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This is an old revision of this page, as edited by Mwalla (talk | contribs) at 16:56, 19 March 2009 (→‎Regarding the efficacy of dietary oils in depression (arbitrary break)). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Featured articleMajor depressive disorder is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.
Article milestones
DateProcessResult
July 9, 2006Good article nomineeListed
December 31, 2006Good article reassessmentDelisted
April 3, 2007Featured article candidateNot promoted
December 6, 2008Featured article candidatePromoted
Current status: Featured article

Cannabis

WP:UNDUE, POV, uncited text removed. SandyGeorgia (Talk) 03:39, 9 January 2009 (UTC)[reply]

Over the years cannabis has come to be demonized by misinformed and selfish people, so much so that propaganda (Above the Influence) are spread about its effects and by a combination of lies and scare-tactics this wonderful plant has been made and kept illegal in the US. Sensible people are now learning of the plants medical value, and more and more people are being prescribed medical Marijuana (as it's now called so that it sounds more friendly) every day. Cannabis has virtually no side affects, is much much more affective than any pain pill or anti-depressant, and is %100 natural.

Read a paper a while back about how THC increases ones risk of both anxiety and depression over baseline.--Doc James (talk · contribs · email) 22:10, 9 January 2009 (UTC)[reply]
I've read that paper. Correlation does not equal causality. Unless you have some other evidence? 219.89.98.127 (talk) 10:53, 27 February 2009 (UTC)[reply]
Correlation may not be causality, but that doesn't look like a very promising correlation. I agree that marijuana has been irrationally demonized, but where's the evidence--correlational or otherwise--that it's a helpful medication for depression? Cosmic Latte (talk) 14:21, 27 February 2009 (UTC)[reply]

Transcraneal magnetic stimulation

This treatment has been approved recently in USA and Europe, has a well proven efficacy, and its likely to be increansingly used. It does not seem logical to have it under a "other" subsection, side by side to an "over the counter herbal remedy" or a recommendation on physical exercise non proved by reviews; it may also confuse its importance the fact that just under the subsection title there is a "see also:self medication"; when nobody can use TMS by their own... I believe these are all reasons for it to have its own subsection just after ECT (since it says that it is used as an alternative to it). Best regards.--Garrondo (talk) 08:30, 6 March 2009 (UTC)[reply]

I've removed the "self-medication" bit from that section because neither rTMS nor VNS can be considered self-medication. As for the placement in an "other" subsection, that is probably okay given that these treatments are newer and less well established. Xasodfuih (talk) 19:59, 8 March 2009 (UTC)[reply]

Cause -> Bad sleep?

The article Are bad sleeping habits driving us mad? in New Scientist states:"TAKE anyone with a psychiatric disorder and the chances are they don't sleep well. The result of their illness, you might think. Now this long-standing assumption is being turned on its head, with the radical suggestion that poor sleep might actually cause some psychiatric illnesses or lead people to behave in ways that doctors mistake for mental problems. The good news is that sleep treatments could help or even cure some of these patients. Shockingly, it also means that many people, including children, could be taking psychoactive drugs that cannot help them and might even be harmful.". In short, sleeping disordes may cause deperssive disorders. I couldn't find it in the article. Maybe I just overlooked it, if not shouldn't it be in here? regards --Cyrus Grisham (talk) 18:28, 6 March 2009 (UTC)[reply]

