Talk:Major depressive disorder

Sub-type Missing

Under sub-types there needs to be included "Psychotic Depression". With this, the onset of a depressive episode also manifests with hallucinations (any type ie. visual, auditory, tactile, etc.). An important note is that people suffering from a Psychotic Depressive episode are usually able to identify their hallucinations as being products of their mind or not real, whereas a schizophrenic is not. —Preceding unsigned comment added by 74.131.111.224 (talk) 17:43, 17 October 2008 (UTC)

Thanks. It was there but appears to have disappeared somewhere...Cheers, Casliber (talk · contribs) 17:59, 17 October 2008 (UTC)

Other methods of treatment

I think this section gives too much weight to either placebo effects, discredited methods, or other stuff. I think it should be digested into one paragraph, similar to what is done in either the treatment or prevention sections of Alzheimer's disease. Sadly, people come here for there medical information. I don't want anyone to get the impression that there's any chance of treating Major depressive disorder with acupuncture or some other off-the-wall treatment. For example, St. John's wort has no effect on MJD, and worse yet, the dosage required to actually have any effect is so large, that we should consider the safety vs. efficacy of the herb. So, should we cut this section down to one paragraph or so per WP:WEIGHT?? OrangeMarlin ^{Talk• Contributions} 21:21, 13 October 2008 (UTC)

Agree. Given it duplicates Treatment for depression, there's no reason to go into much detail in this article. --Ronz (talk) 21:41, 13 October 2008 (UTC)

Yeah, good point. we did a bit but should do some more. Cheers, Casliber (talk · contribs) 22:35, 13 October 2008 (UTC)

Let me take a pass. I need to work on a real article for awhile. OrangeMarlin ^{Talk• Contributions} 22:46, 13 October 2008 (UTC)

Go for it (sigh of relief) - bit busy off keyboard..Cheers, Casliber (talk · contribs) 23:05, 13 October 2008 (UTC)

I'm always suspicious of the CAM sections of any medical article. Most of us ignore it, so it just is filled with stuff. I reviewed each of the citations, and few, if any, supported the statement in the article. In fact, there is no evidence that Omega-3 or tryptophan have any effect on any type of depression. Light therapy has an effect on seasonal disorder, but not on depression, specifically because they couldn't do any trials long enough to determine if it could work. St John's wort may work for major depression, but the pharmaceutical quality of the herb in your local store is so variable, that it probably shouldn't be used. I deleted the stuff that obviously doesn't work. OrangeMarlin ^{Talk• Contributions} 23:32, 13 October 2008 (UTC)

(Back again for a sec)..where I am the connection is so damn slow, just what I need when trying to look at a )^*$&)#(#%( large article....Cheers, Casliber (talk · contribs) 23:51, 13 October 2008 (UTC)

What do you have down there for internet connection, a tin can and string? OrangeMarlin ^{Talk• Contributions} 00:00, 14 October 2008 (UTC)

Nice bit of pruning there; article now at 51 kb readable prose...any other problems?Cheers, Casliber (talk · contribs) 09:24, 14 October 2008 (UTC)

←I wasn't happy about the changes to the section. They were weasel-worded and often outside of what was written in the citations. I reverted. I'm doing some copy editing--I'm finding some redundant prose, that need some work. I think it will help out. OrangeMarlin ^{Talk• Contributions} 17:15, 14 October 2008 (UTC)

I certainly don't want an edit war, but I'm a bit puzzled at OrangeMarlin's changes. He is insisting on, "Other supplements such as omega-3 fatty acids,[161] tryptophan, and 5-hydroxytryptophan (5-HTP),[162] no effect beyond placebo." And yet reference [162] states in the abstract, "Available evidence does suggest these substances are better than placebo at alleviating depression", referring to Trypt and 5-HTP. And again, he is insisting on, "Exercise has shown to have moderate, but not statistically significant, effects in reducing the symptoms of depression.[168]" Reference [168] states in the abstract, "Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant." In short, the sources are drawing the conclusion that there probably are effects but that more studies are needed, whereas the current wording is drawing the conclusion that there probably are not effects. Looie496 (talk) 17:22, 14 October 2008 (UTC)

Dude, I have no patience for this type of discussion. Abstracts are useless. The conclusion states clearly that they have no effect beyond placebo. OrangeMarlin ^{Talk• Contributions} 17:35, 14 October 2008 (UTC)

What you're saying in effect is, the way that the authors summarized their findings is useless, I can summarize them better myself. Anyway, I'm going to leave it there until Casliber can express an opinion on this. Looie496 (talk) 17:51, 14 October 2008 (UTC)

The writer's conclusions are what I used. OrangeMarlin ^{Talk• Contributions} 17:53, 14 October 2008 (UTC)

Just to further waste my valuable time, here's what the authors say about Omega 3 in their conclusions: "The evidence available provides little support for the use of n-3 PUFAs to improve depressed mood." I believe that summarizes it perfectly. Using non-weasel wording, with clear writing, as I have done, Omega 3 is useless for MDD. OrangeMarlin ^{Talk• Contributions} 17:56, 14 October 2008 (UTC)

OM has a point - we always forget abot effects like placebo effect and regression to the mean etc. so caution is advised. I will have a look myself a bit later but need to hop off again - brekfast/coffee/dog walk beckon...Cheers, Casliber (talk · contribs) 20:26, 14 October 2008 (UTC)

Looie, stuff like The presence of funnel plot asymmetry suggested that publication bias was the likely source of heterogeneity. doesn't look good (i.e. the studies which showed no benefit weren't published)....still looking. Cheers, Casliber (talk · contribs) 13:43, 15 October 2008 (UTC)

I think have shown no effect beyond placebo is best solution as it states exactly that. The omega 3 does say they are of little use and then leaves the door open a little (tantalizingly or annoyingly I guess, depending on how you look at it) WRT more data required yada yada yada. FWIW - the whole shebang can be read from a link here. Cheers, Casliber (talk · contribs) 14:07, 15 October 2008 (UTC)

Diagnosis section

I'm having some issues with this section. First of all, the title of the section, "Physical investigations" is kind of weird. Sounds like a UFO investigation. :D Also, what's a medical practitioner? A nurse practitioner? A physician's assistant? A registered nurse? A physician? In the US, in a managed care environment (about 95% of health care), a "primary care" physician usually makes the first diagnosis of depression. In children, that's a pediatrician, in adults, an internist. Can't we just write physician, who is the only person that can prescribe medications? OrangeMarlin ^{Talk• Contributions} 17:20, 14 October 2008 (UTC)

Physician in Oz means someone who is an internal medicine specialist (eg neurologist, gastroenterologsit etc.) i.e. not GP or family doctor really, medical practitioner is standard word for doctor here, hmmm...how about (gasp) "doctor"? Cheers, Casliber (talk · contribs) 20:18, 15 October 2008 (UTC)

How about Primary Care Physician? Doctor might work, but it's fairly generalized. OrangeMarlin ^{Talk• Contributions} 18:33, 17 October 2008 (UTC)

I guess if that is the only common mutually understandable term, then so be it..(?) you guys don't say GP or family doctor (although the later is a bit informal)? Cheers, Casliber (talk · contribs) 18:36, 17 October 2008 (UTC)

GP is hardly used anymore. Mostly, in US managed care, the Primary Care Physician (PCP) is the gatekeeper to healthcare, including prescriptions, diagnostic testing, hospital admission, and referrals to specialists (including headshrinkers). The PCP is almost always Internist (Internal Medicine), Ob-Gyn, or Pediatrician. Again, taking a US perspective, a medical practitioner is so generic and nonspecific, that when I read it, I was a bit confused. Maybe medical doctor is the best term. OrangeMarlin ^{Talk• Contributions} 18:47, 17 October 2008 (UTC)

MEDMOS

I'm kind of anal-retentive (I wonder if that's in DSM IV?), so I'm rearranging to meet WP:MEDMOS, especially if this article is going to be FAC'ed, there are many editors (myself included) who think that all medical articles should meet that standard. I tried to read over some of the comments to see if this was discussed, and I didn't see it anywhere. So, if this has been discussed, and there was some reason to not use MEDMOS, then I'm all right with it, and I'll find some drug to treat my retentiveness. Is there a drug? OrangeMarlin ^{Talk• Contributions} 17:33, 14 October 2008 (UTC)

Alcohol works pretty well. But seriously, I had intended to make it comply with MEDMOS (oh where did I go wrong...)...Cheers, Casliber (talk · contribs) 20:19, 14 October 2008 (UTC)

At first I didn't like MEDMOS, but I like the consistency. And it walks us through the story in a logical manner. OK, now I've got to go turn on the fireplace...it's cold here this morning. OrangeMarlin ^{Talk• Contributions} 14:29, 15 October 2008 (UTC)

Kierkegaard

Is everyone okay with the Kierkegaard image in the causes section? I added this picture, of an existential philosopher, after delldot pointed out that the earlier picture, of existential psychologist Rollo May, was unsourced. But if this seems like too much of a stretch (which I tried to compensate for in the caption), I could replace this image with a picture of a more famously psychological/psychiatric figure, such as Freud. Cosmic Latte (talk) 23:00, 17 October 2008 (UTC)

I do think it is a bit tangential, and a photo of someone more directly involved so to speak would be preferable - this is a hard article to illustrate...Cheers, Casliber (talk · contribs) 12:10, 18 October 2008 (UTC)

I went ahead and added a picture of Freud instead. Will this be all right? It's too bad that there don't seem to be any PD images of Beck or Bandura out there. Cosmic Latte (talk) 04:08, 19 October 2008 (UTC)

Yeah, images are tough. Good as any. Cheers, Casliber (talk · contribs) 08:46, 19 October 2008 (UTC)

Lonelyness is not mentioned

But the word "guilt" is used 5 times. 11:45, 27 October 2008 (UTC) —Preceding unsigned comment added by 68.187.233.197 (talk)

In response to this, I've come up with the following passage:

Depression and loneliness have enough features in common that loneliness may be viewed as a differential diagnosis. In general, depression is likely to coexist with loneliness if the loneliness is chronic rather than transient. If the patient has global concerns that do not focus strictly on interpersonal relationships, if the patient feels a high degree of guilt, or if the patient is particularly vegetative, then he or she is likely to be depressed; if these conditions are not met, he or she may be lonely instead.

Should it be added to the article? If so, where?

As for guilt being mentioned more often, note that my source states that "guilt appears to be more typical of depression than [of] loneliness." Cosmic Latte (talk) 03:10, 28 October 2008 (UTC)

I've gone ahead and added it to Major_depressive_disorder#Differential_diagnoses, but feel free to remove it if it's misplaced or too much text. Cosmic Latte (talk) 15:55, 28 October 2008 (UTC)

Religious faith

From FAC:

This statement noted by Tony as being from a questionable source is still in the article. I am concerned also that many of the sources in this article similarly are very old and/or reference a single study. I am trying to correct some of them, where the sources are accessible, to clarify the meaning in the article in the context of the reference. —Mattisse (Talk) 14:51, 30 October 2008 (UTC)

I don't see why a loss of religious faith would be any less depressing now than it was 36 years ago, at least in individuals for whom faith had been their primary source of meaning. I do wonder which is more often the cause and which more often the effect (e.g., I can picture something like, X --> MDD --> blame/doubt God --> lose religious faith), but if "lose religious faith --> MDD" is sourced, then it at least jives with what I'd call common sense or intuition. Cosmic Latte (talk) 15:07, 30 October 2008 (UTC)

The point is not what you or I think now, but rather that the reference to a statement given prominence in the section is from one questionable source, the Journal of Religion and Health, and is 36 years old. —Mattisse (Talk) 15:18, 30 October 2008 (UTC)

It looks like the journal is still taken reasonably seriously, e.g., [1], [2], [3]. In any event, my point was that there is no reason to assume that the veracity of the referenced finding has changed in the past 36 years. Questioning the finding on account of its age raises the question, "why?"--and I, for one, don't see a reason why the finding would be dated. And as it's worded now, "A depressive episode may also be related to a loss of religious faith," without implying cause or effect, and placed after other components of MDD and directly before a statement that cause and effect are unclear, I certainly don't think it's being given any undue prominence. Cosmic Latte (talk) 15:34, 30 October 2008 (UTC)

I refer you to Tony's comment that the source is not mainstream in the field. The links you give are not reliable sources as to the mainstream importance of the journal. Further, the text in one of your links says: "The Journal of Religion and Health explores the most contemporary modes of religious thought with particular emphasis on their relevance to current medical and psychological research." Current medical and psychological research is not 36 years ago. In medically-related field, recency counts. References to such statements should be to recent review articles (within the last few years). Further discussion of this should move to the talk page. —Mattisse (Talk) 15:56, 30 October 2008 (UTC)

---

The source may not be mainstream, but it is an independent publication expressing, in this case, the argument of a MD/PhD psychiatrist, namely Nancy Coover Andreasen, who is extremely well-renowned. Barring the discovery of some source that refutes the thesis that depression and a loss of religious faith may be related, I really think it's appropriate to let this be. Cosmic Latte (talk) 16:40, 30 October 2008 (UTC)

Reading the beginning of Andreasen's [4] article, she does not say that a depressive episode may be related to a loss of religious faith. She says depression may be expressed in the form of exaggerated guilt experienced by people who worry that they have committed sins or who have feelings of estrangement from God, or in the form of feelings of torment from punishment by an angry God. She is suggesting that if the symptoms of depression are expressed in the form of religious concerns, the best way for a sensitive therapist to proceed is to be flexible and attempt to separate genuine religious concerns from the symptoms of depression. It appears that the article is not research but an opinion piece and makes sense in that context. But Tony's point was also that a great many things may impact depression, as the Major depression article indicates, and is loss of religious faith one of the most frequent and foremost causes? Where is the evidence that it is? —Mattisse (Talk) 17:58, 30 October 2008 (UTC)

My access is limited to the first page of the article, so I assumed that whoever added the reference had read the entire piece. The closest thing I saw to "loss of religious faith" was "estranged from God and from all the wellsprings of meaning, hope, and love." I'd have no problem with changing "loss of religious faith" to "a feeling of estrangement from God" or "estrangement from the divine" or "religious alienation" or something along those lines, but I don't think that it needs to be demonstrably "one of the most frequent and foremost causes," largely because we're not necessarily talking about causes in the first place--the article is explicit about cause and effect being difficult to discern. My thinking here is that, regardless of the stats, this is qualitatively justified for inclusion (albeit perhaps in a reworded form), because 1) given that so many people are religious, of all the things that could be associated with depression, surely religious alienation is among the most appreciable; and 2) the author is clearly a respectable source of information, even opinion. But again, I have no objections to altering the phrasing so that our article is undoubtedly consistent with hers. Cosmic Latte (talk) 18:22, 30 October 2008 (UTC)

I have a "take it or leave it" feeling about the ref, oftentimes in mental health people used to talk about religion being a protective factor (so intuitively I can confirm it is something on folks' radar so to speak), and Andreasen is a well-recognised name in psychiatry (though more in schizophrenia). I figure one sentence in 50 kb of prose isn't undue weight but wouldn't fuss if it was removed either. Cheers, Casliber (talk · contribs) 23:32, 30 October 2008 (UTC)

I see that Mattisse has removed it, but I came across essentially the same finding--just not stated as eloquently as in Andreasen's piece--in the abstract to a 2000 Journal of Clinical Psychology article. Can we settle for this? Cosmic Latte (talk) 04:07, 31 October 2008 (UTC)

Some FAC notes: crit 2c of WP:WIAFA requires consistently formatted citations. Introducing a raw URL is going the wrong direction. And, the URL was to an abstract on a personal website rather than a PMID abstract. I corrected the citation to point at PubMed,[5] but the edit also added text sourced to a primary study. The article should be sourced to high quality secondary sources or reviews. To find reviews in PubMed, please take note of the Review tab, next to the All tab, under the display button when searching in PubMed. Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches explains how to search for reviews in PubMed. We can't just string together conclusions from primary studies: that's original research. For example, compare PMID 11132565 (not a review) with PMID 11077021 (is a review). To find recent reviews on MDD in PubMed, search on Major depressive disorder, and then click on the "review" tab instead of the "all" tab. There are 2800 reviews on MDD in PubMed; text that can't be sourced to secondary reviews might not belong in the article. A Pubmed search on "Major depressive disorder religion" yields seven review articles: those are secondary sources. SandyGeorgia (Talk) 05:08, 31 October 2008 (UTC)

1: Lassnig RM, Hofmann P. [Life crisis as a consequence of depression and anxiety] Wien Med Wochenschr. 2007;157(17-18):435-44. Review. German. PMID 17928946

2: Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005 Dec;89(1-3):13-24. Epub 2005 Sep 26. Review. PMID 16185770

3: Shannahoff-Khalsa DS. An introduction to Kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders. J Altern Complement Med. 2004 Feb;10(1):91-101. Review. PMID 15025884

4: Sullivan MD. Hope and hopelessness at the end of life. Am J Geriatr Psychiatry. 2003 Jul-Aug;11(4):393-405. Review. PMID 12837668

5: Storck M, Csordas TJ, Strauss M. Depressive illness and Navajo healing. Med Anthropol Q. 2000 Dec;14(4):571-97. Review. PMID 11224981

6: Bilu Y, Witztum E. Culturally sensitive therapy with ultra-orthodox patients: the strategic employment of religious idioms of distress. Isr J Psychiatry Relat Sci. 1994;31(3):170-82; discussion 189-99. Review. PMID 7532632

7: Wells VE, Deykin EY, Klerman GL. Risk factors for depression in adolescence. Psychiatr Dev. 1985 Spring;3(1):83-108. Review. PMID 3889900

And I assume text isn't being cited to abstracts only, rather the entire journal article has been read. To find review articles with free full-text, click on "Limits" in PubMed, check the reviews box and check the Free full-text box. SandyGeorgia (Talk) 05:22, 31 October 2008 (UTC)

I found PMID 16924349 by searching with limits on reviews and free full text for "depression religion"; you can access the free full text from the link in the PMID. SandyGeorgia (Talk) 05:34, 31 October 2008 (UTC)

Romantic artist

Since Aristotle, melancholia had been associated with men of learning and intellectual brilliance, a hazard of contemplation and creativity. The newer concept abandoned these associations and, through the 19th century, became more associated with women - While it is true that diseases of the "nerves" became associated with women during the 19th century, I'm wondering just how disassociated depression became from "men of learning and brilliance". Part of the myth of the Romantic artist is that he is a tortured soul - see, for example, John Keats and his "Ode on Melancholy". It is, of course, ironic that the article begins with an image by Vincent Van Gogh, who perfectly illustrates this type. If you need sources that describe this phenomenon, I'm sure I can dig some up. Awadewit (talk) 18:11, 2 November 2008 (UTC)

Interesting issue and more sources would be good. The timing/causation is a bit unclear; the current source[6] is focused on the adoption of the actual term "depression" and says:

Second, for hundreds of years, influenced by Aristotle and almost every subsequent thinker until the eighteenth century, melancholia also carried glamorous associations of intellectual brilliance and later even genius, associations absent from today's conception of depression (Klibansky, Panofsky, and Saxl 1964). It was the disease of the man of learning, the disposition and occupational hazard of the intellectual and of any man of reflective and contemplative tendencies. Such desirable associations are absent from today's conception of depression.

Next, melancholia was the disorder of the man (of genius, of sensitivity, intellect, and creativity), whereas today's depression is both apparently linked with women in epidemiological fact and associated with the feminine in cultural ideas. Depression's gender link is the reverse of the masculine and male associations of melancholia.

These last two are, of course, connected. Because genius, creativity, and intellectual prowess were themselves "gendered" traits associated with men and the masculine, the perceived link between women and depression, a product of the nineteenth century, inevitably expunged these more glamorous associations (Enterline 1995; Lunbeck 1994; Radden 1987, 2000a; Schiesari 1992).

It does seem an exaggeration to say they were "expunged" even today (cf Sylvia Plath as mentioned below); perhaps in formal medical usage. EverSince (talk) 21:27, 2 November 2008 (UTC)

I don't think Sylvia Plath is a typical example. Rather, the romanticizing of her story, perhaps because of its timing during the rise of feminism, is the exception that proves the rule. Remember, Ted Hughes was the bad guy they said then. I do think that depression has lost its glamor, as the section on British literary figures shows. William Styron did not try to glamorize depression when he wrote about it, and we have no quotes from him in this article. Statistics are uniform in showing that women are more afflicted by depression then men today. And the articles you reference below appear to address this issue. —Mattisse (Talk) 21:43, 2 November 2008 (UTC)

I find that there is some vagueness in the source's language. The sources seems to want to link depression to women and femininity without distinguishing much between the two. (Sex and gender are different and I as a woman, for example, can adopt masculine traits, but I cannot be a man.) Did you want me to find sources that discuss the Romantic artist and depression/melancholia? Awadewit (talk) 19:54, 4 November 2008 (UTC)

Gender bias?

