for a featured article-worthy source for Beck. Cosmic Latte (talk) 03:07, 27 February 2022 (UTC)

(groan) ...ok, looking soon Cas Liber (talk · contribs) 12:56, 27 February 2022 (UTC)

Cas, if you are up for the work, I am willing to help make sure this is still at FA standards, but I can't do that alone, and would rather submit it to FAR unless there is a sustained commitment to restoration. SandyGeorgia (Talk) 16:40, 27 February 2022 (UTC)

I have restored an older version here, removing the very old non-MEDRS sources used; if there is a link between creativity and depression, I am not finding it in MEDRS sources. SandyGeorgia (Talk) 19:19, 27 February 2022 (UTC)

Student editing

User:Shalor (Wiki Ed) and User:Ian (Wiki Ed), this Featured article has been tagged by four different student editing courses. SandyGeorgia (Talk) 02:26, 27 February 2022 (UTC)

Oopsie, never mind; I see the issue was only the recent bot edits, that made old courses appear to be current because of the date the bot ran. Nothing to see here; sorry for the ping. SandyGeorgia (Talk) 19:01, 27 February 2022 (UTC)

I appreciate the ping. Four courses tagging this at once would be bad. Ian (Wiki Ed) (talk) 21:36, 27 February 2022 (UTC)

Ketamine

If nobody objects, I'm thinking about adding a line or two about ketamine treatment for MDD to the "Other medications and supplements" subsection of "Management". I've got no less than three MEDRS sources (here, here, and--with its finding of a "large and statistically significant effect of ketamine on depressive symptoms"--here) saying that ketamine is effective at treating MDD specifically, as opposed to BPD. Any thoughts? Cosmic Latte (talk) 04:06, 28 February 2022 (UTC)

Are you familiar with WP:MEDDATE? It is not only generally useful, but Featured article must use the highest quality and most recent sources. How are you going about finding such old sources? The three you propose are seven to eight years old, when there is PLENTY of new material. Here, for example, are three more recent MEDRS-compliant sources:

• Corriger A, Pickering G (2019). "Ketamine and depression: a narrative review". Drug Des Devel Ther. 13: 3051–3067. doi:10.2147/DDDT.S221437. PMC 6717708. PMID 31695324.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• Singh I, Morgan C, Curran V, Nutt D, Schlag A, McShane R (May 2017). "Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight". Lancet Psychiatry. 4 (5): 419–426. doi:10.1016/S2215-0366(17)30102-5. PMID 28395988.
• McIntyre RS, Rosenblat JD, Nemeroff CB, et al. (May 2021). "Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation". Am J Psychiatry. 178 (5): 383–399. doi:10.1176/appi.ajp.2020.20081251. PMID 33726522.

Considering the ethical implications, it would be wise to first propose text based on those sources here on talk.

If you are unfamiliar with how to find more recent reviews, there is a template at the top of this talk page ({{Reliable sources for medical articles}}) which helps. This is a bit dated, but is also helpful. You can also format your citations to match the citation style of this article by using this tool. SandyGeorgia (Talk) 04:39, 28 February 2022 (UTC)

After graduating from university and losing my student access to a lot of databases, I sort of defaulted to Google Scholar for general research, and to PubMed for medical searches, although I relied on the former to find the articles on ketamine. Thank you for the sources, template, and tool. Cosmic Latte (talk) 05:14, 28 February 2022 (UTC)

a new paradigm and treatment for Major depression

an article by Dr. Abraham Shoshani published in "Depression and anxiety" magazine by the name a repetitive somatosensory discrimination a possible treatment for major depression including a clinical trial conducted on resistant patients with encouraging outcomes. — Preceding unsigned comment added by Hoory hanit (talk • contribs) 09:08, 26 March 2022 (UTC)

Poorly cited info added directly to lead

I have removed this content which was added directly to the lead, cited to a source that does not rise to the level of sourcing expected for a featured article; in fact, may not rise to the level WP:MEDRS prefers for even a non-featured article. The content a) should be cited to a recent, high-quality secondary review or textbook; b) should be added to the appropriate place in the body of the article rather than the lead, and c) is probably WP:UNDUE for the lead even if properly cited. MaryMO (AR) please have a look at WP:MEDRS, WP:WIAFA (which require high-quality sources), WP:LEAD (which explains that the lead is a summary of content in the body), and WP:FAOWN. SandyGeorgia (Talk) 21:04, 17 May 2022 (UTC)

