Talk:Major depressive disorder

"Commit" vs "die by" suicide

I just edited three instances of "Commit suicide" to "die by suicide" in line with the Time To Change Media Guidelines. "Commit" refers to criminal acts and risks further stigmatising people affected by suicide and self-harm. Abt21 (talk) 17:49, 30 December 2015 (UTC)

Fair point. Sounds a reasonable change to make. Cas Liber (talk · contribs) 20:20, 30 December 2015 (UTC)

Screening

USPSTF recommendation doi:10.1001/jama.2015.18392 JFW | T@lk 08:21, 27 January 2016 (UTC)

Added. Cas Liber (talk · contribs) 10:05, 27 January 2016 (UTC)

 ToDo Hi, folks ( Cas Liber, JFW ). Checking in here before making this edit. The USPSTF specifies that screening should be implemented "with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up." Additionally, "all positive screening results should lead to additional assessment that considers severity of depression and comorbid psychological problems (eg, anxiety, panic attacks, or substance abuse), alternate diagnoses, and medical conditions." Because about 7-22% of depression-positive people may have bipolar depression, follow-up screening for bipolar disorder should occur, including in primary care settings. . . . Also to add reference to screening tools. I will clean up the references. Drdaviss (talk) 03:43, 19 July 2016 (UTC)

External links modified

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Fixed source mentioned by Cyberbot II by removing dead link and using citation to DSM-5. Also minor content tweak for typo and clarity. Drdaviss (talk) 17:58, 22 July 2016 (UTC)

Typo in first sentence

There is a typo in the first sentence of the article: Major depressive disorder (MDD), often simple called depression.... It should be SIMPLY instead of simple. — Preceding unsigned comment added by 68.8.128.168 (talk • contribs) 20:28, 1 April 2016‎ (UTC)

fixed, thanks. Jytdog (talk) 23:26, 1 April 2016 (UTC)

Non-psychiatric physicians

What do people think about this paragraph relative to the source? (The full-text is available for free.)

Primary-care physicians and other non-psychiatrist physicians have difficulty diagnosing depression, in part because they are trained to recognize and treat physical symptoms, and depression can cause myriad physical (psychosomatic) symptoms. Non-psychiatrist physicians, miss two-thirds of cases and unnecessarily treat other patients. PMID 17968628

Is it just me or is that not really what the source is saying? What I got from the source is summed up in this one sentence: The summary sensitivity showed that less than half of the depressed patients are recognized by their physicians. The way it's worded in the article seems to either come from another source, misunderstands the source, is editorializing or a combination of those 3. This source is also cited, but it's not even about this topic at all. Thoughts? —PermStrump(talk) 00:25, 26 May 2016 (UTC)

Permstrump Hello PermStrump. You make a couple of good points. I am also concerned that this gives readers the impression that non medical doctors, such as clinical psychologists are not trained or are inept in identifying depression. Again, certainly not the reality, nor what the source being used says. How would you approach these issues from here.Charlotte135 (talk) 04:14, 27 May 2016 (UTC)

Does it give the accuracy among psychiatrists? Doc James (talk · contribs · email) 03:57, 21 July 2016 (UTC)

Doc James asked if this meta-analysis gave accuracy among psychiatrists. The paper analyzed studies that compared the accuracy of non-psychiatric physicians' diagnosis of major depression compared with a "gold standard" of psychiatric physician diagnosis. So, according to their methods, the accuracy of psychiatrists was 100%. In the Discussion section (2nd paragraph), the authors state that the specificity for non-psychiatric physicians (NPP) was similar to that reported in the literature for psychiatrists (and thus the last portion, "and unnecessarily treat other patients," is technically true but not to a significant degree, so maybe exclude that (?). It does imply that the sensitivity for NPP is lower than that for psychiatrists. So, they tend to be correct when they say one is not depressed, but they miss true depression 64% of the time. The analysis also notes that post-1998 studies have higher overall sensitivity than pre-1998 (42% vs 30%).