How come the article only lists famous men with depression in the "Sociocultural aspects" section, especially considering the disease statistically affects more women? If you are looking for a depressed female artist, try Mary Wollstonecraft or Mary Shelley. There are more. Those I happen to know I could get sources for. :) Awadewit (talk) 18:23, 2 November 2008 (UTC)

Good point! I also note that neither of those are listed in List of people with depression. /skagedal^... 18:39, 2 November 2008 (UTC)

Also, the mention of hormone replacement for men is mentioned but nothing about all the research being done in the field for hormone replacement for for women, now that giving estrogen for depression and other symptoms is no longer considered safe. The editor dismissed the mention of this by a commenter, saying he had not encountered it. But there are all sorts of substitutions for estrogen being researched, including nasal sprays that affect dopamine receptors in the brain. —Mattisse (Talk) 18:42, 2 November 2008 (UTC)

Regarding adding more British literary figures, although I would agree with that females should be included, there is already a huge British bias to the article, including a section on British literary figures, while literary figures from other countries are ignored, for the most part. —Mattisse (Talk) 18:50, 2 November 2008 (UTC)

Virginia Woolf would probably be a good example, since she suffered very severely from it. Looie496 (talk) 19:02, 2 November 2008 (UTC)

And as a non-British figure, William Styron is probably worth mentioning, since he actually wrote about depression in "Darkness Visible". Looie496 (talk) 19:04, 2 November 2008 (UTC)

What about Emily Dickinson? Kate Chopin? Awadewit (talk) 19:14, 2 November 2008 (UTC)

Sylvia Plath? Fainites ^barley 19:51, 2 November 2008 (UTC)

• Wikipedia:MEDMOS#Notable cases: "One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition." SandyGeorgia (Talk) 19:53, 2 November 2008 (UTC)

• I would favor including substitutions for estrogen being researched for women rather than just mentioning men and testosterone, for example (as mentioned above) studies on estrogen research, including nasal sprays that affect dopamine receptors This is an example of bias in the article that another commenter brought up on the FAC page. —Mattisse (Talk) 20:12, 2 November 2008 (UTC)

One issue I have with historical people, or in reported media etc. with a psychiatric condition is that I get a sense that some reported mood disorders (whether depression or bipolar) actually sound like other conditions (eg personality disorder) when symptoms are listed, but it is hard to diagnose when the person has been dead for hundreds of years. I would be more than happy to include some women (and should have noticed this before), but it goes without saying that the source needs to be peer-reviewed/academic etc. A psychiatric historian would be great. Woolf and Plath come to mind as highly notable for their connection with psychiatric conditions, and there are likely to be others. If someone can find a scholarly source that would be great. I'd love the help :)

WRT hormone therapy, some form of review paper would be good. I will ask and look around. Cheers, Casliber (talk · contribs) 13:25, 3 November 2008 (UTC)

PS: I had not been aware of Mary Shelley or Wollestonecraft being linked with depression (but then again, I have not read much about either), Awadewit, if there is a detailed analysis that may be interesting. Cheers, Casliber (talk · contribs) 13:28, 3 November 2008 (UTC)

First, let me say that the MEDMOS guideline is terrible! Put that on my list to change. The "popular perception" of a disease is often horribly misinformed. Moreover, the list of people who have "lastingly" affected any historical narrative of a disease is a result of the way historians tell that narrative. Considering that until the 1970s, historians were loathe to consider women important in history, women are often not a part of that narrative. Should we therefore be perpetuating that here? I really hope not. (Now that's off my chest....) Second, the information I have on Wollstonecraft and Shelley does not come from psychiatric historians, I'm afraid, nor have I read any in-depth analyses of their states of mind. As you say, it is difficult to diagnose someone two hundred years after their death, particularly of a psychiatric disorder. However, Wollstonecraft did attempt suicide. Twice. Her letters are horrifying to read. Anyway, the sources I have are modern biographies written by historians and literary scholars. If you don't want to use those, I would understand. Awadewit (talk) 20:27, 4 November 2008 (UTC)

Well, given the depth of it, and the fact that there is a 3rd party commentary and discussion on the topic, go for it. The points you raise are valid.:) or should that be :( (depressed emoticon) Cheers, Casliber (talk · contribs) 20:50, 4 November 2008 (UTC)

Linking to here - Elizabeth Wurtzel's Prozac Nation "describes the author's experiences with major depression." .... Judith Guest's Ordinary People "I wanted to explore the anatomy of depression" incl. suicidality EverSince (talk) 04:04, 7 November 2008 (UTC)

Eeks, now bringing modern portrayals into it; I have three books on psychiatric condition depictions in cinema - Girl, Interrupted is listed in two, both detailing how she doesn't actually have borderline personality disorder as the film says but is having a depressive episode, Ordinary People, House of Sand and Fog. I hadn't looked at this in detail before as lots of editors are pretty neutral to modern cultural depictions. Ordinary People stands out for me but it is (yet again) a male...I am thinking of gender balance now. Cheers, Casliber (talk · contribs) 12:23, 7 November 2008 (UTC)

It was written by a woman about a family. Wurtzel is also female. Yes there's also various online articles about psych conditions in films. EverSince (talk) 17:06, 7 November 2008 (UTC)

Wollstonecraft

• On Wollstonecraft, here is an article that might be useful: G. J. Barker-Benfield, "Mary Wollstonecraft: Depression and Diagnosis" Psychohistory Review 13 (1985). Barker-Benfield is a literary critic, though. Awadewit (talk) 15:40, 7 November 2008 (UTC)
• In the major biography of Wollstonecraft written recently by Wollstonecraft scholar Janet Todd, she writes in a footnote "I have used the words 'depressed' and 'depression' anachronistically to refer to Wollstonecraft. 'Depression' in fact became a current term only in the mid-nineteenth century when nit came to be used for the lowness of spirits felt by the sick. By 1900 it had achieved its modern meaning of a general sinking of the spirits. I have used 'melancholy' and 'melancholia' also, especially when Wollstonecraft seemed in part to be celebrating her condition." (Todd, Mary Wollstonecraft: A Revolutionary Life, 464) Awadewit (talk) 15:40, 7 November 2008 (UTC)
• Todd also connects Wollstonecraft's depressive personality with her family and her culture: "Clearly a depressive, even manic depressive, tendency existed in the Wollstonecraft family, there already in passive mother and volatile father, whose moods could swing violently from hatred to fondness. Henry Woodstock is unknown but the siblings Eliza, Everina and James revealed it as surely as Mary, and the bent continued in the few children in the next generation, Mary's and Ned's [for example, Fanny Imlay and Mary Shelley]. But there was also cultural component in their malady: the high esteem in which the middle classes held melancholy in the eighteenth century, an esteem that must sometimes have prevented the sufferer entirely from giving in to despair. In the seventeenth century melancholy seemed part of the human condition, the proper response of a thoughtful, pious man to life's inevitable sadness. In the eighteenth century religious melancholy fell out of fashion while secular melancholy achieved more of an elite status. Male melancholy in particular was much prized; in mid-century Thomas Warton's The Pleasures of Melancholy delivered it not as insanity or disease but as a kind of moody introspection, a sensitivity to oneself in nature and the world...Women followed the line and their commonplace books of favourite passages overwhelming concerned 'grief, disappointment, the fallen leaf, the faded flower, the broken heart and the early grave'. Mary's catalogue of miseries eased her heart and created her in the softened feminine character of the middle-class ideal, in her case still resolutely pious." (Todd, Mary Wollstonecraft: A Revolutionary Life, 75) - Teasing out what was a "disease" and what was cultural about Wollstonecraft's "depression" is impossible. I don't know if you want to raise this issue in the article or not, but it is frequently raised when discussing Wollstonecraft or other figures at this time because of what Todd outlines - the culture itself promoted "depressive" ideas. :) Awadewit (talk) 15:40, 7 November 2008 (UTC)

Mary Shelley

Here are some general statements about Mary Shelley. She had many depressive episodes in her life; if you want the list, I can try to assemble it. It is worth noting that Seymour uses the words "melancholia" and "low spirits" in addition to "depression" to describe Shelley's condition - just like Todd:

Mary wrote one great work when she had only begun to taste the bitterness of rejection [Frankenstein]. The most harrowing aspect of her life is to see how, through no fault of her own, it began to mirror her novel. Mary, like her creature, became a pariah. When [Percy Bysshe] Shelley died, his friends had already been made aware that his marriage was on the rocks, and that the fault was Mary's. Disgraced by her connection to him, tortured by the sense of her own inadequacy as a wife, publicly disowned by his family, Mary in her widowhood was thrust into the icy regions of solitude to which she had banished the Creature of her imagination. Hounded, persecuted and vilified, she taught herself how to survive. She remained, until the end of her life, generous, forgiving, tolerant and hopeful. The depression which she voiced in her journals was, we always need to remember, hidden from her friends. Her father [William Godwin] was one of the few people who saw, and pitied, the disposition to melancholy which she had inherited from his wife [Mary Wollstonecraft]. One wonders how much more sympathy she might have gained if she had been a little less fiercely reserved.

Remorse is at the the heart of Mary's life after Shelley's death and the key to her recreation of him. Her journal tells us that she firmly believed she was condemned by fate to pay for the suffering and death of his first wife, the young woman Shelley abandoned for a greater love. Shelley himself died during a period of estrangement, the worst of emotional situations in which to lose someone you love. The terrible combination of guilt and remorse impelled Mary to dedicate herself to an act of literary atonement. Her recreation of Shelley as a man who was, if not Christian, Christlike, allowed her to repossess him, to give him in death what she felt she had wrongly withheld in life, and absolute and unconditional devotion....

Mary Shelley is not the active, enthusiastic, optimistic woman described by recent biographers. She is a woman who struggled all her life against the unpredictable volatility of her own nature, who never knew when the black cloud of depression would settle around her, who was tormented by the sense of her own inability to become what she felt the world expected her to be, a second Mary Wollstonecraft, who tortured herself with the thought that every misfortune that came to her was directed by fate, as her punishment for having taken Shelley from his first wife, for having failed him herself." (Miranda Seymour, Mary Shelley, 560-61)

Let me know what else I can do. Awadewit (talk) 16:09, 7 November 2008 (UTC)

The first Wollenstonecraft source is PMID 11620749 but I can't access full text. The rest of the text on her raises some concern about depression vs. bipolar, and the sources aren't of the peer-reviewed medical quality I'm accustomed to working with (e.g.; Johnson). If someone can get hold of the full text, it may yield something useful. I found PMID 6759436 on Shelley. Perhaps the gender bias comes from the sources: that historically famous women aren't as well covered by sources as men are. SandyGeorgia (Talk) 02:55, 8 November 2008 (UTC)

• This is not a reliable source, but it does give a list of women for whom reliable sources might be found.
• Ditto: Not a reliable source, but includes women for whom sources might be found.
• Can't access this, don't know if something can be found here: PMID 18232431
• Same: PMID 10888054

Based on how difficult it is to find info, I suspect that Samuel Johnson gets mentioned because the writing about him left such a detailed record, while we don't have that same quality of medical evidence on hardly any other historical figures, much less women. SandyGeorgia (Talk) 03:10, 8 November 2008 (UTC)

I did mention that these were biographies written by historians and literary scholars. Casliber wanted them anyway. As far as I know there is no detailed medical analysis written by medical professionals of either Wollstonecraft or Shelley in the way there is for Johnson. I don't know about other famous women, such as Plath or Chopin, however. Awadewit (talk) 16:20, 9 November 2008 (UTC)

Awadewit, thankyou for the material - I'll give you an example of the difficulties "mood swings" as such have often been likened to bipolar disorder (latter day manic-depression), however what many people outside psychiatry mean by the term is Emotional dysregulation of mood which occurs over minutes to hours, which is more a sign of personality disorder ( (groan) that bluelink just revealed another page which needs fixing :(). I don't know how many patients, relatives, and other laypeople I have had to clarify this to at work, it seems to be once a fortnight. The Shelley stuff looks good, especially the internalisation of guilt..I am trying to address all the remaining primary sources and other material and time is limited (argh!) Cheers, Casliber (talk · contribs) 19:08, 9 November 2008 (UTC)

Hormones and women

• Repeat these two statements as they have gotten no response:

• Also, the mention of hormone replacement for men is mentioned but nothing about all the research being done in the field for hormone replacement for for women, now that giving estrogen for depression and other symptoms is no longer considered safe. The editor dismissed the mention of this by a commenter, saying he had not encountered it. But there are all sorts of substitutions for estrogen being researched, including nasal sprays that affect dopamine receptors in the brain.
• I would favor including substitutions for estrogen being researched for women rather than just mentioning men and testosterone, for example (as mentioned above) studies on estrogen research, including nasal sprays that affect dopamine receptors This is an example of bias in the article that another commenter brought up on the FAC page. —Mattisse (Talk) 17:15, 7 November 2008 (UTC)

• Addendum - This has been mentioned by others also. I am not the only editor to see this bias regarding hormones and women. Of course, the whole article only peripherally addresses sex differences. —Mattisse (Talk) 17:18, 7 November 2008 (UTC)

• This looks like a recent full-text review, available thru the link to CNS spectrums: PMID 18704021 . Go for it !! SandyGeorgia (Talk) 05:28, 8 November 2008 (UTC)

• I was able to read the full-text version of this review article in Current Opinion in Psychiatry. The review ref covers the paragraph, and given the discussion of primary sources I left out those reffing sub-snippets within. Cheers, Casliber (talk · contribs) 12:44, 9 November 2008 (UTC)

Biopsychosocial developmental perspective

There's a couple of recent reviews on the emergence of major depression in adolescence, giving an integrative perspective that I think could be represented more in the causes section here. I'm suggesting first here 'cos of the word count constraints.

"The emergence of depression in adolescence: Development of the prefrontal cortex and the representation of reward" summarizes 3 recent models put forward - the social information processing network model, The triadic model, and the dysregulated positive affect model. The review extends these into a more specific explanatory model that "integrates findings from epidemiology, adolescent ethnography, phenomenology, descriptive psychopathology and the developmental, cognitive and affective neurosciences", and addresses the links between "substantial remodeling and maturation of the dopaminergic reward system and the prefrontal cortex during adolescence" and "the adolescent entering the complex world of adult peer and romantic relationships" described as "a period of particularly high interpersonal stress, associated especially with the establishment and maintenance of the kind of social reputation that will enhance social acceptance and reduce the likelihood of rejection and ostracism. Adolescent relationships as a whole are marked by an increase in depth and complexity. Compared to childhood relationships, they take more effort, and are nested in more complicated social structures that make them less stable and necessitate the development of important new skills to navigate them."

"Stress, sensitive periods and maturational events in adolescent depression" intro's with "The overriding issue of this review is to understand why depression emerges with such force and frequency in adolescence, particularly in young women. Conceivably, a host of psychosocial factors can render adolescents especially vulnerable, but our focus will be on neurobiological factors. In particular, we will examine the interplay of genetic, maturational and experiential factors affecting mood using a translational perspective that melds clinical and basic laboratory findings."

I think a sense of the above could be given in the initial causes bit before the subsections; the first article itself suggests links to the evolutionary perspective that's already mentioned there. In the process the article's current tendency to dualism (incl. in the lead) could be tempered. EverSince (talk) 20:57, 2 November 2008 (UTC)

Unfortunately, I cannot access the complete articles, but PMID 18329735 does mention "gender differences" and you quote "The overriding issue of this review is to understand why depression emerges with such force and frequency in adolescence, particularly in young women." As I mention in the section above (concerned with gender bias in the article), substitutions for estrogen replacement in women are being researched, including nasal sprays that affect dopamine receptors in the brain. I think the issue of gender differences needs to be addressed more forcibly than it is in the article. PMID 17570526 says: "Adolescent development is accompanied by the emergence of a population-wide increase in vulnerability to depression that is maintained through adulthood." These sound like two very interesting articles that, as you say, could allow this article to present a more integrated perspective than scattered statements that are not hooked together meaningfully - dualism, as you say. —Mattisse (Talk) 21:27, 2 November 2008 (UTC)

I have always found the literature on depression (especially review/overview articles) light on analysis of depression in women - which has been frustrating for this article as there are lots of bits and pieces of research, but not much is taken into big overviews. One of course could speculate this may have something to do with the gender of the researchers (top end that is), and political issues - e.g. I was always mindful of the anecdotal incidence of dysphoria in women taking OCP and whether in a large number (say, 50% of the popualtion of reporductive age, as I think was quoted at one point taking it), how many vulnerable were tipped from subclinical to clinical mood disorder. OTOH, states like menopause and childbirth have huge psychological and social implications for many women (even leaving out biology). Anyway, I did work with Christohper Davey briefly a few years ago so I can get complete versions of these. Cheers, Casliber (talk · contribs) 23:15, 2 November 2008 (UTC)

Yes, it is interesting reading through the talk page archives. The issue of sex differences never appears to have been discussed. Many of the articles abstracts linked there do not even break down subjects by sex. —Mattisse (Talk) 03:12, 3 November 2008 (UTC)

Well that may have something to do with the gender of the editors editing the article. :) Cheers, Casliber (talk · contribs) 04:16, 3 November 2008 (UTC)

I notice now that a point I added about childhood disadvantage potentially affecting women more was deleted on 26th Oct, and needs to be reinstated. Reminds me also to put the gender stats on completed suicide in the context of the different picture from suicide attempts and self-harm (e.g. PMID 18341543 Case survey, PMID 18470773 Psych impairmnet). Re. the reviews above, the second refers to onset coinciding with menarche suggesting hormonal mechanisms, a subtype associated with anxiety, sleep/appetite disturbances and fatigue, and "they can also experience more body image dissatisfaction, feelings of failure, concentration problems and work difficulties." and "adolescence is associated with sexually dimorphic pruning of synapses and signaling mechanisms in brain regions implicated in depression. The emergence of depression during adolescence might result, in part, from either insufficient overproduction or enhanced pruning of these brain regions. Estrogenic effects might further exacerbate these processes." The first review refers to "consistent with the proposal by Cyranowski et al. (2000) that this difference emerges because of the heightened “affiliative need” of women that is driven by social and hormonal influences that operate from puberty. The suggestion is that affiliative rewards have more salience for women, who are subsequently more likely to be disappointed by the frustration of these needs (Allen and Badcock, 2003; Allen et al., 2006). Interestingly, there is evidence that the prefrontal gray matter changes that occur in adolescence begin earlier for females, which may account for some of the difference in vulnerability between the genders." This is all quite far removed from the wider cultural contexts and power dynamics of course; tried to cover that a bit in history & link on women refugees in sociocultural aspects, but needs more there as mentioned. EverSince (talk) 15:20, 3 November 2008 (UTC)

p.s. Toward a Comprehensive Developmental Model for Major Depression in Women (2002) -- Toward a Comprehensive Developmental Model for Major Depression in Men (2006) EverSince (talk) 11:41, 4 November 2008 (UTC)

Interesting two studies nice big ones, notable authors, funny I haven't seen them before - but they don't really say too much not covered thus far, and there is little gender-specific apart from a link with early-onset anxiety disorder with women (which I have not seen recorded elsewhere (?), makes me wonder why not) Cheers, Casliber (talk · contribs) 12:58, 4 November 2008 (UTC)

Yeah I was gonna add those last two aren't as promising as their titles might sound... EverSince (talk) 20:37, 11 November 2008 (UTC)

(deindent) I guess I'll start Causes of depression for now, to cover the above, since the naming issue hasn't been resolved. EverSince (talk) 20:37, 11 November 2008 (UTC)

Overdiagnosis

A recent edit in the lead changed the wording from "However, authorities such as Australian psychiatrist Gordon Parker have argued that it is overdiagnosed, and that current diagnostic standards have the effect of medicalizing sadness" to "However, recent trends have overdiagnosed depression with the effect of medicalizing sadness." I do agree with the editor that it might be unnecessary to mention a specific clinician in the introduction, this view is held by more than him. But the new version seems to be saying that overdiagnosing is an objective fact. This is not supported by sources in the article. Is it ok to use weasly wording in the intro, like "Some writers have argued...", when it is clarified later in the article who these critics are? Or how could this be resolved? /skagedal^... 13:56, 3 November 2008 (UTC)

I was responsible for the first edit and naming Parker, to avoid weasel words, and flag it as it is an important point with some support. He is an authority on mood disorders and has published many papers and books on the subject. His view of medicalisation is supported by many and I have seen concerns of overdiagnosis in psychiatry scattered about the literature. Snowman has changed it to the second. I agree that it is better not to state it as fact as it would still be contested by many in psychiatry. My default option is naming Parker as I doubt we can come up with a non-weasly way of wording it, but I am open to suggestions if one can be found. I need to sleep now as it is v. late here in Australia. Cheers, Casliber (talk · contribs) 14:06, 3 November 2008 (UTC)

PS: I have just moved it out as I reorganized the lead for flow and wasn't sure where to put it at first glance. I really need to sleep now. Cheers, Casliber (talk · contribs) 14:23, 3 November 2008 (UTC)

Might I suggest that somebody add some information to Gordon Parker to support using him here? As it is, the information on that page barely suffices to show notability, much less authority in the field. Looie496 (talk) 17:08, 3 November 2008 (UTC)

This has been a problem with many FACs, as side articles sprout all over the place and you can see what else needs to be added where, just getting the time to add it. He is pretty preeminent, just have to add more material and tehre are only so many hours in the day. Cheers, Casliber (talk · contribs) 22:35, 3 November 2008 (UTC)

The current version reads, "However, depression may be overdiagnosed, and current diagnostic trends arguably have the effect of medicalizing sadness." I think this could work, and doesn't sound weaselly, although I favour mentioning Parker because this statement might be surprising to many, and so it seems to beg for early attribution. It's the sort of statement that, without early attribution, might be dismissed as counterintuitive, or be accepted albeit as in conflict with intuition, or--worst of all--be blindly acknowledged by those who aren't really paying attention. IMO it's an important and divergent viewpoint that the reader should take seriously, and I suspect that it'll be most seriously presented if it's properly attributed early on. Parker is obviously notable, so I don't think it's inappropriate at all to mention him by name in the introduction. Cosmic Latte (talk) 00:16, 4 November 2008 (UTC)

I am sure that Parker is important. There are lots of other important psychiatrists and psychologists and they do not get a mention in the introduction. Even Jung and Freud are not mentioned in the introduction. I think that it would be a mistake to single out one psychiatrist to me mentioned by name in the introduction, just to make a point about "medicalizing sadness". He is mentioned and wikilinked in the main text. The same thing is said in the UK, and I have not heard Parker's name here. It would be better to use inline refs in the introduction to indicate the sources. Snowman (talk) 10:16, 4 November 2008 (UTC)

I think the issue could be framed as a "debate", as there is also a view through the literature that much depression is underdiagnosed - that sufferers aren't being reached or are reluctant to talk about it; that allegedly it can be "masked" by other things like somatic complaints, substance use or behavioral problems esp. in men; that whether or not there are as obvious functional problems, quality of life may still be markedly reduced. The opinion piece Parker is contrasted with makes some points, I note they both have pharma links. Going the other way, I also think the issue of medicalization shouldn't be reduced to equivocations over the cut-off point for diagnosis - it also involves more radical foundational critiques of the entire diagnostic and treatment system as currently formulated and employed within societies (some of which are mentioned in sociocultural aspects) EverSince (talk) 12:41, 4 November 2008 (UTC)

Aargh! So much of this is like the tip of the iceberg, as one needs further and further elaboration to explain how, what and why experts come to conclusions. The trick is where to draw the line I guess. Parker has also argued the whole classification has problems too. Cheers, Casliber (talk · contribs) 12:49, 4 November 2008 (UTC)

True... Regarding Parker yes but at the same time he's ultimately defending medicalized categorical diagnosis, in a retrograde melancholia sense even, and he elsewhere chooses to compare different states of depression with different types of breast lump[7] EverSince (talk) 14:38, 4 November 2008 (UTC)

Examples of truer alternatives that actually address the structural issues - Depression, antidepressants and an examination of epidemiological changes - "The interests of modern industry lead to creation of a docile population that seeks socially sanctioned cures for their ills: in this way, the market economy has molded people’s understanding of their own experience ... If we are to develop a more humane society we must begin to address these problems in their complexity." - and The social problem of depression - "Clients who learn to deconstruct the social roots of their depression or other psychosocial problems may be more likely to become involved in their communities to enact change. ... Further, while we are not arguing that the medical profession is intentionally medicating dissidents or those with alternative political agendas, we may be tranquilizing those who might be more politically active or radicalized if they did find a social explanation for their depression." Time for change in other words. EverSince (talk) 20:05, 5 November 2008 (UTC)

Excellent findings. I'd be all in favour of citing both. Cosmic Latte (talk) 16:27, 6 November 2008 (UTC)

Laboured (?) section

I am musing on first para of Efficacy of medication and psychotherapy section, which has been cited as a little hard to follow and on re-reading comes across to me as possibly a little overdetailed, and could be summarised as follows:

Antidepressants have been shown to be effective in severe depression. However minimal gains over placebo in moderate depression have been interpreted as showing no effect over placebo by some, and as of minor benefit by others.

