Talk:Major depressive disorder

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  • Verify: With the rise of Christianity, the scientific thinking of the Greco-Roman period fell into obscurity[citation needed]. The church[who?] focused on the afterlife rather than studying the here-and-now in an empirical fashion[citation needed]. The common people[who?] during the middle ages were wrapped up with superstitious beliefs about devils, magic, and witches[citation needed]. In the seventh century, the Church began to argue that the Devil was behind all mental illnesses[citation needed]. In contrast, in Muslim countries, hospitals for the insane were built to heal mentally ill people[citation needed]. In the 11th and 12th century in Christian countries, though, the devil-possession theories continued[citation needed], and the Church tried to heal mentally-ill people by getting the devil out[clarify]. In the 13th to 16th centuries, this transformed[citation needed] into witch hunts and witch-burning, in which the "demon" was expelled through the cleansing flame of burning at the stake. In these witch hunts, "psychotic women...were easy targets."[1][unreliable source?] By the 15th century, the church tended to associate mental illness with sin and wickedness[citation needed].
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[edit] Normal Course

I think it's worth a bit of discussion on what the course of "untreated" depression normally is in the prognosis section. Meaning does depression typically subside on its own after a specific amount of time? What happens if the depressed person does nothing?98.210.205.24 (talk) 09:04, 25 February 2008 (UTC)

If the person does nothing, the problem falls steadily worse unless the user has sought help or have been willing to accept help. Prowikipedians (talk) 02:20, 15 March 2008 (UTC)
reference? i imagine some percentage experiences remission of symptoms, even if they are predisposed to another bout of major depressive disorder later in life. Xwordz (talk) 06:28, 5 May 2008 (UTC)

[edit] History

This text was just added to the [[Clinical depression#History|]] section, but it looks like it was intended here. - Eldereft ~(s)talk~ 04:08, 19 March 2008 (UTC)

This section can be built up with citations from histroical records. The following two examples make it clear to me that the idea of depression is not a modern or recent one but has been with humans for, at least, hundreds of years..

Hector Berlioz, the composer, complained in 1826, in a letter to a friend, that he was 'depressed'.

Strong's EXHAUSTIVE CONCORDANCE of the King James Bible, published in 1890, elaborates the definition of 'poor' as being 'depressed in mind or circumstances'.

[edit] Dietary Causes

I'm doubtful about the statement that excess sugar consumption alters mood. I believe this was recently disproven in children[2], and since the section doesn't have a reference (the footnote at the end of the paragraph refers only to the claims about alcohol's effect on depression), I propose that it be edited out. Minerva9 (talk) 05:19, 29 April 2008 (UTC)

[edit] Causes: Neurological

These 2 sentences are misleading:

Evidence has shown the involvement of neurogenesis in depression, though the role is not exactly known.[25] Recent research has suggested that there may be a link between depression and neurogenesis of the hippocampus.[26]

This sounds as though depression is caused by neurogenesis (growth of new neural cells). This is the opposite of what has been found in several studies, a few of which were referenced in the opinion article of reference #25.

The wording needs to be changed to reflect what the cited article says: neurogenesis in the hippocampus has been seen in rats after SSRI treatment. A different source (a review by Davidson et al. 2002) mentions that neurogenesis was observed in adult human hippocampus---but I do not know the context of the study, which is published by Eriksson et al. 1998. It may not have had anything to do with depression or pharmaceuticals. (Feel free to check, though...!)

It's okay with me to keep reference 25, since the article can't cite every study ever conducted on brain tissue volume and cell density.

But reference #26 is not verifiable. I have access to Scientific Amer (not a peer-reviewed journal, btw) through my university: "Vol 17" is questionable, because even Dec 1985 was Volume 250; and a search of all issues/all text for "Helen Mayberg" gave zero results. —Preceding unsigned comment added by Xwordz (talk • contribs) 04:33, 5 May 2008 (UTC)

sorry, forgot to sign this earlier :) Xwordz (talk) 06:24, 5 May 2008 (UTC)

[edit] cortisol levels & depression: chicken or egg?

Under "Causes - Sleep Quality"

Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.

It's actually not quite so straight-forward as this (uncited) sentence implies.

It's not known if the higher levels of plasma cortisol often (but not always) found co-occuring with depression are caused by depression --- or if depression is caused by raised cortisol. In fact, a considerable amount of correlative evidence points towards stress-incuded depressive symptoms, although there are working hypotheses for the reverse. And cortisol is actually just the parameter chosen for measuring hypothalamic-pituitary-adrenal [HPA] axis activity, and upstream hormones are of interest as well as other glucocorticoids.

When I have time I'll come back and post a few citations here for community review/feedback. :) Xwordz (talk) 18:27, 5 May 2008 (UTC)

[edit] St John's wort

Is the part about potentially active molecules under dispute? I pulled those from St John's wort just to give it a little context. For stylistic reasons, the bullet should start with the proposed treatment. Including the molecules sidesteps the "whole herb" question. At least based on the Cochrane Review, the evidence base cannot address that question, as different manufacturers use different preparations without a standard reference for what is contained in different pills bearing the same label.

