Talk:Major depressive disorder/Archive 11

Link Psycheducation.org
Please look at the link to Psycheducation.org. The description is lively, popular and entertaining. However, the author is clearly out of his depth. For example, he states as a confirmed fact that antidepressants work by stimulating BDNF and reversing brain shrinkage. That is misleading and oversimplifying the state of the art much like the original serotonin hypothesis did. I think this link should be removed. The Sceptical Chymist (talk) 11:42, 25 November 2009 (UTC)


 * I rather like the site, but I've been tempted to remove it myself, simply because it doesn't focus on MDD in the first place; it focuses more on BPD, especially bipolar II. Cosmic Latte (talk) 12:30, 25 November 2009 (UTC)

Depression out of the shadows?
I have some doubts if the link to "Depression out of the shadows show" Depression, out of the shadows is appropriate. It features infamous Charles Nemeroff who took ~2 million from pharmaceutical companies without reporting it, "authored" ghost written articles, argued (we now know why) against the FDA antidepressant - suicide link warnings, and is not really a credible source by any stretch of imagination. The documentary was criticized by the Columbia Journalism Review (see here, by other mental health advocates for giving disproportionate time to ECT and mentioning CBT only in passing, and at best deserves only "C" grade, for example . Stanford Wellsphere.org holds similar opinion . Should we keep it or delete it? Is there anything better around to replace it? The Sceptical Chymist (talk) 12:25, 25 November 2009 (UTC)


 * This one encompasses anxiety and stress along with depression, but no discussion of depression would be complete without mention of these comorbid and/or causal factors. The man behind this film is an MD and a published researcher, and looks reliable to me--certainly a great deal more reliable than Nemeroff. Cosmic Latte (talk) 15:52, 25 November 2009 (UTC)

Onset
Early in the article it states that the usual onset is in one's thirties. I'm curious about this, because I have read, from numerous sources, that the most common time for an episode of Major Depressive Disorder is in one's early twenties. Furthermore, of those that suffer an episode in their early twenties, it is very common to suffer a second episode in their early thirties. (Exactly like Abraham Lincoln.) I have always read that the most common time for the onset of all mental illnesses is in one's early twenties. Is anyone else familiar with this? —Preceding unsigned comment added by 68.82.204.61 (talk) 22:41, 30 December 2009 (UTC)

Agitation (Restlessness)
Agitation is an obligated depressive symptom. Of their stamping it reaches from internal restlessness (subclinical agitation) to psychomotor restlessness (agitated depression). With suspicion on a light or moderately depressive disorder should be always asked for internal restlessness to secure the diagnosis. --H.-P.Haack (talk) 01:28, 9 March 2010 (UTC)
 * Why have you placed this here? Looie496 (talk) 19:52, 9 March 2010 (UTC)
 * This edit was made earlier today. It does add some relevant information (especially with regard to agitation) that the article doesn't yet contain. However, I reverted this addition because its sole source was another open wiki. I don't mind that it's self-published, but I would say that a featured article should adhere strictly to WP:RS and other guidelines. If anyone can provide a citation of a third-party RS, please do. Cosmic Latte (talk) 17:19, 10 March 2010 (UTC)

Deep Brain Stimulation for Depression
I think this utility must be added given that there is solid research into DBS for treatment resistant depression. An excellent peer-reviewed research article can be found here: http://www.biomedcentral.com/1756-0500/3/60/. I tried to add this subject to this entry, but it was reverted by SandyGeorgia. Since wiki reflects more than one editor's view, I would like to hear from you all on this. If you choose, simply "undo" the revision made by SandyGeorgia. Thank you. Basrblog (talk) 18:46, 13 March 2010 (UTC)


 * Please see WP:MEDRS, WP:UNDUE, and note that this article is a featured article, so the standards for inclusion are high. Unless recent, major reviews mention DBS, it shouldn't be included here, and then, we need to stick with what major overviews say.  A review of a specific issue, on a small sample, is not the same as a major review of the broader topic of Major depressive disorder and due weight must be given to what is included in this (already long) article.  Is DBS mentioned in a recent broad review article on MDD?  Also, do you have a COI?  I notice that you are sourcing Lakhan on many articles, and you recreated similar content at Brain Blogger as an editor several years who had a COI. What is your relationship to Brain Blogger and Lakhan?  Sandy Georgia  (Talk) 18:59, 13 March 2010 (UTC)