Need to check and slot in references. Cheers, Casliber (talk · contribs) 13:20, 4 November 2008 (UTC)

I need to go to bed now, was debating whther a sentence on publication bias was essential. Cheers, Casliber (talk · contribs) 13:32, 4 November 2008 (UTC)

Is it "no effect over placebo" or "no clinically significant [or useful] effect over placebo" with NICE specifying what short of improvement they regard as clinically useful? Colin°^Talk 18:44, 4 November 2008 (UTC)

I agree this section spends too much time discussing the debate rather than just giving the reader the facts, if they can be summarised. But let's rewind to the start of the treatment section. What I'd like to know as a reader is what the aims of treatment are, how the treatment is judged against it, and whether it is judged to be effective and worthwhile. Possible aims are:

• To make the person no longer depressed.
• To reduce the level of depressed feelings (measurable on some scale).
• To stop the depression getting worse.
• To reduce the risk of suicide.
• To shorten the period of depression.
• To allow some other therapy to work well (combination treatment).

I'm guessing that unlike many medicines, the first and most obvious aim isn't actually directly achievable. There isn't a magic bullet. All these things can be regarded as an "improvement" but the text doesn't say what it means by improved. In fact the psychotherapy section compares that therapy with medication or with "usual care" whatever that is. But the reader hasn't read about medication yet, nor does he know the natural history. Perhaps the treatment section should begin with a short sentence or so on the typical duration and re-occurrence patterns. Should the medication and psychotherapy sections be reversed? Could the efficacy of each be discussed within each section rather than an add-on section? Should we mention briefly the cut-off used by folk like NICE when working out whether a medicine is useful, to give the reader an idea of what is achievable.

Both treatment sections suffer somewhat from overuse of primary sources. There's really no excuse for multiple citations other than the editor is trying to strengthen the case by citing more examples. The text could also be improved by mentioning studies/reviews less and just presenting the facts. One particular problematic sentence is "Overall, systematic review reveals CBT to be an ". A systematic review is just a form of article. The review presented the results of a meta-analysis, which was the instrument that "revealed" CBT's attributes. But unless we are writing about history or how research is conducted, I think we should just confidently state "CBT is an effective treatment in depressed adolescents" and cite the best source we have.

Sorry this is a bit rushed. Got to go. Colin°^Talk 18:44, 4 November 2008 (UTC)

I agree with Casliber about summarizing the efficacy section, as done above, and about adding a bit on publication bias. I also agree with Colin about stating the aims of treatment. (I wish Paul were around to comment, too.) But I think that all of these things--along with any aspects of the efficacy section that we'd like to save--should be integrated into the psychotherapy and/or medication sections, rather than left in an efficacy section that begs for far more elaboration than we can give it in this article (e.g., actual efficacy vs. placebo, spontaneous remission, regression toward the mean, etc.). I think that the appropriate place to keep and expand this section is in Treatment for depression, into which that section was already merged a while back. Cosmic Latte (talk) 09:56, 5 November 2008 (UTC)

As it stands, though, there's sure a lot of text devoted to the sheer fact that both medication and psychotherapy leave something to be desired. As Colin put it on FAC, "The spat between the two 'authors' seems like 'A: Drugs are a bit rubbish. B: Depends what you mean by rubbish. Oh and psychotherapy isn't any better.'" Cosmic Latte (talk) 09:59, 5 November 2008 (UTC)

Good to see we all agree on a change and what needs to be done, I had intended getting stuck into it but got diverted by Vassyana's comments, among which were some very good suggestions. Anyway, access has been slow (all the election hits???) and it is 12:30 am here...I need to sleep. Sorry guys. Cheers, Casliber (talk · contribs) 13:40, 5 November 2008 (UTC)

I've tried to tighten the section a bit, but I still think it needs to be replaced or integrated or just completely reserved for Treatment for depression, where it can be given adequate treatment. Cosmic Latte (talk) 16:09, 6 November 2008 (UTC)

How about trimming that section down to the following...

Antidepressants in general are as effective as psychotherapy for both severe and mild forms of major depression.[154][155] The subgroup of SSRIs may be slightly more efficacious than psychotherapy. On the other hand, significantly more patients drop off from the antidepressant treatment than from psychotherapy, likely because of the side effects of antidepressants.[154] Successful psychotherapy appears to prevent the recurrence of depression even after it has been terminated or replaced by occasional booster sessions. The same degree of prevention can be achieved by continuing antidepressant treatment.[155]

...and merging that with the main "medication" section, perhaps tacking it onto the end? Cosmic Latte (talk) 17:47, 6 November 2008 (UTC)

Yep. On it now. Cheers, Casliber (talk · contribs) 10:38, 7 November 2008 (UTC)

I have put it in corresponding sections; I left out the bit about SSRIs as it was a bit vague and I have seen other authors arguing the same for Tricyclics. Cheers, Casliber (talk · contribs) 10:50, 7 November 2008 (UTC)

Image question

Freud

Group photo 1909 in front of Clark University. Front row: Sigmund Freud, Granville Stanley Hall, Carl Jung; back row: Abraham A. Brill, Ernest Jones, Sandor Ferenczi.

I have been searching through commons and this image of Freud could be useful: [[]]. I dont think it has any problems since the author and date of death are stated, but could somebody confirm it?--Garrondo (talk) 17:14, 5 November 2008 (UTC)

Yep, that's PD-US. Good work! Cosmic Latte (talk) 17:39, 5 November 2008 (UTC)

I think if there is an image of Freud there should also be an image of C.J. Jung for balance. Snowman (talk) 18:01, 5 November 2008 (UTC)

To Garrondo, It is easy to forget to do an edit summary, but I have noticed that several of your recent edit summaries are short or nil. It would be easier to follow the changes, if you wrote adequate edit summaries, as per wikiguidelines. Snowman (talk) 18:16, 5 November 2008 (UTC)

It's so easy I forget many times; also because I am not to used at working at an article with som much traffic. I'll try--Garrondo (talk) 18:39, 5 November 2008 (UTC)

An image of Jung might be appropriate if Jung were even mentioned in the article... Cosmic Latte (talk) 18:22, 5 November 2008 (UTC)

My intention is only to give "color" to the article. I do not really think that Jung should have its image in the article; specially since it is really not so easy to find copyright-suitable pictures...--Garrondo (talk) 18:37, 5 November 2008 (UTC)

I'd go ahead and add the Freud image to the "Psychological causes" section, perhaps with a caption similar to the one we had before. (Indeed, there was a different Freud image there previously, but it was removed due to PD concerns.) Cosmic Latte (talk) 18:46, 5 November 2008 (UTC)

I think that the image showing a group of several famous people important in psychoanalysis is better. It does include Jung and others, and it has an appropriate copyright apparently. Snowman (talk) 20:23, 5 November 2008 (UTC)

I can go with either..gawd, we've proably got space for both XD. I am sure the Freud image will get well worked on more articles across WP :) Cheers, Casliber (talk · contribs) 21:01, 5 November 2008 (UTC)

PS: Agree with note about edit summaries above - I have been trying to elaborate as much as possible in them (unless really tired!) due to the delicate stage things are at currently. Cheers, Casliber (talk · contribs) 21:01, 5 November 2008 (UTC)

Why do we need a picture of any psychiatrist or "famous people important in psychoanalysis". Are we to litter every topic in psychiatry/psychology with his portrait? It's not as though any of these people discovered depression. Colin°^Talk 21:13, 5 November 2008 (UTC)

Well, I was only suggesting a group, because someone suggested Freud, on his own. The group photo might provide easy to find links to other pages of people. Having no images of people would be ok with me too. I am not sure that the photo of Samuel Johnson, does anything for the page. It might be interesting to have a photo of an ECT box.

I protest the use of Samuel Johnson's photo. He is already mentioned in two separate sections of the article, and I was not aware that he was important to our understanding of depression or had an impact on the history of the diagnosis. There is already an over emphasis (from my point of view) on British literary figures that seems strange to me, leaving out the issue of representing a world wide view. —Mattisse (Talk) 21:48, 5 November 2008 (UTC)

I think the Samual Johnson image should be removed too, and it is largely irrelevant, and he had a movement disorder, which may be complicating the appearance or the impression the artist formed. There is a "list of people with depression" linked, from which one can find dozens of more links to notable peoples articles. Snowman (talk) 23:10, 5 November 2008 (UTC)

I have no problem if the Johnson image goes - the main reason for some more tangnetially related people is the lack of Public Domain or permission-given images to use...and how do you take a photo of therapy anyway? Or getting permission from a patient etc. I am quite happy to avoid pix of ECT material as I think as it is a rare treatment its role does not need to be emphasised any more than it is already. I think one of Spitzer would be important as he led the group which came up with term in 1980. Cheers, Casliber (talk · contribs) 23:28, 5 November 2008 (UTC)

That reason sounds like you are using an image for decorative purposes only. —Mattisse (Talk) 20:08, 8 November 2008 (UTC)

I support using the image of Freud for the sheer reason that Freud is mentioned in the article (same goes for Johnson). The article doesn't present the opinion of everyone involved in the formation of psychoanalysis, nor does it present the views of everyone in the group photo, one of whom was not even a psychoanalyst. G. Stanley Hall simply invited Freud to give a lecture, as far as I am aware. In any case, this is a long article with a lot of text. Even the most technical of textbooks is often decorated with an illustration or photo on every other page or so. Cosmic Latte (talk) 04:38, 6 November 2008 (UTC)

I'm a huge fan of Jung, by the way, but just how tangential do we want to get? Cosmic Latte (talk) 04:41, 6 November 2008 (UTC)

Per same reasons as Cosmic Latte: I prefer to have a bit tangential images than non having any, and I feel the Freud image is a good one, and the Samuel Jonshon does no bad; however if anybody finds any other interesting images I would be greatly please to change them. The truth is that there is no need really for ANY of the images of the article, and the same could be said for the 99% of images in wikipedia and any other encyplodia. The reason to include them is not a need, but an interest to make the article easier to read, and therefore most images are as valuable as any other. Regarding the debate between the group picture and the Freud picture: the only psychoanalitic author named in the article is Freud, not all others, so I feel is a better ilustration. Apart from that there could be some aesthethic reasons since the quality of the Freud picture is much higher (have any of you tried to zoom the group picture?). Regarding sociocultural aspects how about changing Samuel Jonshon by Stuart Mill? He is more commented in the sociocultural aspects section?--Garrondo (talk) 08:46, 6 November 2008 (UTC)

For me, it is not a show stopper either way. Anyway, perhaps the caption of SJ could be expanded tangentially, like the one of a person on the Schizophrenia page, to make it more tangentially interesting. Snowman (talk) 09:31, 6 November 2008 (UTC)

I have been thinking, maybe there is some sort of therapy picture, I have been looking on commons but nothing interesting has come up yet. Cheers, Casliber (talk · contribs) 10:50, 6 November 2008 (UTC)

I tried to do a similar search a few days ago but I wasnt able to find anything interesting.--Garrondo (talk) 11:03, 6 November 2008 (UTC)

I'd be in favour of adding a picture of Mill--maybe in addition to the Johnson one--but I'm not sure if this picture of him is sourced properly enough. "Someone during 19th century" isn't really much of an attribution, although the rest of the sourcing leaves little doubt that it's PD-US. Cosmic Latte (talk) 14:40, 6 November 2008 (UTC)

Why the insistence on more images of British persons who did not have a significant impact on the history or understanding of depression but are merely decorative? Johnson is already mentioned in two different sections of the article gratuitously, as he has no particular relevance to Major depressive disorder, and where is the evidence that was his diagnosis? Does he meet the DSM criteria? He has already been retrospectively diagnosed with Tourette's syndrome. How many retrospective diagnoses are we going to give him? Considering the over emphasis on British literary persons in this article, this would increase the WP:UNDUE, and increase the British/Australian bias of the article. To me, this is another problem of using the DSM term "Major depressive disorder" to mean depression in general, and therefore a rationale for throwing in tangentially related material. —Mattisse (Talk) 15:11, 6 November 2008 (UTC)

I think that, in the sociocultural aspects section, we're allowing "depression" to be defined a bit more liberally than in the earlier, more technical and clinically-oriented sections of the article. This section follows a history section in which the modern origins of the term "major depressive disorder" are made clear, and in which it is set against the backdrop of "melancholia" and of "depression" more generally. The reader will naturally understand that Johnson, Mill, and anyone else who lived before 1980 may have suffered from a condition comparable to the one named in 1980. Basically we've transitioned from science mode to history mode, and if we don't go into history mode regarding depression in this article, I don't see where else we're going to do it. As for the pictures being merely "decorative"...well, yes, that's the point. This is a long article with a lot of text--some visual aids can't hurt. Cosmic Latte (talk) 18:22, 6 November 2008 (UTC)

That is the problem of the title of the article. If it is titled Major depressive disorder, then the article begins to lose focus when it strays from that topic. Perhaps there should not be a sociocultural aspects section, if you take that to mean you can add tangentially related or misleading material. Johnson was never diagnosed with Major depressive disorder. This section is more of a Trivia section. —Mattisse (Talk) 21:54, 6 November 2008 (UTC)

Response here. Cosmic Latte (talk) 10:11, 7 November 2008 (UTC)

That does not address my objections. You are supporting the use of an image for decorative purposes only. —Mattisse (Talk) 20:08, 8 November 2008 (UTC)

Image suggestion

Churchill in 1904

I think it would be better to have someone more widely known and recent than SJ for someone that had depression. Snowman (talk) 22:30, 6 November 2008 (UTC)

Maslow's hierarchy of needs image

• What is the justification for Image:Maslow's hierarchy of needs.png? The hierarchy itself never mentions depression. Maslow is not noted for his contributions to the theoretical conceptualizations of depression. It certainly was not a major focus of his writings. This article on depression only has one sentence on Maslow and that sentence does not even mention the hierarchy: "American psychologist Abraham Maslow theorized that depression is especially likely to arise when the world precludes a sense of "richness" or "totality" for the self-actualizer." I submit that this sentence makes no sense to a reader not already familiar with Maslow and his hierarchy. The concepts are very Western world biased. The caption on the hierarchy image contains more accurate information than does the article text. The hierarchy itself is not explained in the article text, so why such prominence pictorially, other than that it is pretty? —Mattisse (Talk) 15:09, 10 November 2008 (UTC)

• It's there to supplement the text, not simply to mirror it. See also Talk:Major_depressive_disorder#Verdict_on_Maslow_image. Cosmic Latte (talk) 15:17, 10 November 2008 (UTC)

Differential diagnosis

Casliber, thanks for asking me to have another look. I really can't see any problems with the article as it stands now, except I'm not sure about "loneliness" in the differential diagnosis, for the following reasons (1) it seems wise to limit yourself to the differential diagnosis as described in DSM, and limit the list to other DSM disorders, (2) including loneliness here seems to elevate it to quasi-clinical status, makes it look like a "disorder" (the world has enough disorders already, thank you), (3) the supporting reference is not very strong and (4) the supporting reference refers to loneliness as a "condition" comparable to depression, but I suggest the condition of loneliness (like anomie) is a concept from sociological or existential, not clinical, discourse. Good luck with the FA nomination. Anonymaus (talk) 17:42, 5 November 2008 (UTC)

I agree that the differential diagnosis section might be an awkward spot to talk about loneliness, so I moved it to a relatively less "clinical" area. Feel free to modify it further, or to remove it altogether if it's too problematic. Cosmic Latte (talk) 18:37, 5 November 2008 (UTC)

After some tweaking, the loneliness passage reads, "Loneliness and depression have some features in common, and are likely to coexist if the loneliness is chronic rather than transient.[31] If the individual has global concerns that do not focus strictly on interpersonal relationships, feels a high degree of guilt, or is particularly vegetative, then the person is likely to be depressed; if these conditions are not met, he or she may be lonely instead. It is unclear as to which factors are causes or effects of depression..." Now I'm wondering, would it be better to eliminate the "If the individual has global concerns...may be lonely instead" sentence, so that it simply reads, "Loneliness and depression have some features in common, and are likely to coexist if the loneliness is chronic rather than transient.[31] It is unclear as to which factors are causes or effects of depression..."? Is that sentence too much detail, too distracting, etc., or is it helpful enough to keep? Cosmic Latte (talk) 18:44, 5 November 2008 (UTC)

I must admit I find that the whole loneliness segment I am having trouble gelling with the rest of the article and was pondering whether it should be removed, but am still thinking about it. Cheers, Casliber (talk · contribs) 23:36, 5 November 2008 (UTC)

I shortened the loneliness passage here, but feel free to move or remove the remainder of it if that's still a problem. Cosmic Latte (talk) 04:44, 6 November 2008 (UTC)

(I had to upon readreading a few time. Sorry) Cheers, Casliber (talk · contribs) 06:21, 9 November 2008 (UTC)

• A further comment on the differential diagnosis section: I think that this would be better presented as running prose than a bullet list. Even though it says "including the following", it sort of gives the impression that these are the three "main" diagnoses to exclude. There are other important things to rule out, such as substance abuse, lowered mood as an effect of somatic condition, various psychotic syndromes... /skagedal^... 09:58, 7 November 2008 (UTC)

It says "the list includes:" and it is a list of diagnoses of conditions that may have a similar presentations, I think the list works well. Substance misuse may be a coexisting or different condition. Snowman (talk) 10:34, 7 November 2008 (UTC)

Hopefully a somatic condition would be picked up by investigations and hence excluded, similarly substance use and depression not mutually exclusive and are often comorbid. Almost all other psychiatric conditions will have other symptoms elicited by a good history, but I agree it is sometimes hard to know where to draw the line. - i.e things which are going to be possibly similar even after investigations and a thorough psychiatric history is taken. Cheers, Casliber (talk · contribs) 10:55, 7 November 2008 (UTC)

I was thinking of the cases were the substance use or abuse is thought to be etiologically related to the mood disturbance (see [8]), in which case MDD is not diagnosed, according to criteria D of the major depressive episode diagnosis. Regarding somatic conditions, I'm thinking of Mood disorder due to a general medical condition; this is covered well in the "clinical assessment" section, though. But how about schizoaffective disorder? Isn't that just as relevant as adjustment disorder or bipolar disorder?

If these three are indeed the most relevant differential diagnoses, maybe the text should say so explicitly? "Including the following" could be read as: "here comes three arbitrary examples"... /skagedal^... 12:28, 7 November 2008 (UTC)

The site you linked to above gives a different list for differential diagnoses in DSM-IV for Major despressive disorder than those you have listed in the article. Besides Mood disorder due to a general medical condition, other diagnosis of Major depressive disorder - Differential diagnosis are given, such as Substance-Induced Mood Disorder, Dysthymic Disorder, and Schizoaffective Disorder, as well as mention of some other disorders in which depression may be a symptom. Where is the current list in the article coming from? Loneliness is not a diagnosis, so I am glad you moved it. —Mattisse (Talk) 16:01, 10 November 2008 (UTC)

Diagnosis

"A diagnostic assessment may be conducted by a general practitioner or by a psychiatrist or psychologist". As far as I am aware in the UK a psychologist would not normally make the diagnosis, but might be involved later in the treatment or for specific assessment tasks. Sometimes CPN qualified nurses monitor patients in the community and is could be said that they diagnose or identify depression or a recurrence in the UK. This is based on locality in the UK. Should this line be modified? It is small print stuff, but perhaps this line in the article reflects a different locality position and might be better rephrased, but I do not known. Snowman (talk) 17:59, 5 November 2008 (UTC)

Theoretically a psychologist may be the first port of call diagnositcally if the GP was unclear about the diagnosis and asked for a second opinion. Many GPs may conduct a brief assessment without confirming the diagnosis (say, referring someone for what appeared to be bereavement or who is requesting counselling on an ongoing basis). A psychologist may also see someone after being referred for a medico-legal assessment, or as part of an Employee Assistance program in a large organization. As far as I know, these scenarios can occur in England (?). I only worked in England for a short time over 10 years ago. Cheers, Casliber (talk · contribs) 20:49, 5 November 2008 (UTC)

In the US a psychologist can have a private practice and see individuals who self-refer for whatever reason or are referred by friends, having nothing to do with a professional referral. Also, referrals come from other psychologists, lawyers, government agencies such as Child Protective Services or other such agencies; the court system refers individuals for assessment or treatment or both directly to psychologists. In these situations, generally a psychiatrist or other medical doctor has not been involved. Agencies also refer their personnel directly to psychologists. For example, where I live the sheriff and police departments rely on psychologists for employment evaluations, fitness for duty exams, evaluation and/or counseling after an incident like a use of arms. Also, within agencies, government or otherwise, a psychologist may be the first contact, for example, in the US military or in prison and jail systems. So, psychologists are the first mental health port of call often and the first to diagnose. —Mattisse (Talk) 21:13, 5 November 2008 (UTC)

But to keep to the point of illness diagnosis, as far as I am aware: it is different in the UK, where any illness related diagnosis would be made by a doctors (juniors, psychiatrists or GPs) or sometimes by a trained CPN nurse who would report to a doctor. Psychologists have a variety of roles and take referrals for various forms of therapy - anger management, phobia treatment or testing dementia and much more, but they are not used in the front line as diagnosticians and they can not prescribe in the UK. Psychologists might have a peripheral role in diagnosis in writing a psychological report for a doctor perhaps about some aspect of behaviour or aptitude, but it would be the doctor who would collate all the information and form an opinion about a diagnosis. Snowman (talk) 23:04, 5 November 2008 (UTC)

Snowman, the above has been traditionally true, but I would think Matisse's examples, and mine would bypass doctors in the UK enough times for it to be significant. In Australia, the medicare system insists the GP is the first port-of-call and other specialties only get reimbursed by the government (it is a fee-for-service model here) with a GP referral. However, if a person comes in with a problem that is clearly going to need specialist involvement, the assessment where the GP makes the referral may be very brief indeed, essentially acting as a triage service. Cheers, Casliber (talk · contribs) 23:21, 5 November 2008 (UTC)

PS: WRT the profession, psychologists practise in diverse ways; many do work like the above, that is only seeing people for a prescribed 12 sessions of CBT, IPT, family therapy or other regimen, but there are others who see patents on a longtidinal, open-ended basis using a mixutre of techniques - psychodynamic, CBT and supportive therapy as well, particularly in the private sector here. Cheers, Casliber (talk · contribs) 23:24, 5 November 2008 (UTC)

Also, in the US psychologists are directly reimbursed by Medicare, Medicad, Blue Cross/Blue Shield etc. and the diagnosis by the psychologist is accepted. Also, psychologists do evaluations for Social Security Disability (SSI), a federal program, that involves rendering a diagnosis. In fact, it is possible to make a living in independent practice doing just SSI evaluations. In other words, it is possible to practice psychology completely independently, and providing diagnoses is part of that practice. —Mattisse (Talk) 02:46, 6 November 2008 (UTC)

Good point - they are employed by Centrelink (our dss) here too in Oz. Cheers, Casliber (talk · contribs) 02:48, 6 November 2008 (UTC)

The more specific category of licensed clinical psychologists's should perhaps also be mentioned? But even they don't always diagnose in psychiatric manual terms (though may have to where financial reimbursement is based on it). And also that, ultimately, the majority of major depression is informally assessed by primary care doctors, in 10-minute (5 if poss.) chats comprising a few stereotyped questions, usually resulting in blister packs of SSRIs. EverSince (talk) 15:02, 6 November 2008 (UTC)

In the US, all mental health practitioners, including psychologists and primary care physicians, diagnose mental health problems in DSM terms. There are no other acceptable standards of diagosis. Even if reimbursement were not the issue, malpractice concerns are. So I do not know what you mean: "they don't always diagnose in psychiatric manual terms". What other terms are there, except possibly ICD in research? —Mattisse (Talk) 16:26, 6 November 2008 (UTC)

I'm not disagreeing, in terms of officialdom. But the practice of many clinical psychologists doesn't otherwise revolve around what psychiatric category to stick clients in, but rather to assess an individual's unique issues within a dimensional (continous rather than categorical) model in a psychosocial context. As this US reviewer puts it "Clinical psychologists and social workers tend to be even less committed to it. However, it is the document that has been adopted by most bureaucratic and legislative organizations..." At one extreme in the US is clinical psychologist Paula Caplan], a former DSM consultant. EverSince (talk) 19:01, 6 November 2008 (UTC)

Your first source is a book reviewer's opinion. It is not my experience. There is no context I know of, unless you practice in your garage secretly and never share your clinical notes with other professionals and no one sues you for malpractice. The second reference you give really proves my point. It complains about the DSM categories because the practitioner is forced to use them and in many situations it is difficult to make the categories fit. —Mattisse (Talk) 22:41, 6 November 2008 (UTC)

Major depressive disorder is wrong name for this article

I think the problem with this article is that the title uses the formal term used by DSM as a diagnostic category with specific criteria. ICD uses a different term. Therefore, the DSM criteria of Mood disorder, which specifies the categories of depression Depressive disorders, should be used. Schizophrenia is a more general term, not as restrictive as Major Depressive Disorder, but the article is nonetheless clear about its various definitions depending on what diagnostic criteria are being used.

