Talk:Depression (differential diagnoses)

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American Article?[edit]

According to User:Lova Falk 2) this is an article on the world-wide subject of differential diagnosis of depression. In this American article, the word depression is not even named

In the article, in addition to the title, the words depression or depressive are mentioned 28 times, and I probably missed a few. The article is entitled Depression (differential diagnoses), I think most people would get the point of what the subject matter is without using the word depression in every single sentence.

As far as being an American article it's American only in the fact that the person who gave a crap enough to start an article on the world-wide subject of differential diagnosis of depression is an American of ... European heritage. People from almost every single country in the world are American so I don't understand your Anti-Americanism. 7mike5000 (talk) 03:20, 18 July 2010 (UTC)

This is a complete misunderstanding! This is what happens when I try to express myself in one line...
  • "2)" means that I refer to the second part of my edit
  • "this is an article" - now I talk about this very article: Depression, differential diagnoses
  • "In this American article" - now suddenly I talk about the "See also" link that I removed, Fatal Care: Survive in the U.S. Health System. It is in this American article in which the word depression is not even named.
So all of this was just to explain the reason why I thought that Fatal Care: Survive in the U.S. Health System should not be a "See also" link to Depression (differential diagnoses).
I hope I succeeded to make myself a bit clearer now? And by the way, I am not anti-american. Just sometimes lousy in explaining myself... Lova Falk talk 08:05, 18 July 2010 (UTC)
O.K. thanks for clarifying. Fatal Care: Survive in the U.S. Health System is relevant to Depression (differential diagnoses) whether of not it specifically mentions depression because it drives home the point that people suffer and some die due to gross incompetance, ineptitude and callous indifferance on the part of alleged experts.
  • If misdiagnosis and missed diagnosis can occur in medical conditions with concrete physical symptoms the chances of diagnostic error occuring when the main presenting symptom is psychological is much greater.
  • If there was a book on how many people suffer and go jump off bridges due to a mis- or missed diagnosis when seeking help for depression I would put it there, but there is not. It's about the U.S. health care system in particular but the topic matter is applicable to any country. And last but not least most if not all "psychiatric" conditions are medical conditions that present with psychological manifestations 7mike5000 (talk) 11:25, 18 July 2010 (UTC)
FWIW realistically, in a general adult outpatient population of a first world country - in reviewing depressive symptoms, the chances of physical illnesses masquerading as depression (without other signs) are low. I agree we need to be mindful, but when a physical illness is responsible clues usually pop up early. Need to find a ref for this though :) Casliber (talk · contribs) 10:02, 16 August 2010 (UTC)
I've copied this from Talk:Depression (mood).
Major_depressive_disorder#Clinical_assessment says "a doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms" but 7mike5000 says "Most diagnoses are done without benefit of medical testing". Can you both provide recent WP:MEDMOS-compliant citations to support your conflicting propositions? —Preceding unsigned comment added by Anthonyhcole (talkcontribs)
There are no biological tests used to "confirm" major depressive disorder - what happens ideally is that when someone first presents with psychiatric symptoms, a clinician does a standard battery of investigations, as well as a full physical examination, to exclude organic illness. So the diagnosis of major depression as such is not based on medical testing. What I describe is generally thought of as good practice -how often it actually happens is another matter, and would be good to get data from a review article on. I have read the Hall 78 article (which is not a review article), and it raises some points which I will add after I think about it and read it again. Casliber (talk · contribs) 19:38, 16 August 2010 (UTC)

POV issue[edit]

The introduction of this article was doubtlessly written with the honourable goal to protect patients from wrong treatment. Nonetheless, it is written in a highly WP:POV, not to say advertising, tone. Could you try to switch to a more encyclopaedic and less, well, yellow-press tone? Thanks, ἀνυπόδητος (talk) 08:45, 16 August 2010 (UTC)