 * DBS has been mentioned in a number of comprehensive reviews, and there is solid evidence that it works in some situations where nothing else does, but it is still an experimental treatment and is unlikely to play more than a minor role in treatment in the near future, because it requires implanting electrodes into the brain, with all the risks that entails even when performed with the greatest care. I have a recollection that DBS was actually mentioned in this article at one time (back when there was an "alternative treatments" section), but apparently it has been dropped. Looie496 (talk) 04:13, 14 March 2010 (UTC)
 * 
 * IF anything is added, I suggest wording be based on a major review of MDD, not to Lakhan, based on the history of COI editing from the various GNIF and Brain Blogger accounts, and the perhaps undue weight given DBS by Brain Blogger-- I'd like to see what truly independent, major overviews have to say (I know what they say wrt Tourette's, and I suspect it's similar). I suspect it's an exceedingly minor treatment possibility, so doesn't belong here, but I'm not aware of recent reviews in this topic. Sandy Georgia  (Talk) 14:47, 14 March 2010 (UTC)
 * is one broad review that discusses the topic -- there are others, but none that claims the method is ready for wide application. The most in-depth reviews have involved Helen Mayberg as a co-author; she is highly reputable but can't be considered neutral because she has been heavily involved in the research. Looie496 (talk) 17:52, 14 March 2010 (UTC)
 * That's my concern: DBS is a cash cow, with limited application. Sandy Georgia  (Talk) 18:44, 14 March 2010 (UTC)
 * What are your credentials to make such commentary? Also, do you think antidepressants or vegas stimulators aren't a cash cow? There seems to be plenty of research into DBS for mood disorders. There should be some mention regardless of whom one chooses to cite... 71.106.22.254 (talk) 03:14, 18 March 2010 (UTC)
 * The problem, IMO, is that there are just too many treatments for MDD to mention all of them in this article. DBS already shows up in Treatment for depression as an "alternative treatment". I don't know enough about DBS to have much of an opinion one way or another, but I would think that a case for including it here would hinge on a demonstration that it is something more (e.g., more popular, more substantiated, better-researched, etc.)--or at least something notably different--than the other "alternative treatments" that already appear in the treatment article. Cosmic Latte (talk) 14:01, 19 March 2010 (UTC)

Unjustified use of fair use image
This image makes no sense to me as an explanation of depression. The picture is not explained in the text, as is required by the fair use criteria for a copyrighted image. Therefore, I don't think fair use of this justified. Regard, — mattisse (Talk) 22:20, 10 December 2009 (UTC)
 * I completely agree.--Garrondo (talk) 22:32, 10 December 2009 (UTC)
 * Glad to receive agreement! The image was not in the article when it passed FA. I am quite sure it would have been removed then as there is no rationale for using it. . It is a relatively new addition to the article and I cannot even figure out what it is saying about depression! Regards, — mattisse (Talk) 22:47, 10 December 2009 (UTC)
 * To me it just looks like some lying in bed sleeping at night.-- Literature geek |  T@1k?  00:26, 11 December 2009 (UTC)
 * What is that big orange-yellow thing to the right with tentacles? In any event, what does it describe about depression that cannot be expressed in words? Since it is a fair use image violating a copyright, the standards for inclusion are very high. Regards, — mattisse (Talk) 00:34, 11 December 2009 (UTC)
 * Ha, I dunno, I thought a cat at first for some weird reason but then when I looked closer I got even more confused. I think that it should be deleted for the reasons you gave as well as the picture not being easily related to depression. If a better picture is found I guess it could be considered for addition.-- Literature geek |  T@1k?  00:37, 11 December 2009 (UTC)
 * By all means. I was just trying to address the inadequacy of the Van Gogh image. To paraphrase LG "To me it just looks like some man with hangover sitting in a chair." The Sceptical Chymist (talk) 11:57, 11 December 2009 (UTC)
 * That was very...shall we say, clever. Even so, the picture is kinda nightmare-ish and seems to fit the mood. Not enough that I'd put it back in the article, but still perhaps enough to shed some light on the van Gogh piece: It seems (at least to some) to be intuitively appropriate, even if doesn't seem to fit so well on more articulable grounds. Not that this is (or isn't) ideal--it's just hard to figure out how better to illustrate the entirety of an abstract idea like MDD. Cosmic Latte (talk) 20:37, 12 December 2009 (UTC)
 * Yes, everybody (myself included) agrees that Van Gogh is inadequate but we have nothing better. While it may seem "intuitively right" to you, this illustration creates an incorrect impression of a typical depression patient as a desperate penniless male.
 * As a person who's had depression for the past 4 years, I personally can't think of a better image that illustrates what it feels like 90.193.86.134 (talk) 04:40, 26 February 2010 (UTC)
 * The questions asked above equally apply to the Van Gogh picture. "What does Van Gogh describe about depression that cannot be expressed in words?" "This image makes no sense to me as an explanation of depression. The picture is not explained in the text" "As I looked closer I got even more confused." "What is that falling-apart floorboards thing?" What does it mean? Why the the walls are dirty? What is that supposed to say about people with depression?! ;))
 * On the other hand, Lucy Bristow's picture is an "intuitively right" symbol of chronic depression for Jules Angst, BMJ editors and yours truly. The Sceptical Chymist (talk) 01:44, 13 December 2009 (UTC)
 * Of course the selection is going to be somewhat arbitrary; but as long as it's at least reasonably plausible, it (whatever "it" is) may be the best one can do to illustrate a concept that's almost impossible to illustrate. Unless, of course, we'd rather go with a yellow frowny face that has a speech bubble saying, "Hi, I have major depressive disorder!" :-) Cosmic Latte (talk) 16:55, 13 December 2009 (UTC)
 * P.S.: The BMJ is a far more reliable source than I, so perhaps the Bristow picture is, after all, the better one. Cosmic Latte (talk) 16:58, 13 December 2009 (UTC)

The Van Gogh image is appropriate, I think. First of all, this isn't a "fair use issue" at all. It's an illustration question. I know of no way to definitively resolve the matter. I can offer this possibly interesting perspective, however:

I ran the Admissions Department of the major psychiatric hospital in Portland, Oregon, for a couple of years in the early 1990's, before becoming a private practice psychotherapist, where I often treat depression. I admitted many depressed people at the hospital. A number looked rather like this fellow: self-absorbed, and unaware of their surroundings (and uncaring). They often held their heads with their hands. They were tired. Depressed people sleep badly. The painting well-illustrates all this.

Further, that it's a Van Gogh makes sense, as he appears to have suffered from bipolar disorder, and depression was a frequent issue for him. It's not unreasonable to say that it in fact killed him.