It actually is here, in Major depressive disorder#Other theories: "Depression may be related to abnormalities in the circadian rhythm…". We've talked about discussing this more extensively, but there really isn't space. Still, if you have suggestions for getting the message across more clearly, feel free to make them. Looie496 (talk) 00:19, 7 March 2009 (UTC)[reply]
Well, it is there an it is there not. The Chronobiology (circadian rhythm/Circadian rhythm sleep disorders) part is there (at least partly, but how different wavelengths of the "light" affects our body clocks is another story), but not quality of sleep part (see also Sleep disorder), for example sleep-disordered breathing like sleep apnoea or Insomnia (well, I can't see the part). I qoute the article: "Adults with depression, for instance, are five times as likely as the average person to have difficulty breathing when asleep, while between a quarter and a half of children with attention-deficit hyperactivity disorder (ADHD) suffer from sleep complaints, compared with just 7 per cent of other children.. Normally, like in the Insomnia article:"Poor sleep quality can occur as a result of sleep apnea or clinical depression.", but what if sleep apnea could cause poor sleep quality and clinical depression? Thats what the weblink from New Scientist suggests: that sleep disorders may lead to the depression, and not "just" However, certainly not every depressed person has a sleep disorder, but this should be thought of!
This leads to the question how this could be included. Well thats not so easy, but first we should agree that this part is not in and then how we can implement it to fit nicely into the article. --Cyrus Grisham (talk) 14:54, 7 March 2009 (UTC)[reply]
I agree that it's not in there, and it should be. I do have a feeling (like you?) that research and time will show that sleep disorders cause depression more often than the opposite. They cause "ADHD", too. - Hordaland (talk) 18:59, 8 March 2009 (UTC)[reply]
I have the same opinion, but unfortunately the psychiatric community as a whole doesn't seem to be fully convinced yet, so there's a limit to how much weight the article can give these ideas. We gotta follow the mainstream even if we think they're behind the times. Looie496 (talk) 19:51, 8 March 2009 (UTC)[reply]
Well, this is not the psychiatric community, this is wikipedia. The Peptic ulcer is one example were the psychiatric community told the people it is just "stress" (bad childhood, stressful job, etc), which is causing this. They were wrong! Stress might be a factor (maybe even an importend or the one), but then what is stress? When were are answering this question, we also have to think about stress hormones! Here the problem begins, because when are these hormons released into the body and where are those produced? Here the psychiatric community gives some answers, but is it the full picture? I don't think so. Why? Scientific evidience shows that stress hormons can also be released, when you have a sleeping disorder or when you're on nightshift(?)! Thats a measurable fact. I have no idea what happends, when the organs which is producing these hormones is not working as it should, for whatever reason. Therefore, I believe that this should be included into the article under a section like "Depression and sleep", where both possibilities should be fairly weighted (depression->bad sleep, bad sleep->depression or better depression <-> bad sleep). There is from my point of view a lot from the psychiatric community, so why not add this stuff? The source is there and I think that New Scientist is a realiable one, don't you? What do you think? Best regards! --Cyrus Grisham (talk) 20:32, 8 March 2009 (UTC)[reply]

That article in New Scientist relies almost entirely on this paper for the link with depression. If anything, that study should be cited directly, and the New Scientist article be cited with the "laysummary=" param. I've not read the paper carefully, so no comment on it right now. Xasodfuih (talk) 20:44, 8 March 2009 (UTC)[reply]

Here are some other links:
Yup, including mine (DSPS) until quite recently. Progress is slow, but remember that homosexuality was a disorder to be treated according to the DSM. Now it's not, though transsexuality still is. Circadian rhythm disorders were mental disorders until recently. Now they're not, except for SAD which got left behind. There are certainly still a lot of unknowns. - Hordaland (talk) 01:25, 9 March 2009 (UTC)[reply]
All I am saying is that misinformation/misdiagnoisis is not a feature of the psychiatric/psychological community seeking to "cover" more diseases/disorders under their umbrella, but rather a reflection of the general medical consciousness of the times. —Mattisse (Talk) 02:21, 9 March 2009 (UTC)[reply]

Here are some more studys (some were from mentioned in the New Scientist article, but I couldn't find them all):

By the way, there are far more studys out there between the connection sleep and depression/psychiatric disorders. Quite interesting... --Cyrus Grisham (talk) 12:12, 9 March 2009 (UTC) <-Here's a suggestion: I think a specific article on Role of sleep disturbances in mood disorders would be fully appropriate, and having such an article would make it easier to extract out the gist for the top-level article. If you would like to use your sources to start such an article, I would be supportive. Looie496 (talk) 16:47, 9 March 2009 (UTC)[reply]

