Wikipedia:Featured article candidates/Major depressive disorder/restart

Major depressive disorder

Nominator(s): Casliber (talk · contribs)

• Featured article candidates/Major depressive disorder
• Featured article candidates/Major depressive disorder/restart

This can be considered a group nomination, although where to draw the line can be hazy. For some months, three editors (me, Cosmic Latte and Paul Gene) have been in a concerted effort to get this here, along with EverSince and others along the way. delldot gave a very thorough review, and orangemarlin, Tony and many others have chipped in with advice, including negotiating a way through alternative therapies and so forth. Do I think it is perfect? No, but I do honestly feel it is one of Wikipedia's best articles and stands up well with others I have been involved with. We didn't send it to GAN mainly as delldot did such a thorough workthrough and the size was such I sorta felt it was a big ask for one editor to read and judge. One final thing, the article stands at 51 kb readable prose, 1 kb more than the upper limit for FAC. However, I have been unable to figure out what the last little bit to lose, or whether folks felt ignoring the rules WRT article size was okay. I figured this may be the best venue for consensus on this, in the coal-face as it were. Anyway, lemme know how we can make it betterer. Cheers, Casliber (talk · contribs) 12:57, 19 October 2008 (UTC)

Images

• Image:Albert Ellis 2003 emocionalmente sentado.jpg is concerning; "Received from Martine Mallary of the Albert Ellis Institute on 5/10/2005 in response to my request for a copyright-free photo." — ideally we'd have an OTRS ticket or some other form of evidence. Jay Slupesky doesn't have email enabled but you may wish to try pinging his talk page.

I note Jay has not edited in over a year. I will try to fire off an email to the Institute directly. Cheers, Casliber (talk · contribs) 13:28, 19 October 2008 (UTC)

• Image:Lavater1.jpg needs a specific source (which 18th century text by Johann Kaspar Lavater?). Once that's done I'll move it to Commons.

It comes from Physiognomische Fragmente zur Beförderung der Menschenkenntnis und Menschenliebe (1775-1778). So transfer away...Cheers, Casliber (talk · contribs) 13:28, 19 October 2008 (UTC)

• Image:Emil Kraepelin.png needs a source; there's no evidence that it's PD-US at the moment.
• Same for Image:Wm james.jpg.

Giggy (talk) 13:06, 19 October 2008 (UTC)

• Comment: Isn't it PD-US if it's more than 70 years past the date of publication? Both Kraepelin and James died more than 70 years ago, so I'm assuming that criterion would apply here. Cosmic Latte (talk) 03:43, 20 October 2008 (UTC)

• I thought it was 70 years after the death of the author, but I could be wrong. delldot ∇. 04:44, 21 October 2008 (UTC)

• Hmm, according to this, it's PD-US if it A) was published before 1978, but is now more than 95 years after the first publication; or B) was published after 1978, but is now more than 70 years after the author's death. James died 98 years ago, Kraepelin 82, so I'm thinking it's safe to assume that at least the James picture meets criterion A? Cosmic Latte (talk) 06:56, 21 October 2008 (UTC)

Comments -

• You've mixed using the Template:Citation with the templates that start with Cite such as Template:Cite journal or Template:Cite news. They shouldn't be mixed per WP:CITE#Citation templates.
• Current ref 28 (Warman, et. al.) is lacking a last access date (done)
• Current ref 74 (Beck Depression ..) is lacking a last access date (done)
• Current ref 83 (World Health Organization) is lacking a last access date (done and formatted)
• Looks like current ref 176 (WHO) has a formatting glitch of some sort (done and formatted)
• Current ref 209 (gutenburg.org) is just a bare url (done and formatted)
• Current ref 235 (Geoghegan) is lacking a last access date (done)
• Current ref 242 (Pita) is lacking a publisher. Also what makes this a reliable source? (the link shows it having been published in a newspaper's magazine supplement. Not great I know, I didn't put it there and will see what consensus here decides, and read the RS bit elsewhere)

• Comment: The publisher appears to be a major Spanish newspaper; the article is a translation of this. Cosmic Latte (talk) 13:42, 20 October 2008 (UTC)

• http://nccam.nih.gov/health/stjohnswort/sjwataglance.htm+ deadlinks (fixed, it was the erratn '+' on the end which glitched it)