The reverting edit summary indicated that the conclusions of the Cochrane Review (link) may be interpreted differently from my reading. My interpretation of the abstract and plain language summary is that the evidence is weak, inconsistent, and confusing. Given the well-known problems of publication bias, this probably means "no", but WP:V says we should wait for a reliable source to say so. To quote the abstract, "[Extracts of St John's wort] seem more effective than placebo and similarly effective as standard antidepressants for treating mild to moderate depressive symptoms. Beneficial effects for treating major depression appear minimal." The sentence previously cited to this review read: "A meta-analysis by the independent Cochrane Review found that current evidence suggests that St John's Wort preparations may be similarly efficacious to standard antidepressants for mild to moderate depression, but only minimally efficacious in cases of major depression." The review can (and probably should) be qualified with language about the strength of this conclusion based on the poor quality and heterogeneity of results of included studies, but I would appreciate clarification of exactly how the conclusions presented differ from those of the source. - Eldereft ~(s)talk~ 07:45, 7 May 2008 (UTC)

http://www.nimh.nih.gov/health/publications/depression/treatment.shtml http://www.ncbi.nlm.nih.gov/pubmed/11939866 http://www.mayoclinic.com/health/st-johns-wort/NS_patient-stjohnswort Here are links to a good secondary sources that take both sides of the issue and which should be treated as majority opinion. This is a scientific question and the Cochrane review at best should be considered minority, possibly fringe opinion. Try a rewrite here. Lets see if we can't do a better job then what is on the page now.--scuro (talk) 11:42, 7 May 2008 (UTC)

Doctors among us, would you comment please on the Scuro's conclusion that "Cochrane review at best should be considered minority, possibly fringe opinion". Paul Gene (talk) 14:53, 7 May 2008 (UTC)
What I offered was a citation from the Journal of the American Medical Association and two citations from National health institutions...all with excellent creditability and secondary verifability. A simple informal personal judgement from ANY contributor really has little currency within wikipedia...although the any well thought out and reasoned response is always appreciated.--scuro (talk) 16:49, 7 May 2008 (UTC)
And those are good sources. The fact that the NCCAM trial has been cited by NIMH &c. certainly gives it more WP:WEIGHT than some of their trials. Those good sources also agree with my interpretation that the evidence is weak but positive compared with placebo for mild to moderate depression and negative for major depression. Next time instead of reacting with hostility and taking an at best dubious stance on reliability, just point out that this is the Clinical depression article, and mild to moderate depression is beyond its scope. I just edited the article to reflect this, please feel free to improve. - Eldereft ~(s)talk~ 18:31, 7 May 2008 (UTC)
Minimal effects for major depression does not mean no effect. The Cochrane meta-analysis states: "In trials restricted to patients with major depression, the combined response rate ratio (RR) for hypericum extracts compared with placebo from six larger trials was 1.15 (95% confidence interval (CI), 1.02-1.29) and from six smaller trials was 2.06 (95% CI, 1.65 to 2.59)." So even in the most reliable and least favorable large trials SJW was statistically significantly better than placebo. As for the effect size, it is known that some meta-analysis of established antidepressants also indicated only weak to moderate effect size. This is also consistent with the second conclusion of the Cochrane review, that SJW was equivalent to antidepresants in trials for major depression: "Compared with selective serotonin reuptake inhibitors (SSRIs) and tri- or tetracyclic antidepressants, respectively, RRs were 0.98 (95% CI, 0.85-1.12; six trials) and 1.03 (95% CI, 0.93-1.14; seven trials)." Paul Gene (talk) 02:29, 8 May 2008 (UTC)
I am no expert on Depression. Yet I do know of SJW and it's possible benefits, the NIMH speaks to this treatment. In my eyes it deserves more weight. From my eyes, quoting studies is useless for a lead on a subsection. If you need to quote anything, quote what a major national health institute has to say on an issue. That is majority opinion and should receive the majority of the space on the issue. In this particular instance I believe the issue should be flushed out some more because it is notable and readers generally will have heard about this herb. Once that is taken care of, a sentence or two can be used for minority viewpoints or new studies.--scuro (talk) 02:55, 8 May 2008 (UTC)
That sounds fine, but probably we should keep it short with more in depth discussion reserved for St John's wort. On a related question, should we link to the relevant subsection over there, or is the article link preferred? - Eldereft ~(s)talk~ 03:39, 8 May 2008 (UTC)
Sure you could link back here. Actually I don't particularly like the theraputic section of that article. It relies to heavily on studies and data and there is no reason why generalizations can't be made supported either by direct quotations or citations. I'll tweak this section a little right now.--scuro (talk) 16:30, 8 May 2008 (UTC)
Meta-analysis is an approach which was invented for the cases exactly like SJW - when both negative and positive studies exist. Meta-analysis combines the results of all studies into one super-study with much higher validity and lower error. That is why the meta-analysis by Cochrane Foundation is not just a study, but exactly what you are asking for - the systematic scientific summation of the knowledge on SJW for depression. On the contrary, the NCCAM trial is just a study; moreover, its results were included in the Cochrane meta-analysis and their summation. The NCCAM study is just one out of 37 analyzed by Cochrane foundation, so it cannot carry more weight than Cochrane meta-analysis. The Cochrane foundation carries enormous authority in medical community, and certainly, the authority of a website (even government-affiliated) with popularized information is much much lower. Paul Gene (talk) 22:34, 8 May 2008 (UTC)
A meta-analysis is not necessarily the best source for Wikipedia. I would argue that a webpage from the NIMH or the Mayo clinic would be the better source. First an MA is stuck in a moment of time. Webpages are fluid and updated. Secondly, a meta-analysis is only as good as the people doing the analysis. Third, the best in the field would be at the national institutes and would be aware of the best sources including the meta-analysis. They would be even more accountable then the researchers because their information would be consumed by the general public.--scuro (talk) 11:43, 9 May 2008 (UTC)
I'd go with Cochrane. It is pretty gold-standard. Webpages of clinics etc. are often distilled and may also degrade over time and/or not be updated, or reflect views not more widely held. This is a controversial area, but I'd trust Cochrane's rigour more. Cheers, Casliber (talk · contribs) 14:33, 10 May 2008 (UTC)