The OP Permstrump asked if the paragraph content represented the source content properly. My answer is "Yes, but...". The two-thirds part is close enough (33% vs 36%). The statement, "in part because they [NPP] are trained to recognize and treat physical symptoms", incorrectly reflects the source's statement, which states that it is the patients' focus on somatic symptoms, not the NPP's. "Patients reduce the likelihood of being diagnosed by presenting with somatic rather than emotional complaints and may resist a diagnosis of depression or anxiety by attributing their symptoms to physical causes." Finally, this paragraph has two citations; the second one (of which I reviewed the abstract) is irrelevant to the paragraph's content and should be removed. I suggest revising the paragraph as follows:

Primary-care physicians and other non-psychiatrist physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatric physicians, in part because of the physical symptoms that often accompany depression, in addition to the many potential patient, provider, and system barriers that the authors describe. A systematic review of 36 studies found that non-psychiatrist physicians miss about two-thirds of cases, though this has improved somewhat in more recent studies.[118][119]

Finally, addressing Charlotte135's comment about this statement implying that non-physicians (eg, psychologists) are "inept", I do not read or infer anything at all about the abilities of non-physicians to diagnose depression in this section. The section is titled Non-psychiatric physicians, so it does not address non-physicians at all, nor does the cited study address the capabilities of non-physicians. Furthermore, the first sentence of the Diagnosis section does mention psychologists as being able to diagnose depression.

Drdaviss (talk) 12:52, 21 July 2016 (UTC)

I like Drdaviss's suggestion. It's in spirit of what the source is saying, as opposed the wording I pasted above which seemed overly accusatory. —PermStrump(talk) 17:08, 21 July 2016 (UTC)

Drdaviss Thank you for such a detailed reply to this discussion and I too agree with your perspective and comments. My concern regarding clinical psychology has also now been addressed.Charlotte135 (talk) 07:44, 22 July 2016 (UTC)

Awesome, Permstrump and Charlotte. Good consensus development. I am not sure what the etiquette is for who executes a consensus edit. I will be "bold" and do it, but if this is a faux pas, I will accept correction. Drdaviss (talk) 16:50, 22 July 2016 (UTC)

Thanks, Drdaviss! I had kind of forgotten about this. —PermStrump(talk) 19:24, 22 July 2016 (UTC)

Thanks Drdaviss, Permstrump & Doc James. Nice consensus.Charlotte135 (talk) 01:25, 23 July 2016 (UTC)

DSM-5

This article cites the DSM-IV-TR and has a section about DSM-IV-TR. In 2013, the next edition of the DSM was published, the DSM-5. Any reason that this hasn't been updated? Or just not done yet? Drdaviss (talk) 04:37, 23 July 2016 (UTC)

Not done yet Drdaviss. If you want to update it, go ahead. I will also take a look tomorrow. I've updated a number of the mental disorder articles that are still included in the DSM 5. Thanks for pointing it out.Charlotte135 (talk) 09:45, 23 July 2016 (UTC)

Management section: exercise vs others

I have a concern with undue weight. Currently there is a subsection of Management for Transcranial magnetic stimulation, but there is no subsection for Exercise. Taking a brief peek in this search compared to this search, and also looking at some of the sources and the content of the section, I think it's clear that exercise is a more mainstream, accepted therapy type for major depressive disorder, whereas Transcranial magnetic stimulation is both a more esoteric or rare treatment type, less-studied, and less-established to work.

On the basis of this I'm going to create a subsection for exercise, move the material from "other" on exercise here, and reference exercise in the list of treatments at the beginning of the "Management" section.

We can consider consolidating the existing subsection for transcranial magnetic stimulation into the "other" section, I wouldn't be opposed to it, but I also don't feel strongly about doing it. Cazort (talk) 22:15, 30 August 2016 (UTC)