Otherwise, sources look okay, links checked out with the link checker tool. Ealdgyth - Talk 13:34, 19 October 2008 (UTC)

• WRT cite templates, I use cite book/journal etc, but I thought the generic citation was necessary for Harvard referencing, which I tried to do with the cited texts which have several inline references scattered through the list. I can change the harvard ones to cite book but would hte harvard still work? Will get to work on the others when I wake up, but I need to sleep now. Cheers, Casliber (talk · contribs) 13:44, 19 October 2008 (UTC)

• Check with Mav (talk · contribs) or one of his latest FARs ... he has a way of doing it (using cite xxx templates with Harvnbs) that I haven't figured out or bookmarked yet. SandyGeorgia (Talk) 16:59, 19 October 2008 (UTC)
  • Found it (although I don't understand it): see Death Valley National Park. SandyGeorgia (Talk) 01:58, 23 October 2008 (UTC)

• To use the code that's in the templates directly without using the templates themselves, you would put (e.g.) [[#Smith99|Smith AB (1999)]] for the harv and <cite style="font-style:normal" id="Smith99">{{cite book|author=Smith AB |...}}</cite> for citation. I'm sure there's some more elegant way of doing this though. delldot ∇. 04:44, 21 October 2008 (UTC) (Actually you could keep using {{harv}} as long as you format the cite tag with id="CITEREFLastnameYear" to correspond with how the harv template sets it.) delldot ∇. 06:43, 21 October 2008 (UTC)

Comment about the world map why are low sucide rates in red? and high rates in yellow & orange? I suggest switching to something more obvious such as green/blue, then yelow, then orange and red/black for worst. Nergaal (talk) 23:01, 19 October 2008 (UTC)

Good idea. I will ask on the commons page. Cheers, Casliber (talk · contribs) 04:03, 20 October 2008 (UTC)

Comment - Wording seems misleading in places. Examples:

• (from lead) - "However, the relief of symptoms usually occurs several weeks or more after changes in neurotransmitter levels, which suggests that the precise role of neurotransmitter levels in depressive illness is still not fully understood." - That symptom relief may occur weeks after neurotransmitter levels change is not the only evidence "that the precise role of neurotransmitter levels in depressive illness is still not fully understood." - It is only one example. Perhaps rewording could generalize for a statement in the lead.

OK, good point - regarding detail in the lead, do you think just noting tehre are several factors is enough, or shall I add the facts that depletion in some people does not cause or worsen depression, and drugs which don't work on the pathway. How much detail you think we need there? Cheers, Casliber (talk · contribs) 04:39, 20 October 2008 (UTC)

Seems like it would be complex to detail factors in the lead as it is a complex issue, as you note (depletion in some people does not cause or worsen depression, some antidepressant drugs don't work on the pathway, some drugs work on pathway but don't relieve depression, effective drugs vary as to neurotransmitter(s) or neurotransmitter combination primarily affected). And you might have to explain "how" the mechanism might work (blocking reuptake receptors rather than increasing release, etc.). So, one suggestion would be to remove the specific example, so to read something like: "The neurotransmitters serotonin and norepinephrine have been implicated, and most antidepressants work to increase their active levels in the brain. However, the precise role of neurotransmitter levels in depressive illness is still not fully understood." —Mattisse (Talk) 14:32, 20 October 2008 (UTC)

I like it; done. Cheers, Casliber (talk · contribs) 08:23, 21 October 2008 (UTC)

• "Psychological factors include the complex development of personality and how a person has learned to cope with external environmental factors, such as stress." Perhaps you could reword it. The last part is just a specific example of the first part. The reference given for the sentence does not say anything about "personality development" or "stress" but rather describes a study in which 78 subjects received 20 sessions of cognitive-behavioral therapy for treatment of depression and gives specific examples of behaviors associated with subsequent relapse derived from questionnaire data. —Mattisse (Talk) 04:11, 20 October 2008 (UTC)

yeah, need to fix that one. Will check some refs tonight. Cheers, Casliber (talk · contribs) 04:39, 20 October 2008 (UTC)

OK, reworded and combined with following para, so there is general intro sentence followed by several more specific sentences. Cheers, Casliber (talk · contribs) 08:16, 20 October 2008 (UTC)

Also, the referencing seems off base, perhaps the result of so many people editing the article.