Thanks Looie496, thats an good idea. I would even suggest an article like sleep and health (Maybe thats too general, and quite a lot of things are in other articles, but there is no article in wikipedia, which gives a quick overview, what might happen when someone has sleep disturbances). However, first I'd like to hear what others are thinking and then we can decide what to do. So I'll be back in this discussion in a few days, I have lots of work to do (and I'm not an expert in this area). Best regards! --Cyrus Grisham (talk) 21:22, 10 March 2009 (UTC)[reply]
  • You might look through
For sure :-)
One approach might be Sleep disorder as a list, showing a hierarchy. F.ex. shift work, DSPS and Non-24 are all circadian rhythm sleep disorders, as are ASPS and even Jet lag. One section of Sleep disorder is already in list form. As is:
This almost should be a project. In fact, I think I proposed it as a task force once upon a time!
(This whole discussion should be moved someplace more appropriate.) - Hordaland (talk) 00:55, 11 March 2009 (UTC)[reply]
Until then: There is an article on sleep medicine, which could be of use.--Garrondo (talk) 08:33, 11 March 2009 (UTC)[reply]
Task force: found it! I did indeed suggest a task force for Sleep medicine here last June. (That was before I wrote the article Sleep medicine referred to above.) Only one other person (user:Medicellis) ever expressed an interest. As this discussion shows, some clean-up and reorganizing is needed. Might there be enough interest now for a Task Force? - Hordaland (talk) 12:22, 11 March 2009 (UTC)[reply]
Insomnia got redirected to Sleep medicine (from my point of view, an annoying redirect.) I don't know much about wikipedia projects, but I wonder if "Sleep" could be a "Topic", or is that what it is in the template above? Not sure. Does a project deal with a topic? How does a task force operate? I agree that the subject of sleep is very important and has relevance to many issues/subjects/conditions. —Mattisse (Talk) 12:59, 11 March 2009 (UTC)[reply]

Undue weight? to the exclusion of other causes?

There seems to be a big focus on psychological and biological causes of depression which definitely should be included in the article and are relevant but there is zero mention of drug induced depression, which is a common cause of depressive disorder, such as chronic alcohol misuse and chronic sedative hypnotic use. I am not talking about someone getting drunk and "feeling depressed", that is depression the symptom but I am talking about major chronic depression associated with suicide etc caused by chronic use of certain drugs of dependence, specifically alcohol and other sedative hypnotics. I am not talking about self medicating either but the dependency and the chemical imbalances caused by the dependence either directly causing the major and chronic depression or worsening depression. I am not saying that we need a huge section on this but even just a short paragraph or two would do. I can't see why these factors have been totally excluded but a huge amount of text is used on the biological/genetic/chemical imbalance and social factors but nothing on chemical induced depressive disorder. Here is one paper, a 25 year follow-up study.[1] Certain drugs can cause chemical imbalances in serotonin, dopamine etc which leads to depression. I can provide more references but as this is a featured article I did not want to "dive in" and start editing and pulling up refs without discussing first.--Literaturegeek | T@1k? 21:22, 11 March 2009 (UTC)[reply]

The new cause section chemical imbalance should be renamed from my point of view drug use. BTW, alc has both an effect on sleep and mood, I qoute from this article [2]: "Alcohol-use disorders are associated with depressive episodes, severe anxiety, insomnia, suicide, and abuse of other drugs." and this [3] "How alcohol produces disturbed sleep remains unknown.". I just rename it. Greetings Cyrus Grisham (talk) 19:29, 14 March 2009 (UTC)[reply]
A fairly glaring problem with "chemical" is that everything composed of matter is a chemical. I guess it has a colloquial meaning akin to "noxious substance," but really, all of the neurotransmitters discussed in Biological Causes are chemicals. The entire body is made of chemicals, especially the scary-sounding dihydrogen monoxide--which is, indeed, lethal in certain doses. The main idea of this section appears to be that foreign, psychoactive chemicals can induce depression. And because another name for a foreign, psychoactive chemical is a drug, "drug use" would appear to be the clearest heading. I just wonder if all these headings have led the Causes section slightly astray from the trifurcate "biopsychosocial" theme. Cosmic Latte (talk) 20:11, 14 March 2009 (UTC)[reply]

Thanks for the comments. I was unsure about the best name for that section when I chose it. Yea I know alcohol can cause anxiety and sleep disorders. I didn't mention anxiety or sleep in the article as I didn't want to veer off the article topic of major depression too much. Your points are good and I am happy with the sub section name change.--Literaturegeek | T@1k? 00:28, 15 March 2009 (UTC)[reply]

In my opinion you need better sources. PMID 19014977 is not a very strong source per MEDRS, and I know from my own experience that the sort of tricky statistical methods it uses are prone to produce spurious results. Most of the evidence I've seen indicates that alcoholism tends to follow depression rather than vice versa -- not sure of the story for other drugs. Looie496 (talk) 00:44, 15 March 2009 (UTC)[reply]