• Greetings @SandyGeorgia:. I'm concerned that this Wikipedia article includes little or no discussion of depression as a women's health issue, particularly in perimenopausal women. There's a passing mention of the higher incidence of depression in women, "Major depression is about twice as common in women as in men" (citation 2003) but little else. Given the current structure of the article, I'm not sure where to start. Do you have any suggestions as to what might be an appropriate place in the body of the article? Or examples of where this is handled well? Many thanks, MaryMO (AR) (talk) 15:51, 18 May 2022 (UTC)

  Where to put the content depends on what the content is; for example, the FA on TS has a Tourette_syndrome#Pregnancy section under the Management section, because the secondary-sourced review literature covers management during pregnancy. See WP:MEDORDER for suggestions of what content goes where. Keep in mind that content for a featured article should be from high-quality secondary literature reviews or textbooks, that due weight should be taken into consideration (does information belong better in a sub article?), and the lead is not the place to introduce content that is not in the body of the article. It will be easier to help decide what content to put where if you first provide the high-quality sources you would like to reflect. SandyGeorgia (Talk) 21:17, 18 May 2022 (UTC)

• Hi @SandyGeorgia:., Would these sources be more MEDRS compliant? My thanks for the suggestions, I will check them out, MaryMO (AR) (talk) 21:22, 19 May 2022 (UTC)

  If you could provide a PMID on each one, I can get to them quicker. This old but still useful information may help you understand how to use PubMed to find recent secondary reviews. SandyGeorgia (Talk) 23:11, 19 May 2022 (UTC)

  I have correctly formatted the citations you listed below (see WP:WIAFA, WP:CITEVAR for the style used in this article, and the Diberri tool for formatting a cite journal template from a PMID, and entered comments after each one. SandyGeorgia (Talk) 23:27, 19 May 2022 (UTC)

• Gordon, Jennifer L.; Sander, Bethany (1 November 2021). "The role of estradiol fluctuation in the pathophysiology of perimenopausal depression: A hypothesis paper". Psychoneuroendocrinology. 133: 105418. doi:10.1016/j.psyneuen.2021.105418. ISSN 0306-4530.

  The correctly formatted citation for this article is:

  Gordon JL, Sander B (November 2021). "The role of estradiol fluctuation in the pathophysiology of perimenopausal depression: a hypothesis paper". Psychoneuroendocrinology (Review). 133: 105418. doi:10.1016/j.psyneuen.2021.105418. PMID 34607269.

  It is a recent review, but it is also a hypothesis; WP:DUE should be taken into consideration on proposed text. SandyGeorgia (Talk) 23:14, 19 May 2022 (UTC)

• Albert, Kimberly M.; Newhouse, Paul A. (7 May 2019). "Estrogen, Stress, and Depression: Cognitive and Biological Interactions". Annual Review of Clinical Psychology. 15 (1): 399–423. doi:10.1146/annurev-clinpsy-050718-095557. ISSN 1548-5943.

  The correctly formatted citation for this article is:

  Albert KM, Newhouse PA (May 2019). "Estrogen, stress, and depression: cognitive and biological interactions". Annu Rev Clin Psychol (Review). 15: 399–423. doi:10.1146/annurev-clinpsy-050718-095557. PMID 30786242.

  It is a recent review and seems usable. SandyGeorgia (Talk) 23:18, 19 May 2022 (UTC)

• Maki, Pauline M.; Kornstein, Susan G.; Joffe, Hadine; Bromberger, Joyce T.; Freeman, Ellen W.; Athappilly, Geena; Bobo, William V.; Rubin, Leah H.; Koleva, Hristina K.; Cohen, Lee S.; Soares, Claudio N. (1 February 2019). "Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations". Journal of Women's Health. 28 (2): 117–134. doi:10.1089/jwh.2018.27099.mensocrec. ISSN 1540-9996.

  The correctly formatted citation for this article is:

  Maki PM, Kornstein SG, Joffe H, et al. (February 2019). "Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations". J Womens Health (Larchmt). 28 (2): 117–134. doi:10.1089/jwh.2018.27099.mensocrec. PMID 30182804.