• "The impact on functioning and well-being has been equated to that of congestive heart failure." - This type of referencing just makes me wonder about the relationship of information in the article to the references. The article abstract says, "Cross-sectional studies have found that depression is uniquely associated with limitations in well-being and functioning that were equal to or greater than those of chronic general medical conditions such as diabetes and arthritis. ... [We conducted a study of] 1790 adult outpatients with depression, diabetes, hypertension, recent myocardial infarction, and/or congestive heart failure. ... RESULTS: Over 2 years of follow-up, limitations in functioning and well-being improved somewhat for depressed patients; even so, at the end of 2 years, these limitations were similar to or worse than those attributed to chronic medical illnesses."

So what is the rationale for picking congestive heart failure specifically and singling it out?

• I can only speculate about the original rationale, although it certainly gets across the point that depression can be bad news. Anyway, I've modified it with this diff. Cosmic Latte (talk) 07:14, 21 October 2008 (UTC)

• The original article uses CCF as a particularly dramatic example WRT impact on functioning, for some reason not mentioned in the abstract. Cheers, Casliber (talk · contribs) 08:26, 21 October 2008 (UTC)

• Kent, Deborah (2003), Snake Pits, Talking Cures & Magic Bullets: A History of Mental Illness, Twenty-First Century Books, ISBN 0761327045

What makes this book an appropriate source for this article? Surely you could have found a recognized historian of medicine/psychology/psychiatry reference in place of this one to source The Anatomy of Melancholy as the "seminal scholarly work of the 17th century".

Agree, not hugely fussed as it is historical, but I will look into it and see what I can find. Cheers, Casliber (talk · contribs) 14:59, 22 October 2008 (UTC)

• "Norepinephrine may be related to alertness and energy as well as anxiety, attention, and interest in life; [lack of] serotonin to anxiety, obsessions, and compulsions; and dopamine to attention, motivation, pleasure, and reward, as well as interest in life." - Is this direct quote from the reference at the end of the paragraph?

Yes Cheers, Casliber (talk · contribs) 14:59, 22 October 2008 (UTC)

• (picked at random): "General population studies indicate around half those who have a major depressive episode (whether treated or not) will have at least one more and a minority experience chronic recurrence." - The reference to this is one prospective study of subjects in East Baltimore, Maryland, an urban setting, a very specific subject group, and so does not support the sentence re "General population studies". Such a general statement, in my opinion, should be referenced by a minimum of one general review article covering multiple studies that comes to this conclusion.

Prognosis varies according to population drawn from (eg data vary between general community, outpatient and inpatient populations etc.), and this is part of a larger paragraph with other sources. I can see your point and have been looking around. Agree an extra review article would be handy Cheers, Casliber (talk · contribs) 14:59, 22 October 2008 (UTC)

• Reference 190 This link for the article title appears to be dead:http://archpsyc.ama-assn.org/cgi/content/abstract/48/9/851 You have a PMID reference to it, so you might just take the link out of the article title.

—Mattisse (Talk) 14:32, 20 October 2008 (UTC)

done Cheers, Casliber (talk · contribs) 08:30, 21 October 2008 (UTC)

Comments VERY IMPRESSIVE ARTICLE. It has great prose and explains everything in a very neat and undestandable way. Clearly one of the best articles recently seen in the medicine category for FAC. Congratulations to each one of the editors. If I had to vote right now I would clearly support it. However I have a few minor (very, very minor) issues. I only had time to read though half of the article. I will add some more tomorrow.

Signs and symptoms

• this is a typical presentation in developing countries: Is there any reason to think that there is a different presentation in developing countries and alredy developed? What are the differences? (I think there is not; so I would symply eliminate the sentence and leave the ref).

• I'd prefer to leave as is - presenting with somatic symptoms is more common in developing countries, and is hence a specific feature to look for. This was a late addition to the article as I gathered material to make the article less first world-centric. It actually rings true as I find in practice that many people from non-english cultures offer up somatic symptoms prominently. Cheers, Casliber (talk · contribs) 23:17, 20 October 2008 (UTC)

• Older people with major depression are more likely than younger people to show cognitive symptoms such as forgetfulness, and also tend to show a more noticeable slowing of movements.: The ref has no abstract and it is from 1961. It would be great if a newer ref with abstract was provided since it would be easier to access it. (Not mandatory anyway) (I have added a readable online book reference from consensus guidelines produced by the RANZCP)

• In severe cases, depressed people may experience psychotic symptoms such as delusions or, less commonly, hallucinations: I would provide a succinct definition of delusions and hallucinations inside brackets after each of the words for clarity.