There is a difference between a point of view and mentioning facts. The facts are referenced. Most non-medical mental health professionals are deficient in their ability to make a proper diagnosis. The "PLEA" isn't my "PLEA" it's from a professional I placed a verbatim statement that he made, not me. What exactly am I advertising? I am stating facts. It may seem like a point of view to some because they are FACTS that most people may not be aware of, but still facts none the same. 7mike5000 (talk) 09:09, 16 August 2010 (UTC)
When I get a chance I will add more citations, which state the same as the ones already included. Psychiatric misdiagnosis is common. It takes just as much effort probably less to type in psychiatric misdiagnosis PMID into the search engine and wala out comes a pizza, I mean a peer reviewed article at the National Library of Medicine. 7mike5000 (talk) 09:20, 16 August 2010 (UTC)
There is a problem with the tone, in my opinion. From my reading the other day, I do think it does need work to conform more to encyclopedia style (whatever that is) and look less like advocacy. I have no issue with the statements of fact - but I have a lot more reading to do - but there is something unconvincing about the tone. I'm going out now and will check in later. Anthony (talk) 09:55, 16 August 2010 (UTC)
More chores more chores...I'll take a look too. Casliber (talk · contribs) 09:59, 16 August 2010 (UTC)

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Please don't remove POV tags without fixing the problem. The neutrality has been disputed; just because you have an EXPERT saying something doesn't mean it's neutral. In my view the introduction is clearly not neutral. Edgepedia (talk) 11:31, 16 August 2010 (UTC)
As an example I've highlighted a generalisation in the first sentence relating to the causes of Major depressive disorder (which I think that what you're talking about here). Only the biological model is mentioned, yet under Major_depressive_disorder#Causes five (or is it six) models of the illness are mentioned. Edgepedia (talk) 16:19, 16 August 2010 (UTC)
Now your getting carried away, and your not amusing anymore, what is your malfunction. Do you have nothing better to do than harrass and annoy. WTF is this</ref> is thought[according to whom?] to occur primarily due to dysregulation of neurotransmitters in the brain such as serotonin and norepinephrine.[1] it has a reference; author=Nemeroff CB |title=Recent advances in the neurobiology of depression |journal=Psychopharmacol Bull that's by whom.
How many damn references does it need. It must be a Full moon all over the world simultaneously you people are out in full force. GO DO SOMETHING CONSTRUCTIVE, STOP BEING ANNOYING, try writing something on your own, I'll even help...Once upon a time there was this guy with an internet connection and a lot of free time...then little miss muffet sat on her tuffet eating her curds and... oops wrong story.OKAY CIAO 7mike5000 (talk) 21:49, 16 August 2010 (UTC)
I think all I can say to that is HUH? I have absolutely no clue what the heck your talking about. What exactly is the purpose of all these comments? Nothing constructive unless just irritating me is the point then it's working great, it's not my POV they're called facts. I provided references to experts, it's their statements, unless you can provide references to EXPERTS who say everything is Just groovy baby in the mental health field, than those complaining about POV are the ones who have it. So I'm removing the tag, please don't replace it unless you can provide some Just groovy baby references to support your position, cause now your starting to rise to the level of rudeness and harassment "(DO NOT remove tags without solving the problem.)" Don't dictate, and with keeping with the attack the content and not the editor, I can't attack your content because you don't have any. This is from: 2006 The Royal College of Psychiatrists utilizing various studies, including from the Harvard Medical School. So enough already. go do something positive.
Medical misdiagnosis, missed diagnosis and error in general are rampant, in the US, Europe, Australia etc.
  • These and other recent results indicate the need for adverse events (AEs) to be considered a public health priority in Europe. PMID 19008366
  • Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management PMID 15159366
  • that between 44,000 and 98,000 deaths per year occur in United States hospitals as a result of error PMID 17126682
  • A review of the medical records of over 14,000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an "adverse event", PMID 7476634
—Preceding unsigned comment added by 7mike5000 (talkcontribs)

[according to whom?][edit]

Edgepedia, I recently replaced

Depression, one of the most commonly diagnosed psychiatric disorders,[2][3] is thought[by whom?] to occur primarily due to dysregulation of neurotransmitters in the brain such as serotonin and dopamine.[4]

with

Depression, one of the most commonly diagnosed psychiatric disorders,[2][3] is thought to occur primarily due to dysregulation of neurotransmitters in the brain such as serotonin and norepinephrine.[4]