Hi Looie. The rat study Cosmic suggested is not necessary anyway. There are lots of authoritative sources for the sleep disturbances of alcohol and also info on sleep disturbances is not relevant to this article I don't think.--Literaturegeek | T@1k? 02:10, 15 March 2009 (UTC)[reply]

I deleted the section, mainly because I think we're giving too much weight to unclear causal relationship. Please see WP:MEDRS. You need consensus here first, and I'm not seeing it. OrangeMarlin Talk• Contributions 03:10, 15 March 2009 (UTC)[reply]
I suggested a rat study? Cosmic Latte (talk) 09:21, 15 March 2009 (UTC)[reply]

There was no opposition if you read above about that section, so I don't know why you say that you are not seeing consensus. I know in the mental health field sedative hypnotics, especially alcohol are well known as causes of depression and psychiatrists will often screen for alcohol misuse when making a diagnosis of depression. Furthermore sedative hypnotics decrease serotonin and noradrenaline which is inline with antidepressants which increase those neurotransmitters having therapeutic effect and those neurotransmitters being involved in depression.--Literaturegeek | T@1k? 07:19, 15 March 2009 (UTC)[reply]

IMHO, the alcohol and drug abuse should go into co-morbidities as the causality is tenuous. In addition, we have to mind the undue weight issue. For example, the co-morbidity with drug abuse should not take more room than the whole antidepressant treatment chapter. It deserves, at the most, one or two sentences. The Sceptical Chymist (talk) 12:31, 15 March 2009 (UTC)[reply]

Hi Sceptical, The references were not talking about comorbidities but major depression induced by alcohol misuse or chronic use of other sedative hypnotics. They cause an increased risk of major depression, probably due to depletion of serotonergic and noradrenergic function. Your suggestion would be misrepresenting the references.--Literaturegeek | T@1k? 23:10, 15 March 2009 (UTC)[reply]

Sorry Cosmic I meant to say Cyrus, I got you two mixed up.--Literaturegeek | T@1k? 23:10, 15 March 2009 (UTC)[reply]

Your point is well taken. Indeed, the authors of PMID 19255375 suggest that alcoholism causes depression. However, such a causation is far from being clear-cut. For example PMID 16917682 suggests that the association of alcoholism with depression disappears if the cases with bipolar symptoms correctly assigned to BP-II disorder and not to MDD. Furthermore, "in the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years." To the contrary, PMID 18215474 finds that the onset of alcohol abuse tended to precede the onset of major depression. And PMID 17960298, which you recommended, maintains that it may go both ways: "Major depressive episodes with an onset before the development of alcohol dependence ... were observed in 15.2% of the alcoholics, while 26.4% reported at least one substance-induced depressive episode."
We have to mind the weight issue, too. And write as concise as possible. What about something like this: "Major depression is associated with alcohol abuse. Alcohol abuse often precedes major depression and a recent meta-analysis suggested that it may cause depression. At the same time, in many cases mood disorders precede drinking problems." And I am not sure if the depression caused by benzodiazepine withdrawal can be classified as a bona fide MDD. Is there an MD who could help? The Sceptical Chymist (talk) 00:54, 16 March 2009 (UTC)[reply]

The 2nd ref uses the "broadest" criteria for BP II. They use very broad criteria outside of the accepted DSM, so I think their paper is more of a theory hypothesis based paper, rather than a traditional paper. If you use very broad criteria outside of the DSM you can end up distorting data. So I wouldn't say that they are "correctly" assigning cases to bipolar, if anything they are incorrectly doing so in my opinion and by their own admission the DSM's opinion. When using very broad criteria outside of the DSM you can end up diagnosing mild to moderate paranoia as schizophrenia and double or treble the amount of people diagnosed for example. Same with ADHD, insomnia and other disorders you could end up with figures like 30% or more of the population having those or other disorders if you use the broadest of criteria outside of and or in addition to the DSM. Infact that paper seems to be doing some synthesis or original research by using DSM but then adding in more broad diagnosis criteria, which is not universally accepted like the DSM which itself has even been criticised by some as being too broad. Self medicating with alcohol in bipolar patients (the sedative effect of alcohol reducing the manic symptoms) is very common and do agree that self medicating for bipolar is common but this would be relevant for the bipolar article.--Literaturegeek | T@1k? 03:13, 17 March 2009 (UTC)[reply]