This article is not clear. Although it is termed Major depressive disorder, implying to me at least, the DSM criteria, the article itself seems to cover depression in general and seems to use terms haphazardly. Granted that the articles on psychological/psychiatric disorders are a mess, but should not this article try to clarify? Perhaps it should be renamed Major depression, or some other name that is not associated with a specific diagnostic manual.

Schizophrenia is a much better article. It is clear and well focused. This article jumps all over the map. I think we should use the Schizophrenia article as a model. —Mattisse (Talk) 20:03, 5 November 2008 (UTC)

DSM III's decision to use MDD rather than Major depression is a frustrating one, as it is one step further from the lay term depression. Schizophrenia has been lucky in having the one name, though has had similar issues with changing standards of diagnosis (scz used to be more inclusive, and the UK and US definitions differed). Defining lay terms never equates exactly with clinical definitions. MDD is the entity used in research so all the epidemiology and treatment etc. refers to that entity. Mood disorder already has an article and refers to a family of disorders (including bipolar disorder and several other distinct entities such a dysthymia). If the consensus was that major depressive disorder=major depression, and that that was the much mor recognised name (in th same way that William Clinton is Bill Clinton, say - the quickest analogy I cna think of), I'd be open to that I guess. Cheers, Casliber (talk · contribs) 21:11, 5 November 2008 (UTC)

Except that one of the problems with this article's sources is that they generally use the term "depression" and not "major depression" and so it is not clear what they mean or if they are differentiating between subtypes, or which of the various subtypes they are including. Plus the article itself is unclear. It throws around words like mild, moderate, severe, when if I look at the sources it is not clear what is meant. Is it including the subtypes in these qualitative terms? What is the rational for the subtypes vs. the differential diagnosis, and are you discussing all of these in the article? Dysthymia is a differential diagnosis in the article, a rule out. Yet it is used in the article as an example of a condition effectively treated by an antidepressant. Also, some sources use persons diagnosed with Dysthymia. It is confusing to me. Of course, I am not British or Australian. ICD does not use the term. When you say "MDD is the entity used in research so all the epidemiology and treatment etc. refers to that entity", is this true? As it is not so in the US. —Mattisse (Talk) 21:37, 5 November 2008 (UTC)

P.S. When you say "MDD is the entity used in research", do you mean they are using the DSM criteria? Or what criteria are they using? Where do they get that term? Are the ICD terms irrelevant and unused? —Mattisse (Talk) 21:39, 5 November 2008 (UTC)

DSM is becoming lingua franca and DSM criteria are used alot more than ICD all over the place, it is even creeping in in the UK and Europe, and certainly australia has gone completely DSM in the past 15-20 years or so. I was keen to find a comprehensive ref on this but haven't been able to, yet it's pretty well known in mental health. Cheers, Casliber (talk · contribs) 23:13, 5 November 2008 (UTC)

But then, should you not clarify that in the article and stick to the DSM specified criteria etc. rather than use it as a general term for depression? In practice, in the US, DSM is taken very seriously in diagnosis and used strictly as intended by DSM. To see a DSM term used so freely and applied to topics it is never intended to address seems so "off" to me. —Mattisse (Talk) 02:52, 6 November 2008 (UTC)

Googling "Major depression" -wikipedia seems to give about twice as many pages as "Major depressive disorder". That term does seem less biased to either DSM or ICD, both of which are widely used around the world. And maybe goes some way to addressing the issues Mattisse raises. Ultimately whatever the term, it's going to involve inconsistent artifical cut-offs from depression (mood) and from the full spectrum of human emotion and life. EverSince (talk) 15:23, 6 November 2008 (UTC)

I think ""Major depressive disorder" is a clinical term used by clinicians and not the general public. —Mattisse (Talk) 16:00, 6 November 2008 (UTC)

That is probably correct, but Med:MOS uses the medical names for headings, and it is standard on the wiki. There is "Herpes zoster" and not "Shingles". Questions might be what medical name is the best one, and what is the article about? I am neutral on the name of the page, except I think that a lay term would be even more confusing. Snowman (talk) 16:47, 6 November 2008 (UTC)

"Major depression" is also widely used clinically/medically, check out Pubmed (more than twice as often in article titles) EverSince (talk) 01:58, 7 November 2008 (UTC)

• I find it strange that, as quoted from above, "DSM is becoming lingua franca and DSM criteria are used alot more than ICD all over the place". Yet this article does not even mention the American Psychiatric Association who developed DSM. Why the WP:UNDUE on "black dog" and the "Black Dog Institute" in the article (which has nothing to do with DSM), yet so little on the developers and development of DSM? The reference to the "Black Dog Institute" (http://www.blackdoginstitute.org.au/aboutus/overview.cfm) uses the term "depression" and not "Major depressive disorder". Why so much on black dog? —Mattisse (Talk) 16:12, 6 November 2008 (UTC)

• I don't see how WP:UNDUE applies to Winston Churchill or to a major Australian research/education institute...although if something about the APA can be added to the section, it certainly couldn't hurt. Cosmic Latte (talk) 16:38, 6 November 2008 (UTC)

Just want to point out that the title of the article is actually not of much importance to readers, so long as all of the reasonable alternatives redirect to the right place.

It is of some importance in determining the scope of the article and the uses of sources, as described above. It is also important stylistically, since the title will appear throughout the article. Major depressive disorder contravenes our style guidelines WP:MTAA and WP:JARGON. I prefer the previous title of Clinical depression. Colonel Warden (talk) 19:15, 6 November 2008 (UTC)

I think it mentioned APA & WHO in the criteria section... should be in history too. Nationalistic bias has to be avoided of course. Regarding the relative usage, it's already been noted elsewhere that an international survey of psychiatrists found "ICD-10 was more frequently used and more valued for clinical diagnosis and training and that DSM-IV was more valued for research]. EverSince (talk) 19:13, 6 November 2008 (UTC)

This is a more complete discussion: I believe the (current DSM) name accords with WP:MEDMOS. SandyGeorgia (Talk) 19:16, 6 November 2008 (UTC)

The section "Sociocultural aspects" is a problem currently, in my view, because, as one editor said, in that section the diagnosis is not important because anything relating to "depression" in general can pertain. Major depressive disorder is not just "depression", although I agree that seems to be what the article is becoming. The article lacks focus and seems to be a general treatise on "depression" or "clinical depression", a very broad topic. So in essence, anything related to "depression" can go into this article. Given that focus, it really should cover diagnoses of depression not included in the DSM Major depressive disorder. However, this article attempts to strattle the fence, and therefore, is a muddle. —Mattisse (Talk) 22:49, 6 November 2008 (UTC)

• Wow. That reference to a "This is a more complete discussion:" above is a total distraction as there is really a discrediting of the journal reference involved as "obscure" and only pertaining to "Danish". Just more opinions not more weighty than those here. Not proof at all of superiority of one diagnostic method over another, except preference and familiarity. —Mattisse (Talk) 02:37, 7 November 2008 (UTC)

• The link is to a broad dicussion at WP:MEDMOS (in which you participated and agreed), where it was decided to use DSM in naming articles: broader consensus than at one article. SandyGeorgia (Talk) 03:06, 7 November 2008 (UTC)

I agreed on the narrow issue of Borderline personality disorder, a specific and controversial diagnosis and I tried to make sure the article limited itself to the DSM criteria. I agreed to nothing so broad as to confine depression in its many variations to one term. —Mattisse (Talk) 03:23, 7 November 2008 (UTC)

Yeah the relevant point from that brief debate is that there's also http://www.ncbi.nlm.nih.gov/pubmed/18408417 that gives a different view on ICD vs DSM usage, in terms of journals. I agree that overall it's a wash in terms of proof of superiority. Also I'll just mention again (in case my back-insertion of it above is missed) that the term "Major depression" is at least as widely used as "Major depressive disorder" in Pubmed articles (twice as often in titles), as well as being used twice as often in websites generally. EverSince (talk) 03:43, 7 November 2008 (UTC)

WRT names and scope, there is no perfect answer to this question. I figured on major depressive disorder as that is the DSM IV name which most research etc is done under and hence figures for epidemiology, treatment etc. It more or less corresponds to the older endogenous depression, and to melancholia before that, though there have been shifts in diagnostic yardsticks, and to what is commonly termed depression (i.e. condtion of pervasive low mood impacting on function) in the community. Psych books etc. will talk about all these entities connected with each other when talking about impact/history/public perception etc. I agree the term major depression is commonly seen and repeat my frustration that DSM IV went with major depressive disorder but go with it they did. Now, as I said I am frustrated by a lack of solid material confirming that DSM IV is lingua franca and I will be chuffed if something turns up, but that is somewhat beuyond the scope of the article and more an issue for a DSM or ICD page, or mental health classification etc.

This is not perfect but as far as I can see is the best fit with all the literature, research and data at hand. I have seen the term clinical depression about half a dozen terms in my professional life and I work in mental health - no one in mental health calls it that, and outside of mental health it is often shortened to simply depression (as it is in lots of journal articles too). Cheers, Casliber (talk · contribs) 05:06, 7 November 2008 (UTC)

Do you have access to PMID 18408417 ? The abstract says DSM five times ICD. From a more practical point of view (since the FAC is frequently straying off topic), WP:MEDMOS is clear. SandyGeorgia (Talk) 05:12, 7 November 2008 (UTC)

WP:MEDMOS does not seem to conform to our policy which is superior. Wikipedia is a general reference work and so should avoid professional jargon. Colonel Warden (talk) 07:54, 7 November 2008 (UTC)

Yes, it explicitly does (differ, that is), and has for much longer than my three years on Wiki (although I've seen it sucessfully defended many times in the three years I've been here). I could go into a long explanation of the reasoning, including the number of times it has been looked at, but if you go into the WT:MEDMOS and WT:MED archives, you can find numerous editors who explain it much better than I can, and the discussion here would create an unnecessary diversion. The need for precise terminology in bio/med articles, rather than layperson jargon (which is frequently inaccurate), is better explained by others. SandyGeorgia (Talk) 16:22, 7 November 2008 (UTC)

• I do not have past knowledge of WP:MEDMOS as you do. Are you saying that those discussions conclude that a specific diagnostic term can be picked out from DSM (without conclusive evidence that DSM is the lingua franca for the diagnosis of general depression around the world) with the article content not reflecting the definition of the term as used in the US at least, nor as defined by DSM? You are saying it is agreed that a specific diagnosis can be used as a title for an article that is not primarily on that specific diagnosis but is on a generalized concept that the specific diagnosis on DSM takes care to exclude? —Mattisse (Talk) 17:04, 7 November 2008 (UTC)

• No, I don't believe my comments went into that territory at all. SandyGeorgia (Talk) 17:09, 7 November 2008 (UTC)

• But that is the issue of concern in this section. I assumed your repeated references are addressing the topic of concern here. If not, what is it addressing? —Mattisse (Talk) 17:25, 7 November 2008 (UTC)

• The topic of concern is the article title (since I was specifically addressing Colonel Warden's question about MEDMOS). Per WP:MEDMOS, there is not a problem with the article title: that is the issue I'm addressing as it relates to WP:WIAFA (the article name is in accordance with practice). If you are separately arguing that the article content is not in agreement with the article title, that's another issue. You've elsewhere expressed frustration that the issues you are raising aren't being addressed quickly enough for you. I submit that the task before the FAC nominator would be much easier if your comments weren't spread over multiple sections of the FAC and the article talk page, and repeated in several places. Long discussions spread across multiple sections are hard to keep up with: perhaps you might start a list somewhere. SandyGeorgia (Talk) 17:39, 7 November 2008 (UTC)

• Side note: I have some concerns regarding the second sentence in the article: "The general term depression is better used to describe a temporary depressed or sad mood." I think this should instead clarify that "depression" is often actually used to describe the condition. A quick search on "depression" on Amazon finds books like The Cognitive Behavioral Workbook for Depression and Overcoming Depression One Step at a Time – these books are not about overcoming a "temporary depressed or sad mood". Even in diagnostic composites, we speak of "atypical depression", not "atypical major depressive disorder"... Also, I don't think normative language like "is better used" should be used. Descriptive language is better used. :) I've attempted to correct this. /skagedal^... 09:09, 7 November 2008 (UTC)

• Fully agreed! Cosmic Latte (talk) 10:09, 7 November 2008 (UTC)

I think that you have done a good job of the repair. Snowman (talk) 10:11, 7 November 2008 (UTC)

• Problem with title - The problem with the title is that it gives the impression that the article is really about Major depressive disorder, when it is not. It has been said that the justification for the title is that the use of DSM is worldwide, and therefore the use of the term Major depressive disorder is worldwide. However, there is no proof of this. If a specific diagnostic term is being used, then I think the article should be about the diagnostic term and reflect its definition accurately. The term does not mean depression in general. The way the article is now, 90% of it has nothing to do with the diagnostic term Major depressive disorder. This is misleading and disorienting to anyone who actually knows what the term means. —Mattisse (Talk) 16:40, 7 November 2008 (UTC)

Yes & the other inconsistency is that the subarticles are just called "whatever of depression", as Treatment of depression, Biology of depression, which doesn't even distinguish between this article and Depression (mood) (& that last is itself a bit ambiguous too, because major depression is of course considered a "mood" disorder) EverSince (talk) 05:08, 10 November 2008 (UTC)

To me, having separate articles for Major depressive disorder and Depression (mood) is a bit like having separate articles for "severe bronchitis" and "mild bronchitis." There is nothing magical or genuinely discontinuous about the two-week stipulation about when the mood becomes a disorder (am I just having a "mood" swing if I'm depressed for 1 1/2 weeks? do I have a "disorder" if I'm depressed for 2 1/2 weeks but elated for the rest of my life?). If we merged Depression (mood) into this article, and renamed this one "Depression (psychology)" or "Depression (mental health)" or something like that (just to distinguish it from Depression, which is a disambiguation page), then we could at least tone down the reification that the DSM so generously promotes. But even if we accept the DSM as the psychiatric lingua franca, we still don't hear "major depressive disorder" relatively often in clinical settings. To echo other editors, clinicians talk about "atypical depression," "severe depression," and "postpartum depression"--not "atypical major depressive disorder," "severe major depressive disorder," and "postpartum major depressive disorder"; and, indeed, articles like "Treatment of depression" and "Biology of depression" seem to reflect an understanding that simply calling the disorder "depression" will suffice. Cosmic Latte (talk) 14:55, 10 November 2008 (UTC)

I support the change of the name of this article for the reasons Cosmic Latte and EverSince detail. Also, almost none of the article's sources use the term "Major depressive disorder". I do not think it is a term the general reader would seek out. If a general reader were given a diagnosis of "depression", most likely that diagnosis would not be Major depressive disorder. I do not think Major depressive disorder is the diagnosis of most of the many, many persons taking antidepressants, for example, or probably of those seeking books at Amazon. If I were a general reader, and my doctor told me I was depressed and I went to Wikipedia to look up depression, I don't think Major depressive disorder, a specific disorder, should be what I am redirected to. —Mattisse (Talk) 16:26, 10 November 2008 (UTC)

Unfortunately, many articles are written like this one where depression is used in the title but major depressive disorder is used throughout the article. The term depression is thus used as shorthand for MDD (or the ICD term) in many cases in medical texts, while it has a broader use elsewhere, lay use can include low mood, bereavement, adjustment disorder as well as all the depressions (and dysthymia). If depression (mood) can easily incorporate much of this. I can see the analogy with bronchitis above but heart attack redirects to Myocardial infarction, whereas unstable angina which some may consider a 'heart attack' redirects to angina pectoris - all these things have technical definitions; whereas heart attack and depression don't. MDD is already huge and making it more inclusive would make it enormous. Cheers, Casliber (talk · contribs) 05:35, 11 November 2008 (UTC)

in fact, let's look at which sections are more on MDD and which ones aren't. Symptoms and signs=MDD, Causes=MDD (some of psychological more general but some not, and evolutionary bit more general), Diagnosis=definitely MDD, Treatment = definitely MDD, Prognosis = definitely MDD, Epidemiology (and Comorbidity) = definitely MDD, History is arguable, much of it talks of melancholia which is clearly a pervasive disturbance equated by other authors to MDD more or less and certainly discussed as such, Sociocultural aspects = difficult to say authoritatively as they are historical figures, but often a more pervasive malady is noted. Cheers, Casliber (talk · contribs) 03:24, 12 November 2008 (UTC)

I agree there needs to be a defined scope to this article, but since when did the aim in Wikipedia become deciding which POV to adopt rather than how to best achieve NPOV? It's been implied by omission that MEDMOS favors the DSM-IV term (or others have interpreted statements up above that way) but I assume it only favors a clinical term. All the terms being discussed are used clinically. And the actual Wikipedia naming guidelines say to use the most familiar to readers. Which as has been pointed out is probably not MDD (& the historical source on it in the article says Major depression gained international usage*, it doesn't say MDD did). And while the DSM manual is used more in some ways/regions, the ICD is used more in some (the EU probably & e.g. the British NICE depression guidelines are ICD). Btw I had a look at the MEDLINE MESH subject categories and they use the terms Emotional depression and Depressive disorder, major. On the other hand, PsycInfo, the other database often used in conjunction with MEDLINE in literature reviews on this topic, uses Depression (emotion) and Major depression. EverSince (talk) 03:42, 13 November 2008 (UTC) *although it also notes that of course the ICD avoided the term major depression... & re. the database terms, have to say the distinction between emotion and disorder is also problematic...I recall a book by an Irish psychiatrist, Depression: An Emotion not a Disease. EverSince (talk) 04:12, 13 November 2008 (UTC)

I did think of just plain depression, yet that title is ambiguous (clinical syndrome vs. colloquial usage for state of low mood) - and there is nothing to stop depression (mood) being worked up as a comprehensive GA or FA, as WP is not paper. The vast majoritiy of content here refers to MDD, and yes I am annoyed they didn't leave it at Major depression but had to change it with DSM IV Cheers, Casliber (talk · contribs) 10:14, 13 November 2008 (UTC)

I'm not sure what the reluctance is to take the World Health Organization's ICD in to proper account...only DSM is mentioned in the lead now, justified by title. The recent epidemiological reviews from Canadian journals that Eubulides posted below discuss both DSM & ICD (& the artifical cut-off problem, & consequent high use of "Depression not otherwise specified", how about that for a title? ;) The 2007 World Health Survey results on depression are cited, which used ICD criteria (in 26 countries from the European region, 15 from the African region, six from the Americas, four from the eastern Mediterranean region, five from the southeast Asia region, and four from the western Pacific region, giving a total of 60 countries). Regardless of DSM currently haing a majority here, both are notable, present throughout & worldwide, and so the issue is NPOV (and most titles/abstracts use other clinical terms that don't commit to either). Depression on its own is too unqualified 'cos not even specific to psych usage, but there must be a way of framing this article that is consistent with NPOV & Wikipedia naming guidelines. EverSince (talk) 20:18, 13 November 2008 (UTC)

I agree with EverSince. When this FAC opened, DSM was barely mentioned in the article. It is only after many, many complaints that given that the title was a specific diagnosis from a specific diagnostic manual, the article should conform to this and the article has been increasing subsequently modified to support the title. ICD now is barely mentioned. Yet there is no justification for preferring DSM to ICD.