Shortly afterwards, you restored the [according to whom?] tag. How about this, then:

In psychiatry, Depression refers to a state of low mood and reduced activity (see depression (mood)) or it may refer to major depressive disorder, one of the class of psychiatric syndromes called the mood disorders. Mood disorder is one of the most commonly diagnosed classes of psychiatric disorder.[2][3] The mood disorders are thought to be associated with unusual concentrations of monoamines in the brain, and unusual brain morphology, such as, in major depressive disorder and bipolar disorder, reduced size of the hippocampus and part of the anterior cingulate cortex.

It clarifies (somewhat) the meaning of "depression" and stresses correlation rather than causation, removing the controversial implication that monoamine dysregulation is etiologically primary. Anthony (talk) 06:16, 17 August 2010 (UTC)

7mike5000, the abstract of the article by Nutt
Nutt DJ (2008). "Relationship of neurotransmitters to the symptoms of major depressive disorder". J Clin Psychiatry 69 Suppl E1: 4–7. PMID 18494537
discusses a relationship between depression and monoamines (i.e., they are somehow involved in the process). It does not say depression is "due to" dysregulation of monoamine systems. "Due to" implies monoamine dysregulation is the primary factor, the ultimate cause, and overstates Nutts paper. Since there are many currently competing theories about the underlying cause of depression, and the monoamines are not the only disturbed chemical system associated with depression (HPA axis dysregulation seems to have a reliable association with mdd), I've removed mention of possible etiology from the lead. Anthony (talk) 17:36, 17 August 2010 (UTC)

Proofreading[edit]

This sentence doesn't make sense: In addition of those with CFS symptoms have an undiagnosed medical or psychiatric disorder such as diabetes, thyroid disease or substance abuse. --Hordaland (talk) 06:12, 17 August 2010 (UTC)

College students[edit]

I have removed the statement about rising incidence of depression in college students from the lead because it is supported only by one study, as yet unpublished in a peer reviewed journal and as such doesn't conform to WP:MEDRS. Anthony (talk) 18:44, 17 August 2010 (UTC)

Good move. We need to be careful about isolated reports and primary sources. Casliber (talk · contribs) 21:19, 17 August 2010 (UTC)

Point of view[edit]

The lead contains 16 references to peer-reviewed articles written by experts in the field, which state in varying terms that misdiagnosis and missed diagnosis are prevalent in the mental health field. The references included are from different countries including the United States, Canada, the United Kingdom and Australia. There are an additional 60+ separate references to various medical conditions which state that they are often misdiagnosed as depression. Included are studies of the effect that smoking has on depression an suicide. One of the studies, conducted amongst 300,000 young, healthy soldiers shows a definitive link between suicide and cigarette smoking. The fact that smoking in itself may cause depression is often overlooked. How all this information taken from 80+ sources becomes my Point of View is irrational.

There are no sources referenced which support the supposition that what is stated in the article is a "viwepoint" as opposed to accepted facts. The facts being that differntial diagnoses of depression and comorbid medical conditions which may exacerbate depression are often missed. The consequences for those on the receiving end are severe upto and including suicide.

A collegiate process does not mean that every irrational and unsupported position has to be humored. No valid argument has been made that the article, as it now stands is my "Point of View". Unless the individual/s supporting the position as stated in the aformentioned tag can come up with references then there is no debate. I have not only made a cogent argument but a definitive one. The tag is an unnecessary and unwarranted detraction. 7mike5000 (talk) 17:27, 18 August 2010 (UTC)