You already included the following good sentence into the causes of depression chapter: "Long term drug use or abuse or withdrawal of certain sedative and hypnotic drugs eg. alcohol or benzodiazepines can also cause a chemical imbalance which may result in major depressive disorder.[14][15]" Minding the due weight issue, is there need for more? If yes, for how much more? Ref [15] (name=ashman>{{cite web | author= Professor Heather Ashton | year= 2002 | url= http://www.benzo.org.uk/manual/bzcha03.htm | title= Benzodiazepines: How They Work and How to Withdraw) is probably not very reliable. How about replacing it with some of the discussed above? changing eg to for example for the lay reader?The Sceptical Chymist (talk) 10:30, 17 March 2009 (UTC)[reply]

Prof Ashton is a world expert on benzodiazepines and The Ashton Manual is often referenced in medical publications, on google scholar. I don't think that the text that I added was undue weight if you look at the size devoted to biological chemical imbalances, although I guess that I could shorten it a bit. I have found a medical text book which speaks about protracted withdrawal symptoms including depression so I can certainly improve the quality of the references if necessary.--Literaturegeek | T@1k? 13:19, 17 March 2009 (UTC)[reply]

I added back the data and included an oxford text book reference. I am trying to get a hold of another oxford text book for reference.--Literaturegeek | T@1k? 14:09, 19 March 2009 (UTC)[reply]

Regarding the efficacy of dietary oils in depression

Header edited to comply with WP:TALK#New_topics_and_headings_on_talk_pages, which indicates that headers should indicate the topic, but no specific view on that topic. Original header preserved in an anchor tag. --Scray (talk) 06:31, 15 March 2009 (UTC)[reply]

Regarding these edits [4] [5] [6] by OrangeMarlin: (clarification added after topic was renamed)

  • Metaanalysis1: (PMID 17194275) "CONCLUSIONS: The preponderance of epidemiologic and tissue compositional studies supports a protective effect of omega-3 EFA intake, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mood disorders. Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02)."
  • Metaanalysis2 (PMID 17877810): "A meta-analysis of trials involving patients with major depressive disorder and bipolar disorder provided evidence that omega-3 PUFA supplementation reduces symptoms of depression. Furthermore, meta-regression analysis suggests that supplementation with eicosapentaenoic acid may be more beneficial in mood disorders than with docosahexaenoic acid, although several confounding factors prevented a definitive conclusion being made regarding which species of omega-3 PUFA is most beneficial."
  • Metaanalysis3 (PMID 17158410): "Meta-regression provided some evidence that the effect was stronger in trials involving populations with major depression-the difference in the effect size estimates was 0.73 (95% CI: 0.05, 1.41; P = 0.04), but there was still considerable heterogeneity when trials that involved populations with major depression were pooled separately (I2 = 72%, P < 0.001). CONCLUSIONS: Trial evidence that examines the effects of n-3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity."
  • Editorial (PMID 17919344): "The evidence supporting the use of EPA+DHA in the management of psychiatric disorder appears strongest for conditions involving disturbances of mood/anxiety and/or impulse control. Thus in addition to the benefits for major depression and bipolar disorder highlighted by the APA's meta-analysis, ..."

OrangeMarlin, you are in gross violation of WP:V and WP:MEDRS trying to debunk 3 metanalysis with one negative study done in a different population PMID 17956647 (read the editorial in Br. J. Nutr. carefully). You are also stating the exact opposite of what metaanalyses cited say; presumably you need a refresher in statistics. Desist at once! Xasodfuih (talk) 05:45, 15 March 2009 (UTC)[reply]

Please see WP:NPA. Each one of your citations quote mines. In fact, none of them support your statements, and most of them say "you know, we see some variability, maybe it might do something, but really, we're not seeing it." I'm paraphrasing for effect. Any further personal attacks about my intelligence, fields of study, etc. will be dealt with quite radically. Otherwise, YAWN. OrangeMarlin Talk• Contributions 06:01, 15 March 2009 (UTC)[reply]