[edit] Major depression vs clinical depression

Erm, any idea why this is not listed under its official DSM IV TR name? Has this discussion been had before? Cheers, Casliber (talk · contribs) 14:29, 10 May 2008 (UTC)

The official DSM-IV name would be major depressive disorder, and ICD-10 - depressive episode. I suggest renaming the article Major depressive disorder. Clinical depression term is not really used by anyone, and I am at a loss as to how this article got named so. Paul Gene (talk) 10:51, 13 May 2008 (UTC)
I agree. Unless there's reasonable opposition, let's move it to Major depressive disorder. Aleta Sing 17:52, 13 May 2008 (UTC)
From what I can make out, the original page placement was way back in 2003 or earlier as per here. Funnily enough The Anome, and Delirium are still around. Hopefully some more folks will drop by. I'll drop a note on the medicine and psychology wikiproject talk pages. Cheers, Casliber (talk · contribs) 19:09, 13 May 2008 (UTC)
  • Support for major depressive disorder. The present form is outdated. The only argument against I could imagine is that the lay readership does not recognise the term, but neither would they be familiar with the concept "clinical depression" vis a vis other forms of depression. JFW | T@lk 05:53, 14 May 2008 (UTC)
  • What about depression (mental disorder). Depression seems to be used more than major depression or clinical depression (e.g. [1]) — fnielsen (talk) 09:25, 14 May 2008 (UTC)
  • Why not simply move to depression? Probably the most common search term. --Steven Fruitsmaak (Reply) 23:30, 14 May 2008 (UTC)
    This is where it gets tricky. Major Depressive Disorder is part of a group of mood disorders in DSM IV-TR (the psychiatric bible). Now the article is just starting to be polished up and hte issue is that much of the research that quotes incidence of problem/effectiveness of medication etc, uses MDD as the goalposts/yardsticks etc. Techincally there are some other conditions which would colloquially be called depression, including Adjustment Disorder with Depressed Mood (related to what was previously Reactive Depression (sort of)), Dysthymia and Minor Depression (this was a research diangosis in DSM IV for further study), which would feasibly be considered under 'depression' but not 'major depression'. Thus having the article simply as 'depression' would introduce ambiguity, even though I agree it is a much simpler title. I am thinking a brief disambig and discussion on the depression disambig page with links to all the diagnoses I have mentioned is the best bet. Cheers, Casliber (talk · contribs) 03:15, 15 May 2008 (UTC)
  • Oppose We already have a web of redirects and dab pages for all the variations on naming for this topic. Clinical depression seems fine in that is a common term for the topic and falls nicely midway between slang like Blues and jargon like Major Depressive Disorder. The essential feature of the topic is that it is about depression considered as an illness rather than just a mood. Clinical says this better than Major. Colonel Warden (talk) 12:00, 15 May 2008 (UTC)
    Erm, CW, do you actually know anyone who calls it clinical depression, 'cos I don't. In which case it could be construed as OR. Most folks who aren't calling it MDD or major depression would just call it depression. Cheers, Casliber (talk · contribs) 21:51, 15 May 2008 (UTC)
  • Yes, I know many people who use the term. For example, see scholarly sources for many thousands of examples. Since you are not familiar with such a widely-used term and have not even made such a simple search, your suggestion seems frivolously grounded in ignorance. Colonel Warden (talk) 11:56, 16 May 2008 (UTC)
Please refrain from insults - that diminishes your argument. Besides the Google search for "clinical depression" as you suggest gives 28,700 hits, while the search for "major depressive disorder" gives 56,900 hits and for "major depression" 370,000 hits. Paul Gene (talk) 15:51, 16 May 2008 (UTC)
Google Scholar naturally returns hits which use scholarly language. A more general search gives the following numbers:
  • Depression = 90 million
  • Major Depression = 2.5 million
  • Clinical Depression = 1.2 million
  • Depressive illness = 1.0 million
  • Major depressive disorder = 0.5 million