I am not so sure - delusion is a pretty common word, I can add (fixed false beliefs) after it if a consensus think it will help. Cheers, Casliber (talk · contribs) 01:37, 22 October 2008 (UTC)

Similarly, a hallucination is a "false sensory perception without a real external stimulus" - I feel this would be cumbersome to include and see the value of a bluelink in linking to a detailed explanation. However, I can include if folks think it is necessary. Cheers, Casliber (talk · contribs) 01:42, 22 October 2008 (UTC)

Feel free to add it or not. I tend to explain more words in medical articles that what it is done in this article, but that is only a custom, and as the length of this article is at its maximum I would understand you kept it as condensed as possible. --Garrondo (talk) 09:13, 22 October 2008 (UTC)

• Those older than 12 years may also begin abusing drugs or alcohol, or exhibit disruptive behavior. Diagnosis may be delayed or missed as symptoms may be interpreted as normal moodiness. Thoughts or attempts of suicide are rare in children with major depression under 12 years of age.: Unreferenced (reffed two bits and removed third, as that bit involves speculation about suicides after the event - epidemiological figures for children I am not too familiar with, but what I have found would be more general. I was debating a general statement about suicide in children under 14 being rare, but is that going off-topic if not specifically attached to major depression? Cheers, Casliber (talk · contribs) 09:40, 21 October 2008 (UTC)

Causes

• "Norepinephrine may be related to alertness and energy as well as anxiety, attention, and interest in life; [lack of] serotonin to anxiety, obsessions, and compulsions; and dopamine to attention, motivation, pleasure, and reward, as well as interest in life." Why does it have this sentence "? Is it a quotation?

• Yes, that's a direct quotation being used to elucidate the Monoamine Hypothesis. Cosmic Latte (talk) 07:00, 21 October 2008 (UTC)

• Antidepressants that do not act through the monoamine system, such as tianeptine and opipramol, have been known about for a long time.: it is not clear which is its ref

Diagnosis

• This one is very important: An EEG may be ordered to rule out the early dementia that can present with depressive symptoms in older patients: Most common dementias (Alzheimer, Parkinson and Lewy Bodies) can not ruled out with an EEG. Would not be more useful to search for a reference on cognitive screening; which is the most common way of searching for dementia? There are probably a good buch of refs on the use of mini-mental and depression-dementia. In most cases patients feel that they have cognitive impairment (mainly memory problems) but they are depressed so a mini-mental or other more complete neuropsychological tests would rule out cognitive impairment. However depression can also precced or cooccur with dementia and there are also some indications that depression does cause mild cognitive deficits in executive functions.

Garrondo (talk •

Aha, good pickup. what I had meant was that EEGs will sometimes have characteristic slow waves in delirium or dementia - this was for the investigations section, and you are right, it is less important than cognitive testing (to rule out dementia) in older people. I just note we haven't got anything on cognitive testing in older people in the article (d'oh!). Will try to rectify later tonight. Cheers, Casliber (talk · contribs) 10:43, 21 October 2008 (UTC)

Some more comments:--Garrondo (talk) 07:44, 21 October 2008 (UTC)

Treatment

• Exercise has shown to have moderate, but not statistically significant, effects in reducing the symptoms of depression: If something is not statistically significant it means there was no effect. There are not non-statistically significant effects.

reworded to "Exercise has not been shown to reduce the symptoms of depression". Cheers, Casliber (talk · contribs) 08:35, 21 October 2008 (UTC)

Some more comments: With this ones I finish my review. I want to say again the impressive work made in this article.--Garrondo (talk) 10:28, 21 October 2008 (UTC)

Epidemiology

• Depression is a major cause of morbidity the world over: Is not over the world?

changed it to "worldwide" (the world over is a quaint english idiom anyway) Cheers, Casliber (talk · contribs) 10:39, 21 October 2008 (UTC)

• In the year 2030, it is predicted to be the second leading cause of disease burden worldwide (after HIV), according to the World Health Organization: Are the brackets really needed? (I would eliminate them)

parentheses duly removed Cheers, Casliber (talk · contribs) 10:39, 21 October 2008 (UTC)

Comments by delldot ∇.