  Guidelines from The North American Menopause Society (NAMS) and the National Network of Depression Centers Women and Mood Disorders Task Group (NNDC) ... WP:MEDRS calls for guidelines from national or international expert bodies ... has anyone ever heard of these groups ??? Depending on consensus as to whether these guidelines are in sync with better recognized international bodies, content may be usable. SandyGeorgia (Talk) 23:23, 19 May 2022 (UTC)

• Zsido, Rachel G.; Villringer, Arno; Sacher, Julia (2 November 2017). "Using positron emission tomography to investigate hormone-mediated neurochemical changes across the female lifespan: implications for depression". International Review of Psychiatry. 29 (6): 580–596. doi:10.1080/09540261.2017.1397607. ISSN 0954-0261.

  The correctly formatted citation for this article is:

  Zsido RG, Villringer A, Sacher J (December 2017). "Using positron emission tomography to investigate hormone-mediated neurochemical changes across the female lifespan: implications for depression". Int Rev Psychiatry (Review). 29 (6): 580–596. doi:10.1080/09540261.2017.1397607. PMID 29199875.

  It is a review, but somewhat dated; whether it is usable depends on a search to make sure the information remains current. SandyGeorgia (Talk) 23:25, 19 May 2022 (UTC)

Psychosocial factors

Very little is said in the article about the psychosocial factors that may play a role in the development of a major depressive disorder. I hope somebody with more knowledge than me on the subject can improve the article with this info. --Savig (talk) 08:35, 15 June 2022 (UTC)

Esketamine as treatment for MDD

@SandyGeorgia removed my edits concerning the use of esketamine as a treatment for depression (as well as a reference to an FDA press release stating that it had been approved) and stated that I needed to obtain a secondary source and discuss this on the talkpage. Spravato is an FDA-approved intranasal formulation of esketamine with an indication for treatment resistant depression when combined with an oral antidepressant. I think that this is an important treatment modality that should be listed with other treatments for depression. There are many high-quality, WP:MEDRS complaint sources that are about Spravato that are readily available. Examples of peer reviewed MEDRS sources include PMID 32729898 and PMID 32163257. While on the topic of ketamine for depression, I feel that it could be worthwhile to discuss racemic ketamine as a treatment like the management of depression has, although this is not currently FDA approved for this indication. In closing, I feel there should be a mention of esketamine in the treatment section of the article and possibly also about ketamine in general. Thanks. Wikipedialuva (talk) 00:38, 20 August 2022 (UTC)

I am very open to how it would be phrased. An example text might be: "A nasal spray formulation of the NMDA receptor antagonist esketamine, sold under the brand name Spravato, gained FDA approval in 2019 for the treatment of treatment-resistant depression when combined with an oral antidepressant." Wikipedialuva (talk) 02:35, 20 August 2022 (UTC) Wikipedialuva (talk) 02:35, 20 August 2022 (UTC)

This is an updated version of proposed langue for ketamine. All sources are MEDRS complaint with each been peer reviewed and have cited multiple times in other publications. Please feel free to offer opinions or changes. "Ketamine, an NMDA receptor antagonist, has demonstrated rapid-acting antidepressant effects in patients with treatment-resistant major depressive disorder. A nasal spray formulation of esketamine (Spravato) received FDA approval in March 2019 for the treatment of treatment-resistant depression when used in combination with a conventional antidepressant." Wikipedialuva (talk) 05:50, 21 August 2022 (UTC)

References
References

Wikipedialuva first, thank you for using secondary literature reviews and for proposing your addition on talk. It would be helpful if you would use this template for generating a citation conforming with the WP:CITEVAR of this (and many medical) articles. It would also be helpful if you would wait for feedback, and when other editors are busy, ping if necessary.

More importantly, you are not a novice editor, and POV contributions to such a serious extent should not be happening. Please remember that changes to Wikipedia are immediately viewable by thousands of people every day, and we have a responsibility to get it right. The content you added grossly misrepresented the sources, and in a dangerous way—appearing to promote a treatment for which serious concerns exist. Using MEDRS sources is not sufficient; you also need to represent correctly what they say. Please do not do that again, anytime, anywhere on Wikipedia so that further intervention to prevent harm from your edits won't be necessary. You can wait longer than a week for others to weigh in, or ping others as needed, on proposed text if you are unsure how to write it yourself.