I think the article needs attention other places, for pete's sake. The painting is a fully acceptable illustration of major depression. Tom Cloyd (talk) 02:40, 1 April 2010 (UTC)


 * I agree with you about the painting. But what are the other places where the article still needs work? Cosmic Latte (talk) 03:01, 1 April 2010 (UTC)


 * Fair question, but one I cannot take up at this time. The article, as is, is pretty darned good, I'd say. Other articles are far more in need of attention than this one, to my eye and mind.
 * Since I can only do Wikipedia work part time, and very few mental health professionals seem to show up here at all, and PTSD is my professional specialty, I will remain focused on that article. Depression is a critically important topic, and I'd love to be involved with it. Maybe in the future I can be. I hope so. As it is, I happened by here by accident... I wish the best for all working on this article! Tom Cloyd (talk) 03:40, 1 April 2010 (UTC)

Correction of article's illiterate outline format
On 2010.03.31 I found and corrected two structural errors in the article. Both involved section headings with a single subsection beneath them. This is simply not correct outline form. My corrections were subsequently reverted, with reference made to WP:MEDMOS and WP:LAYOUT. However, the references did not specify what section of either applies to the current issue. Looking at both, I was unable to find a relevant section. The references appear to be for effect only, sad to say. I'm certainly willing to be proven wrong on this, but I will be surprised if this occurs.

Meanwhile, the central issue is correct form for an outline. The convention in the English speaking world (and likely elsewhere as well, but to that I cannot attest) is plain and well known: every division of a heading must have at least two members. One cannot divide something into one part - not in this universe, anyway. I have documented this principle quite well in the Outline article, and need not repeat that material here. I will point to one sentence in the brief article, which you will find in [this] section:


 * "Each category above has at least two subcategories,[4] as is advised in major style manuals in current use.[5]"

Follow those notes to find my documentation.

I agree that there is no WP Policy mandating this, but neither does there appear to be one mandating that the first word of sentences be capitalized - both for the same reason: one normally learns these things relatively early in one's schooling.

Since I find this error in outlining all too often in Wikipedia, I will be advocating for an addition to its Style Manual specifically addressing the issue. I cannot imagine that there will objection - not among the literate, anyway. It is a universal practice when constructing an outline. (And I mean no insult whatsoever in using the term "illiterate" here. We all have illiteracy problems. If it weren't for the spell checker in my browser you'd readily see that mine has to do with inability to spell many words correctly! Illiteracy is just a label for a certain kind of problem, nothing more, in my usage here.)

Tom Cloyd (talk) 13:25, 2 April 2010 (UTC)


 * You're certainly right about outlines: If a section has just one sub-heading, then why not have the sub-heading as the main heading in the first place? It's like calling a subdivision a city, or like calling one stick a tree. Since you're making the article better, and since WP:MEDMOS and WP:LAYOUT are getting in the way of this, you probably have a strong case to ignore Wikipedia's "rule"--if something so implicit can be called a "rule" at all--and go with the basic English rule. It couldn't hurt to raise the issue at WP:MEDMOS and WP:LAYOUT before adjusting the article accordingly, but your argument for changing it here is certainly defensible, and it was completely reasonable--even commendable--that you took the matter to the talk page so quickly, and that you explained yourself so well. My point is, the following section has something of an antagonistic tone, and I don't want you to be discouraged from editing this article by that tone. I have considerable respect for SandyGeorgia, and she also has reasonable concerns and good suggestions for the article, but I think that she could help out even more right now by engaging with you on the talk page, rather than abandoning the article. I hope that both of you will continue working on this article, which hasn't been edited very heavily in about a year and a half (i.e., since the time of its WP:FA discussion and promotion). With much Wikilove, Cosmic Latte (talk) 15:37, 2 April 2010 (UTC)


 * I don't give a damn if Comorbidity is a heading or subheading. I do deeply worry that an editor thinks this is such a significant flaw in the article that he not only feels the need to revert another editor and write a short essay (above) on why others are stupid or illiterate but then he also edits the Wikipedia article on the subject to reflect his own prejudices. The lecturing tone taken by those edits is dreadful. Yes you do mean to insult when you use the term "illiterate" and you should apologise. Healthy discussion is one thing, but taking an "I'm right; you're stupid" attitude just rubs everyone up the wrong way.This article will only improve through collaboration and respect for other editors. Somebody here needs to take some timeout and come back in a better mood, with more humility and a better understanding of our own style guide. Colin°Talk 16:36, 2 April 2010 (UTC)
 * I do - the subject matter of comorbidity sits better as a subsection of epidemiology. It gives further structure to the article. The section has in fact two sections, the core material on epidemiology as well as comorbidtiy. Casliber (talk · contribs) 06:18, 10 April 2010 (UTC)


 * Addendum: Yes, subesctions in epidemiology are good. Reference section now looks silly because of some arbitrary guideline I've never heard of. I like Hierarchical outlines and believe that articles of any size don't look so good with only level two headings. Generally there is too much information to have in big sections without some splitting - web reading is different to book reading and benefits from splitting up more rigorously.