Wow, very much improved since the peer review I gave it, it's a really great read now, very well organized and informative. Most of these are very minor points about wording.
Lead

• However, the relief of symptoms usually occurs several weeks or more after changes in neurotransmitter levels, which suggests that the precise role of neurotransmitter levels in depressive illness is still not fully understood. - Sounds a little repetitive with two uses of 'neurotransmitter levels'. Also use of 'suggests' seems a little weird there; wouldn't we know for sure whether it's fully understood?

Has been changed in the course of this FAC, and you are right BTW Cheers, Casliber (talk · contribs) 10:56, 21 October 2008 (UTC)

• Is there a reason why 'percent' is used in the lead and % is used elsewhere?

::No idea...will check MOS, if nothing there then a symbol it shall be... Cheers, Casliber (talk · Wikipedia:MOS#Percentages - erm, not sure. Having read this, ee could go either way I guess. Cheers, Casliber (talk · contribs) 10:59, 21 October 2008 (UTC)

I would make it consistent one way or the other. I think more scientific articles tend to use %. delldot ∇. 03:11, 22 October 2008 (UTC)

agree on thinking about it; done Cheers, Casliber (talk · contribs) 15:01, 22 October 2008 (UTC)

Signs and symptoms

• Could you shorten this without losing meaning? in the typical pattern, a person reports waking very early and being unable to get back to sleep → in the typical pattern, a person wakes very early and is unable to get back to sleep (done) Cheers, Casliber (talk · contribs) 08:41, 21 October 2008 (UTC)
• Those older than 12 years may also begin abusing drugs or alcohol, or exhibit disruptive behavior. -- This kind of makes it sound like kids under 12 never do this, I imagine it's supposed to mean something more like kids over 12 are more likely to, but it's not impossible in younger kids either. Also, just mentioning drugs and alcohol in the peds para makes it sound like that's not a symptom in adults; I thought it was.

Causes

• ...the idea that some components of depression are adaptations. This is a surprising assertion, could we have an example? What could possibly be adaptive about depression?

• The elaboration currently comes toward the end of the article, in Sociocultural aspects--i.e., depression can elicit social support, or it can work in a way analogous to physical pain by preventing hasty actions. Maybe something about this should be said earlier? Cosmic Latte (talk) 07:07, 21 October 2008 (UTC)

• Most antidepressants increase synaptic levels of the monoamine neurotransmitter serotonin. - this is the first use of 'monoamine', maybe give a bit of an explanation of what it means?
• tianeptine and opipramol, have been known about for a long time. -- 'been known about' sounds weird.
• A depressive episode may also be triggered by a loss of religious faith. - non-sequitur there, maybe would fit in with a list of events that can precipitate it (e.g. Vulnerability factors—namely early maternal loss...).
• an external locus of control, a tendency to attribute outcomes to external events perceived to be uncontrollable. - it's better to avoid reusing a word from the term you're trying to define in the definition (e.g. 'external is external').
• What's going on with the two different sets of quotation marks here: "In mourning 'it is the world that has become poor and empty; in [depression] it is the ego itself.'" Who's saying what?

• The article authors are quoting Freud, but the initial "In mourning" comes from the article authors themselves. Cosmic Latte (talk) 07:09, 21 October 2008 (UTC)

• parents have problems with alcoholism -- this strikes me as redundant, maybe because it seems like alcoholism would always be problematic. Maybe parents are alcoholic or have problems with alcohol.

yep, good tautological pickup, changed to "..a parent with alcoholism" Cheers, Casliber (talk · contribs) 09:48, 21 October 2008 (UTC)

Diagnosis

• If you're looking for material to cut down for length, you could remove the para starting Specialist mental health services are rare in rural areas... this is not remarkable for depression probably, it would be the case for everything. (Or cut it down).