@Casliber, Ajpolino, Colin, Spicy, and Graham Beards: this content stood for five days before I found time to address it; I suspect we need to proceed to WP:FAR as this article is not adequately watchlisted, and trying to keep up with these declining (to the point of dangerous) medical FAs is demoralizing. SandyGeorgia (Talk) 14:22, 27 August 2022 (UTC)

Medications and treatments for MDD a bit less clear cut than for schizophrenia, with some treatments coming into use more quickly and dynamically. Not sure what and how some newer ones are discussed in review articles. Part of checking process. Cas Liber (talk · contribs) 23:53, 27 August 2022 (UTC)

SandyGeorgia, I want to genuinely thank you for both giving me advice about improving my references in the future and improving my edits regarding ketamine. I do, however, object to several of your statements you made. I will address point by point.

“It would also be helpful if you would wait for feedback, and when other editors are busy, ping if necessary” and “you can wait longer than a week for others to weigh in, or ping others as needed, on proposed text if you are unsure how to write it yourself.”

I did ping you in my original post and then I waited for several days for anyone to comment on my proposed edits. No one responded, asked me to wait for comment, or said that they had any intention of ever commenting on my proposed edits. In 2019, an editor discussing ketamine took months before anyone commented back (discussed more below). So I was bold, and went ahead and edited.

“More importantly, you are not a novice editor, and POV contributions to such a serious extent should not be happening.”

First, I feel I do have a neutral POV concerning ketamine and assuming I lack a NPOV fails to AGF. I do not have any disclosures regarding ketamine. I do not and have never had any financial interest in any business that manufactures or sells ketamine. I am not and have never been employed by a facility that uses ketamine to treat any mental health condition. Neither I, nor any of my immediate family or close friends, have ever been treated with ketamine for any mental health condition. I have nothing to gain and no reason to support or not support ketamine or esketamine for depression. I added ketamine to the article not because I lack a neutral point of view, but because esketamine is FDA approved for the treatment of treatment-resistant MDD and, for better or worse, ketamine is becoming increasingly popular as a treatment. They deserve to be mentioned in the article in which treatments for MDD are discussed. I am also not the only one that feels this way. The overall topic of ketamine has been discussed at least twice on this article’s talk page. The first discussion was in 2019 when two editors (Asmageddon and SSyntaxin) agreed that esketamine and ketamine should be included in the article. The latter was in 2022, when Cosmic Latte proposed adding ketamine and your response suggested that they post the proposed text (which I did).

“Please remember that changes to Wikipedia are immediately viewable by thousands of people every day, and we have a responsibility to get it right.”

I agree with this statement completely. As editors, we do have a responsibility to get it right. I feel that part of that includes ensuring that approved treatments or treatments that are increasingly becoming popular (once again, for better or worse) are discussed in the article.

“The content you added grossly misrepresented the sources, and in a dangerous way—appearing to promote a treatment for which serious concerns exist. Using MEDRS sources is not sufficient; you also need to represent correctly what they say. Please do not do that again, anytime, anywhere on Wikipedia so that further intervention to prevent harm from your edits won't be necessary.”