Don't worry about the tags. They look like shit but they'll be gone soon enough. You have written a substantial and important medical article here. The next step in the process is for it to be pored over by others for format and style (per WP:MEDMOS), quality of sources (per WP:MEDRS), and the closeness of its claims to those of its sources (per WP:NOR and WP:NPOV). The ideal biomed Wikipedia article is supported entirely by WP:MEDRS-compliant sources (university-level textbooks, reviews published in high impact journals, etc.). This process can be excoriating for the main author if the editors doing the poring are stupid or agenda-driven. Hopefully that won't be the case here.
I have access to 2 mid-level university databases, so can access many journals. If there is an article you need, email me and, if I have access, I'll email you a copy. I will make mistakes. When I do, just point them out. To start with, it isn't clear what is meant by "depression" in the lead. Is it referring to major depressive disorder? Anthony (talk) 08:38, 19 August 2010 (UTC)
You articulate an important question, Anthony. Does this article talk only or mostly of Major depressive disorder, or (also) of depressed mood? If both, that too must be clarified. I looked at (the abstracts of) some of the first refs, and my impression is that they are about MDD primarily. Hordaland (talk) 13:46, 19 August 2010 (UTC)
"Depression" is somewhat of a "catch-all" word that covers depressive disorders used for the sake of brevity and clarity, and it is used as such in the medical field in North America, Europe, Australia etc. e.g.
  • A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression. Prim Care Companion J Clin Psychiatry. 2008;10(2):120-8.PMID 18458765
  • Cerebral perfusion in chronic fatigue syndrome and depression. MacHale SM. et al. Br J Psychiatry. 2000 Jun;176:550-6. PMID 10974961
7mike5000 (talk) 17:53, 19 August 2010 (UTC)
I agree and I find it unfortunate. The point is, it needs to be specified in the lead somehow, and the terminology in use doesn't make it easy. Maybe like this, early in the lead?
--Hordaland (talk) 19:43, 19 August 2010 (UTC)

Tag is coming off[edit]

80+ references stating that misdiagnosis and missed diagnosis is common. Unless I am mistaken Wikipedia has not been sold to my pal User:Edgepedia in England. "I would imagine there's a counterargument" unless you can make one the tag is coming off. Just slapping tags because you feel like it doesn't cut it. The neutrality is disputed by who? Yourself. Please see the discussion on the talk page. I have you not. State your case already. NO CASE NO TAG. There has to be a valid basis. Same with the merge tag. Two different topics. the mood called depression and medical conditions that might be misdaignosed as depression7mike5000 (talk) 21:54, 19 August 2010 (UTC)

Merge to Depression (mood)[edit]

Two separate topics cut and dry. What I started was an article on the differential diagnoses of depression. Simple elucidation: It is not about the mood, it is about other conditions, a majority of which are medical in nature, which may be and have been misdiagnosed as various types of depression.

Should it be retitled as:A list of medical conditions and other psychiatric disorders which have been misdiagnosed as a depressive disorders due to an inadequate screening process or a lack of knowledge ?

I started this article because for whatever the reason I have an altruistic nature, it does serve a purpose and provides information and I believe in that strongly enough, that despite the intense aggravation I'm responding to what I quite frankly think are some irrational people.

I would love for somebody to explain in a rational argument how articles such as the following are somehow deemed acceptable:

How does this Fart lighting warrant a "stand alone" article yet this: Depression (differential diagnoses) does not? I personally belive that Fart lighting should be merged into [[Fart]]:{{Merge to|Fart|discuss=Talk:Fart#Fart Lighting Merge |date=August 2010}} Is it a silly example? Something that affects untold numbers of people, somehow doesn't warrant a stand alone article, but Fart lighting does, that's the epitome of ludicrousness.

"FWIW realistically, in a general adult outpatient population of a first world country - in reviewing depressive symptoms, the chances of physical illnesses masquerading as depression (without other signs) are low." Need to find a ref for this though :) Casliber (talk

I provided 80+ refernces that state otherwise, from such sources as the Royal College of Psychiatrists and the Harvard Medical School.