I have mixed feelings about this. Tony noted a first-world bias about the article and wondered if/how it could be addressed. I actually feel it is important to briefly touch on the contrast between urban first-world services and developing countries (and even rural Australia for that matter!). It is important WRT MDD as it is often thought a disorder of developed countries only, yet data shows it worldwide. Cheers, Casliber (talk · contribs) 09:43, 21 October 2008 (UTC)

Prognosis

• I think it should be 40–70% rather than 40% to 70% per WP:MOSNUM# Percentages. (done)Cheers, Casliber (talk · contribs) 08:38, 21 October 2008 (UTC)

Refs

• Some journal titles are abbreviated, some aren't. Some abbreviations have periods, some don't. I don't mind helping to go through and make these consistent if you let me know which style you prefer for all of them.

• Aargh, thought I got 'em all. Go for it! Cheers, Casliber (talk · contribs) 08:37, 21 October 2008 (UTC)

Which style? delldot ∇. 03:11, 22 October 2008 (UTC)

• Isn't the first letter after a colon in an article title supposed to be capitalized? Again I don't mind doing it myself as long as I know I'm supposed to. Either way it should be made consistent.

Ditto. Cheers, Casliber (talk · contribs) 08:37, 21 October 2008 (UTC)

Caps after the colon, right? delldot ∇. 03:11, 22 October 2008 (UTC)

Great work overall! More comments to follow. delldot ∇. 06:43, 21 October 2008 (UTC)

• Support—although I must disclose that I copy-edited the lead and first one or two sections last month. I hope that this is the first of a run of articles in a woefully undertreated part of WP (psychiatry and psychology) in which Casliber puts his considerable expertise to great public benefit. I'd like to return and make a few detailed comments. Here's one: " A depressive episode may also be triggered by a loss of religious faith." I think this is oddly prominent in the rather short lead para to the section "Psychological", and the Journal of Religion and Health, although published by Springer, is hardly a mainstream source in the field. The article is from 36 years ago; is it relevant nowadays? BTW, can you insert "causes" after the solely adjectival subtitles in the "Causes" section? They look strange, and I think MoS says titles should usually be nominal groups. Tony (talk) 08:28, 22 October 2008 (UTC)

Thanks, I was trying to keep subheadings as succinct as possible, but agree above improvement sounds good. An opinion on whether a bracketed explanation of delusions and hallucinations (i.e. whether we should have them or not) would be appreciated, as I am torn/on the fence with this one. Cheers, Casliber (talk · contribs) 08:55, 22 October 2008 (UTC)

• Support as contributor. Cosmic Latte (talk) 09:31, 22 October 2008 (UTC)

• Support as a minor contributor. I think it was well-written, and this process is great. I must have read the article 5 times, and I didn't see half the points that have been pointed out. I'm embarrassed that I missed the Alzheimer's EEG issue, since I helped write the Alzheimer's with Garrondo. I'm kicking myself. Anyways, excellent article. OrangeMarlin ^{Talk• Contributions} 14:26, 22 October 2008 (UTC)

• Comment on prose - The prose is rather dull and repetitious. For example, the overuse of "may", which is a weak, vague word, in the Biological causes section:

They may also enhance the levels of two other neurotransmitters, norepinephrine and dopamine.

Norepinephrine may be related to alertness and energy as well as anxiety, attention, and interest in life;

Serotonin may help regulate other neurotransmitter systems,

and decreased serotonin activity may allow these systems to act in unusual and erratic ways

Facets of depression may be emergent properties of this dysregulation

There may be a link between depression and neurogenesis of the hippocampus

Drugs may increase serotonin levels in the brain

This increase may help to restore mood and memor

Depression may also be caused in part by an overactive hypothalamic-pituitary-adrenal axis

Depression may be affected by variations in the circadian rhythm.

Can this be worded better? There is one paragraph in this section that does not contain the word "may", starting with "In the past two decades, research has uncovered multiple limitations of the monoamine theory, and its inadequacy has been criticized within the psychiatric community..." and this paragraph is by far the clearest, most straightforward one in the section. And it does not use the passive voice which improves it. In general, so much use of the passive voice in this section makes for less interesting reading. —Mattisse (Talk) 00:56, 23 October 2008 (UTC)

delldot noted lots of "may"s a while ago and I did a big sweep through; I ddid notice some more but you have pointed out a fair few. The issue is alot of the ideas in the paragraph are not definite but conjectural. Nevertheless, I will do a sweep-through and see if we can "mix up" the prose a little. Cheers, Casliber (talk · contribs) 05:15, 23 October 2008 (UTC)