(out-dent) From what I see presented here (I am not an expert on this subject), it appears that no randomized, placebo-controlled clinical trial has shown a clear protective or therapeutic benefit for omega-3 or other dietary oils. Meta-analysis (a less-compelling form of evidence because it is not a direct comparison and is subject to publication bias and other limitations) has suggested a modest effect tempered by heterogeneity among trials (worrisome in a meta-analysis). Let's see how others weigh in, but I would attempt to write soft language that captures the limited support these data provide. The gold standard remains randomized placebo-controlled study, and to date those have not shown a clear benefit. --Scray (talk) 06:30, 15 March 2009 (UTC)[reply]

There's too much happening to this article too quickly. OM's wording is far more negative than the wording that was in the article a couple of days ago, which was a result of a lot of careful editing. There are a couple of dozen other dubious new changes too. For an FA this sort of thing is really unacceptable. I would like to revert back to the version of March 13 and then take things one at a time, discussing on the talk page and reaching consensus before making changes to the article. Looie496 (talk) 06:32, 15 March 2009 (UTC)[reply]
I agree with your concern about the rapid succession of edits, but it's not obvious where to draw the line. I'll defer to others on how exactly to get there, but part of the message is that we need consensus in a situation like this, not rash action. This is not an emergency. --Scray (talk) 06:41, 15 March 2009 (UTC)[reply]
Taking PMID 17158410 as example (the other metaanalyses are also on RCTs): "Eighteen randomized controlled trials were identified; 12 were included in a meta-analysis. [...] The pooled standardized difference in mean outcome (fixed-effects model) was 0.13 SDs (95% CI: 0.01, 0.25) in those receiving n–3 PUFAs compared with placebo." Please read what a metaanalysis is, and also what WP:MEDRS recommends wrt. to them (hint: they're the best level of evidence. Xasodfuih (talk) 06:44, 15 March 2009 (UTC)[reply]
I assure you that I am well-versed in meta-analyses, and they do have serious weaknesses to which I specifically alluded. They are certainly not simply the best level of evidence - they can be very useful, but their accuracy depends on many factors. --Scray (talk) 06:54, 15 March 2009 (UTC)[reply]
"not simply the best level of evidence" WP:MEDRS disagrees with you; take that discussion there. Yes, heterogeneity is a concern for the validity of the results, hence the careful wording I proposed "meta-analyses of controlled studies showing positive results but also high heterogeneity and small effect size". Xasodfuih (talk) 06:58, 15 March 2009 (UTC)[reply]
(after edit conflict, and relevant to this comment) The specific example chosen (PMID 17158410) it is remarkable that the exact sentence quoted above actually continued, "with strong evidence of heterogeneity (I2 = 79%, P < 0.001)". This is exactly the sort of problem that plagues meta-analysis. Also, I don't dispute that meta-analysis can be an excellent form of evidence, but it is not simply the best form - there are many bad meta-analyses. --Scray (talk) 07:05, 15 March 2009 (UTC)[reply]
So? The wording I used "meta-analyses of controlled studies showing positive results but also high heterogeneity and small effect size" captures this finding which was common to all three metaanalyses. Compare with OM's "with controlled studies and meta-analyses showing negative results exclusively." which is clearly a false statement given the sources. Xasodfuih (talk) 08:12, 15 March 2009 (UTC)[reply]

I saw request for comments on wiki medicine. I read the edit summary and the reason for deleting was "CAM pushing". I don't think diet and nutrition is CAM pushing. It is basic biology that certain nutrients have effects on brain function, essential effects on brain function. I think that the scientific literature does seem to suggest that there is some benefit all be it small benefit from taking omega 3. Furthermore omega 3 is deficient in western diets. HOWEVER, like I say the effect size appears to be small and to effect only a small proportion of those with major depressive disorder. Basically my stance is as the literature seems to suggest a small effect size, it is an issue of accurately wording the conclusions and not giving undue weight. I do not think that it should have been deleted and I don't think that it can be compared to alternative medicine as explained in this post. It is certainly not like kinesiology or something, the body needs nutrients to function and that is fact.--Literaturegeek | T@1k? 07:01, 15 March 2009 (UTC)[reply]

Scray you are correct meta-analysis have their weaknesses although it depends on what they are assessing. If they are being used to assess a paradoxical effect for example of a medication they are useless as all they prove is you are more likely to have a therapeutic effect than a paradoxical effect (I am recalling a debate I had on another talk page :)). Unfortunately authors then commit scientific fraud by then misusing meta-analysis to debunk uncommon paradoxical effects. I am sure they have other weaknesses to, but I think that there does appear to be enough evidence of a small effect size on omega 3. By the way, I don't have a strong view point on omega 3 and don't want to get in an edit war over it. I am merely commenting on this because it was raised on the medicine talk page for comments, so whatever the decision is on this so be it but these are my views.--Literaturegeek | T@1k? 07:07, 15 March 2009 (UTC)[reply]