In the version that was nominated DSM was not even mentioned in the lead.[9] DSM was not mentioned until 3.3 DSM IV-TR and ICD-10 criteria, half way through the article. This has had the effect of limiting the scope of the article (rightfully if it really is on the DSM diagnosis) and preventing an open examination of depression, the problem of artificial cut-off points, the consequent use of vague categories, like "Depression not otherwise specified" or "Adjustment disorder, with depressed mood" and other relevant issues. How many outpatient are told by their "mental health professional" that their diagnosis is "Major depressive disorder"? I would think that number is low to almost none, regardless of how the disorder is coded by the professional. —Mattisse (Talk) 20:58, 13 November 2008 (UTC)

Change and needed formatting

I took the intiative to replace a bit of text that was a original research concern to me.[10] I used an on-topic source and followed the indications regarding the subtopic in that reference. I also moved the text to the opening of the paragraph to contextualize the statements that follow. If this is a problem, please feel free to revert and let me know why it is problematic.

Also, the references need to placed into a single standardized format. I recommend using {{harvnb}} for the footnotes and the various "cite" templates (such as {{cite book}}) for the "cited texts" list. The texts list should also be alphabetized or placed in chronological order. If I can find the time and energy over the next day, I will begin updating the references in such a fashion myself, barring any significant objections. Vassyana (talk) 17:50, 6 November 2008 (UTC)

I wouldn't recommend that, Vassyana. Harvnbs seem to be standard to some other topic areas (like literature), while the cite journal format used in this article is actually very typical of other medical articles, and if the format is changed, it becomes hard to move citations between articles (something I learned while working on Samuel Johnson, where the format used by the literary types forced me to rewrite all citations used in other medical articles in order to transport them). I found a couple of sources that weren't in alphabetical order, but other than that, I'm not seeing a problem here. The "Cited texts" section already used standardized Cite book templates, and cite xxx is used throughout, with shortened footnotes linking to the texts—it's a very standard format for medical articles. SandyGeorgia (Talk) 18:03, 6 November 2008 (UTC)

Would it be reasonable to have all book citations use the harvnb/cite book format? (For example, coverting citations like this to said format.) Vassyana (talk) 18:43, 6 November 2008 (UTC)

It would just add clunk to the text: it's really fine to use shortened notes for repeat book citations. And if you introduce Harvnbs, you have to convert the entire article to the citation template, which isn't used in almost any medical articles. With other work to be done, ... SandyGeorgia (Talk) 18:50, 6 November 2008 (UTC)

I'm fine with the actual edit to the text. It makes sense and flows well for me. Cosmic Latte (talk) 18:10, 6 November 2008 (UTC)

Good with the changes - WRT citation format, I inserted some code before which allowed the harvard referncing to work with cite book rather than citation...Cheers, Casliber (talk · contribs) 23:27, 6 November 2008 (UTC)

That is good because there are some harvard references in article, I noticed. —Mattisse (Talk) 23:38, 6 November 2008 (UTC)

Since the Harvard style is not used throughout the article, and is generally only used for reused references, I intend to standardize the citations. I would use the standard convention for repeated citations to the same material: The first citation using the full publication information and following references to the same source using the Author Name, op. cit., page number(s) format. It just seems better to use the same citation style throughout the article. Are there any objections to this? Vassyana (talk) 13:05, 7 November 2008 (UTC)

See WP:CITE and WP:FN (op cit aren't used on Wiki); also, the shortened format used here helps lower the article size and load time (it's already a large article, at around 9,000 words). No objection if you prefer that longer style, other than the effect it may have on load time, as long as op cit isn't introduced, as explained at MOS. SandyGeorgia (Talk) 16:06, 7 November 2008 (UTC)

Black Dog Institute and "black dog" - not world wide

A black dog. Not to be confused with Major depressive disorder.

There appears to me that there is an undue emphasis on "black dog", including singling out the "Black Dog Institute" for mention as a major research institution on the subject of this article, when no others are mentioned. The reference link given says the Black Dog Institute activities include "depression" but does not mention "Major depressive disorder". Are there some references that Black Dog Institute is a major institute world wide on the subject of Major depressive disorder and worthy of inclusion when others in the world are not? Is it more major that the National Institute for Mental Health, for example? The reference to "black dog" appears to be English/Australian in interest and not world wide. —Mattisse (Talk) 19:17, 6 November 2008 (UTC)

"English/Australian" does cover two continents (and four hemispheres). The Black Dog Institute is, if i recall correctly, headed by Gordon Parker, an extremely well-published researcher on depression/MDD/whatever you'd like to call it. Cosmic Latte (talk) 19:24, 6 November 2008 (UTC)

England is not a continent, as far as I know. I believe if is part of an island. I realize this article is mainly "English/Australian". That is evident throughout the article. But why is this Institute mentioned when no others are? Is "black dog" of interest outside of "English/Australian" editors? Considering the title of this article is of American derivation from an American diagnostic manual , there is nothing on the American Psychiatric Association who developed DSM, or important American research institutions like the National Institute of Mental Health or others in the world. France, Germany, Switzerland etc. have none. None on the other six continents in the world besides Australia?

"Is 'black dog' of interest outside of "English/Australian" editors?" Well, given that I'm neither English nor Australian, yet nonetheless fascinated by the concept, I'd say it's a distinct possibility. Cosmic Latte (talk) 19:47, 6 November 2008 (UTC)

Provide references that the Australian Gordon Parker is "an extremely well-published researcher on depression/MDD/" and worthy of mention over other well-published researchers world wide and of note to a world wide readership. Why not strive for more variety is content and sourcing, instead of so much emphasis on "English/Australian". —Mattisse (Talk) 19:36, 6 November 2008 (UTC)

Casliber is more familiar with Parker than I am, so I'll have to defer to him on that, but see here. And here, for that matter. I don't think anyone would object to some more variety, but the black dog idea is certainly interesting enough to mention in a sociocultural aspects section. Cosmic Latte (talk) 19:47, 6 November 2008 (UTC)

• Those are just references to Casliber's statements on a talk page, and he is Australian. Do a Google search of many researchers that publish a lot and you will get many results. Give a secondary source that he is important. —Mattisse (Talk) 20:17, 6 November 2008 (UTC)

• Methinks this is overkill. The article does not assert his importance (so I don't think we need a citation saying, "Gordon Parker is important, folks"), even if it implies it (which is where common sense comes in, and, based on the fact that he heads a major research/education institute and has published oodles of papers, I'd say there's enough of a common-sense reason to include him). Of course, this doesn't mean that someone else with a comparably interesting perspective should be excluded, but I'd say the onus of inclusion is upon whomever would like to diversify the section more. Cosmic Latte (talk) 20:27, 6 November 2008 (UTC)

Except that to be mentioned at all in the article , Gordon Parker needs a reference from a reliable source. —Mattisse (Talk) 02:22, 7 November 2008 (UTC)

Cosmic Latte, would you mind formatting citations that you add, per 2c of WP:WIAFA? Introducing raw URLs and unformatted citations to an article under consideration at FAC work against the nomination. Alternately, you could suggest the citation on talk and wait for others to format and add it. Thanks, SandyGeorgia (Talk) 19:53, 6 November 2008 (UTC)

Thought I fixed that here... Cosmic Latte (talk) 19:52, 6 November 2008 (UTC)

• Re "black dog". Perhaps you could explain what is fascinating about it, Cosmic Latte? I don't get it. It seems like fluff in an article that sorely needs credibility via statements that are well sourced and of interest to a world wide readership. What is fascinating about "black dog"? —Mattisse (Talk) 20:09, 6 November 2008 (UTC)

• What's fascinating is that, of all that has been written about depression, "black dog" seems to be the most enduring metaphor. The fact that Johnson's term has been kept alive by the disparate likes of Churchill and Parker is fascinating, as is its presence in several disparate facets of culture. Cosmic Latte (talk) 20:19, 6 November 2008 (UTC)

• Fascinating why? You could find many things in a culture that are "kept alive" in that culture. That is what culture is. My point is that it is a narrow reference in an article that is supposed to be relevant to a world wide readership. Also, regarding your google search for Gordon Parker, here is one for Robert Spitzer [11] who actually is important in the development of DSM and more known world wide than Gordon Parker. But he is not Australian or British/English. —Mattisse (Talk) 20:57, 6 November 2008 (UTC)

• I don't think anyone would object to saying something about Spitzer, if he has said something about depression that could fit into the article. Cosmic Latte (talk) 21:10, 6 November 2008 (UTC)
• There is, by the way, a legitimate field of study devoted to understanding the survival of certain ideas in a culture. Cosmic Latte (talk) 21:14, 6 November 2008 (UTC)

I have heard of "black dog" depression, because of Churchill. I have not heard of "Black Dog Institute" ever being mentioned in the UK. This is a bit anecdotal. Are there references about "Black Dog Institute" having relevance in the UK? Snowman (talk) 21:37, 6 November 2008 (UTC)

This is hopeless. I have repeatedly complained about this issue of "Black Dog Institute" and other mentions of material without sources that confirm its importance to the article topic in general. Posting on this talk page is useless and frustrating. —Mattisse (Talk) 21:46, 6 November 2008 (UTC)

There are two separate issues, black dog expression and the institute. Parker has been published in British and American Journals; sometimes biographies of living people written independently can be tricky to find online. More than happy for refernece to Spitzer to be embellished. Cheers, Casliber (talk · contribs) 23:31, 6 November 2008 (UTC)

We realize that, if you read the above. The question is if the "Black Dog Institute" has any relevance outside of Australia, as a UK editor above says he has never heard of it and feels it is a trivial mention, as do I. The only reference is to the institute's own web site, and it really doesn't make it sound very important to this article. However, I feel very frustrated by this article and very sick of black dog. Actually, I don't know what it means, other than a black anything can be associated with depression, "a black depression", "a black mood", "a black dog", "a black _____". It is not particularly enlightening to the degree it is mentioned in this article. —Mattisse (Talk) 23:51, 6 November 2008 (UTC)

"Black dog" was/has been singled out as a specifically notable black something to describe depression yes. I will look a bit later to see about third party refs. I am doing other stuff at the momnet off-wiki so involved searching is a bit tricky for a few hours. Cheers, Casliber (talk · contribs) 00:16, 7 November 2008 (UTC)

PS: Another reason why alot of this is tricky to establish notability is that often (but not always) the work (as it should be I guess) is focursed on ideas, theories and studies, rather than emphasising who did them (they are listed as authors obviously but often not much more is given), so sometimes a person's contribution to a field can be somewhat hard to define with sources. Just a thought. Cheers, Casliber (talk · contribs) 00:25, 7 November 2008 (UTC)

It is interesting, reading through the article, that the British are not mentioned as having contributed much of note to the field, except the literary/political/black dog references that are so emphasized. So maybe that is why the black dog stuff is clung to with such tenacity? Just asking, as it is striking when the article is read, how it diverts when the reader gets to the mushy "social and cultural" part where suddenly the Brit literary types, like Samuel Johnson, are repeatedly mentioned. Are there some real content providers from Britain who are being left out? There are Americans (Lincoln, Styron) who wrote vividly of depression, but no quotes from them. The black dog stuff I find empty without further elaboration. It is just a phrase repeated over and over, unless something meaningful can be added. —Mattisse (Talk) 02:18, 7 November 2008 (UTC)

?The metaphor is mentioned once in the text and once in a textbox, and once (referring to the institute again) again. This is hardly "over and over". Mapother is English, and a brief not on English pracitce in the next sentence. We could easily write an article double or triple the size, the key is to sifting out the most notable. I was waiting for Awadewit to add something too. Cheers, Casliber (talk · contribs) 03:03, 7 November 2008 (UTC)

That is over and over to me, for a reference that has little meaning to others than UK/Austrialians. It is not clarified or amplified so that others from a non UK/Austrialian culture would understand. It is not linked to anything. It is just repeated over and over. Other than Samuel Johnson, who similarly is repeated, is there anything else in the article that is repeated, pardon me, so repetitiously? —Mattisse (Talk) 03:18, 7 November 2008 (UTC)

Addendum: Perhaps you should include the picture of the black dog, as for some reason I always think it is an alcoholic beverage when I see "black dog". —Mattisse (Talk) 03:26, 7 November 2008 (UTC)

Your comment about Brits & depression reminded me of an article that I just managed to find again - doctors realized he wasn't depressed at all…..........only Scottish (the English of course just have Stiff Upper Lip) EverSince (talk) 03:30, 7 November 2008 (UTC)

ROFL Cheers, Casliber (talk · contribs) 05:09, 7 November 2008 (UTC)

Can we use this in the "differential diagnosis" section? :-) /skagedal^... 08:47, 7 November 2008 (UTC)

• I think that the bit about Samuel Johnson and his "black dog" serves as a nice illustration of the topic, made more relevant by the subsequent use by Winston Churchill. It is a bit arbitrary of course, as any illustration will be. I do agree with Mattisse on that "the term lives on in the Black Dog Institute, an Australian facility for research and education into mood disorders such as major depression and bipolar disorder" is undue. There are many such facilities, it is not clear why this one is special, and also this sentence strays away from the topic in the secion.
• As for a general English/Australian bias, I don't really see this problem; I think a much greater problem with the section is the gender bias that was previously mentioned. /skagedal^... 08:47, 7 November 2008 (UTC)

• That also. It has been mentioned many times previously. The article's major editors says this reflects the fact that the article editors are male. I have given up on this point, as I cannot manage to get it to be seriously considered. —Mattisse (Talk) 16:32, 7 November 2008 (UTC)
• Agree with both Mattisse and Skagedal that the reasons for mentioning the Black Dog Institute link are pretty lame. It's a metaphor. Somebody, somewhere on the other side of the world from me repeated a metaphor that was coined and popularised by two notable individuals. Big deal. Colin°^Talk 17:00, 7 November 2008 (UTC)

• Except that this "somebody, somewhere on the other side of the world" is also notable. But since there doesn't seem to be consensus either way, and since this is a medicine-related article, perhaps we can default to the Hippocratic position that, hey, it's not doing any harm. *G* Cosmic Latte (talk) 10:03, 8 November 2008 (UTC)

Erm, the fact that he is part of a feature discussing diagnosis here in the British Medical Journal and holds a professorial position and chairs a unit specialising in mood disorders suggests his opinion is valued by some. I suspect the peer-reviewed BMJ know what they are doing when they have a debate like this on in their journal. Nevertheless I do know what folks are getting at with the use of teh metaphor WRT an australian institute and am rereading teh section again given we have so many bits and pieces jostling for a ghuenrsey as it were. Cheers, Casliber (talk · contribs) 06:29, 9 November 2008 (UTC)

PS: Did think, and ultimately we have so much valuable material jostling for spots in teh article that the 'colour' I added about the institute I have removed; ultmiately would I be mentioning it if it were not called "Black Dog"? Answer, very unlikely, hence removed. Cheers, Casliber (talk · contribs) 06:42, 9 November 2008 (UTC)

Use of boldface

Under "Subtypes" and "Differential diagnoses", the entries in the bullet lists start with a bolded term. Is this really supported by MOS:BOLD? Can they be considered "definition lists"? /skagedal^... 10:05, 7 November 2008 (UTC)

The emboldened blue links (as headings) seem to be inconsistent with the rest of the formatting, and probably should be unemboldened, pending on what MOS says. Snowman (talk) 10:42, 7 November 2008 (UTC)

I suppose they are follwed by a definition of sorts afterwards (?) Cheers, Casliber (talk · contribs) 11:27, 7 November 2008 (UTC)

WP:MOSBOLD treats lists like that in bold (before, they were in italics, which is incorrect); it's very common throughout Wiki. Although the bolding is not incorrect, removing it wouldn't raise any eyebrows (I don't think): the italics were incorrect, though. SandyGeorgia (Talk) 16:03, 7 November 2008 (UTC)

Biopsychosocial model vs. Diathesis-stress model

Under "causes": In the biopsychosocial model, both biological and psychological (including social) factors play a role in causing depression. I find the second link to be problematic: first, it's somewhat easter-eggish; second, it's a very long link; third, it seems to explain the biopsychosocial model by referring to the diathesis-stress model. The reader wonders, are they the same model? If so, why two different articles? (The two articles, while covering two very similar topics, do not even refer to each other... I think I'll at least add some "see also" links.) I'm not sure I know enough about the theoretical differences to suggest a good alternative. /skagedal^...

Yes that phrasing is problematic and I was planning to change it back when I next edited that section, because they are two different models (though sometimes complimentary) and one shouldn't be explained as if it's the other (esp. by wrongly subordinating social causes to parentheses). EverSince (talk) 16:59, 7 November 2008 (UTC)

Also, the article never explains what psychosocial means, although it mentions the term at least twice, once under "Evolutionary hypothesis" and once under "Social". I suggested on the FAC page that perhaps there could be a psychosocial section, since there are several social psychologists and social learning theorists mentioned under "Psychological". A separate section could then explain the term. (Or, failing than, move the social psychologist to be under "Social"). —Mattisse (Talk) 22:19, 7 November 2008 (UTC)

I've reworded the causes section a bit. Hopefully that'll resolve most of these concerns. See what you think. Cosmic Latte (talk) 19:04, 8 November 2008 (UTC)

Good, I like it! Also, there probably should be some sources for the two models... /skagedal^... 19:19, 8 November 2008 (UTC)

Incomplete citations

Some of the citations are incomplete. Some are missing page numbers. Others are missing ISBN/ISSN/OCI/PMID/etc numbers. Could someone more familiar with the source material and citations correct this? Vassyana (talk) 13:06, 7 November 2008 (UTC)

Which ones? Not all journals are indexed by PubMed... /skagedal^... 13:19, 7 November 2008 (UTC)

While not all journals have PMIDs available, it would be exceedingly unusual for the article itself (or the journal issue, depending on which identifier is used) to not have an ISBN, SICI, DOI and/or similar identifier used. At the very least, the journal itself should have an ISSN available. Also, some books cited in the article lack ISBN numbers. Vassyana (talk) 14:41, 7 November 2008 (UTC)

Be careful...

Earlier the intro had a statement about neurotransmitters being implicated in depression. Someone changed that to state that they are involved, but I changed that back to something like the original wording. Be careful not to commit the treatment-aetiology fallacy (the Latin name escapes me), inferring from a (more or less) successful treatment (e.g., raising serotonin levels in the synapses) that the cause of the problem is the opposite of the treatment (e.g., low serotonin levels in the synapses). I'm saying this, partially because it's fun to point out, but more importantly as a deterrant to anyone who might feel tempted to simplify the language so as to say that neurotransmitters are aetiologically involved. Cosmic Latte (talk) 15:42, 7 November 2008 (UTC)

I think your edit is ok, and as far as I can see the meaning has not been changed by your edit. It did not say that they are "aetiologically involved" it said "neurotransmitters are involved in depression". which is very similar to "implicated in depression"? Snowman (talk) 17:31, 7 November 2008 (UTC)

I guess the difference is subtle, but still important. "Implicated" suggests that there's evidence of their involvement (just like if you're implicated in a crime, then there's evidence that connects you to it, but still doesn't prove your guilt). Cosmic Latte (talk) 18:05, 7 November 2008 (UTC)

Suicide numbers

Those in the opening paragraphs don't have a references. There are some numbers further below, but whoever added them did not read the papers carefully. For instance, the 15% is historical number used in 1970, and the 2000 AJP paper cited (http://ajp.psychiatryonline.org/cgi/content/full/157/12/1925) simply uses it in the abstract as basis of discussion, but finds different numbers, namely:

There was a hierarchy in suicide risk among patients with affective disorders. The estimate of the lifetime prevalence of suicide in those ever hospitalized for suicidality was 8.6%. For affective disorder patients hospitalized without specification of suicidality, the lifetime risk of suicide was 4.0%. The lifetime suicide prevalence for mixed inpatient/outpatient populations was 2.2%, and for the nonaffectively ill population, it was less than 0.5% —Preceding unsigned comment added by Psychotropic sentence (talk • contribs) 17:38, 7 November 2008 (UTC)

Too many edit conflicts, but agree that the text about suicide numbers doesn't seem supported by the citation given, and now the lead also disagrees with the numbers cited in the body. SandyGeorgia (Talk) 18:54, 7 November 2008 (UTC)

Hopefully that's all fixed now. Cosmic Latte (talk) 19:58, 7 November 2008 (UTC)

(edit conflict, afraid not fixed) There were two citations (also PMID 11437805) and the wording was changed since I'd added them - the first as mentioned above was the paper that showed that the old 15% hospital figure was being wrongly generalized in textbooks (and still crops up around the place), and the second paper gave updated population figures specific to modern major depression dx (the first covered a jumble of affective disorders). Needs staightening out. I'll also add the previously mentioned differnet gender picture that emerges from the stats on attempts and non-suicidal self-harm. EverSince (talk) 20:23, 7 November 2008 (UTC)

Three people editing this, and we still have an uncited 2.2% in the lead, but 3.4% in the text. Many cooks in the kitchen :-) Additionally complicated by the fact that PMID 11437805 is not a review; it would be best to get a recent, authoritative review for one set of data. SandyGeorgia (Talk) 22:49, 7 November 2008 (UTC)

I've finished some editing now (still not formatted ref ideally), is at least consistent again. There are several problems still... that article isn't technically a review but it is a summary, but a more recnet broader & international review would definitely be better, prob is they tend to be on suicide generally and not enough detail on depression or come from a different angle, or if on dep not enough on suicide stats. Also the baseline suicide rate varies substantially by country, so is difficult to compare; not sure how much it varies re depression specifically. EverSince (talk) 23:34, 7 November 2008 (UTC)

Thx btw for fixing the new citation, had tried unsuccessfully to use full text link in Diberri thing EverSince (talk) 05:34, 8 November 2008 (UTC)

Can't remember if I left this here (how to search PubMed for free, full-text reviews, and how to use Diberri): Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. SandyGeorgia (Talk) 05:44, 8 November 2008 (UTC)

Oh I know yeah, it's just Diberri seems to only work with via a PMID number rather than a URL... EverSince (talk) 06:22, 8 November 2008 (UTC)

Subtypes

Earlier versions didn't refer to DSM at all,[12] but the current version specifically refers to the DSM, yet contains text and a citation referencing ICD,[13] so I'm not sure what's up there. Since I don't have any of the full-text of the sources, I can't verify the text: just asking. SandyGeorgia (Talk) 21:19, 7 November 2008 (UTC)

I would be happy if DSM were removed from the article entirely, as the article misrepresents its category of Major depressive disorder. The article tries to straddle both justifying its title by referencing DSM and its focus on general depression, since almost none of its references include mention of Major depressive disorder. Further, there is still no reference that DSM is lingua franca around the globe. Having been trained very strictly to follow DSM criteria, as I think most US practitioners are, this is very distressing. —Mattisse (Talk) 22:06, 7 November 2008 (UTC)

All that section does refer to classification within DSM IV TR yes. Cheers, Casliber (talk · contribs) 23:30, 7 November 2008 (UTC)

Comorbidity section

Comorbidity with depression is not an unusual topic. The section came in to the FAC looking like this, but now has typos and grammatical errors, and is straying from the topic of comorbidity. Besides the need for a copyedit (that has been introduced by changes made during the FAC), I'm unclear why the focus is straying to individual researchers and their background and primary studies, rather than citing text to recent peer-reviewed secondary sources. Perhaps a rewrite can be sourced to a high-quality secondary review. SandyGeorgia (Talk) 23:35, 7 November 2008 (UTC)

I would be happy if the whole reference to Ellen Frank were removed, as the reference [14] does not add to the article and I am puzzled why it is there. —Mattisse (Talk) 00:17, 8 November 2008 (UTC)

Also I added tags as I was surprised that most of the statements were unsourced. Perhaps that was wrong of me, but I have found that complaining on the talk page or on the FAC has no effect. So I decided to interfere. —Mattisse (Talk) 00:20, 8 November 2008 (UTC)

Perhaps a more organized approach would make it easier on all: the FAC is one of the messiest seen in months, with multiple sections saying the same thing. Prose errors are now complicating the other matters:

American psychiatrist Ellen Frank, developer of Interpersonal and social rhythm therapy, in a study the c onceptualization and rationale in the definition major depressive disorders, concluded that research on depression needed more consistency in the "definition change points in the course of illness".