 * The references section doesn't make any sense splitting it up like you have. If we really must stick to this rule of only one subsection then I'd do this, even though I feel the old way is simpler. Casliber (talk · contribs) 02:58, 11 April 2010 (UTC)


 * reply to Casliber -
 * Glad you like the "Epidemiology" subsections. I think they do work.
 * Re: "arbitrary guidelines" - well, not really. It's the accepted style standard in scholarly work. I've given adequate references to back this up (see Outline_(summary)). The guidelines given in the Style Manuals are logical: the action termed "divide" cannot logically result in ONE thing (where's the division?), but in TWO or more.
 * Completely agree with you re: the value of reasonable subdivision: they mark article access easier, and quicker. The experts I follow on design of web pages completely agree with this notion. We're on solid ground here. (Have the citations in hand.)
 * "References" section - your proposal looks fine, to me. Go for it, if it still works to your eye. The "old way" is simpler, in that there are fewer headings. But it's illogical, as already pointed out. Tom Cloyd (talk) 05:41, 11 April 2010 (UTC)


 * reply to Colin -
 * "...I do deeply worry that an editor thinks this is such a significant flaw in the article that he not only feels the need to revert another editor..." - she reverted me, after I'd taken an action that would be universally recognized at any university as fundamentally correct. I was hardly being small minded or impulsive. It was a well-justified action.
 * "...and write a short essay (above)..." - giving a clear explanation of my action, whatever you call it, seems to me simply to be a responsible and respectful action. Your characterization is ridiculous.
 * "...on why others are stupid or illiterate..." - My section title is "Correction of article's illiterate outline format" - It is your misreading of my text as being about people rather than formats which might be characterized as stupid, if one were so inclined. I'll merely characterize it as hasty and poorly thought out.
 * "The lecturing tone taken by those edits is dreadful." I explain carefully. I document. You engage in mis-characterization and near slander. As you said,..."dreadful".
 * "Yes you do mean to insult..." - Well, I'm sure you do know more of my intentions than do I. Do you also give prescient stock-tips? You're on dangerous ground here.
 * "Somebody here needs to take some timeout and come back in a better mood..." - My mood's fine. I did my research. I knew what I talking about and demonstrated it. When I asked Sandy to give specific rather than vague references, she promptly retired from this page, without providing the asked for references.


 * Kindly consider, as evidence that I used the word correctly:
 * illiterate - 3 : showing or marked by a lack of acquaintance with the fundamentals of a particular field of knowledge 
 * illiterate - S: (adj) ignorant, illiterate (uneducated in the fundamentals of a given art or branch of learning; lacking knowledge of a specific field) "she is ignorant of quantum mechanics"; "he is musically illiterate"


 * My concern was not for editors bbut for the appearance of the article itself. A "Featured article" should reflect accepted standards for scholarly writing, I would assume. Outlining with single subheads does not do this. Some readers will surely think (as I did): if they cannot get this right, is the rest of the article to be trusted?


 * Finally, since you have not addressed the basis of my primary assertion, I suspect you are not able to, because I didn't make an error in my logic. So, it appears you took the traditional alternative "win/loss" strategy: attack the person, not the argument - a classic logical error. Oh, forgive me...was I lecturing again? Well, I give you permission to lecture me, when you know something I don't. I'll just thank you.


 * As I've told you elsewhere, Colin: make sense to me and I'm yours, without prejudice (and I've already demonstrated that to you, elsewhere). Come at me illegitimately and it just won't work. Trust me. I'm not new at this, nor particularly inept. And...(this is important) I'm absolutely not out to put anyone down - there's no value in that. I'm interested in producing good articles, period. However, if you throw enough punches at me, I'll likely punch back. Work with me to produce good articles and we can climb that hill together. No problem. Let's get back on track here.
 * Tom Cloyd (talk) 04:25, 11 April 2010 (UTC)
 * The only comment I will make is that one should always tread carefully when making substantial changes to featured articles as such articles are considered to be complete and in total or near total compliance with the various guidelines for writing encyclopedic articles. Wikipedia guidelines may at times differ from other scholarly guidelines. That is not to knock you Tom, you have done excellent work to PTSD, some of your suggestions for this article may be worth implementing, others perhaps not. I tend to pretend I am "walking on ice" when I am editing a featured article due to the high standard of such articles.-- Literature geek |  T@1k?  16:01, 13 April 2010 (UTC)
 * Good advice surely, and I agree with it. But, as I've elsewhere suggested, my correction was anything but radical, so I didn't (and don't) see a problem. It's all very straightforward. Do I need approval for fixing a punctuation error? A spelling error? I saw the outline problem I fixed as the same sort of thing. Substantive content was in no way changed.  I continue to be surprised that there is any objection to what I did. Please consult the authoritative style manuals I've already listed. There is no style manual of which I'm aware which supports the outline format which I found in this article when I first saw it. Not one. Certainly not any of the primary ones in current usage. Tom Cloyd (talk)