I came here for the same reason (the appeal on wikimed; my very first visit to this page was just minutes ago), and agree with the tone of your comments. We need a moderate position - the data are very imperfect. --Scray (talk) 07:12, 15 March 2009 (UTC)[reply]
(copied from above) The wording I used "meta-analyses of controlled studies showing positive results but also high heterogeneity and small effect size" is a moderate statement that captures the common findings from all three metaanalyses. Compare with OM's "with controlled studies and meta-analyses showing negative results exclusively." which is clearly a false statement given the sources cited. Xasodfuih (talk) 08:12, 15 March 2009 (UTC)[reply]
WP:MEDRS is only a guideline, so editors can override its general advice if they have good reason. However, before the meta-analyses are dismissed, I ask what would be used instead? If the best published attempts to review the literature are imperfect, are we to replace them with some wikipedian's own attempts to review the literature? Or do we have other reviews to consult? The article should reflect what our best sources have to say on the subject, and that is best done by consulting those who have already reviewed the research and had their conclusions published in a respectable journal. WP:V policy is "verifiability, not truth" so this article should reflect their conclusions, whether we think they are strong founded or not, subject to publication bias or not. There are biases and flaws in all source types and the real world is messy. BTW: don't interpret this as leaning towards one side or another -- I haven't read those sources and am not qualified to judge here. Colin°Talk 08:39, 15 March 2009 (UTC)[reply]

Regarding the efficacy of dietary oils in depression (arbitrary break)

Let's avoid selective citation and look at the CONCLUSION part in the abstract of each meta-analysis:

Metaanalysis1 PMID 17194275) positive but not quite conclusive: "Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02). The results were highly heterogeneous, indicating that it is important to examine the characteristics of each individual study to note the differences in design and execution... EPA and DHA appear to have negligible risks and some potential benefit in major depressive disorder and bipolar disorder, but results remain inconclusive in most areas of interest in psychiatry."

Metaanalysis2 PMID 17877810 inconclusive, further studies needed: "While it is not currently possible to recommend omega-3 PUFA as either a mono- or adjunctive-therapy in any mental illness, the available evidence is strong enough to justify continued study, especially with regard to attentional, anxiety and mood disorders."

Metaanalysis3 PMID 17158410 negative, further studies needed: "Trial evidence that examines the effects of n-3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity. The evidence available provides little support for the use of n-3 PUFAs to improve depressed mood. Larger trials with adequate power to detect clinically important benefits are required."

Study and meta-analysis4 PMID 17956647 negative: "In conclusion, substantially increasing EPA+DHA intake for 3 months was found not to have beneficial or harmful effects on mood in mild to moderate depression. Adding the present result to a meta-analysis of previous relevant randomised controlled trial results confirmed an overall negligible benefit of n-3 LCPUFA supplementation for depressed mood."

Opinion PMID 17919344 controversy: One of the authors of Metaanalysis1 slams authors of metaanalyses 3 and 4 for poor methodology. "Their choice of a new population to study makes good sense. But pooling their results with those of other trials involving very different populations does not. This all encompassing approach to meta-analysis was used in an earlier publication from the same group12, and it is repeated in the current paper, with the inclusion of this latest trial. What have males with angina, chronic patients with schizophrenia, and mothers who choose to breastfeed got in common?" However, the author of this opinion notes a very important detail that the abstract of his own meta analysis1 did not mention. "It was strongly emphasised [in metaanalysis1] that these recommendations are not intended as a substitute for standard treatments for psychiatric disorders, as most trials to date have used n-3 fatty acids adjunctively."