I respectfully, but strongly, disagree with this characterization of my edits, especially with implying that my edits were going to cause “harm”. Both of my statements were factual and nowhere did they promote anyone doing anything. The first sentence in my edits was: “Ketamine has been shown to have rapid antidepressant effects in patients with treatment-resistant major depression.” This sentence was mostly based on the abstract of PMID 30844397 (a MEDRS source which you have retained after revising my edits), which, in entirety, states: “Ketamine is the first exemplar of a rapid-acting antidepressant with efficacy for treatment-resistant symptoms of mood disorders. Its discovery emerged from a reconceptualization of the biology of depression. Neurobiological insights into ketamine efficacy shed new light on the mechanisms underlying antidepressant efficacy. The rapid, profound, and sustainable antidepressant effects of ketamine seem poised to transform the treatment of depression, while mechanisms through which it may work are overturning the received wisdom regarding the underlying neurobiology.” Frankly, I feel my edit is much more neutral in tone of voice than this MEDRS abstract and do not feel like I mischaracterized that article. Second, I based discussion, or lack thereof, of side effects and how detailed my edit was with how other treatments were being discussed, and also tried to ensure that my edit was trying to keep with the style of the section. The article in general has stuck to single sentences for a variety of depressive treatments without giving a list of possible issues with them or the risks they carry. Take for example: “Limited evidence suggests stimulants, such as amphetamine and modafinil, may be effective in the short term, or as adjuvant therapy.” Let’s examine the two references for this. First, PMID 26906078 states in the abstract that: “the use of traditional psychostimulants (methylphenidate and dexamphetamine) and stimulant-like drugs (modafinil and armodafinil) for the treatment of depression is a growing concern given the lack of research evidence supporting their effectiveness,” “traditional psychostimulants is often dramatic but short-lived,” “research is urgently required to clarify psychostimulants' mechanisms of action and to evaluate their long-term benefits and risks in the treatment of major and bipolar depression,“ “until then they should only be prescribed if absolutely necessary, and even then their prescription should be facilitatory and time limited unless it is for investigational purposes.” PMID 25295426 notes that “one study was stopped prematurely due to safety concerns of increased suicidality.” This is not even beginning to discuss that amphetamine is not FDA approved for treatment of MDD, is more controlled than ketamine (CII vs CIII), and the fact that amphetamine carries black box warnings about life-threating risks. This edit has stood since 2017, and to my knowledge, no one objected to the edit or updated the statement to discuss the risks, lack of studies, or accused the editor that posted it of grossly misrepresenting facts. The article also states that: “there is tentative evidence for benefit from testosterone in males.” This edit also fails to go in-depth about possible abuse risks/controlled substance status, or discuss the significant risks associated with this unapproved treatment (including, but not, limited to effects related to hormone-sensitive cancers and blood clots). In summary, I feel my edit (which I admit could be improved as you did) was in line with how other treatments have been and are described in the article and that my edits have been singled out.

In conclusion, I genuinely appreciate the constructive feedback about references, and I also appreciate that you are working to keep such an important article accurate. I also honestly feel like you improved my edits regarding ketamine and included information that is helpful. I also, however, feel that your response accusing me of not having a NPOV and that my edits were misrepresenting research more than other article content and were out of line with the article, and most of all, that they were causing harm and were dangerous, is inaccurate and unnecessarily harsh. Wikipedialuva (talk) 04:53, 28 August 2022 (UTC)

Wikipedialuva thank you for clarifying, and thank you again for using secondary reviews, and proposing your content on talk. I'll place my much-needed apology on your talk page,[5] and address only the content issues here.

The portions of your edit that made it seem driven by POV were a) the mention of a specific brand name product, and b) the information from the reviews that you left out. (Your edit was: Ketamine has been shown to have rapid antidepressant effects in patients with treatment-resistant major depression. A nasal spray form of esketamine, sold under the brand name Spravato, gained FDA approval in March 2019 for use in treatment-resistant depression when combined with an oral antidepressant. That sounds quite promising -- in a way not supported by a full read of the sources. It might even make one want to go out and get some Spravato!) In your penultimate paragraph above, you have understandably explained what led you to so briefly summarize the reviews and leave out some information.

Going forward:

1. Please do not insert content based only on the abstract: for example, this review was specifically published to address the popularity of the treatment and raise concerns about it. The very reason the review was done, with the seriousness of the concerns, is overlooked by reading only the abstract, leaving a rosy impression that the sources do not support. There are limited instances when one might be able to add content from the abstract only, but this is not one of those situations.
2. The issues you raise about other content in the article now are very good examples of why I have been expressing concerns about this article for almost two years (and why I became so frustrated that no one else addressed your proposal, which you raised correctly). You can scan down this page to see when I gave up.
3. I can't speak to content that was inserted – or not updated – between 2014 and 2020 when I had given up and was not watching the article; until there is a top-down rewrite and update of this article, I can only address what I see going in now. That is, there's bad content now, but let's not make it worse. That much cleanup is needed is just an example of WP:OTHERSTUFFEXISTS, and we should not be guided by faulty current content.
4. A broad overview of this magnitude should be using summary style, and reflecting generally (with limited exceptions) that which is mentioned in general reviews of the topic. Until someone has looked at recent reviews, and rewritten the article to them, it's hard to say whether your addition belongs in this article at all, or would be better placed at management of depression. There's a good chance that a lot of that content needs to be cut to sub-articles and summarized back to here, depending on what weight is given in broader secondary reviews.

Thanks for pitching in ... off to your talk page I go next. SandyGeorgia (Talk) 17:06, 30 August 2022 (UTC)

Other terms related to major depressive disorder/episodes.