 * Tom applied his "Correction of article's illiterate outline format" here and here. Sandy objected with this revert saying "yes one can divide a section once, no guideline against". Tom then edit warred here with his revert of Sandy's revert and the comment "Please see Talk page re: this". The talk page section is this one. Tom suggested he would add a specific rule about section headers to our MOS, claiming it was something "one normally learns ... relatively early in one's schooling" and that "I [Tom] cannot imagine that there will objection - not among the literate, anyway." This is Tom's response to Sandy objecting to Tom's grammar "correction". Draw your own conclusions, folks. Tom, if you can't see what you're doing wrong, I can't help you and I suspect we won't be climbing any hills together. Colin°Talk 17:01, 13 April 2010 (UTC)
 * Well, as I read WP's various policies, one isn't edit warring until one reverts 3 times in a 24 hour period, or reverts repeatedly across several days. I reverted with very solid documentation (which no one's challenged). I did it right. How can there possibly be a problem with that? Does Wikipedia live in it own little style world, apart from the conventions used for decades in the world's major universities? Not likely, I think.
 * As for my use of the word "literate" - I already fully explained that. It was appropriate usage. I was saying that those who think an outline may be properly constructed in the incorrect way I fixed have not read (i.e., are not literate in relation to) the authoritative style manuals views on such things.
 * My training in academic psychology was very explicit about the form of writing. It's so important to psychology that the APA has an entire manual on the subject. I taught APA format in college, in fact.
 * I haven't addressed WP's Policies in the appropriate place, yet, only because of lack of time. I will. Trust me.
 * You seem to be looking for an opportunity to take offense. What's the point? I didn't and don't intend any. I just want a good article to look like it was written by people who understand the basic rules of scholarship, one of which has to do with how one constructs outlines. I didn't intent there to be a ruckus. No point to that at all. Tom Cloyd (talk) 19:05, 13 April 2010 (UTC)

Full documentation of the necessity of having two or more items in every level in an outline is now to be found in the Outline (summary) Notes section - see note #6. (As I get time, I'm working on the whole article, which is a bit thin.) Tom Cloyd (talk) 14:49, 15 April 2010 (UTC)

Separate section for cited texts
(Split out from previous section - new topic)

Splitting out cited texts as a separate section makes no sense - these texts are the texts which are used in the page numbered refs in the references section, hence must be classified in that section (???) Casliber (talk · contribs) 06:21, 10 April 2010 (UTC)

Totally agree. I was bewildered when I first saw this. It's not only anything-but-standard-practice for scholarly articles, it also serves no real purpose (what am I supposed to DO with this list - these texts aren't easily found in any single place), and it increases the article load time.

Unless there is substantial, reasoned objection voiced here within, say four days (I'm setting a tickler in my scheduler for Thursday, 2010.04.15), I'll be bold and retire the list at that time. Tom Cloyd (talk) 00:31, 11 April 2010 (UTC)


 * Hang on, what do you mean "retire the list"? Casliber (talk · contribs) 08:35, 11 April 2010 (UTC)


 * Oops. There I go being creative with word usage, again. You might think I'd learn, after "illiterate"(!). Try this: "...delete the Cited texts section". Better? Tom Cloyd (talk) 11:40, 11 April 2010 (UTC)
 * Casliber was just double checking what you meant, I think. I don't believe that he deserves an unprovoked sarcastic response, which only serves to make the editing environment toxic.-- Literature geek |  T@1k?  16:15, 13 April 2010 (UTC)
 * Oh dear. I wasn't in any way being sarcastic. I was publicly chiding myself for not thinking ahead. I write a lot of poetry, and tend to use words in unusual ways without thinking about how others might read what I write. One doesn't write poetry for other people, usually. Such "narcissistic" word usage isn't always a good idea! I'm a little bewildered that you saw sarcasm (which I strongly dislike - because of its indirectness) in anything I wrote. I don't see it at all, and certainly wasn't intending it. If I were angry about something, it'd be obvious. I don't need to hide it. Tom Cloyd (talk) 18:44, 13 April 2010 (UTC)

They're now gone. Looking over the list, this deletion is an even better idea than I first thought. To call this list "Cited texts" is plain wrong. They're obviously all books, and to call a book a text, in this context, implies that it's a "textbook", which most, if not all, of these are not - for example, the DSM is in this list. A text book is a book of texts (articles, book chapters, etc.), in the original version, and in more modern times it's a digesting of a body of texts, for presentation to students. So...good thing it's gone, for several reasons. Tom Cloyd (talk) 14:41, 15 April 2010 (UTC)


 * Tom, you've just removed the full citations to any books mentioned in the Notes section. The inline citation notes link from e.g. "Sadock 2002, p. 108" to "Sadock, Benjamin J.; Sadock, Virginia A. (2002)....." in the Cited texts section. I've undone it. Colin°Talk 16:50, 15 April 2010 (UTC)


 * Nuts. My error for not checking the content more closely. Frankly, this all looks very fishy to me - I've never seen reference citations done this way. It certainly isn't any standard format that I've ever seen, and I'm rather familiar with MLA, APA, Chicago, etc. You seem to have identified another problem that must be fixed first: all citations should resolve to the same list. That's just the way it's done in scholarly articles in psychology, medicine, literature, and so on. This is fixable. We can chip away on it for a while until it's fixed. Make sense to you? (And thanks for catching my mistake - didn't expect this situation, and so didn't look for it - a complete surprise to me.) Tom Cloyd (talk) 22:21, 15 April 2010 (UTC)

Unwatching
I am unwatching this article now that Tom Cloyd is taking it out of compliance with MEDMOS, and too many long-standing issues in this article are not being corrected, and it is not well enough watched. The article is simply too long, takes too long to load, and needs to make better use of summary style-- clearly there are many sections that could make better use of summary style, by cutting info to daughter articles in areas such as Causes and Treatment. Further, part of the load time issues-- which make it so hard to even revert vandals and track diffs-- are due to the extreme reliance on primary sources rather than secondary reviews. There are simply too many references in this article, and that ups the load time. There are increasingly short stubby sections and paras that need to be merged or moved to daughter articles, on issues that are undue. This article is not well watched, it has issues that need to be corrected, and I'm tired of watching and waiting-- unwatching. We simply can't have FAs built from primary sources, and the article needs to address recent reliable secondary reviews, giving them due weight, reducing the reliance on primary sources, conforming with WP:MEDMOS and WP:MEDRS rather than giving undue weight to individual opinions of what should be included, and drastically needs a reduction making better use of summary style. Certainly, I can't take it to FAR because I promoted it, but I do hope some serious work will get underway here, and I'm no longer willing to watch or engage when Tom Cloyd is reverting me to a version that doesn't conform with WP:MEDMOS and I'm seeing too much emphasis here on personal opinions rather than secondary reviews that conform to MEDRS and due weight. Sandy Georgia (Talk) 13:31, 2 April 2010 (UTC)