So why not return to the balanced version: "The issue of efficacy of omega-3 fatty acids for major depression is controversial,[1] with controlled studies and meta-analyses supporting both positive[2][3] and negative conclusions.[4][5]" The Sceptical Chymist (talk) 11:50, 15 March 2009 (UTC)[reply]

I largely agree with the version you restored, which preceded OM's edits. An observation: metaanalysis3 PMID 17158410 and Study and meta-analysis4 PMID 17956647 are pretty much one and the same as the authors list overlaps significantly, and meta-analysis4 added one study to metaanalysis3. As for caveats, authors of Metaanalysis2 also wrote a similar caveat that authors of Metaanalysis1 in a reply to a letter to the editor. Regardless of metaanalysis and the spin given in the conclusion section, the statistical results of metaanalyses are in the same ballpark in terms of heterogeneity and effect size. Even though Metaanalysis2 puts a different sticker on its conclusions than Metaanalysis1, their statistical findings agree: "The magnitude of that effectiveness is approximately 0.91 standard deviations of improvement, given the characteristics of the populations studied to date and noted above. Such a finding is in line with a previously reported meta-analysis which analysed a smaller number of trials [89]. There was, however, significant heterogeneity between the studies." Also metaanalysis3, when restricted to MDD patients, gave a similar result. That's why I thought we should report on their actual statistics, which they actually agree upon, rather than whatever spin they put on them, which is where they disagree. But I'm fine with taking the spin from the horse's mouth, even when it makes little sense to me to present this as controversy over "positive" and "negative" findings when the statistics are pretty much the same, just the spin differs. Xasodfuih (talk) 13:29, 15 March 2009 (UTC)[reply]
X, on such a controversial topic we have to stick closely to the original interpretations, the more it is controversial the less editorial discretion we have. As omega-3 is an unproven treatment (all the analyses call for more research), it does not deserve more than a short mention. Please also note that the efficacy was suggested only for adding omega-3 to the antidepressant treatment, the fact that your version missed. With all the caveats this can be explained in the article on omega-3 themselves or in the article on the treatment for depression. The Sceptical Chymist (talk) 19:02, 15 March 2009 (UTC)[reply]
Agree (in part) with preceding, in that omega-3s also aren't actually used in psych wards or prescribed by any psychaitrists that I know of. The treatment for depression is an ideal page for a greater in depth summary. I have only very briefly scanned over the material and will look into it a bit further to see what is out there. Casliber (talk · contribs) 20:14, 15 March 2009 (UTC)[reply]
Maybe they should start prescribing omega-3s. Omega-3s are harmless and the placebo effect is a powerful thing. :) The Sceptical Chymist (talk) 01:26, 16 March 2009 (UTC)[reply]

I think that returning to the balanced version that Sceptical suggested is a good idea.--Literaturegeek | T@1k? 23:36, 15 March 2009 (UTC)[reply]

I don't.

Exercise

The section on "somatic treatments" did not accurately reflect the results of a recent Cochrane review (see note 160) on the impact of exercise. A detailed reading of this review reveals that 1) the 23 studies that were originally selected show a "large clinical effect." 2) this conclusion is qualified by a statement that three of these studies "with adequate allocation concealment, intention to treat analysis, and blinded outcome assessment" are inconclusive. As far as I can see the secondary selection of this small subgrouping is (puzzlingly) not mentioned at the outset of the study and so should not be considered as a major finding, but only as a qualification, at best. The scale and rigor of many of these studies as well as the main conclusion of the Cochrane review indicates that a separate section on exercise is merited, and so I have created one. The new section obviously needs beefing up, and we have a plentiful supply of serious studies to facilitate this. —Preceding unsigned comment added by Blissblog (talk • contribs) 21:33, 15 March 2009 (UTC)[reply]

  1. ^ Richardson AJ (2008). "n-3 Fatty acids and mood: the devil is in the detail". Br. J. Nutr. 99 (2): 221–3. doi:10.1017/S0007114507824123. PMID 17919344. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. ^ Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, Keck PE, Marangell LB, Richardson AJ, Lake J, Stoll AL (2006). "Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry". Journal of Clinical Psychiatry. 67 (12): 1954–67. PMID 17194275.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Ross BM, Seguin J, Sieswerda LE (2007). "Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?". Lipids Health Dis. 6: 21. doi:10.1186/1476-511X-6-21. PMC 2071911. PMID 17877810.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  4. ^ Appleton KM, Hayward RC, Gunnell D; et al. (2006). "Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials". Am. J. Clin. Nutr. 84 (6): 1308–16. PMID 17158410. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ^ Rogers PJ, Appleton KM, Kessler D; et al. (2008). "No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial". Br. J. Nutr. 99 (2): 421–31. doi:10.1017/S0007114507801097. PMID 17956647. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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