I have found other terms related to major depressive disorder/episodes. I thought that they could be included in this article to increase the scope of MDD but somebody says that none of them belong here and that the article is already too long, even though there are articles that are even longer [6]. The list of other terms are:

• Anxiety/aggression-driven depression
• Atypical depression
• Endogenous depression
• Psychotic depression
• Treatment-resistant depression

Do you think these terms should be included in this article? zsteve21 (talk) 18:45, 22 July 2022 (UTC)

In reply to @Zsteve21:

• Anxiety/aggression-driven depression - esoteric. Term not in general use at all, so no.
• Atypical depression - short para included in article
• Endogenous depression - is mainly a historical term not used any more. Overlaps with MDD. Target page needs review
• Psychotic depression - is discussed already in article
• Treatment-resistant depression - is discussed already in article

Cas Liber (talk · contribs) 02:57, 15 September 2022 (UTC)

FA review needed

These issues have not been addressed. SandyGeorgia (Talk) 15:46, 20 November 2020 (UTC)

Management

... section is getting stubby ... lots of short paragraphs and information that needs to be merged or possibly removed. I see student editing here. (Also found info chunked in to the lead that was nowhere in the body, so fixed that.) SandyGeorgia (Talk) 18:50, 17 August 2020 (UTC)

Yes! This is next on the to-do list Cas Liber (talk · contribs) 03:20, 15 September 2022 (UTC)

Elderly

This section looks also like it was chunked in as an afterthought. It duplicates some management information, which can be merged to Management or deleted, and the rest of it can go within the other sections as appropriate (prognosis or epidemiology?). SandyGeorgia (Talk) 19:08, 17 August 2020 (UTC)

@SandyGeorgia: this and the chldren section that had been tacked on at the end have been incorporated and vague or reduplicated bits removed (easier than I thought it would be actually) Cas Liber (talk · contribs) 03:19, 15 September 2022 (UTC)

Terminology

This section is not "terminology" and some of it looks undue; relevant content can be merged elsehwere. SandyGeorgia (Talk) 19:11, 17 August 2020 (UTC)

Stigma

Out of whack, and looks like people are just chunking in random factoids here, rather than following WP:WIAFA. "There has been a continuing discussion of whether neurological disorders and mood disorders may be linked to creativity," has WHAT to do with stigma? The section is not very well written. SandyGeorgia (Talk) 19:13, 17 August 2020 (UTC)

Sigh....I'll compare current with featured version in the first instance for structure etc. Cas Liber (talk · contribs) 23:25, 17 August 2020 (UTC)

That section dates right back to the FAC. I can see it there almost unchanged in December 2008. So I think I might be the guilty party on that one. :P - I do think we need to do something about the length of the article and updating etc. Am looking now.Cas Liber (talk · contribs) 01:20, 18 August 2020 (UTC)

If you are guilty, so am I;) SandyGeorgia (Talk) 01:37, 18 August 2020 (UTC)

Resurrecting this from the archive, as this is now the longest standing medicine-related FA at Wikipedia:Featured article review/notices given. Sandy and Casliber, how do you feel about the article's current state? If you're pleased with changes, I can remove it from the template. If not, I can try to whip up some volunteers to plug away at any deficiencies. All else fails, we can start the WP:FAR process. Thanks for all your work on this! -- and of course thanks to Casliber for doing the heavy lifting to bring this to FA condition almost 13 years ago. I hope you're both doing well. Ajpolino (talk) 14:47, 8 August 2021 (UTC)

@Ajpolino: I think the article needs some cleanup. I've mostly been looking at unclear/inelegant prose today, but I intend look into Sandy's content concerns soon. Haven't gotten through the whole article yet, but the "Pathophysiology" section, for one, seems overly detailed. Cheers, Ovinus (talk) 00:39, 25 September 2021 (UTC)

Sigh...on the "to do" list - will have a look later. Daytime here Cas Liber (talk · contribs) 01:02, 25 September 2021 (UTC)

Thanks both. Take whatever time you need, of course. And let me know if there's anything I can do to be useful. Ajpolino (talk) 13:46, 25 September 2021 (UTC)

What I'm doing is comparing the current version to this which was soon after it was promoted and near time it was mainpaged. Just to compare the prose and scope mainly. However, the data needs to be updated to latest studies. I've begun adjusting the prose a bit. Work in progress....Cas Liber (talk · contribs) 14:16, 25 September 2021 (UTC)