I have provided multiple references that state many of the listed condtions are underdiagnosed, that a conservative 10% of those with a diagnosed mental illness actually have a medical condition cauising their symptoms. Upwards of 50% of patients in psychiatric facilities may have an undiagnosed medical condition that is causing or exacerbating their condition. I think the findings of the Royal College of Psychiatrists and the Harvard Medical School carry a little weight. These tags are a detraction, I don't think they were placed there in good faith, I can state my position and refernce it. 7mike5000 (talk) 18:32, 18 August 2010 (UTC)

I hope the request to merge Fart and Fart lighting is not an attempt to make a point. Whether or not you think the articles you've listed are worthy of stand alone articles, their existence or otherwise should not be used to argue the case for this article. Certainly the contents of fart lighting have no relevance to the article on fart, and would instead be appropriate in the article on flatulence, or more probably flatulence humor. I can't see that you've made a case on that page for a merge or otherwise beyond the reason you've expressed above ('How does this Fart lighting warrant a "stand alone" article yet this: Depression (differential diagnoses) does not?') hence my concern about a breach of WP:POINT, as well as the fact that you don't seem to have considered what the article you'd like to merge it to is actually about. Assuming good faith I'll close the current discussion, but you're welcome to request a merge to flatulence or flatulence humor as you prefer, and make a cogent argument there. Benea (talk) 19:16, 18 August 2010 (UTC)
Why of course the request to merge Fart and Fart lighting was not an attempt to make a point. Making a point and using an example are two different things. But, I do appreciate you reinforcing the example. Somebody gets bent out of shape and comes to defense of Fart lighting and Fart, thats amazing. And actually this Fart lighting should not be an article, even though I personally enjoy lighting my farts on fire. 7mike5000 (talk) 19:33, 18 August 2010 (UTC)

Don't merge to Depression (mood)

Here's the Merck Manual on differential diagnosis of depression: Succinct, and much more helpful, could be referenced in article on Depression (mood)

Differential diagnosis: Depressive disorders must be distinguished from demoralization. Other mental disorders (eg, anxiety disorders) can mimic or obscure the diagnosis of depression. Sometimes more than one disorder is present. Major depression (unipolar disorder) must be distinguished from bipolar disorder (see Mood Disorders: Bipolar Disorders).
In elderly patients, depression can manifest as dementia of depression (formerly called pseudodementia), which causes many of the symptoms and signs of dementia such as psychomotor retardation and decreased concentration (see Delirium and Dementia: Dementia). However, early dementia may cause depression. In general, when the diagnosis is uncertain, treatment of a depressive disorder should be tried.
Differentiating chronic depressive disorders, such as dysthymia, from substance abuse disorders may be difficult, particularly because they can coexist and may contribute to each other.
Physical disorders must also be excluded as a cause of depressive symptoms. Hypothyroidism often causes symptoms of depression and is common, particularly among the elderly. Parkinson's disease, in particular, may manifest with symptoms that mimic depression (eg, loss of energy, lack of expression, paucity of movement). A thorough neurologic examination is needed to exclude this disorder.
Testing: No laboratory findings are pathognomonic for depressive disorders. Tests for limbic-diencephalic dysfunction are rarely indicated or helpful. However, laboratory testing is necessary to exclude physical conditions that can cause depression. Tests include CBC, TSH levels, and routine electrolyte, vitamin B12, and folate levels. Testing for illicit drug use is sometimes appropriate.

http://www.merckmanuals.com/professional/psychiatric_disorders/mood_disorders/depressive_disorders.html#v1028089

99.190.133.143 (talk) 18:43, 11 March 2012 (UTC)

Might usefully be retitled as:

Medical or psychiatric disorders which have been misdiagnosed as a depressive disorders.

The thrust of the article is better captured by that title. And, an article like this with a title like that does have value.

The current "Differential diagnosis" title is more appropriate for a succinct article focused directly on tests, etc., that are appropriate to clinical practice (like the Merck manual section cited & quoted above). The Merck Manual seems to be saying there is no definitive lab test readily available -- patients are trialed empirically on antidepressants to see if they improve.

The current article is somewhat sensational in tone, e.g., the brain-tumor anecdote deserves a paragraph in a section on one-off spectacular missed diagnoses; elevating it to a position in the summary above the table of contents creates more of a tabloid article feel, and you can't help suspecting that the omission of all of the data facing the clinicians before the surgery has been swept away in an ex-post-facto one-sided statement of what may have been a challenging diagnosis before the end results were known.