I performed searches of this sort before venturing any opinion on the matter. Major depression has a numerical lead but we must allow that there will be many non-medical usages in there - economics, especially. Note that both NIMH and NHS use the phrase depressive illness which we should include in our considerations. This phrase was not previously familiar to me but now I am less ignorant than before. Colonel Warden (talk) 17:04, 16 May 2008 (UTC)
  • Support for major depressive disorder. Clinical depression is too wide and too ambiguous to be used in clinical practice. Major depressive disorder is not jargon, but the commonly used term and standard terminology. Depression as a layterm and cultural phenomenon also deserves to be discussed, but separately as proposed by Casliber. All the types of "clinical depression" can be briefly explained there with links provided to their respective articles. --Eleassar my talk 10:35, 16 May 2008 (UTC)
  • ''Major depressive disorder is certainly technical jargon and is likely to get a big "huh?" from most lay people. As such, it is not appropriate for the main title of an article in a general encyclopaedia. Per WP:NAME: "The names of Wikipedia articles should be optimized for readers over editors, and for a general audience over specialists.". Colonel Warden (talk) 12:05, 16 May 2008 (UTC)
What about e.g. erectile dysfunction, hypertension or myocardial infarction etc. etc.? I don't know what do the lay people understand under these terms if anything at all. Per Wikipedia:Manual of Style (medicine-related articles). The article title should be the scientific or recognised medical name rather than the lay term. As for the jargon, please read Technical terminology before arguing that major depressive disorder is jargon; jargon is informal. --Eleassar my talk 14:58, 16 May 2008 (UTC)
We absolutely should use the correct medical term. Colonel Warden, "Clinical depression" can and should be a redirect to "Major depressive disorder", thereby allowing anyone who searches under that term to go directly to the article. Aleta Sing 15:48, 16 May 2008 (UTC)
Right, Aleta - that is exactly what WP:MEDMOS recommends! Use the systematic name, for example, from ICD10 and create redirects from other terms. Quote: "Create redirects to the article to help those searching with alternative names. For example, heart attack redirects to myocardial infarction." Another example of WP using systematic name vs the easier version is the article named Attention-Deficit Hyperactivity Disorder not Attention-Deficit Disorder Paul Gene (talk) 16:04, 16 May 2008 (UTC)
Heart attack/Myocardial infarction is a similar case and so it's no surprise to find that that article name is also disputed. It is a good example because the medical name is absurdly pompous and obscure. It's like arguing that we should have articles called Equus caballus rather than Horse. Colonel Warden (talk) 16:24, 16 May 2008 (UTC)
Some definitions from the OED so that our usage is clear:
  • Jargon - ...the terminology of a science or art, or the cant of a class, sect, trade, or profession.
  • Clinical - ...treating a subject-matter as if it were a case of disease
Colonel Warden (talk) 16:32, 16 May 2008 (UTC)
It is a difficult issue. Elsewhere where there is a difference, two articles exist, eg. Raven and Common Raven. Thus here I'd recommend embellishing discussion of general psychological Depression into a fairly concise paragraph on the depression page, with a link to MDD for all the scientific material on this page. Cheers, Casliber (talk · contribs) 21:51, 17 May 2008 (UTC)
An example of the term being used by the Canadian Mental Health Association: "Depression becomes an illness, or clinical depression, when the feelings described above are severe, last for several weeks, and begin to interfere with one's work and social life. Depressive illness can change the way a person thinks and behaves, and how his/her body functions." (Emphasis added)OnBeyondZebrax (talk) 18:03, 27 May 2008 (UTC)
  • Don't care. I think the content of the article is much more important than the name at the top. All of the terms are used. Any of the terms could be appropriate. The lead should include all the names and explain their differences in how they are used: Clinical depression as a catchall for all the things that are, or might be considered by a lay person, to be "depression serious enough to warrant attention in a physician's or therapist's office," and Major depressive disorder and Depressive episode to describe the more carefully delimited concepts in the DSM or in research papers. WhatamIdoing (talk) 16:12, 17 May 2008 (UTC)