Basic Problems of this Article

Hi, I was studying this article that I realized there were many sentences that do not have a reference. Also, the references were not added to the article alike, some one are sfn and others are not. Many parts need to be updated and the article is not comprehensive. I do not know how this article was Featured but must not be Featured now. Pereoptic ^Talk✉️   09:29, 13 August 2022 (UTC)

I can't find a single unsourced paragraph in this entire article, are they any concrete instances you can point out where a source would be needed but is lacking? I ask the same for what you think needs updating and what information is missing.--Megaman en m (talk) 11:21, 13 August 2022 (UTC)

Likewise, where is the specific uncited text? Every sentence does not need to be cited; the reference may after a subsequent sentence. SandyGeorgia (Talk) 15:42, 13 August 2022 (UTC)

@Megaman en m:For example, the first paragraph of the management section, the second paragraph of Antidepressants.

@SandyGeorgia: The main problems I mentioned in the article were not the only one. To the things I mentioned above, add the short introduction of the article and Having a reference in the introduction.

Issues not covered in the article: [7], In the pathophysiology section, it is also possible to discuss the relationship between major depression and chronic diseases

Updates: [8][9][10]

Pereoptic ^Talk✉️   19:28, 13 August 2022 (UTC)

The first paragraph of management clearly references the NICE guidelines, which are cited at the end of that para (including the bullet points). The second paragraph of antidepressants is cited, so I'm unsure if I'm looking somewhere different than you are ??

The size of the lead is fine, and citations in the lead are neither required nor discouraged; I see no problem there.

Could you please provide a PMID or description of what you consider not covered, so others don't have to click on each little bracketed number to see the concern? It would help, thanks.

Casliber I am wearying of being the only person maintaining this article. Can we get it updated or else move to the next step? I am swamped, and yet here I am, trying to click on little numbers to figure out what is wanted next. SandyGeorgia (Talk) 20:51, 13 August 2022 (UTC)

Oh joy. Updating medical articles. Ok, will have a look soon. Just got some other chores to attend to (long time since I looked at this) Cas Liber (talk · contribs) 21:45, 13 August 2022 (UTC)

Joyous it is not, and I'm really tired of it; we need committed FA-knowledgeable editors to keep this article updated. Are the 2004 NICE guidelines the latest? SandyGeorgia (Talk) 21:53, 13 August 2022 (UTC)

The statistics presented in this reference to ==> Epidemiology (update)

Citation: "Major depression". U.S. National Institute of Mental Health (NIMH). January 2022. Archived from the original on 9 August 2022. Retrieved 14 August 2022. SandyGeorgia (Talk) 11:40, 14 August 2022 (UTC)

Done, but this may be overemphasizing one country (Wikipedia is global); I would not be surprised if someone deletes it. SandyGeorgia (Talk) 22:45, 15 August 2022 (UTC)

«Structured psychotherapies» section in this reference to ==> Management (for reference update and article expansion)

PMID 34877271 is how you can easily reference a source on talk for others. SandyGeorgia (Talk) 11:28, 14 August 2022 (UTC)

Citation format: Karrouri R, Hammani Z, Benjelloun R, Otheman Y (November 2021). "Major depressive disorder: Validated treatments and future challenges". World J Clin Cases (Review). 9 (31): 9350–9367. doi:10.12998/wjcc.v9.i31.9350. PMC 8610877. PMID 34877271.{{cite journal}}: CS1 maint: unflagged free DOI (link) SandyGeorgia (Talk) 11:28, 14 August 2022 (UTC)

This reference to ==> Cause and Prognosis (for example generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and social anxiety disorder and poor treatment outcomes)

That is a news source, not a secondary review. SandyGeorgia (Talk) 11:22, 14 August 2022 (UTC)

I think this reference is considered a secondary review, because at the end of it, the bibliography section is placed. In addition, its source is the American Psychiatric Association. Pereoptic ^Talk✉️   13:09, 14 August 2022 (UTC)

I'm not using a source like that in a Featured article; an alternate approach to adding whatever content you wish to include is to see if any of the sources listed at the end of that article are secondary reviews, and use them. SandyGeorgia (Talk) 15:09, 14 August 2022 (UTC)

I will mention the shortcomings of the article's introduction in the future. My written English grammar is a little weak, otherwise I would have added the required content to the article myself. Pereoptic ^Talk✉️   09:27, 14 August 2022 (UTC)