99.190.133.143 (talk) 18:57, 11 March 2012 (UTC)

italics and [small][edit]

I've never seen (another) Wikipedia article using so much italics and [small text]. I'll be removing some of it. --Hordaland (talk) 20:08, 26 October 2010 (UTC)

Done. --Hordaland (talk) 21:07, 26 October 2010 (UTC)

Pain and Depression[edit]

Has there been any conclusive study done that links longterm pain conditions, even mild ones, to longterm depression? Im talking specificly about pain conditions, ones that have no readily obvious source. A person with a sensory processing disorder, for instance, suffering increased pain would be a good example. There should not be any other major source which could be contributing as well. I have been looking but im not too good with search engines, or with using words, so just tossing this out there incase a more interested party would like to confirm or deny the validity of this assumption. — Preceding unsigned comment added by Chardansearavitriol (talkcontribs) 04:50, 14 February 2011 (UTC)

NPOV - lacks instances of the frequent harmful failure to diagnosis depression, coupled with misdiagnosis of depression as something else.[edit]

Valuable article, but seems entirely one-sided. Turns a blind eye to the significant problem of overlooking actual depression which is too often diagnosed and treated as something else, often with disastrous effects for the patient.

Where syndromes share symptoms, differential diagnosis is digging out which is which. NPOV is abdicated when only the failures to diagnose anything-but-depression is presented, and failure to diagnose depression is not. NPOV responsibility is abrogated when the article suggests by omission that depression is never the overlooked diagnosis.

Needs a thorough rework to restore balance.

Often, depression masquerades as something else, is diagnosed as the something else, and treated for the something else.

Misdiagnosis of depression as not-depression is double damaging to the patient:

first, the actual depression goes untreated (leading to serious progression, sometimes fatal); and
second the treatments for the misdiagnosed condition are inappropriate for the depressed person and have costs and side effects;

Examples are legion. E.g., both thyroid deficiency and depression can cause forgetfulness, fatigue, sleep disturbance, etc. http://www.webmd.com/depression/guide/depression-the-thyroid-and-hormones?page=2 Both are often misdiagnosed for the other. Life-threatening iatrogenic osteoporosis results when thyroid is inappropriately prescribed due to overlooking the depression diagnosis and prescribed to treat a thyroid condition which the patient did not have in the first place (but develops in adaptation to the inappropriate medication).

Feel free to add to the article. Wikipedia health content is governed by this guideline: WP:MEDRS. If you add text that breaches that guideline, or any other policies or guidelines, it may be removed. So, read and understand that guideline, then have a go. Text stays or changes according to consensus on the article talk page. If you'd prefer, propose something here for discussion before inserting it into the article, and I and others can help you format it. --Anthonyhcole (talk) 16:52, 11 March 2012 (UTC)

To merit current title, would need to begin with crieteria for depression (mood) from, e.g., DSM-IV-TR and ICD-10 criteria for Depression (mood)[edit]

Before an article can claim to treat the topic of differential diagnosis of depression, it needs to lay out the framework of diagnosis of depression in general. As this article and the main article on Depression (mood) both point out, it's a tough diagnosis in any case.

Differential diagnosis only makes sense when cast against the background of general diagnosis.

For diagnosis of depression in the first instance, a good place to start would be the DSM-IV-TR and ICD-10 criteria referenced in the main article on Depression (mood). — Preceding unsigned comment added by 99.190.133.143 (talk) 19:09, 11 March 2012 (UTC)

emedicine provides a list of hyperlinks of differentials for depression[edit]

http://emedicine.medscape.com/article/286759-differential — Preceding unsigned comment added by 99.190.133.143 (talk) 12:54, 12 March 2012 (UTC)

  1. ^ Nemeroff CB (2002). "Recent advances in the neurobiology of depression". Psychopharmacol Bull. 36 Suppl 2: 6–23. PMID 12490820.