[edit] Update

OK, I have moved it. Main thing is to check redirects, and convert points into a nice prose pragraph on ]]depression]] page...Cheers, Casliber (talk · contribs) 07:05, 24 May 2008 (UTC)

Also check out depression (mood) page, which is full of crap but nevertheless manages to misinform ~50,000 Wikipedia visitors per month. Paul Gene (talk) 10:01, 24 May 2008 (UTC)

[edit] Acupuncture

Eldereft removed the positive meta-analysis results from the acupuncture sub-chapter because the evidence was "sub-par", I am returning it back. The evidence is sub par for most of the non-mainstream methods. That does not prevent Cochrane and APA from supporting, for example, light therapy. As much as I may disagree with it, the meta-analysis shows that acupuncture (or light therapy) appear to be efficacious, reflecting the fact that most of the studies in the literature were positive. Noting that is a duty of encyclopedia, the same as qualifying these findings. Paul Gene (talk) 10:32, 15 May 2008 (UTC)

I do not mean to imply that weak evidence should be excluded (properly characterized and weighted, yes, but not excluded when that is all that we have). I have not checked the full paper, but according to the abstract and plain language summary (doi:10.1002/14651858.CD004046.pub2), that meta-analysis made one and only one conclusion - that the evidence base provides no evidence. Without larger methodologically sound studies, no conclusion as to the efficacy of acupuncture vs. sham, medication, or nothing may be drawn. - Eldereft ~(s)talk~ 11:27, 15 May 2008 (UTC)
Here is what the summary states: "There was no evidence that medication was better than acupuncture in reducing the severity of depression (WMD 0.53, 95%CI -1.42 to 2.47), or in improving depression, defined as remission versus no remission (RR1.2, 95%CI 0.94 to 1.51)." Paul Gene (talk) 23:17, 15 May 2008 (UTC)
Which does not lead to a conclusion that "acupuncture improved depression to a degree similar to conventional medication", which our article stated. It especially does not justify wording that seems to imply that the authors conclusions were wrong or otherwise not supported by the data. "No evidence" is absolutely in accord with my interpretation, as well as with "There is insufficient evidence to determine the efficacy of acupuncture compared to medication, or to wait list control or sham acupuncture, in the management of depression.", "There is insufficient evidence that acupuncture may be helpful with the management of depression", and "Based on the findings from seven trials of low quality, there is insufficient evidence to determine whether acupuncture is effective in the management of depression." The evidence base simply does not support any conclusions. If your accusation of POV-warring were correct, I would interpret failure to discard the null as negative evidence. Instead, I have restored the section to match what the source says without interpretation or editorializing. - Eldereft ~(s)talk~ 21:45, 16 May 2008 (UTC)
It does lead to the conclusion that acupuncture improved depression to a degree similar to conventional medication. If you do not believe me, here is how the professional journal "Journal of affective disorders" interprets the Cochrane evidence in their review on complemetary and alternative therapies for depression (I bolded the critical part):
"A Cochrane systematic review and meta-analysis of 7 RCTs on Acupuncture (Smith and Hay, 2004) produced equivocal results. The results from 5 trials (409 participants) included in the meta-analysis showed no difference in the reduction in the severity of depression (HAM-D) compared to medication (WMD 0.53, 95% CI −1.42 to 2.47). 4 trials (375 participants) reported on improvement in depression as an outcome (RR 1.20, 95% CI 0.94–1.51), again showing no differences between groups. However, the evidence was insufficient to determine the efficacy of acupuncture vs. medication due to the poor methodological quality and reporting of these trials. There was insufficient data to demonstrate whether acupuncture is more effective than a wait-list control, non-specific or sham acupuncture control, or whether acupuncture plus medication is more effective than acupuncture plus placebo." Paul Gene (talk) 00:30, 17 May 2008 (UTC)

[edit] Bullets or prose?

Hi, I changed some bulleted lists in the treatments section to prose, following the Wikipedia:Manual of Style, which states that "Do not use lists if a passage reads easily using plain paragraphs." The Manual says that "Most Wikipedia articles should consist of prose, because prose allows the presentation of detail and clarification of context," while a list does not. "Prose flows, like one person speaking to another, and is best suited to articles, because their purpose is to explain." As well, when you take bulleted points and convert them to prose, you can indicate the importance, usage, or other comparisons for each example. Another editor changed the section back to bullets, on the grounds that they like the bullets better. In this case, though, I argue it should be the widely-accepted Wikipedia style conventions which we should follow, not any single editor's preferences.OnBeyondZebrax (talk) 20:51, 17 May 2008 (UTC)

WP:MOS states only: "Do not use lists if a passage reads easily using plain paragraphs." It does not. Prose in this case obscures the individual items - the list, on the other hand, offers easy navigation among them. There is no need for the prose to flow since the paragraphs are very short, nor the goal is to explain anything or present the details but only to offer the summation of scientific evidence. The reader then can pick the item of interest and read the full article to which the item is linked.
WP:EMBED states: "However, it can be appropriate to use a list style when the items in list are "children" of the paragraphs that precede them. Such "children" logically qualify for indentation beneath their parent description. In this case, indenting the paragraphs in list form may make them easier to read, especially if the paragraphs are very short." Which matches our case precisely. WP:EMBED then goes on to show an example, which is quite close to what we have in this article. Paul Gene (talk) 00:07, 18 May 2008 (UTC)

[edit] Depressive episodes with somatic syndrome

I can't seem to find any mention of depressive episodes with somatic syndrome on wikipedia. It's mentioned in the ICD-10 criteria for research (~p97, F32.01, F32.11), and it's something that's in a couple of psychiatry textbooks I've seen. I'm not sure how clinically relevant it is, but should it be mentioned? Ged3000 (talk) 17:52, 18 May 2008 (UTC)

[edit] Sociological and cultural aspects section and Cultural references subsection

I have reorganized the bottom of the article like we have done in schizophrenia. I am trying to get a list of the most notable books/media/films etc. on depression to write about in a paragraph or two here. The list of books by psychiatrists seems unwieldy and I think should be trimmed if not cut completely. Input most welcome. I was rather pleased howthe section in schizophrenia turned out. Cheers, Casliber (talk · contribs) 14:05, 24 May 2008 (UTC)


[edit] Illustrations

Both illustrations do not fit the article well.

MDD is not one among the 30-some diagnoses the contemporary psychiatrists try to apply to Van Gogh, since his illness was characterized by seizures, changes in the mood and periods of euphoria. The diagnosis of epilepsy he got from his physician is still the most likely one according to the consensus. Nor is the content of the painting is typical for the contemporary presentation of MDD. Most of the MDD sufferers are women. The despair in more often not completely black, and melancholia is a minority of major depression cases.