SandyGeorgia (Talk) 00:54, 8 November 2008 (UTC)

This article would be better off if it did not rely on so many primary sources for general statements. —Mattisse (Talk) 00:22, 8 November 2008 (UTC)

I still don't understand why the text is chunked up with extra detail on personalities. For example:

• American psychiatrist Ellen Frank, developer of Interpersonal and social rhythm therapy, in a study on the conceptualization and rationale in the definition of major depressive disorders, concluded that research on depression needed more consistency in the "definition change points in the course of illness".

could be:

• A study on the definition of major depressive disorders concluded that research on depression needed more consistency in the "definition change points in the course of illness".

There are names mentioned throughout: perhaps an article on the History of depression or History of the DSM needs to look at individuals, but does this article need so much mention of personalities ? For that matter, I'm unclear why any of the text above is needed, as it relates to comorbidity. There is so much to be said about comorbidity and depression, that I'm not clear what that convoluted construct is adding. The earlier version made more sense to me. SandyGeorgia (Talk) 04:08, 8 November 2008 (UTC)

Remove reference to Ellen Frank's article, remove her. That is what I recommend. Her article disagrees with what is being advocated here anyway. —Mattisse (Talk) 04:13, 8 November 2008 (UTC)

Glad you said that as I was about to as well :) Cheers, Casliber (talk · contribs) 04:24, 8 November 2008 (UTC)

ECT

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

Gosh, when did that happen? Oh well...time to clean up..Cheers, Casliber (talk · contribs) 01:33, 8 November 2008 (UTC)

Well some of the changes could no doubt be argued & there's advantages to some of the new sources...just difficult when other reliable soruces removed without discussion. EverSince (talk) 02:00, 8 November 2008 (UTC)

Yeah, a fly-by person with a strong point of view too..(in Hx)Cheers, Casliber (talk · contribs) 03:51, 8 November 2008 (UTC)

Rating scales section

The prose in the Rating scales section has also noticeably deteriorated: each time I check back in here, I'm finding new prose errors introduced. Text that was copyedited at the initiation of the FAC now has errors. When I checked prose yesterday, the Rating scales section looked like this. (I'm unclear why this article is going in to so much detail about personalities involved: those details should be in the rating instrument articles, but I guess that's a choice made in this article.) The last version I checked has grammatical and prose errors and snakes for chopping. Beck is introduced after it's discussed. MADRS is found to be the equivalent of MADRS. The Inventory is a tools (plural). Although clauses abound.

The two most commonly used rating scales completed by clinicians are the highly regarded Hamilton Depression Rating Scale (HRSD-21) designed by psychiatrist Max Hamilton in 1960, although there is increased criticism that it is flawed both as a test instrument and in its conceptual basis, and the Montgomery-Åsberg Depression Rating Scale (MADRS), found to be the equivalent of the Beck Depression Inventory and the MADRS. The Beck Depression Inventory is the most commonly used tools which is completed by the patients themselves, although scales completed by observers are more common. Originally designed by American psychiatrist Aaron T. Beck in 1961, it is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex and thoughts including feelings of guilt, hopelessness or of being punished.

I've not seen another article at FAC deteriorate quite this dramatically; perhaps the editing pace here can slow down, with a better organized list of changes needed (the FAC is a shotgun blast at best) and more discussion before changes are introduced ? I suggest a thorough review of the daily diff to pick up prose errors. SandyGeorgia (Talk) 00:41, 8 November 2008 (UTC)

(ec) The trouble is that primary sources are used in misleading statements. This has been a constant problem throughout the article. But the rating scales section is particularly bad in this regard. Or maybe I have just noted it because I have been complaining about it since the beginning. The sources simple do not support the statements. Since I have complained endless about this, to no effect, I modified the statements to fit the sources. I do not know what else to do to draw attention to the problem. I am very frustrated. Making comments on the FAC and endless talk page discussions have no effect. Nada. —Mattisse (Talk) 00:54, 8 November 2008 (UTC)

There's no need for frustration, as there aren't really deadlines on Wiki. Casliber has stated several times that he's getting to things as fast as he's able, but with this much deterioration, it's become a moving target. Now the article has 1) copyedit errors that need attention, and 2) a FAC that is so convoluted it's hard to see what remains to be done. It would help if reviewers struck and cap items as they are completed, kept comments to one section, and took a more organized approach to presenting issues. SandyGeorgia (Talk) 01:01, 8 November 2008 (UTC)

Something is off here as well:

• Existential and humanistic approaches are generally grouped together, representing a forceful affirmation of individualism, as does phenomenological approach pioneered by American psychologist Carl Rogers.

Grammar error, and no idea what it says or how it relates. SandyGeorgia (Talk) 00:49, 8 November 2008 (UTC)

Sorry about that. I was going to improve the section but I decided it wasn't worth it. Sorry to have left that in. I was annoyed at the seemingly random way they describe this section as humanistic and existential are not exactly related and Carl Rogers, the "father" of humanism was actually important. Far more so that that Gordon Parker who they insist on promoting, without any references, other than primary, as to his general importance. But who cares about another "father" and who cares if that section is the jumble it has been all this time or whether it actually says something meaningful. I am very frustrated. Sorry. You can just delete my attempts as I will not bother with that section. —Mattisse (Talk) 00:59, 8 November 2008 (UTC)

Actually, what is there without my addition doesn't relate. However, if you allow the name of this article to change, I will cease having any investment in what it says. It is only that it is so misleading that I am involved. I have worked on other diagnositic articles without this problem of insistence on using a DSM category in a misleading way. —Mattisse (Talk) 01:02, 8 November 2008 (UTC)

Well, we're running into another issue: with this pace of frenzied editing, I'm pretty sure everyone here has passed 3RR many times a day for many days. I'm no longer sure who can correct what, but I suggest a slower and more deliberative approach to addressing issues would be helpful. SandyGeorgia (Talk) 01:04, 8 November 2008 (UTC)

I am not sure of what constitutes a 3RRR, but I am not aware of anyone changing what I have done or visa versa. I have made edits to relatively confined areas. I am not responsible for the rest of the deterioration. Perhaps others are growing frustrated also. The talk page is useless. There is no way to get a response. And when a response is given, it is often misleading. Now, I feel I have to second check everything. Sorry. —Mattisse (Talk) 01:08, 8 November 2008 (UTC)

Except for some wikilinking, I have not edited the article for a long time, until today. This afternoon I edited the article. But, as I said, to relatively confined areas. And I have never edited the lead, the ETC section or anything to do with suicide. Mostly rating scales, except for ill fated desire to fix the psychology section.

I have added nationality and occupation to names over the days, but that was agree to on FAC. —Mattisse (Talk) 01:12, 8 November 2008 (UTC)

No-one has actually reverted in the 3RR sense, but there is an aligning going on between sources and prose which needs fine tuning and some substitution of references for better ones, and some comprehensiveness issues addressed. I looked at the changes between when I went to bed and this morning and I initially thought it was going to be massive when I looked at the history, but it wasn't that extensive and the fine tuning was ok. Snowman has done a great job at reducing some jargon which until he came along all of us had missed as we were/are all familiar with many of the words. I will have another look now. Cheers, Casliber (talk · contribs) 01:26, 8 November 2008 (UTC)

I recommend a solid review by all editors here of WP:3RR to avoid confusion, noting the limited exceptions, and recalling that bad faith 3RR reports are easily filed, and editors have been blocked. There's no exception for "we were all discussing in an open and collaborative manner and working together on a FAC": the page is clear, and I've seen bad faith reports filed, and editors blocked. Of course, I would come out of my skin if I saw it happen to someone working on a FAC, and I'd protest, but sometimes that doesn't help, and based on other 3RR reports I've seen, I wouldn't be surprised at anything anymore. I recommend caution. For the record. SandyGeorgia (Talk) 03:51, 8 November 2008 (UTC)

PS: Yes, the changes have been discussed in an open and collaborative manner, the nationality/occupation prefixes are the only actual reverts I vcan think of. Cheers, Casliber (talk · contribs) 01:43, 8 November 2008 (UTC)

Could you make sure that primary sources are not used as much as they are, and if they are used (there are a lot of them) that they do not misstate what the source actually says? That is a problem with this article in that regard. For example, a source states that a rating scale is out of date and has construct validity problems, and that source is used as a reference to say the rating scale is a "gold standard" just because the source intro says the scale was long considered a "gold standard" but goes on to say there are this and that problem with the scale and says, in essence, that it is not a "gold standard". Do you not think that is misleading? —Mattisse (Talk) 02:01, 8 November 2008 (UTC)

The more I look at that the more I am thinking that this is better relegated to the Hamilton scale page, as it is difficult to explain succinctly and is possibly in too much depth, as it requires more elaboration that the parent article can give, and anyway these are more research than clinical tools, so just touching on things is better. Cheers, Casliber (talk · contribs) 03:28, 8 November 2008 (UTC)

Agree, as I don't think rating scales are important to primary diagnosis as much as is the clinical interview, and so much mention of individual ones is just more unclarified verbiage for the general reader, however preoccupied professionals may be with them. —Mattisse (Talk) 03:37, 8 November 2008 (UTC)

Btw Major Depression Inventory is another one, is also interesting regarding the naming issue since designed to cover both DSM & ICD EverSince (talk) 03:42, 8 November 2008 (UTC)

Can someone rearrange that paragraph now to minimize the snakes, and get the flow corrected (Beck discussed before it's mentioned in passing, and lowering all the although clauses and disclaimers)? The flow in the original version (linked above) was pretty good. SandyGeorgia (Talk) 03:53, 8 November 2008 (UTC)

OK - I am thinking of removing

Originally designed by American psychiatrist Aaron T. Beck in 1961, it is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex and thoughts including feelings of guilt, hopelessness or of being punished.

as it is pretty obvious, I would have thoguht, what questions are going to be asked (they ain't going to ask about shoe size are they...) Cheers, Casliber (talk · contribs) 04:35, 8 November 2008 (UTC)

Too much detail throughout: that level of detail can come from the Beck link. This article should stay tightly focused on the condition (not the people, not the instruments, not the history of the DSM, and so on). SandyGeorgia (Talk) 04:37, 8 November 2008 (UTC)

Done. Cheers, Casliber (talk · contribs) 05:14, 8 November 2008 (UTC)

Recent epidemiology reviews

Here are some recent reviews that might be helpful in improving Major depressive disorder #Epidemiology.

• Patten SB, Bilsker D, Goldner E (2008). "The evolving understanding of major depression epidemiology: implications for practice and policy" (PDF). Can J Psychiatry. 53 (10): 689–95. PMID 18940037.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Patten SB (2008). "Major depression prevalence is very high, but the syndrome is a poor proxy for community populations' clinical treatment needs" (PDF). Can J Psychiatry. 53 (7): 411–9. PMID 18674395.
• Andrews G (2008). "Reducing the burden of depression" (PDF). Can J Psychiatry. 53 (7): 420–7. PMID 18674396.

Someone also asked about depression in women: here's a reliable review (though not as recent):

• Kessler RC (2006). "The epidemiology of depression among women". In Keyes CLM, Goodman SH (eds.) (ed.). Women and Depression: A Handbook for the Social, Behavioral, and Biomedical Sciences. Cambridge University Press. pp. 22–40. ISBN 0-521-83157-1. {{cite book}}: |editor= has generic name (help)

Eubulides (talk) 09:12, 8 November 2008 (UTC)

Thanks for that; will have a look. Cheers, Casliber (talk · contribs) 12:38, 8 November 2008 (UTC)

Carl Rogers

I generally like Carl Rogers (as I do Carl Jung), but I'm worried that the reference to him may be a bit tangential (just as I was worried about the image of Jung proposed earlier). If we're going to mention Rogers, then we should probably say something about what he thought about depression. Unfortunately, I'm not aware of his views on depression specifically. Is anyone else? If not, then do we really need to mention him? (As it stands, when I see his name in the beginning of the paragraph, I'm naturally expecting to read something about his theories before the paragraph is over.) Cosmic Latte (talk) 10:26, 8 November 2008 (UTC)

By the way, he said plenty about "psychopathology" in general (see Carl_Rogers#Psychopathology), and although I'm fine with using melancholia/depression/MDD more or less interchangeably, "psychopathology" is just too broad. So again, does anyone know his views about the relatively specific type of psychopathology that we're discussing in this article? Cosmic Latte (talk) 10:31, 8 November 2008 (UTC)

Only mention Rogers if he said something specific re depression, otherwise not; we could mention loads of people in that case. I think we have plenty in the article already and wouldn't be hunting out Rogers references. Cheers, Casliber (talk · contribs) 12:16, 8 November 2008 (UTC)

Agreed and fixed. Cosmic Latte (talk) 14:39, 8 November 2008 (UTC)

Why is Heidegger mentioned in footnotes? Has he "said something specific re depression"? If so, it should be referenced. —Mattisse (Talk) 21:40, 8 November 2008 (UTC)

Treatment

The section mentions medication and psychotherapy as if it was one or the other. Generally, if it was for severe depression, then both might run simultaneously to make the outcome quicker. Years ago, I am sure I have heard of papers showing the quicker effectiveness of medication with psychotherapy than with psychotherapy by itself. Combined treatment is an omission. Snowman (talk) 13:06, 8 November 2008 (UTC)

Slaps hand on forehead) I thought it we had it in (?) ...ok, off to find it. Cheers, Casliber (talk · contribs) 19:04, 8 November 2008 (UTC)

Combined treatment is in the second sentence of the Psychotherapy section, but another account in the next section, the medication section, just mentions medication or treatment. It is in but it is spread over two sections. Snowman (talk) 19:48, 8 November 2008 (UTC)

Fonagy and Roth's 1996 book What Works for Whom was a definitive text on effectiveness and evidence to date; I read it yesterday afternoon and info was surpirislingy sparse and vague on the point. I did recall seeing something else somewhere...Cheers, Casliber (talk · contribs) 18:54, 9 November 2008 (UTC)

Illness

Note that the term "condition" is being used deliberately rather than "illness" in the intro. I often say "mental illness" myself, but if we really want to be WP:NPOV, we've gotta acknowledge that medical-model terminology is a matter of debate. Note that even mental illness is a redirect to mental disorder. Cosmic Latte (talk) 14:30, 8 November 2008 (UTC)

"Affliction" might work, though, if "condition" sounds too bland. Cosmic Latte (talk) 14:46, 8 November 2008 (UTC)

But the article "mental disorder" implies that "mental illness is a synonym. This indicates that MDD is an illness, and there is no POV issue. Snowman (talk) 17:18, 8 November 2008 (UTC)

My mention of the redirect was sort of a side note, as WP isn't really supposed to be self-referential. See the external link for my main point. Cosmic Latte (talk) 17:26, 8 November 2008 (UTC)

Unwatch

I'm going to unwatch now that things seem to be somewhat on track, but I hope the comprehensive issues will be addressed soon (the gender bias section above, how to work in more about women, I left a link there to a recent full-text review, and Eubulides left some reviews on epidemiology, I suspect Comorbidity needs a new look), use of primary sources should be reviewed and replaced with high-quality secondary source reviews where indicated, and I hope the FAC will stay on track now ... rather than massive multiple repeat sections on the FAC page, it would be helpful if someone would generate a succint list of remaining work so the FAC can stay somewhat readable. SandyGeorgia (Talk) 15:47, 8 November 2008 (UTC)

Images

I've added a few more images--all properly sourced, as far as I can tell--and I hope that the extra colour is a welcome addition to the article. But please feel free to modify or remove them if they look too clunky. Cosmic Latte (talk) 16:51, 8 November 2008 (UTC)

I'd vote for the picture of the hippocampus going away. I'm a hippocampus specialist myself (I created the image you added, from a Gray's Anatomy picture), and I think the case for it playing a major role in depression is pretty weak -- the discussion in the article is okay, but adding the picture gives it too much weight in my opinion. A picture of the Raphe nuclei and their projections would be more appropriate -- I'm not aware of a usable one, though. The other pictures look good to me. looie496 (talk) 17:02, 8 November 2008 (UTC)

I like it, except for the Maslow "hierarchy of needs" triangle. It seems to take over that whole section, and frankly isn't all that relevant. /skagedal^... 17:04, 8 November 2008 (UTC)

Thanks for the input, both of you. I went ahead and removed those two images. Cosmic Latte (talk) 17:08, 8 November 2008 (UTC)

I managed to find and add a much smaller version of Maslow's hierarchy. The original one didn't like to display properly unless it was set at precisely a whopping 400px. But if you still feel that relevance is an issue, I'll understand. Cosmic Latte (talk) 19:31, 8 November 2008 (UTC)

More images of molecular structures of drugs and neurotransmitters could be added. Some illustrations are made to have the 3D appearance. Snowman (talk) 20:00, 9 November 2008 (UTC)

Fluoxetine (Prozac) is probably the most famous antidepressant, is the most prescribed, and was (I think) the first FDA-approved SSRI. I added a 3-D image of fluoxetine a while back, but Paul replaced it with the Isoniazid picture that's now in History. I like visual aids (can you tell?), though I hope we don't get too carried away, as there are already two chemical-structure images on the page. Cosmic Latte (talk) 20:54, 9 November 2008 (UTC)

On seeing the 3D image, it is not as informative (to me anyway) as the molecular structure. Snowman (talk) 22:56, 9 November 2008 (UTC)

New image on page

Is there a personality rights issue with using the image of poor street children in this article? Snowman (talk) 17:27, 8 November 2008 (UTC)

Probably not any more than there is with any of the countless other pics of living folks that are on WP. Cosmic Latte (talk) 18:29, 8 November 2008 (UTC)

I think that there is a problem here, as the children might not want their images to be reproduced on such a page as this. They are minors. The image needs immediate unlinking in my opinion. Snowman (talk) 19:29, 8 November 2008 (UTC)

That's a bit of a stretch IMO. Lots of people do/don't want their pictures taken, and if anything, children are probably more enthusiastic about seeing themselves on film than self-conscious adults are. The image is properly sourced. If there are genuine legal concerns with it, which somehow don't apply to other pictures of living people, then I'd be open to removing it. Cosmic Latte (talk) 19:45, 8 November 2008 (UTC)

I wonder what Anne Geddes would think about all of this... Cosmic Latte (talk) 19:51, 8 November 2008 (UTC)

They look too young to understand the consequences and give consent themselves. Do you have their parents permission? Snowman (talk) 19:52, 8 November 2008 (UTC)

I didn't take the picture. Whether or not it was morally proper for this photograph to have been taken and uploaded to Commons is a matter for the photographer's conscience to contend with. But as editors, the facts before us are: It's on Commons, it's perectly legal (as far as I am aware), and it's germane to the article. Cosmic Latte (talk) 19:59, 8 November 2008 (UTC)

I would leave it out pending an experts opinion on what "Personality rights" are as applied to images of young children possibly taken without their parents consent. See Personality rights. Snowman (talk) 20:20, 8 November 2008 (UTC)

(deindent) Don't want to put another spanner in the works 'cos I personally never have any luck finding appropriate images, but need to be careful about the difference between findings on relative socioeconomic disadvantage in Western societies, vs poverty in other parts of the world; rates of Western-defined Depression probably do'nt show the same associations to both. EverSince (talk) 04:41, 9 November 2008 (UTC)

I have to add I also feel uncomfortable with the image - very tricky to link a pic of kids to an article on a mental illness. We just had a discussion on the schizophrenia talk page with this image Image:The Schizophrenic House.jpg to illustrate delusions. Cheers, Casliber (talk · contribs) 10:18, 9 November 2008 (UTC)

Update: user Cosmic Latte has unlinked this image of children. Snowman (talk) 18:48, 9 November 2008 (UTC)

Source

Would this be sufficient for the tag regarding Feighner and the RDC in 20/21st century? Its by Spitzer (who did the RDC) saying they based it on Feighner and the DSM built on RDC.Fainites ^barley 18:08, 8 November 2008 (UTC)

Looks good to me! Cosmic Latte (talk) 18:30, 8 November 2008 (UTC)

OK. I'll stick it in when I get a proper turn on the computer. Fainites ^barley 18:44, 8 November 2008 (UTC)

According to that source, at least one of the authors of the Feighner criteria (sic) - otherwise known as the Feighner Criteria, was a psychologist, and psychologists and research by psychologists was part of the process of developing DSM, so that fact should be added if this informal source is used, per Spitzer. —Mattisse (Talk) 18:51, 8 November 2008 (UTC)

That source doesn't say psychologists plural played a significant role developing the DSM-III - it says they (& probably referring primariy to Rosenhan) were instrumental in showing "the sorry state of pscyhiatric diagnosis". It explicitly says "a small group of psychiatrists developed the Feighner criteria" (a load of artifically medicalized criteria to artifically improve inter-rater reliability, regardless of validity). It only mentions one psychologist, Jean Endicott, as having a role in modifying some of them for the RDC (incidentally, by the way, she is described elsewhere as an academic in a psychiatry dept, who has long pushed for some forms of premenstrual distress to be classed as a psychiatric disorder, and worked with the pharmaceutical company Eli Lilly to* help them rebrand Prozac (just as its patent was running out) as Sarafem in order to* "treat" it). Anyway, perhaps there's other sources on involvement of psychologists, but for now I think the new wording in the section obscures the fact that virtually all were (research-oriented) psychiatrists (male, white etc, which almost goes without saying I guess) EverSince (talk) 22:37, 12 November 2008 (UTC) (*& to get the diagnosis voted in by committee in the first place) EverSince (talk) 23:11, 12 November 2008 (UTC)