 * Luckily we have daughter articles such as Biology of depression and Treatment for depression which are places that experimental and not-widely supported theories and practices can be discussed, and others not backed up by Review Articles. I just moved something on fructose intolerance over and I am sure there is more material which can be conveyed. Casliber (talk · contribs) 06:30, 10 April 2010 (UTC)


 * Re: "...taking it out of compliance with MEDMOS..." - how? Indeed, how could bringing the article's outline structure into compliance with standards recognized in universally used Style Guides (MLA, Chicago, APA) cause a problem with MEDMOS? I've been all over MEDMOS, and cannot find a problem at all. Until someone demonstrates otherwise, this allegation is nonsense. Tom Cloyd (talk) 09:34, 13 April 2010 (UTC)

(outdent)There is one or two primary sources which I added a while back, I shall replace them when I get a chance (when I finish the alcoholism GA review).-- Literature geek |  T@1k?  16:09, 13 April 2010 (UTC)

Article load time
As Sandy notes above, the article is too long and has too many primary-source references. That will take a while to fix. But there is a short fix that may help somewhat with the load time. The article makes heavy use of the cite journal and cite book templates. These produce bulky and complex HTML. They can be simply replaced by the vcite versions (see Autism for an example). The visible effect on the article would be to change the citation format from Wikipedia's home grown style to the Vancouver stile used by some medical journals. The change involves merely prefixing "v" to the cite template calls. Wikipedia has no preference for one citation style (certainly no preference for the one produced by the cite templates -- many of our FAs use hand-written citations). Does anyone here object to such a change being made? Colin°Talk 15:15, 3 April 2010 (UTC)
 * [Previous comment withdrawn.]


 * OK...I withdraw my objection, which was that vcite appears to eat date information. I now see that the date IS appearing in the Autism Reference list. It's just not where I expect it. I have no problem with that. You're right about the efficiency of the vcite template, as well as its output formatting. I like that, and support your proposal. Tom Cloyd (talk) 01:28, 4 April 2010 (UTC)


 * I support as well. Cosmic Latte (talk) 14:25, 4 April 2010 (UTC)
 * (belatedly) I'll be happy with vcite if it makes the page speedier. Casliber (talk · contribs) 06:20, 10 April 2010 (UTC)

Colin, good work. The vcite usage looks great. Tom Cloyd (talk) 22:31, 15 April 2010 (UTC)

The problem
This problem is fixed: [ ] NO [X] YES

Look in the Notes section and you'll see a number of errors registered - all of the form "Template:VCitation". There a number of different reasons for this. First of all I found a number of cases where the citation in the text read something like -

The problem here is that it should begin. These have to be found and fixed case by case, so far as I can see.

I have already fixed 34+ instances of the initial problem, in which the original "Citation" was replaced with "vCitation", throughout the article - which won't work; "vcite..." will, of course (assuming what follows it also complies with the template).

I'll get to as many of these problems as I have time for, but I won't have time for them all tonight.

When they are all fixed, someone should remove this note or check the correct box at its beginning.

Tom Cloyd (talk) 07:41, 19 April 2010 (UTC)


 * Appears to be a problem with the citation bot here. I'm guessing someone's written some naive code to change all "cite web" to "Citation" without checking whether it was a "vcite web". I don't have time at present to fix them. I'll alert the bot owner. Colin°Talk 07:47, 19 April 2010 (UTC)

Possible fix, of several problems, including this one?
Is it possible to "name" a reference - as in " " (if I don't have this quite right, just consider it pseudo-code), then refer to it in additional contexts, each with a different page number? This makes so much sense that it surely must be possible. I currently investigating this. Meanwhile, can it be done - and if so how???

Here's my thinking. Given that
 * this present article has a non-standard "blended" citation scheme (some works have their full citation in the References section and other in the Notes section), and...
 * that this craziness really should be fixed, and...
 * that the use of "named" references are efficient in multiple ways, and
 * that use of the full citation in the article text makes it harder to read when editing,

might not it them make sense to work at having all full reference citations in the References, where they are named as I've exemplified above, with specific citations in the text referencing the reference name and the page number - ONLY???

This would make the article more formally consistent, give readers an author alphabetized reference list, and give editors a simpler way of citing already listed references in some new way. If it's possible...

update - I see now how to cite a work, giving the citation a name or ID, and then re-cite it, referencing that name or ID. One can append a page number to the citation, producing something like. BUT, this is not the citation system used in this depression article. I still don't have a solution. Tom Cloyd (talk) 11:05, 19 April 2010 (UTC)

update #2 - I've gotten some good information at the Village Pump - here. I'm not sure where it leaves me, as I need to digest it and experiment a bit, but it looks promising. Will report back, although not immediately. Tom Cloyd (talk) 13:48, 19 April 2010 (UTC)


 * I thought the referencing was pretty simple really - if a book has more than one different page reffed, the inline page references are in the Notes bit (and if you click on them you're magically transported down to the bottom), and the bookref is in the now generically-and-unhelpfully named References section. The notes are references (?!) Casliber (talk · contribs) 12:22, 19 April 2010 (UTC)


 * PS: Incidentally, I never think of a noun 'text' as meaning 'textbook' - so I will use 'work' instead. I contemplated cited oeuvres ...Casliber (talk · contribs) 12:26, 19 April 2010 (UTC)


 * I'll agree that "text" is a complex word in this context. Books that are called "texts", in my experience, are textbooks - book prepared for educational contexts, for students. The DSM is no such thing, for example. You solution works, I think.