Melencolia is a heavily symbolic and philosophical painting illustrating the concept of four humors, and is even more out place on the MDD page. Paul Gene (talk) 21:18, 24 May 2008 (UTC)

Yeah, good point. The painting is rather a good one (of a sad person, that is), unfortunately Van Gogh had other mental health symptoms suggesting problems other than depression. OK, let's leave it open for a little bit but removing I think I agree with. Cheers, Casliber (talk · contribs) 21:39, 24 May 2008 (UTC)
....which leads me to ponder what are good illustrations. A nice 3D model of imipramine in the drug bit? Umm....Cheers, Casliber (talk · contribs) 21:43, 24 May 2008 (UTC)
I completely agree the Durer doesn't fit here. I do think the Van Gogh works, but that we need to change the caption not to focus so much on Van Gogh himself or any possible diagnosis of his illness. It does seem to portray someone in emotional anguish, such as from an episode of major depression - even if that episode was actually caused by some other disorder than MDD. Aleta Sing 23:02, 24 May 2008 (UTC)
Funnily enough, I pulled out my copy of Kaplan & Sadock...and there was Durer's illustration in the mood disorders section. I wanna be different from a psych textbook too....hehehehe. Cheers, Casliber (talk · contribs) 09:20, 25 May 2008 (UTC)
Because of silly WP copyright policies, we cannot use anything more contemporary than Van Gogh. And in comparison with a shiny imipramine molecule he wins hands down. But we have to change the caption, yes. Paul Gene (talk) 11:01, 25 May 2008 (UTC)
How about.......Cheers, Casliber (talk · contribs) 11:07, 25 May 2008 (UTC)

[edit] Booklist moved to here - can we identify most notable for a prose paragraph on them?

OK - I moved this here so we can identify most notable for a prose paragraph on them...and this is onlty the tip of the iceberg...Cheers, Casliber (talk · contribs) 00:09, 25 May 2008 (UTC)

[edit] Books by psychologists and psychiatrists

  • Beck, A. T., Rush, A. J., Shaw, B. F., Emery, G. (1987). Cognitive therapy of depression. New York: Guilford.
  • Bieling, Peter J. & Anthony, Martin M. (2003) Ending The Depression Cycle. New Harbinger Publications. ISBN 1572243333
  • Burns, David D. (1999). Feeling Good : The New Mood Therapy. Avon. ISBN 978-0380810338
  • Griffin, J., Tyrrell, I. (2004) How to lift Depression – Fast. HG Publishing. ISBN 1-899398-41-4
  • Jacobson, Edith: "Depression; Comparative Studies of Normal, Neurotic, and Psychotic Conditions", International Universities Press, 1976, ISBN 0-8236-1195-7
  • Klein, D. F., & Wender, P. H. (1993). Understanding depression: A complete guide to its diagnosis and treatment. New York: Oxford University Press.
  • Kramer, Peter D. (2005). Against Depression. New York: Viking Adult.
  • Manning, Martha. (1995) Undercurrents: A Life Beneath the Surface. ISBN 978-0062511843
  • Papolos, Demitri & Papolos, Janice. (1997) Overcoming Depression. ISBN 978-0060927820
  • Plesman, J. (1986). Getting off the Hook, Sydney Australia. A self-help book available on the internet.
  • Rowe, Dorothy (2003). Depression: The way out of your prison. London: Brunner-Routledge.
  • Sarbadhikari, S. N. (ed.) (2005) Depression and Dementia: Progress in Brain Research, Clinical Applications and Future Trends. Hauppauge, Nova Science Publishers. ISBN 1-59454-114-0.

[edit] Psychotherapy section

The therapies generally used fall under the broad categories of CBT, IPT and psychodynamic therapy (the last also includes psychoanalysis and should probably discuss some link into Attachment theory somehow too). I have begun restructuring. Cheers, Casliber (talk · contribs) 11:04, 5 June 2008 (UTC)

Oops. actually supportive therapy is a new thing which needs defining as well. This secion really needs some work....Cheers, Casliber (talk · contribs) 11:14, 5 June 2008 (UTC)

[edit] POV in History section

The part of the article that I flagged seems to be entirely inspired by a single essay, the reliability and neutrality of which are questionable. (For example, the essay makes the claim that, "King Saul is described as experiencing depression," without giving any evidence to support this. Our article does a very good job of making that NPOV, "In the Old Testament description of King Saul, has symptoms that resemble some elements in the modern diagnosis of depression.")

Even beyond the source, this section has been made more POV with weasel words. I flagged each statement that I think ought to be reliably justified.

Just trying to help, hope this doesn't cause a stir. --π! 09:10, 9 June 2008 (UTC)

No, that's a good start. We should start verifying it. I was the one who place the expand tag in the first place and can see obiovus stuff like galen etc. The rest I have not checked, so the tags were the best thing to do. If you have any scholarly sources it would be great but we'll get there... Cheers, Casliber (talk · contribs) 11:06, 9 June 2008 (UTC)
Paul Gene was somewhat more unequivocal than I was, but I placed it in a 'to-do' box for verifying. I find these boxes useful now as a place to store information on large articles which cannot be left in as is. Cheers, Casliber (talk · contribs) 11:53, 9 June 2008 (UTC)

[edit] "No laboratory test for major depression"?