How about supplying some sources before getting into a POV rant? —Mattisse (Talk) 00:01, 13 November 2008 (UTC)

Sources for what? I've pointed out that the source doesn't support the word change (my "rant" presumably being the one sentence in parantheses). EverSince (talk) 00:18, 13 November 2008 (UTC)

I suggested the word "clinicians" as a safe altenative, as a variety of researchers were/have been inolved. Cheers, Casliber (talk · contribs) 00:28, 13 November 2008 (UTC)

I can appreciate that, but it was basically a group of research-oriented psychiatrists. Btw I also now notice wording has been changed so it incorrectly states (while still citing a source I added on concepts of major depression) that the term "major depressive disorder" was incorporated into DSM-III - in fact the DSM-III and DSM-III-R used "major depression" EverSince (talk) 01:32, 13 November 2008 (UTC)

O.K. Just supply a reference. At the beginning of DSM-II, the names of two M.D.s and one Sc.D. are given, saying they served as "consultants to the APA Medical Director and approved the final form of the Manual before publication" in 1967. I can't find my DSM-III, but you are probably right about the diagnostic label, showing the evolution of the term into its current fixed state did not occur until DSM-IV. (Suppose it is changed again! What will Wikipedia do?) —Mattisse (Talk) 01:55, 13 November 2008 (UTC)

This is'nt to do with the DSM-II. Reference for what, it states in the one above that it was psychiatrists with odd exception. EverSince (talk) 03:54, 13 November 2008 (UTC)

inline notes

I am using inline notes as a last resort. I have found that talk page comments are largely ignored or answer by irrelevant replies on another subject, or merely with threads that are discursive and chatty, or photos posted meant to dismiss comments. Comments on the FAC page are ignored. After several weeks, I am losing hope. —Mattisse (Talk) 18:42, 8 November 2008 (UTC)

Yes, the tags are very helpful for this article. I think I can change a few primary sources. I am busy so my time is in bits and pieces for a few days but can get there. Cheers, Casliber (talk · contribs) 22:44, 8 November 2008 (UTC)

Yeh will try to address in due course; the biopsychosocial reviews I posted above cover some of it. I'm wondering if it would be best to cover within a causes subarticle first (what to call it though), then consider how to address within the word count constraints here. EverSince (talk) 04:45, 9 November 2008 (UTC)

I have to say though, I'm unclear how a 2008 peer-reviewed "meta-analytic review" is a "primary source only" and better replaced with a 2002 psychiatric textbook... EverSince (talk)

Also not comfortable with some of the other sources (whcih as well as providing new data, summarize the existing) being replaced by nonspecific textbooks that are several years older, which probably cover it less progressively & sourced to even older studies (I recall the psychiatrist in a Simpsons episode telling Bart to stop messing around climbing on the shelves in his office because "most of those books haven't been discredited yet". EverSince (talk) 05:14, 10 November 2008 (UTC)

I know it is frustrating - I guess my take on it is the book/review article forms the 'core' of an article, and the studies act as dressing if need be and thus are aligned with their sources (eg. A 1988 multicentre study reported...x), and thus the issue of synthesis is avoided. I have been trying to look for review articles to place here. The book I used is like a big fat review article wirtten by a load of psychiatrists and epidemiologists which was very notable (and cost $200!!) when it came out, and is a fascinating read. Cheers, Casliber (talk · contribs) 03:40, 12 November 2008 (UTC)

I don't disagree with that, and no doubt that 2000 book on unmet need in psychiatry is excellent. It's a shame that along the way an important sourced (2008) point has been deleted - that the association found between early adverse events and later major depression can be at least partly due to the fact that an adverse environment has itself persisted from childhood through adolescence. I might try to cover it again. EverSince (talk) 22:07, 12 November 2008 (UTC)

Sorry about that, listen, a good idea may be to place material removed into the to-do box at teh top of the page for a future cuases of depression page down the track like what has happened with schizophrenia. That way, it won't get archived and lost on talk pages or in diffs. Cheers, Casliber (talk · contribs) 00:24, 13 November 2008 (UTC)

Philosopher Heidegger used as reference under "Causes - Psychological " is inappropriate

Presumably we are seeking to provide scientifically validated data in this section. However interesting a philosopher's opinion is, it does not provided support for psychological data for the causes of Major depressive disorder. Perhaps he could go under cultural influences or somewhere. I have objected to this but my objections have been removed. —Mattisse (Talk) 19:17, 8 November 2008 (UTC)

If we're seeking "scientifically validated data," then we'll have to eliminate the entire sections on psychoanalysis and existentialism and humanism. If one wants fully to appreciate this stuff, one must head to the library, not the laboratory. The bias towards positivism--itself a philosophy--is discussed at length in the talk archives, and I think it's safe to say that we came to at least a rough consensus that both scientific and literary/philosophical views merit mention here. Cosmic Latte (talk) 19:26, 8 November 2008 (UTC)

I should again point out that all of these folks are discussed in the Hergenhahn source, which explores the history of psychology. Cosmic Latte (talk) 19:26, 8 November 2008 (UTC)

Those are provided in the context of the history of psychology and the history of depression. The article discusses the importance of historical figures predating the current status of depression. Heidegger is not mentioned in this section, in fact, he is not mentioned at all. He is give as a reference in a section of the article "Causes - Psychological", in which all the other references are to scientific data and follow WP:MEDRS. The fact is, any references Heidegger made to these concepts do not belong in this section. If you or others have problems with positivism, they should be discussed in the article. Your objections do not belong in this section, disguised in footnotes. —Mattisse (Talk) 20:00, 8 November 2008 (UTC)

Heidegger's contributions to our understanding of what is now known as depression make the most sense in the general context of existential psychology. I'm not sure what you mean by "scientific data." If the writings of Freud, Maslow, and even Rogers can now be acceptably referred to as "scientific," then I'll be a monkey's uncle. There is variation in the degree to which psychologists/philosophers-of-psychological-relevance are positivistically oriented. If we are going to be WP:NPOV, then we need to reflect this variation. Cosmic Latte (talk) 20:09, 8 November 2008 (UTC)

Please see WP:MEDRS for explanation of scientific data. The point is that you do not discuss Heidegger at all in the article. You have hidden him in footnote references in a section that otherwise attempt to follow WP:MEDRS. Please provide some evidence that Heidegger is an expert to reference Rollo May's statement that "lack of awareness leads to neurotic anxiety ... inauthentic living,[50][51] guilt,[50][51] and depression." Two references to Heidegger is being used as reference in each example here. If Heidegger is important to the article discussion, please explain openly in article, and not hidden in disguised references. —Mattisse (Talk) 21:05, 8 November 2008 (UTC)

P.S. Has Heidegger addressed depression? The lack of the provision of specific references to depression was the reason for excluding some relevant psychologists. —Mattisse (Talk) 21:38, 8 November 2008 (UTC)

Heidegger discusses what happens when people "fail to construct a future" (to paraphrase May, who echoes Heidegger on this point), which is exactly what the article says. Further discussion of Heidegger in the article probably would be undue, because he was not addressing "depression" per se; May, who happened to be echoing Heidegger, addressed depression more explicitly--hence the mention of May, and not Heidegger, by name in the article. Cosmic Latte (talk) 21:49, 8 November 2008 (UTC)

If he was not addressing "depression" per se, then he certainly should not be used as a reference. That seems obvious. —Mattisse (Talk) 22:14, 8 November 2008 (UTC)

It all depends on what is being said. Nowhere is it said that Heidegger is talking about "depression." But maybe that is what he was talking about, after all--see the book link that I provided below. Cosmic Latte (talk) 22:19, 8 November 2008 (UTC)

(outdent) The issue is if there is a reference, you know very well from the quotation below from this article talk page re Carl Rogers:

Only mention Rogers if he said something specific re depression, otherwise not; we could mention loads of people in that case. I think we have plenty in the article already and wouldn't be hunting out Rogers references. Cheers, Casliber (talk · contribs) 12:16, 8 November 2008 (UTC)

Agreed and fixed. Cosmic Latte (talk) 14:39, 8 November 2008 (UTC)

So, please apply standards evenly. —Mattisse (Talk) 22:12, 8 November 2008 (UTC)

I agree that Rogers shouldn't be mentioned if he's not saying something about depression. The same does indeed go for Heidegger, who is not mentioned at all, but is simply cited in passing, in an attempt to elaborate on what May is saying about depression. By the way, for an interesting equation of Heideggerian "existential anxiety" and depression, see p. 149 of this book. Cosmic Latte (talk) 22:16, 8 November 2008 (UTC)

He has said plenty about depression. I just did not supply an article. If Heidegger is important to the history and study of Major depressive disorder, then mention him with proper referencing in the article. Do not disguise him by hiding him in a footnote, under the pretense that you are following WP:MEDRS. And please use edit summaries, as it is rude not to. —Mattisse (Talk) 22:34, 8 November 2008 (UTC)

WP:AGF... EverSince (talk) 05:06, 9 November 2008 (UTC)

Btw actually, re presumably scientifically validated data in this section...WP is also of course about representing notable points of view on subjects, right or wrong (but they should be noted as points of view not facts of course)... EverSince (talk) 05:11, 9 November 2008 (UTC)

Heideggerian existentialism and social work practice with death and survivor bereavement (2006):

One example of application of Heideggerian existentialism in clinical social work practice can be found in the treatment of depression due to unresolved bereavement. Although the client may seek assistance from a social worker for the depression, bereavement issues may come to the surface through the manifestation of the client's depression. The presenting problem of facing one's own death or the death of a loved one can be addressed by Heideggerian existentialism through viewing the client's depression from the total perspective of the client's environment. Therefore, the client can see that the immediate problem of depression, for which the client initially sought help from the social worker, is only the characteristic of unresolved grief. Also, clients may not have dealt with specific life issues, such as relationship difficulties, that often become accentuated when confronted with bereavement issues. The death of a loved one is very representative of the types of problems that can be addressed through the application of such Heideggerian existential concepts as totality and remembering, which will be discussed later.

EverSince (talk) 05:21, 9 November 2008 (UTC)

• Primary source reference from abstract of the article you source:

Heideggerian existentialism has not been applied on a widespread basis to the Generalist Social Work Practice Model. This paper explores the relationship between social work practice with bereavement issues and Heideggerian existentialism. Applications of Heideggerian existentialism in the social work profession with clients and families experiencing bereavement are examined. Conceptual applications also address future utilization of Heideggerian existentialism.

Suggest if you want to use Heidegger, you bring him up in a legitamite way in article content with reliable sources, not in disguised footnote purporting to follow WP:MEDRS. —Mattisse (Talk) 06:11, 9 November 2008 (UTC)

I assume that suggestion is being addressed to Cosmic Latte, seems a fair point though I don't see where s/he purported it followed MEDRS EverSince (talk) 06:23, 9 November 2008 (UTC)

Heidegger is not mentioned more than he is because that would probably be overkill, at least without a separate "Philosophy" subsection; he is not mentioned less than he is because he gives colour to what fellow existentialist Rollo May (who was strongly influenced by Heidegger, and who is discussed in the same chapter in the same tertiary source [Hergenhahn, 2005] as Heidegger) is saying. This is called balance--i.e., a careful consideration of weight, as in "WP:WEIGHT." I've yet to see which part of WP:MEDRS this balance conflicts with, nor have I seen how the good ol' citation process has suddenly transformed into a method of "hiding" POVs in "footnotes." And even if there were a conflict with WP:MEDRS, it would be easy to overstate the point, because this article does not fall strictly under the scope of WP:MED; it is also covered by WP:PSY, and a fair amount of psychology--including the Rogerian approach that you tried to introduce--is not especially congruous with the medical model. Even some psychiatrists, such as R. D. Laing and Thomas Szasz, have taken issue with this model. I'm not going to give my own opinion about the model here, as it is irrelevant, but I do support WP:NPOV. Psychology and psychiatry share boundaries with both medicine and philosophy; indeed, science itself was once a branch of philosophy, known as natural philosophy. To dismiss the philosophical boundary arbitrarily is to defy WP:NPOV, even if to acknowledge it is somehow to conflict with some absolutistic reading of WP:MEDRS that no one else appears to share. Cosmic Latte (talk) 10:27, 9 November 2008 (UTC)

• It does according to Sandy. That is the sole justification of the title of this article, "Major depressive disorder". And Sandy has mentioned WP:MEDRS many times. Again, I advocate changing the title so you can put into the article what you want. —Mattisse (Talk) 02:26, 13 November 2008 (UTC)

Dream interpretation

Although this is neglected in the West somewhat, dreams themes that depressed people get in their dreams could make a very interesting section and fill an omission. Snowman (talk) 12:54, 9 November 2008 (UTC)

Psychiatry has massively moved away from things like dream interpretation with the swing away from psychoanalysis and toward a more biologicla model between the mid 1960s and 1980. I guess the dream article would be a first point of call with some boosting of material from Jung and Freud really. Dreaming was more a part of analysis and thus detached from diagnosis somewhat. Fascinating topic :) Cheers, Casliber (talk · contribs) 13:20, 9 November 2008 (UTC)

OK, perhaps dream interpretation as part of psychoanalysis is beyond the scope of the page. However, it might be worth mentioning something about the themes of dreams depressed people get, as a feature of depression. Just to make something up to illustrate the point - a depressed person is unlikely to dream about flying admiring the view, but might dream about running in quicksand uphill and finding the going difficult. The article would need actual examples of dream themes and not this example I made up. Snowman (talk) 13:31, 9 November 2008 (UTC)

If you can find any good sources that discuss this topic, it might be worth thinking about further. I'm not aware of any myself, but the literature is vast, so who knows? You could try hunting around on Google Scholar to see if you find anything. looie496 (talk) 16:26, 9 November 2008 (UTC)

This paper, by Aaron T. Beck and another author, most certainly looks interesting to me: "The obtained differences between the depressed group and the control group are statistically significant and clear-cut. On the basis of these results the hypothesis that the depressed patients show a greater incidence of dreams with 'masochistic' content than the nondepressed patients appears to be clearly confirmed" (p. 53). Cosmic Latte (talk) 21:13, 9 November 2008 (UTC)

Published in 1958. —Mattisse (Talk) 22:31, 9 November 2008 (UTC)

Suppression of scientific evidence by Looie496

How much are you getting paid for this spin job Looie? I bet you're cheaper than Charles Nemeroff. —Preceding unsigned comment added by Psychotropic sentence (talk • contribs) 01:21, 10 November 2008 (UTC)

I'm sure I'm a lot cheaper than Charles Nemeroff. I reverted your changes for three reasons: (1) they need discussing, (2) you used news items as sources, which is not desirable, (3) this article is struggling to stay short enough for FA and you added a substantial amount of material. I won't revert them again, because I restrict myself to one revert per article per day, but given your apparent determination to push your point of view regardless of the opinions of other editors, I perceive that you're going to run into difficulties. looie496 (talk) 01:37, 10 November 2008 (UTC)

Psychotropic, several editors have been working in collaboration to improve this article. If you have some input, I encourage you to work with them by discussing changes here on the talk page. Please don't let their hard work degenerate into an edit war. I'm sure they will take your proposals for changes seriously if they are well argued. --GraemeL ^(talk) 01:42, 10 November 2008 (UTC)

I acknowledge the issue about moderate depression is worth raising (we discussed it above). I will see how we can do it in a succicnt manner, but not in hte detail as just added. Cheers, Casliber (talk · contribs) 02:13, 10 November 2008 (UTC)

I've replied on my talk page, I won't repeat myself here. Psychotropic sentence (talk) 02:17, 10 November 2008 (UTC)

Essentuially it is a tricky subject to do justice in a brief manner - unfortunately there is some issue over interpretation of response rates in moderate episodes, and yet more issues on how patients are selected for trials (many used to have to rule out people with suicidal thoughts (often, not surprisingly, more serious cases) which make up a fair proportion of psychiatric pracitice, and often the duration of illness is shorter in trial patients than it is in patients seen in psychiatric practice, hence regression to the mean probably plays a role. On the other side there is publication bias and I have wondered what they do actually use as a placebo to make the studies blind at times. I do recall all these issues and more being discussed at length in literature. The idea of an overview article is that it has subarticles - hence there is treatment of depression which should go into more detail on these subejcts too. Cheers, Casliber (talk · contribs) 03:12, 10 November 2008 (UTC)

Psychotropic sentence: See this section of the talk page for further discussion about drug efficacy. Treatment for depression might be the appropriate place to go into some depth about the Kirsch study. It's a fascinating study, and one of the authors was a professor of mine, so I'm certainly not biased against elaboration. But the topic probably merits more elaboration than we can give it in an article as long as this one, especially while it's in the FAC process. Cosmic Latte (talk) 10:05, 10 November 2008 (UTC)

Verdict on Maslow image

Should we keep or nix the diagram of Maslow's hierarchy of needs? It gives some colour (literally) to the humanism paragraph, but, apart from the caption, it doesn't address depression directly and isn't usually used for that purpose. I'm rather ambivalent about it; Casliber seems ambivalent, too; and Skagedal objected to an earlier, larger version of the image, although partially due to its size, which isn't as much of an issue with the current version. I just wanted to see what the consensus is here. Cosmic Latte (talk) 10:28, 10 November 2008 (UTC)

The hierarchy itself never mentions depression. Maslow is not noted for his contributions to the theoretical conceptualizations of depression. It certainly was not a major focus of his writings. This article on depression only has one sentence on Maslow and that sentence does not even mention the hierarchy: "American psychologist Abraham Maslow theorized that depression is especially likely to arise when the world precludes a sense of "richness" or "totality" for the self-actualizer." I submit that this sentence makes no sense to a reader not already familiar with Maslow and his hierarchy. The concepts are very Western world biased. The caption on the hierarchy image contains more accurate information than does the article text. The hierarchy itself is not explained in the article text, so why such prominence pictorially, other than that it is pretty? —Mattisse (Talk) 17:29, 10 November 2008 (UTC)

This time I agree with Mattisse: Although its a beautiful image I do not feel it is really relevant. I would remove it.--Garrondo (talk) 11:30, 11 November 2008 (UTC)

Yes I am ambivalent too, and would remove if the consensus were to do so, which it looks like it is...Cheers, Casliber (talk · contribs) 13:32, 11 November 2008 (UTC)

Opinions about the image seem to be ranging from negative to neutral, so I went ahead and removed it. Cosmic Latte (talk) 14:23, 11 November 2008 (UTC)

Heads up - US spelling

Hi all, I am busy for a few hours. mattise has (rightfully) pointed out US/UK spelling inconsistencies (not surprising given the speed of editing). I would be grateful if anyone could convert UK --> US spelling. Also, I need consensus on best ref for discussion of 'black box' as upon consideration this was an important development. It got alot of press outside the US incl. here in Oz. if some folks can do these, then I can get stuck into other issues (groan). Cheers, Casliber (talk · contribs) 23:56, 10 November 2008 (UTC)

Depression and the elderly

In discussing Major depressive disorder with a USA psychiatrist today, he said that by far Major depressive disorder in the elderly was the biggest problem and accounted for the most diagnoses. Other than mentioning that the diagnosis is primary one of older persons and peaks between 50 and 60 years old, you do not address the issues of depression in the elderly. Is it that you do not see this group has having unique issues? Is there a reason that Major depressive disorder tends to occur and "peak" in older persons? Are there special treatment issues regarding the elderly patient? —Mattisse (Talk) 23:26, 11 November 2008 (UTC)

Absolutely, I was just musing on this as much of the review material with Burden of Disease/etc and epidemiology seems to not really address this. My first find was this note which is leading me off looking for some Review Material to include/look at. I did start an article on pseudodementia some time ago. Give us a few mnutes...Cheers, Casliber (talk · contribs) 02:52, 12 November 2008 (UTC)

PS: Just retrieving the fulltext of this Cheers, Casliber (talk · contribs) 02:54, 12 November 2008 (UTC)

PPS: hmmm..interesting. Cheers, Casliber (talk · contribs) 02:59, 12 November 2008 (UTC)

This topic reminds me of Erik Erikson's notion of "integrity vs. despair" (the latter having something to do with depression) among the elderly. See, for example, here. Cosmic Latte (talk) 03:40, 12 November 2008 (UTC)

Humm, those articles contradict what is in the article already. The lead statement states about the incidence of Major depressive disorder: "The most common time of onset is between the ages of 30 and 40 years, with a later peak between 50 and 60 years." So, that is not true, but there is a decreasing incidence? Also, article(s) have been quoted in the article that say exercise has no proven effect on depression, yet one of your sources above says the opposite. Are "truths" different for the elderly? —Mattisse (Talk) 04:04, 12 November 2008 (UTC)

Elderly these days is often over 70, but usually 65 is the minimum. The two articles are not mutually exclusive. I haven't looked deeply into articles on exercise, and not for the elderly although...Cheers, Casliber (talk · contribs) 06:41, 12 November 2008 (UTC)

I keep forgetting I was involved in doing the Hamiltons for this one... :) Cheers, Casliber (talk · contribs) 06:42, 12 November 2008 (UTC)

Even funnier, the first two of these are me, no idea who the third is...[Author&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVCitation]...Cheers, Casliber (talk · contribs) 06:44, 12 November 2008 (UTC)

Perhaps this issue should be clarified in article with appropriate explanations/hypotheses as to why the elderly (65 >) get happier, with some references. Biological? Psychological? What? Also, common definition of elderly is needed, also referenced. —Mattisse (Talk) 13:58, 12 November 2008 (UTC)

It isn't necessarily true that the elderly get happier. It could be that the unhappiest people die at younger ages, leaving a happier remnant. No individual person needs to get happier to produce the statistics. looie496 (talk) 03:59, 13 November 2008 (UTC)

• These are the kind of things I am wondering about. What accounts for this belief or effect that Major depression is an affliction of older people? —Mattisse (Talk) 04:16, 13 November 2008 (UTC)

It is undoubtedly a common affliction in old age, and I was musing on its prevalence before as it was not mentioned specifically in many of the general review articles on depression, and was intrigued to find what I did when I looked into it. Cheers, Casliber (talk · contribs) 10:09, 13 November 2008 (UTC)

Here is a meta analysis that found positive results for treatment of depression in the elderly, finding a variety of treatments to be equally effective (PMID 16955421). —Mattisse (Talk) 00:04, 14 November 2008 (UTC)

That looks a good one, i will have a read of the full-text and add (gotta jump off the keyboard for a bit, so you are welcome to add beforehand otherwise in a few hours I will look). Cheers, Casliber (talk · contribs) 00:19, 14 November 2008 (UTC)

PS: I note there is a cochrane review as well linked to the right. Cheers, Casliber (talk · contribs) 00:22, 14 November 2008 (UTC)

 Done The more I thought about it the more important it is, as I would assume it may be a misconception among readers that psychotherapy may be of limited use in old age. Cheers, Casliber (talk · contribs) 03:48, 14 November 2008 (UTC)

Mindfulness-based Cognitive Therapy

According to the references, Mindfulness-based Cognitive Therapy is not psychotherapy, but an 8-week class-based therapy. Therefore, it should not be included in the "Psychotherapy" section. —Mattisse (Talk) 02:22, 13 November 2008 (UTC)

Eh? The Mindfulness-based Cognitive Therapy article describes it as a form of psychotherapy in the very first sentence. Could you explain your point a bit more, please? looie496 (talk) 03:50, 13 November 2008 (UTC)

That when I looked at the full text cited as reference for Mindfulness-based Cognitive Therapy, it said the study was confounded by the fact that "usual care" that the subject received did not incude antidepressant or psychotherapy. —Mattisse (Talk) 04:22, 13 November 2008 (UTC)

I don't see any specific mention at all of "psychotherapy" in the cited article (PMID 18085916)..? But I see the point, I'm not very familiar with MBCT but it seems to be mostly an educational approach. One solution would be to use the more general heading "Psycho-social treatments". But also, it depends on your definition of "psychotherapy" – this term seems to often be used rather broadly, encompassing many different kinds of psychological treatments. /skagedal^... 09:02, 13 November 2008 (UTC)

It definitely is a form of psychotherapy. I need to look up some definitions..(psychotherapy is a broad def)Cheers, Casliber (talk · contribs) 10:07, 13 November 2008 (UTC)

This is an educational approach. It does not involve forming a "therapeutic relationship". —Mattisse (Talk) 14:49, 13 November 2008 (UTC)

"Some of the key ideas in mindfulness based psychotherapy and research are radically different from our cultural (and perhaps human) assumptions". Cosmic Latte (talk) 20:19, 13 November 2008 (UTC)

• Again, that does address Mindfulness-based Cognitive Therapy (MBCT) which is a class-based program per [15]:

• "The MBCT programme takes the form of 8 weekly classes, plus an all-day session held at around week 6. A set of 5 CDs accompany the programme, so that participants can practise at home once a day throughout the course."
• Per [16], MBCT classes: "In MBCT programmes, participants meet together as a class (with a mindfulness teacher) two hours a week for eight weeks, plus one all day session between weeks 5 and 7. The main ‘work’ is done at home between classes. There is a set of CDs to accompany the programme, which you use to practise on your own at home once a day. In the classes, there is an opportunity to talk about your experiences with the home practices, the obstacles that inevitably arise, and how to deal with them skilfully."