 * However, my solution makes more sense in a larger context, and in fact is explicitly exemplified here - Separate lists of references and footnotes (grouping footnotes). This Notes / References distinction is a convention in the in the larger world of scholarly writing. I've lived and worked in that world for years, and I came here and was immediately struck by the, ahem, creativity of the citation system. I consider it nuts, because it's inconsistent. Some citations go one place, and others another. It just isn't done that way in the real world.


 * Also look at Alternative system in "Wikipedia:Referencing for beginners". What's described there is what the system used in this depression article appears to use, until one looks more closely. Note that the author distinguishes citation notes from works cited in the same way I do. It's not just me.


 * Notes and References can mean many things, of course. A reference can be both a pointer to a cited work and the listing of that work. In most book contexts, References is a list of works cited (in the Notes) or just used in the writing of the book, when there's no formal notes. In Wikipedia, I grant, References and Notes get used interchangeably, in that the same sort of list is called one thing in one article and the other in some other.


 * As I had things set up, the names of things WERE helpful, in that they conformed to long adopted standards in the publishing world (which, of course, also has its non-conformists!). What is unhelpful is the citation scheme used in this article, where some citations to go Notes and some to References. THAT's just weird, and should be fixed, I think, unless conventions don't matter and we can just make it up as we go along. Creativity is great, but there are some things one shouldn't get creative about.


 * Your grouping of Notes and Cited works under "References" still confuses me. My background (5 universities in the USA) tells me that citations are notes, and references are works cited. You cannot call both references. I can settle for the terms now used, though. Reluctantly. Bigger fish need to be fried! Tom Cloyd (talk) 12:52, 19 April 2010 (UTC)


 * Agree that named refs are best and that the actual citation should be moved out of the body text for ease of editing. This is an editor-preference thing and can't be done without seeking consensus on a per article basis. This latter point has only been possible recently with the creation of Help:Footnotes (see also Citing sources. I've used this approach in Ketogenic diet.
 * The short refs approach works cleanest when all the notes are short and refer to pages drawn from a relatively small collection of texts/works/whatever-you-want-to-call-them. Arts and literature subjects suit this. It isn't needed if very few references are drawn from the same work (e.g., I didn't bother for the one book I referenced a few chapters from in Ketogenic diet). For medical articles, most of the references should be journal articles and some academic book chapters. I wouldn't like to get an inline citation jump to a footnote which then jumps to a reference for every journal article mentioned. The mixed approach here might be messy but it does the job. There are far, far more important things to worry about: like why does this article cite so many web pages or so many primary research papers. Colin°Talk 16:15, 19 April 2010 (UTC)


 * Certainly agree, as to priorities. My sense is that every section needs to be revised and reduced to core summary material as much as possible. Secondary references won't always be available, but seem too often to be set aside, at present. Tom Cloyd (talk) 22:17, 19 April 2010 (UTC)

Obtaining a reference
Can anyone obtain this reference for me? I would like to replace a primary source with it, depending on its quality and what it covers (I don't want to cite a title, guessing what it says, even though I am pretty sure what it will say). :) It would be much appreciated.-- Literature geek |  T@1k?  00:50, 12 May 2010 (UTC)
 * Here we have medscape and here we have the abstract   Doc James  (talk · contribs · email) 01:22, 14 May 2010 (UTC)

Wording
The lead states "Most patients are treated with antidepressant medication". Usually we shy away from using the word patient and second do we have reference for this? Doc James (talk · contribs · email) 16:06, 13 May 2010 (UTC)
 * I've rephrased the line a bit to do away with "most" (which certainly would need to be sourced), but I obviously would favour a sourced line over an unsourced one. I also have reservations about the word "patient", at least in general, but in the context of that sentence I don't really see what else could be intended: Of course many people with MDD are never treated at all or are never treated with antidepressants; however, it's probably safe, I'd think, to refer to those who are so treated as psychiatric patients. Cosmic Latte (talk) 22:59, 18 May 2010 (UTC)
 * Most people are now treated by primary care provider but that is a different issue. Yes I agree and will change it back. Doc James  (talk · contribs · email) 00:16, 19 May 2010 (UTC)

Why don't you rephrase this:"A large number of sufferers of depression are treated with antidepressant medication".Karlp295 (talk) 07:30, 26 July 2010 (UTC)
 * I like sufferers even less than patients. Will leave as patients.  Doc James  (talk · contribs · email) 07:02, 28 July 2010 (UTC)
 * In this case sufferers and patients are not interchangeable: to be medicated somebody has to be a "patient" (i.e: go to the doctor), while "sufferers" (i.e: people with the disorder, independently of whether they have been diagnosed or not, or wether they attend to the doctor or not) will have lower rates of antidepressant use (you can not use medication if you do not go to the doctor).--Garrondo (talk) 08:05, 28 July 2010 (UTC)
 * You can in the third world :-) They sell iv antibiotic solutions at corner stores in many countries.  Doc James  (talk · contribs · email) 10:03, 28 July 2010 (UTC)