I'm willing to help do the updates as I have time, but I can get to things faster if you provide MEDRS sources and if I don't have to do all the citation formatting (see above). Do you have the tool for citing PMIDs used in this article? Or you can use the PMID template followed by a bracket and the number for easier reference. For today, I have to finish work on another Featured article, so perhaps someone else will get to them faster. Spicy have you any interest in helping maintain this FA? I don't have time to get to it today, and two updates needed are identified above. SandyGeorgia (Talk) 11:45, 14 August 2022 (UTC)

Sorry Sandy, but this is pretty far out of my wheelhouse and I'm busy with other things at the moment. Spicy (talk) 17:48, 15 August 2022 (UTC)

Only one source remained:

Laishley EJ, Barrett AM, Isaac O, Thiemer K, Jariwalla R, Grossberg SE, Sedmak JJ, Anderson TR, Slotkin TA (November 1975). "Regulation and properties of an invertase from Clostridium pasteurianum". Can J Microbiol. 21 (11): 1711–8. doi:10.1139/m75-251. PMID 140. to ==> Cause Pereoptic ^Talk✉️   13:22, 14 August 2022 (UTC)

That's a very dated primary source; the information should have been mentioned in a WP:MEDDATE compliant WP:MEDRS. SandyGeorgia (Talk) 15:12, 14 August 2022 (UTC)

@SandyGeorgia:It seems that I mention the wrong reference. Correct reference: PMID 34634250 Pereoptic ^Talk✉️   16:58, 14 August 2022 (UTC)

Better :) I can attempt to work on some of this over time, but for the next few days, I am up to my eyeballs at the Joan of Arc Featured article review, and must stay focused on getting that wrapped up. I'm hoping someone else will jump in here to help ... what is listed so far does not look insurmountable. SandyGeorgia (Talk) 18:54, 14 August 2022 (UTC)

I hope you will be successful in improving the above article. There is no rush, we will improve the article as time permits. I will also try to add things to the article over time, although it needs to be checked grammatically by an English speaker. Sincerely Pereoptic ^Talk✉️   20:28, 14 August 2022 (UTC)

Urgent FAR needed

I am one person and cannot maintain this old FA alone, and will no longer endure the demoralization of trying to do so. This is one of the oldest listed at WP:FARGIVEN, and my recommendation is that someone submit it urgently to WP:FAR. SandyGeorgia (Talk) 14:36, 18 August 2022 (UTC)

Citation 283 is mis-linked

It should be linked to https://doi.org/10.1080/09638239917427 Fairthomas (talk) 14:19, 12 October 2022 (UTC)

Dated text removed for improvement

There is not a single modern citation in this text, which should be updated to modern sources if re-incoporated. Most of this dated text is based on sources at least 20 years old; WP:MEDDATE. Debatesdebates? It's also unclear why it belongs in the Terminology section. SandyGeorgia (Talk) 14:37, 12 October 2022 (UTC)

The diagnosis is less common in some countries, such as China. It has been argued that the Chinese traditionally deny or somatize emotional depression (although since the early 1980s, the Chinese denial of depression may have modified). Alternatively, it may be that Western cultures reframe and elevate some expressions of human distress to disorder status. Australian professor Gordon Parker and others have argued that the Western concept of depression medicalizes sadness or misery. Similarly, Hungarian-American psychiatrist Thomas Szasz and others argue that depression is a metaphorical illness that is inappropriately regarded as an actual disease. There has also been concern that the DSM, as well as the field of descriptive psychiatry that employs it, tends to reify abstract phenomena such as depression, which may in fact be social constructs. American archetypal psychologist James Hillman writes that depression can be healthy for the soul, insofar as "it brings refuge, limitation, focus, gravity, weight, and humble powerlessness." Hillman argues that therapeutic attempts to eliminate depression echo the Christian theme of resurrection, but have the unfortunate effect of demonizing a soulful state of being.

Sources
References

@SandyGeorgia: I originally placed it there as elaborates on idea of definition and meta-aspects. However looking at it now, and given the length of the article and the age of the quotes, I feel the article is better without it - much of these are more pertinent to more general discussion of mood disorders, the reification sentence possibly could stay if I can update it and find discussion making it notable but not fussed really. Cas Liber (talk · contribs) 03:04, 23 November 2022 (UTC)