Talk:Major depressive disorder

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Effectiveness of SSRIs/TCAs[edit]

We have a number of high quality refs that support the effectiveness of SSRIs [1][2][3]. There are others that do not support the effectiveness except in the most severe cases. How should we balance these? Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:09, 4 May 2014 (UTC)

Defer to cochrane where possible I think - if I get some time I will look through all these. Cas Liber (talk · contribs) 01:37, 5 May 2014 (UTC)
  1. We have a 2010 JAMA meta analysis which states "The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial." [4]
  2. We have a 2008 PLoS meta analysis that states "Drug-placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients." [5]
  3. This 2013 metaanalysis states "This systematic review provides evidence for the efficacy of both SSRIs and TCAs in the treatment of chronic depression and showed a better acceptability of SSRIs." [https://www.ncbi.nlm.nih.gov/pubmed/22963896[
  4. The 2009 Cochrane review concludes "Both TCAs and SSRIs are effective for depression treated in primary care." Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:36, 5 May 2014 (UTC)
Only two of them break the effectiveness down by the severity of disease thus we currently have "The effectiveness of medication appears to be significant only in the most depressed" Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:37, 5 May 2014 (UTC)

James, looking thru the articles, the 2010 JAMA had a relatively small pooled sample and the difference in the severely depressed was skewed by big differences in a few patients. The other articles show statistically significant differences, it's the magnitude that's in question. They also seem to mention the limitations of the primary publications repeatedly. I think including the word "only" in the summary may be misleading based on the current data. Maybe, "Medication appears to be effective, but the effect may only be significant in the severely depressed" or "Medication appears to be effective, but the effect may be insignificant in mild to moderate depression"??? Ian Furst (talk) 00:19, 6 May 2014 (UTC)

Yes I like that wording.Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:46, 6 May 2014 (UTC)
I'd go with your first alternative Ian. Cheers, Cas Liber (talk · contribs) 01:54, 6 May 2014 (UTC)

Request: edit or clarify reference to "clinical significance" in opening paragraph[edit]

The opening paragraph of the article refers to "other mood conditions without clinical significance," but the wiki page for "clinical significance" only defines it as a description of treatments, not conditions. Therefore, as written, I don't understand what the sentence in the original article is saying (which is unfortunate, since it seems like an important sentence). Can someone with some knowledge fix this? Is there another definition of "clinical significance" which applies to conditions rather than treatments? If so, maybe someone could add this information to the clinical significance article? (And to be clear, I am not disagreeing with any particular classification of conditions.) Thanks! Lewallen (talk) 21:40, 8 May 2014 (UTC)

Clarified Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:33, 8 May 2014 (UTC)

Van Gogh Picture[edit]

Is it really necessary or insightful to include a picture of a Van Gogh painting on the page of a medical article? I request that this be removed. Wiki.correct.1 (talk) 19:59, 26 May 2014 (UTC)

clearly somebody thought it gave insight and resonance. please provide a reason why you would like to removed. thanks.Jytdog (talk) 20:56, 26 May 2014 (UTC)
Van Goh was an artist who had extreme depression issues, and eventually killed himself. He viewed his work as horrific yet he is remembered as one of the greatest painters of all time. The work shown is... him being depressed. Both in what the work represents as well as the artist behind it, at least in my opinion, the work is an exceptional example of what depression is. - MaJoRoesch (talk) 10:30, 29 July 2014 (UTC)

New DSM Version[edit]

Could you please update this article to DSM-V? DSM-IV-TR is already outdated. Thank you.

Air pollution and daily emergency department visits for depression.[edit]

In Toronto positive and statistically significant associations of sulphur dioxide with migraine ED visits were obtained: all ages, OR = 1.04 (95% CI: 1.00, 1.08); age group [15, 50], OR = 1.05 (95% CI: 1.01, 1.09). In Ottawa positive correlations were observed: all ages, OR = 1.05 (95% CI: 0.97, 1.13); age group [15, 50], OR = 1.06 (95% CI: 0.97, 1.15). The results suggest that female migraine may be affected by ambient sulphur dioxide.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317030/

— Preceding unsigned comment added by Ocdnctx (talkcontribs)

Thanks, but migraine is not depression, and that source doesn't meet WP:MEDRS anyway -- it's a primary source. Looie496 (talk) 15:36, 17 August 2014 (UTC)

Serotonin's role in depression pathophysiology[edit]

In a very recent study, mice with a gene knockout for an enzyme responsible for the rate-limiting step for the synthesis of serotonin in the CNS were tested for depression and showed almost no symptoms of it compared to wild-type mice. This is potentially a revolutionary finding and may tremendously alter the research in this field, which has traditionally focused on the serotonergic hypothesis of depression. http://pubs.acs.org/doi/abs/10.1021/cn500096g

It behooves the Wiki community to make the public aware of such a study and its potential ramifications for the direction of research in this disease state. — Preceding unsigned comment added by 148.177.1.215 (talk) 18:08, 28 August 2014 (UTC)

Thanks, but this is not relevant to Wikipedia. Jytdog (talk) 18:15, 28 August 2014 (UTC)
Please see WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:21, 28 August 2014 (UTC)