The introduction states that "there is no laboratory test for major depression", however the article goes on to name several laboratory tests that should be done to determine if there is a physiological basis for depression. It also cites a study that shows high levels of MAO-A are significantly correlated to depression. While I agree there is no single universal laboratory test which can rule in or out major depression, there are certainly laboratory tests used to determine at least some kinds of major depression. As it is, it sounds a bit like a Scientology claim to me. Can we get some clearer wording on this please? -- HiEv 11:47, 9 June 2008 (UTC)

I've added a clause to the sentence to explain this. Does it address your concern? Gimme danger (talk) 11:51, 9 June 2008 (UTC)
It's given that here is no laboratory test for MD. If there was it would be called a disease, hence the term "disorder". Furthermore, why does this need to be inserted into the intro which should be a synopsis of the article?--scuro (talk) 16:25, 9 June 2008 (UTC)
Physical causes being ruled out is part of the article, but I agree that the lead probably doesn't summarize the diagnosis section properly. Gimme danger (talk) 16:37, 9 June 2008 (UTC)

[edit] Placement of history section

I'd like to suggest that the "history" section of this article be moved from (nearly) rock bottom to at least somewhere higher up in the article. My personal inclination is to move it to the very top, but I'd settle for somewhere in the middle. To describe the "nature" of depression so long before describing the historical context, in which our understanding of that nature has emerged and evolved, is to impose upon the reader a very clunky hermeneutic circle, through which one really has to read the entire article before getting any sense of how the contemporary parts and the historical whole synergistically create a more-or-less NPOV (or at least a thorough) picture of depression. Becausee the current revision emphasizes the ahistorical, it implicitly reifies depression, treating it in an essentialist manner, as if it were as objectively "real" an entity as gold, silver, or even a bona fide mental disease such as neurosyphilis. But, you'll notice that the "history" sections even in the articles for hydrogen, oxygen, and gold--things that can be treated in an essentialist manner--are in the middle of their pages. The historical context for something far less elemental, such as MDD, should feature at least as prominently, if not more so. Cosmic Latte (talk) 11:24, 12 June 2008 (UTC)

A fair point. However, here is an order of medicine related articles as per Wikipedia:Manual of Style (medicine-related articles). I think we can get around it by a summary of (a) current classification and (b) ensuring a succinct summary an distinction between what is known and what is hypothesised. Agree reification is an issue in DSM but wikipedia is not a place for OR. Cheers, Casliber (talk · contribs) 11:46, 12 June 2008 (UTC)
The histortical context is very complicated. There is not much left from the historical concept of insanity in the contermporary concept of major depression. That renders the discussion of the views of the ancients almost irrelevant. Even since 1970s, the concept of major depression changed significantly. Because of that, I do not feel that history is more important than symptoms, causes and treatment. I would only be confusing, if the article starts with history, which will have to include the historical split of the diagnosis of manic depression into bipolar disorder and MDD before explaining what MDD is. Paul Gene (talk) 16:36, 12 June 2008 (UTC)
Thank you for alerting me to WP:MEDMOS, Casliber. I had not been aware of that page before (although it appears that I'm not the only one who has had issues with the placement of "history" sections in MEDMOS-related articles). For now I just tweaked the second paragraph of the intro, in order to counteract reification a bit, and in the process I removed some editorializing language in accordance with WP:WTA. Cosmic Latte (talk) 07:42, 13 June 2008 (UTC)
I would just like to note that MEDMOS is only a guideline, and conditions such as this are also the domain of non-medical fields such as clinical psychology (but they don't have a style guide). I assume NPOV takes precedence ultimately. EverSince (talk) 14:05, 13 June 2008 (UTC)

[edit] "Historical significance of psychoanalysis"

Just pointing out that it's completely appropriate to include psychoanalysis in the main psychotherapy section of this article. It may appear to be of "historical significance" from the perspective of many research-oriented institutions, but just google "psychoanalytic institute" to get a glimpse of how alive and well it is in many areas. Cosmic Latte (talk) 00:28, 13 June 2008 (UTC)

Also be advised that, after adding the foregoing note, I did quite a bit of reorganization in the psychotherapy section, so that cognitive-behavioral approaches are consolidated (and, yes, even first), and so that the difference between "psychoanalysis" and later "psychodynamic psychotherapy" is clearer. Cosmic Latte (talk) 00:50, 13 June 2008 (UTC)

Wikipedia's charter is to reflect the general expert consensus on the topic, and not how often Google mentions the term. WP:Weight recommends that rare or fringe views (in our case treatments) should not be overrepresented in the articles.

The general expert consensus is that psychoanalysis is a fringe treatment, which is rarely used, but of significant historical interest. So I would suggest that it can written about, and in more detail, in the History section.

Quoting from the textbook I have on the shelf (author=Durand, Vincent Mark; Barlow, David |title=Abnormal psychology: an integrative approach |publisher=Brooks/Cole Pub. Co |location=Pacific Grove, CA, USA |year=1999 |pages=20-21 |isbn=0-534-34742-8 |oclc= |doi= |accessdate=), and many other textbooks say the same:

  • Rarely used. "Because of the extraordinary expense of psychoanalysis, and the lack of evidence that it is effective in alleviating psychological disorders, this approach is seldom used today."
  • Fringe. "A major criticism of psychoanalysis is that it is basically unscientific, relying on reports by the patient of events that happened years ago. ... There has been no careful measurement of any of these psychological phenomena, and there is no obvious way to prove or disprove the basic hypotheses of psychoanalysis. This is important, because measurement and the ability to prove or disprove a theory are the foundations of the scientific approach."
  • Of significant historical interest. "Nevertheless, psychoanalytic concepts and observations have been very valuable, not only to the study of psychopathology and psychodynamic psychotherapy but also to the history of ideas in Western civilization." "Careful scientific studies of psychopathology have supported the observation of unconscious mental processes, ... understanding that memories of events can be repressed,... the importance of various coping styles or defense mechanisms."