• A "teacher" is not a psychotherapist. —Mattisse (Talk) 20:27, 13 November 2008 (UTC)

• Says who? Cosmic Latte (talk) 20:35, 13 November 2008 (UTC)

• I don't know what that diff is supposed to prove. The fact is that Mindfulness-based Cognitive Therapy (MBCT) describes itself as a class-based program. Psychotherapy is not class-based. —Mattisse (Talk) 21:03, 13 November 2008 (UTC)

• Further, the reference you gave[17] does not say MBCT is psychotherapy. After examining four studies (all that could be found), all it says regarding psychotherapy is: "The researchers are trying to say, look, we think the research that has looked at MBCT has found some positive results (for those 3 or more depressive episodes — in other words, people with more chronic, treatment resistant type of depression). But none of the research could say it was the MBCT or some non-specific general therapeutic effects often found in psychotherapy treatment studies." It also says "So the answer of its effectiveness remains elusive, but people will continue to pursue MBCT regardless." Not a ringing endorsement. —Mattisse (Talk) 21:14, 13 November 2008 (UTC)

May I humbly suggest that this discussion is kept on one place, preferrably this? There have been repeated requests of keeping the FAC page short and to the point, and keeping lengthy discussions on this page. Mattisse asked on FAC: Where does it say that Mindfulness-based Cognitive Therapy (MBCT) is Cognitive behavioral therapy + meditation?. I'd point to this passage in the text: The 8-week, class-based MBCT program combines mindfulness training (Kabat-Zinn, 1990) with elements of cognitive–behavioral therapy for depression (Beck, Rush, Shaw, & Emery, 1979), and teaches patients to recognize and disengage from modes of mind characterized by negative and ruminative thinking and to access and use a new mode of mind characterized by acceptance and “being” (Segal et al., 2002). So while it takes an educational approach, it includes components of CBT, which makes it topically close enough to be under this heading, if it should be in the article, IMHO.

I do think that the available research on MBCT is a bit lacking (four studies?) to justify inclusion here, though. The article mentions nothing about purely behavioral treatments, which have a long history, with modern approaches such as behavioral activation that have received good support. (e.g., PMID 17184887) /skagedal^... 21:19, 13 November 2008 (UTC)

Agree. There are a bunch of "alternative" therapies if you want to mention "mindfulness". Why not mention Acceptance and Commitment Therapy (ACT) which says "ACT is sometimes grouped together with Dialectical behavior therapy, Functional Analytic Psychotherapy, and Mindfulness-based Cognitive Therapy as The Third Wave of Behavior Therapy." I also suggest Behavioral activation as an alternative. —Mattisse (Talk) 21:14, 13 November 2008 (UTC)

• Albert Ellis's Rational Emotive Behavior Therapy should be mentioned since has a long history and was one of the first Cognitive behavioral therapy to gain wide recognition and is still practiced today. It had a huge impact on the field of psychology, and specifically the practice of psychotherapy. —Mattisse (Talk) 22:02, 13 November 2008 (UTC)

• Certainly nothing wrong with mentioning REBT, although it's already noted in the caption to "Albert Ellis 2003 emocionalmente sentado.jpg," which is currently commented out due to copyright concerns. As for mentioning more alternative therapies, I normally wouldn't object, except that article length and WP:DUE might be issues in this article's case. As with the Heidegger issue, though, there's no WP:ABSOLUTISM; we don't need to say either everything or nothing about a given topic, and one or two alternative approaches should suffice. And I still see no problem with referring to MBCT as "psychotherapy," and I find the attempt to distinguish between "teachers" and "psychotherapists" somewhat contrived. Let me put it this way: What adjective would you use to describe MBCT teachers? Primary? No. Postsecondary? No. Financial? No. Dietary? No. Spiritual? Eh, maybe to an extent. How about "psychotherapeutic"? It seems a decent fit. Besides, in the US at least, the word "psychotherapist" (unlike "psychologist" and "psychiatrist") is not officially regulated. If what you do can, within reason, be construed as therapy for the psyche, then you have every legal and semantic right to call yourself a psychotherapist. Why not give MBCT practitioners their moment in the sun? After all, she would, and I'd be willing to bet that he would, too. Cosmic Latte (talk) 09:52, 14 November 2008 (UTC)

• Again, that does address Mindfulness-based Cognitive Therapy (MBCT) which is a class-based program per [18]: "The MBCT programme takes the form of 8 weekly classes, plus an all-day session held at around week 6. A set of 5 CDs accompany the programme, so that participants can practise at home once a day throughout the course." Per [19], MBCT classes: "In MBCT programmes, participants meet together as a class (with a mindfulness teacher) two hours a week for eight weeks, plus one all day session between weeks 5 and 7. The main ‘work’ is done at home between classes. There is a set of CDs to accompany the programme, which you use to practise on your own at home once a day. In the classes, there is an opportunity to talk about your experiences with the home practices, the obstacles that inevitably arise, and how to deal with them skilfully."

Albert Ellis should be in article The Daniel Goleman [http://www.mbct.co.uk/ "glowing review" repeatedly mentioned by Cosmic Latte is at the MBCT company website. The article he mentions above [http://psychology.berkeley.edu/faculty/profiles/erosch2007.pdf does not mention MBCT but talks of mindfulness as a general approach. Cosmic Latte states, "Why not give MBCT practitioners their moment in the sun?". This article is not the place to give a scantly research packaged program with "dubious" effectiveness advertising space as an example of "mindfulness" therapy. Why not mention Acceptance and Commitment Therapy (ACT) which says "ACT is sometimes grouped together with Dialectical behavior therapy, Functional Analytic Psychotherapy, and Mindfulness-based Cognitive Therapy as The Third Wave of Behavior Therapy." As /skagedal said above:

"I do think that the available research on MBCT is a bit lacking (four studies?) to justify inclusion here, though. The article mentions nothing about purely behavioral treatments, which have a long history, with modern approaches such as behavioral activation that have received good support."

If Albert Ellis is commented out in the article, then he is not in the article. He is one of the pioneers of Cognitive behavior therapy. His Rational Emotive Behavior Therapy has had a huge impact on the field of psychotherapy. He is a psychologist and a psychotherapist. His omission from this article is glaring. —Mattisse (Talk) 15:03, 14 November 2008 (UTC)

Did you even read the Rosch paper? Here are some lines from this article that, you say, "does not mention MBCT": "These systems are: Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002; Teasdale & Barnard, 1993), Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b), and Acceptance and Commitment Therapy (ACT; Hays, Strosahl, & Wilson, 1999)" (p. 5). "MBSR and MBCT incorporate actual meditation sessions as part of the practice" (p. 5). "Facilitators in MBSR and MBCT are required to have had mindfulness meditation experience in formal settings for good reason; early MBSR groups led by individuals who lacked personal experience tended to be ineffective. MBCT, DBT, and ACT are actual therapies" (pp. 5-6). And no one is objecting to mentioning Ellis or REBT. Cosmic Latte (talk) 15:18, 14 November 2008 (UTC)

Bullying and depression

Finding anything other than primary sources is proving tricky for this as I try and find some review articles --> this cites two studies. There are several studies about the place showing links between bullying and depression, yet no Review article as such, which I am looking to bolster the Social Causes section. Cheers, Casliber (talk · contribs) 04:27, 14 November 2008 (UTC)

And this..Cheers, Casliber (talk · contribs) 04:28, 14 November 2008 (UTC)

Stuff it - no reviews and I have been looking for hours!! These bullying studies are important and I am moving them to 'to do' box for noting in a future causes article. Cheers, Casliber (talk · contribs) 13:04, 14 November 2008 (UTC)

How about this one (see p. 5 onward)? Cosmic Latte (talk) 15:06, 14 November 2008 (UTC)

Albert Ellis should be in article

Apparently Albert Ellis is commented out in the article, and consequently he is not mentioned in the article. He is one of the pioneers of Cognitive behavior therapy. His Rational Emotive Behavior Therapy, still in use today, has had a huge impact on the field of psychotherapy. He is a psychologist and a psychotherapist. His omission from this article is glaring. —Mattisse (Talk) 15:08, 14 November 2008 (UTC)

Resolving inline queries

More there still, I did a few:

• [20] When citing opinion (which is OK in some circumstances), attribute the opinion to the "owner" of that opinion: don't state opinion as fact.
• [21] Laysource summaries can be added to the journal source by using the laysource parameter on cite journal. That allows readers to access the peer-reviewed literature along with the laysource.
• [22] See Wikipedia:CITE#Citation templates and tools; the issues is not Harvnbs (that has been fixed, and Harvnbs can be made to work with cite xxx templates now). The issue is mixing citation formatting: this article does not mix cite xxx with citation, and the format is consistent. It's easy to discern when there's a problem: citation separates items with commas, and the cite xxx family of templates separates them with periods.
• Please see the differences in WP:ITALICS, WP:LEAD and WP:MOSBOLD regarding "words as words" and bolding of synonyms in the lead. [23] [24]

SandyGeorgia (Talk) 18:45, 14 November 2008 (UTC)

• I am confused. Feature article criteria state: "2(c) consistent citations—where required by Criterion 1c, consistently formatted inline citations using either footnotes or Harvard referencing (Smith 2007, p. 1) (see citing sources for suggestions on formatting references; for articles with footnotes, the meta:cite format is recommended)."

This article uses both {{citation}} and {{Harvnb}} in the body of the article. When {{citation}} are mixed into the article body, the publications are also listed in the Cited text, but the full information is again given in the footnote itself. Therefore, some of the footnotes in the article body, those using {{Harvnb}}, "hop" to the Cited text while those using {{citation}} do not "hop" there, although the info is repeated there. Therefore, some listings in the Cited text never get "hopped" to, while others do. It seems to me less than optimal and inconsistent for an FAC.

Also, I'm not sure if the {{Harvnb}}s are showing up without a "Footnotes section" and {{reflist}}. —Mattisse (Talk) 19:43, 14 November 2008 (UTC)

This article does not use citation (only cite xxx, one of the cite xxx templates now trancludes something from citation/core) and it doesn't use Harvard inline citation method either (see Battle of Red Cliffs for an example of Harvard inlines). The "hopping" issue is not what is referred to at WP:CITE, it's a commonly used hybrid method on Wiki. The confusion comes from similar terminology used in two different ways to refer to different things on different pages. Crit 2c refers to the difference between the Harvard inline citation style and cite.php footnote method. WP:CITE refers to not mixing citation with cite xxx because they are two different styles (periods vs. commas for example). Harvnb is a method to an end. Confusing, yes. SandyGeorgia (Talk) 19:57, 14 November 2008 (UTC)

• Actually, I see they do. So "Cited texts" only refers to the {{Harvnb}}s? —Mattisse (Talk) 19:50, 14 November 2008 (UTC)

A ref has introduced some from of glitch, so all the harvard pages references of teh APA are diverting to ref 159 (??). Cheers, Casliber (talk · contribs) 20:10, 14 November 2008 (UTC)

I'm trying to track it down. It could be related to the spaces in the APA citation. We're supposed to use quotes around ref names with spaces for that purpose: someone has a bot that fixes those. It could be related to that; trying to figure it out still. SandyGeorgia (Talk) 20:16, 14 November 2008 (UTC)

Still testing: when was the last time they were working? SandyGeorgia (Talk) 20:27, 14 November 2008 (UTC)

I put the article in use to try to fix it, but got edit conflicts, so I'll stop now. It is definitely coming from the spaces in American Psychiatric Association; Jbmurray (talk · contribs) knows how to fix this, please call him in, because I can't track it down with the edit conflicts, and this is one of the reasons I Hate Harvnb. Jbmurray will know how to fix it. SandyGeorgia (Talk) 20:36, 14 November 2008 (UTC)

<ref name="Caspi">....</ref> occurs twice in the "Causes" section. Possible cause. --GraemeL ^(talk) 20:49, 14 November 2008 (UTC)

Sorry! I didn't see the in use template, as I was only editing sections, and it doesn't show up. I have stopped editing, if you want to try again. —Mattisse (Talk) 20:51, 14 November 2008 (UTC)

GraemeL, that won't cause that error (although it should be fixed). When I added underscores, the error went away, so it's certainly the spaces. Now it needs a workaround, because we don't want underscores in the refs. Mattisse, I'm done because it will be more efffective to just ask Jbmurray what the best fix is: I got far enough to know it's coming from the spaces. SandyGeorgia (Talk) 20:55, 14 November 2008 (UTC)

• I don't know if this is part of the problem, but if you click one of those harvnb type footnotes and hop down to the "Cited text", there is no way to get back into the article except by clicking the browser back button, which takes you back to the harvnb footnote. From there, by clicking on that little ^ you can make your way back into the article. —Mattisse (Talk) 21:10, 14 November 2008 (UTC)

• PS, the reason you can tell it's the spaces is that this ref works; the problem is, we can't have underscores in the refs. Notice that it works now, while the others don't. The way you get back with Harvnbs is counterintuitive; you have to hit the back button. Another reason I hate Harvnbs (most of our readers probably don't realize that). That's the way they work. SandyGeorgia (Talk) 21:13, 14 November 2008 (UTC)

• Perhaps this is a problem with "cite xxx." With {{citation}}, there's no problem with spaces. See, for instance, the "de la Luz Montes" references in María Ruiz de Burton. There shouldn't be any need for a work-around of using underscores or whatever. --jbmurray (talk • contribs) 21:19, 14 November 2008 (UTC)

• I was afraid you were going to say that ... it's implementation with cite xxx involves that citeref parameter, which apparently isn't recognizing the spaces (see my example that works). I think the workaround involves using a single-word parameter (like APA) somewhere. SandyGeorgia (Talk) 21:23, 14 November 2008 (UTC)

• I think that is it! I remember a conversation on an FAC page regarding this. If you use Harvnb you have to use {{citation}}, as cite xxx screws them up. —Mattisse (Talk) 21:26, 14 November 2008 (UTC)

• No, that changed. Now you can use Harvnb with citeref, but there seems to an issue with spaces. (Notice that all of the rest of them work, and the one I added underscores to work ... only the APAs with spaces aren't working). Jb is looking at it now. SandyGeorgia (Talk) 21:29, 14 November 2008 (UTC)

(outdent:) OK, here's a problem: in fact there are two citations to the APA in 2000. Understandably, the harvnb template doesn't know to which it should refer. It goes for the first it can find. You can fix this by adding dates "2000a" and "2000b." I also note that the problematic reference in the footnote used the "author=" field rather than the "last=" field. (A perennial weakness of "cite xxx" if I may be permitted to get on my hobbyhorse again!) --jbmurray (talk • contribs) 21:29, 14 November 2008 (UTC)

You're a gem :-) Are they all set now, or do a and b have to be sorted? I'll go back and fix that Caspi situation above. SandyGeorgia (Talk) 21:33, 14 November 2008 (UTC)

I think I've fixed the APA ones. (Heh, and of course this is another advantage of using harvnb... it keeps you honest when you're using different sources with the same author and year.) --jbmurray (talk • contribs) 21:39, 14 November 2008 (UTC)

• (copied from my talk archives re Wikipedia:Featured article candidates/Albert Speer, a recent FAC ) In this Wikipedia:Featured article candidates/Albert Speer, if you read down far enough, there is this discussion:
• Comments: I believe there's something wrong with the Harvard referencing; the links in the citations do not seem to lead anywhere, when in fact they are supposed to link to the works under "Bibliography", yes? Also, per WP:DASH, dashes for page ranges in the citations need to be changed to en dashes. María (habla conmigo) 14:52, 20 October 2008 (UTC)

• I just copied what was already in the article. Can someone point me in the right direction in fixing the refs? I'll fix the dashes after I fix the refs, just in case I totally have to redo the refs.--Wehwalt (talk) 17:46, 20 October 2008 (UTC)

• Swapping the various {{cite web}} and {{cite book}} templates to {{citation}} seems to have solved the issue. - auburnpilot AuburnPilot

• —Mattisse (Talk) 21:33, 14 November 2008 (UTC)

  Unnecessary, because they didn't know how to use the citeref paramter: they made that change before I saw it or I would have explained. Once they made the change, I didn't want to explain so they wouldn't have to undo it all. Either way works. SandyGeorgia (Talk) 21:39, 14 November 2008 (UTC)

Circadian rhythm image

Rather than jumping in with another illustration, I figured I'd make the suggestion here first. How about adding this to the Biological causes section? Correct me if I'm wrong, but I believe that the associations between depression and the circadian rhythm are better-documented than those between depression and the hippocampus (a picture of which I removed upon Looie's suggestion).

Depression appears to be related to disruptions in the circadian rhythm, or human biological clock.

Cosmic Latte (talk) 19:32, 14 November 2008 (UTC)

Books need ISBNs

There is at least one that still does not have one. I am sick to death of going through this article and still finding so many mistakes. I am tired of putting the inline notes in. Unless I recover from my current prostration, I will not complete the check of the article. —Mattisse (Talk) 22:10, 14 November 2008 (UTC)

hard to look for what's not there...oh wait (lightbulb above head goes on), I can CNTRL-F "book"....Cheers, Casliber (talk · contribs) 22:28, 14 November 2008 (UTC)

I would have preferred that you had addressed my comments on the FAC page rather than spend you time writing other articles and collecting DYKs. Instead you did not. I feel like I have put more work into this article since the FAC opened than you have, that I have been doing your work for you. I am done. Cheers, —Mattisse (Talk) 23:16, 14 November 2008 (UTC)

How dare you dictate to me how I spend my time on WP???? I spent hours yesterday looking for review articles of material which I have moved to the talk page. I have pandered and changed or tried to address lots of your points except where you are plainly wrong, and had to listen to your threats of signing off several times over, and not-so-subtle digs at other editors. You complain about acrimony yet you were the one who brought acrimony into this. Your tone has been impossible and you are holding this to ransom and you know it, your behaviour is incredible. i have a life off-wiki and cannot devote 24 hours a day to it at your beck and call. Cheers, Casliber (talk · contribs) 00:01, 15 November 2008 (UTC)

bare book references

The following are the bare text references as of this version.

• Ref 53: Fromm E (1941). Escape from Freedom. New York: Holt, Rinehart, & Winston.
• Ref 54: Heidegger M (1927). Being and time. Halle, Germany: Niemeyer.
• Ref 70: Mashman, RC (1997). "An evolutionary view of psychic misery". Journal of Social Behaviour & Personality 12: 979–99. (issn best I could find)
• Ref 88: Yesavage JA (1988). "Geriatric Depression Scale". Psychopharmacology Bulletin 24 (4): 709–11. (pmid elusive but found)
• Ref 151: Depression Guideline Panel. Depression in primary care. Vol. 2. Treatment of major depression. Clinical practice guideline. No. 5. Rockville, MD: Agency for Health Care Policy and Research, 1999.
• Ref 215: Hirschfeld RMA (2001). "The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care". Primary Care Companion to the Journal of Clinical Psychiatry 3 (6): 244–254.
• Ref 223: Hippocrates, Aphorisms, Section 6.23
• Ref 238: Mapother, E (1926). "Discussion of manic-depressive psychosis". British Medical Journal 2: 872–79.
• Ref 244: Schildkraut, JJ (1965). "The catecholamine hypothesis of affective disorders: A review of supporting evidence". American Journal of Psychiatry 122 (5): 509–22. (done)
• Ref 261: Heffernan CF (1996). The melancholy muse: Chaucer, Shakespeare and early medicine. Pittsburgh, PA, USA: Duquesne University Press. (got that one)
• Ref 270: James H (Ed.) (1920). Letters of William James (Vols. 1 and 2). Boston, MA, USA: Atlantic Monthly Press, pp. 147–48.

Hope this helps. --GraemeL ^(talk) 22:30, 14 November 2008 (UTC)

Thanks. Cheers, Casliber (talk · contribs) 22:41, 14 November 2008 (UTC)

Feel free to edit the comment and strike them out as they are dealt with. Makes it easier on you. --GraemeL ^(talk) 22:44, 14 November 2008 (UTC)

There's an ISBN finder in the userbox on my userpage. SandyGeorgia (Talk) 22:45, 14 November 2008 (UTC)