Paul Gene (talk) 11:04, 13 June 2008 (UTC)

Incidentally, I own a copy of, and have read, the very book you're referencing--and I don't deny its value one bit. When it comes to many, many psychological and psychiatric issues, especially to new anxiety disorder treatments, Barlow is the man. But, with all due respect, I think that he and his co-author fall prey to the common tendency among research-oriented scholars (one of which I consider myself to be!) to gloss over psychoanalysis as the proverbial elephant in the room. We can't deny it's there, and we don't know what to say about it, and all we end up uttering is "it's of historical interest"--which, IMHO, has become rather cliché among contemporary psychologists. Yes it's "unscientific," but aside from Freud's antiquated use of the term "science," it was never really supposed to be "scientific" in the sense that it could be dissected with psychometrics or experimentally validated for a large population. As dogmatic as Freud could be, he did not believe that his therapy would work for everyone. I believe his term for those who wouldn't benefit was "worthless"--a demeaning choice of words, to be sure, but a testament to the fact that those who criticize his approach as "unscientific" may be, in large part, preaching to the choir. Because psychoanalysis is more of an interpretive than a curative therapy, why should we be surprised that experimental evidence of curativeness is not exactly forthcoming? As for the "extraordinary expense" and relative rarity of psychoanalysis, well...let's take an analogy. Rolls-Royce cars are also "extraordinarily expensive" and seldom used, but does that relegate them to mere artifacts from the history of automobiles? I think not, given that Rolls-Royces are still in use today. Psychoanalysis, despite falling outside the reign of APA/APS hegemony, is certainly still used today, as I'm sure the American Psychoanalytic Association would be happy to attest. Cosmic Latte (talk) 11:41, 13 June 2008 (UTC)
I take it that, although we disagree in regards of how often psychoanalysis is used, we agree that most research scholars agree that it is a fringe unscientific treatment ("elephant in the room", "preaching to the choir" in regard of it being unscientific), which is rarely used. That all that matters.
It's probably fair to say that psychological/psychiatric research scholars tend to see psychoanalysis as a "fringe treatment," although it would probably be more encyclopedic (and more NPOV, considering that many literary scholars, and a notable minority of practitioners, still find Freud and insight-oriented therapy to be highly relevant) to paraphrase this as something like, "Most scholars would agree that psychoanalysis is generally more effective at providing insight into mental disorders than at alleviating their manifest symptoms." (In fact, I once heard a very scientifically-minded researcher make a concession quite like that.) It may also be appropriate to mention in the article that psychoanalysis is "rarely used," at least relatively speaking. But it hasn't disappeared from the face of the earth, and it's still a viable option for those with the means (i.e., $$) and the motive (i.e., insight), so I think it'd be a tad premature to dismiss it as "historical." Expensive, yes. Eccentric, yes. But non-notable enough to exclude from the main body of the article? Not yet, anyway. Cosmic Latte (talk) 13:12, 13 June 2008 (UTC)
Also bear in mind that, although psychoanalysis might not be widely available today, it wasn't widely available from the outset. Sure, Freud acquired a considerable lay following, and American psychiatry certainly co-opted his ideas enthusiastically for a while. But formally, Freud was always very esoteric. His harsh treatment of "dissenters" like Jung and Adler provides ample illustration of the idea that if psychoanalysis is a "fringe treatment" now, then things haven't really changed a whole lot from what Freud allowed in the beginning. (One might even go so far as to argue that such continuity, or at least such coming-full-circle, betrays the unilinear sense of the "historical," as in "historical significance," in which many people hold the term.) Cosmic Latte (talk) 13:22, 13 June 2008 (UTC)
As an aside, I personally believe, that DSM (and ICD derived from it) is doing a great disservice to psychiatry, and is more harmful than useful for the research. It may even be more harmful than Freudism, since the latter only arrested the development of biological psychiatry in the US, while the DSM-ICD has a worldwide stifling effects. But in Wikipedia we have to work within this framework provided by the current consensus. Paul Gene (talk) 12:52, 13 June 2008 (UTC)

I walked into this late but I need to add that psychodynamic psychotherapy (which is I guess can be seen as a more pragmatic descendant of psychoanalysis), is definitely not fringe and definitely used by a large number of psychiatrists and psychologists today. It has been under-studied in quantitative research and marginalised by many in psychiatry for a number of reasons but remains a lot broader in usage than psychoanalysis. Still, some features of the the latter are still widely seen in psychiatry to this day. I was waiting for some material before really getting stuck into this article on a march to FAC, but can see there may need to be some planning pretty quickly...Cheers, Casliber (talk · contribs) 15:38, 13 June 2008 (UTC)

Oh heck this could be a really big discussion....(groan)... :(