Suicide
Yes we all agree that people with depression have increased risks of suicide. The fact that pharmaceuticals does not change this and may infact increase the risk should be mentioned in the lead IMO. Here is an interesting paper on the topic  Doc James  (talk · contribs · email) 16:22, 13 May 2010 (UTC)


 * Interesting paper, I knew this was the case with paroxetine, which seems to be the most controversial SSRI; first I have heard the overall suicidal risk was raised with the whole class of SSRIs. Be WP:BOLD and add your source, if other editors disagree, and if sources are available they can always add an opposing view for balance etc. :)-- Literature geek |  T@1k?  17:08, 13 May 2010 (UTC)


 * On second thoughts, the reference is specific to SSRIs, so might be undue weight to add to thee lead here. Perhaps the main SSRI and perhaps also the paroxetine page would be more appropriate? You could still mention it Major_depressive_disorder here.-- Literature geek |  T@1k?  23:28, 13 May 2010 (UTC)
 * On third thoughts, I dunno, maybe it is worth a mention in the lead, ah my brain is dying, indecision, a sign that I am getting tired and need sleep. :)-- Literature geek |  T@1k?  23:47, 13 May 2010 (UTC)
 * We do state that SSRIs are the primary treatment for depression. The list we should do is mention there limitations. Doc James  (talk · contribs · email) 01:17, 14 May 2010 (UTC)
 * I think it'd be undue weight in the lead. As far as I can tell it isn't a review article as such (?) Definitely needs to be somewhere prominent on a page on the SSRIs and also somewhere on a page on antidepressants though. Casliber (talk · contribs) 04:05, 14 May 2010 (UTC)
 * Both the FDA and the health ministry of Japan have applied warning on the boxes of SSRIs stating this. If we are going to say suicide is common in depression, than say SSRIs are the main treatment for suicide, we should at least say that SSRIs do not decrease suicide but infact increase it in certain patient populations.  I am not using the ref above but am basing this on the FDAs statement found in the text of this article.  I can find a review tomorrow if you like but I think a major governmental statement is okay as well.  Otherwise people might just jump to the conclusion that SSRI prevents suicide which is in fact what they have done post GSK 2000s marketing campaign in Japan which left out the third and most important point.
 * Further note SSRIs may decrease the risk of suicide in older men I was reading somewhere. Doc James  (talk · contribs · email) 04:12, 14 May 2010 (UTC)
 * Maybe add it to the antidepressant section of this article, reduced risk of suicide in older people, increased in younger etc but leave it out of the lead and add it to the SSRI articles as suggested by casliber.-- Literature geek |  T@1k?  23:52, 14 May 2010 (UTC)
 * I must say I disagree. The lead should pull a person into the article.  We all know suicide is associated with depression and that SSRIs are common treatments.  What many do not know is that even though they are lead to believe that SSRIs decrease rates of suicide this is not infact the case.  We do state this in the body of the text with references.  Here is the most recent Cochrane review on the topic  Doc James  (talk · contribs · email) 04:29, 15 May 2010 (UTC)
 * I think that if it is added to the lead, that it should be sourced in the body of the article to high quality sources. Maybe evidence that use of antidepressants in people younger than 24 years old is associated with increased suicide but older individuals decreased suicide risk?-- Literature geek |  T@1k?  20:34, 15 May 2010 (UTC)

(undent) Well we have the 2007 Cochrane review above along with the FDA. I have not seen a good quality source for the second point that it might decreases risk in older males but will try to find one. BTW it is risk for suicide rather than suicides themselves. There is no change in overall suicide rate but the number are too small to determine a statistical difference at this point. Doc James (talk · contribs · email) 20:44, 15 May 2010 (UTC)

This statement - " Treatment with medications however has not been shown to decrease the risk of suicide" needs to be clarified as it contrasts with the body where it states "Furthermore, lithium dramatically decreases the suicide risk in recurrent depression" as supported by this and this. There are caveats and issues to discuss to the point that I feel a one-sentence statement is too sweeping. At least change it to 'SSRI antidepressant' meds not just 'medication'. Not sure on literature of TCAs and suicide. Casliber (talk · contribs) 08:47, 13 July 2010 (UTC)

Also, one line is added to the lead but am I missing something as I can't see where it is discussed in the article (??). Casliber (talk · contribs) 08:49, 13 July 2010 (UTC)
 * I agree with you about the statement " Treatment with medications however has not been shown to decrease the risk of suicide". To me, this sounds like POV. At least we should write something like "concerning the question if medications decrease the risk of suicide, the results are conflicting," with references both to research that finds decreases and to research that doesn't find decreases.  Lova Falk     talk   18:24, 13 July 2010 (UTC)
 * PS I just removed this sentence. When there is neither consensus about content, nor a source, it should not be in the article.  Lova Falk     talk   18:34, 13 July 2010 (UTC)


 * This was reflecting the black box warning. I have added another review article.  Not sure how this is POV?  The black box warning states "SSRI and other antidepressant medications".  Most believe that medications in fact increase suicide risk.  Doc James  (talk · contribs · email) 20:36, 15 July 2010 (UTC)
 * I have added three other reviews/meta-analyses, in order to make the section more balanced  Lova Falk     talk   19:36, 16 July 2010 (UTC)
 * Section is looking good now. Casliber (talk · contribs) 21:28, 16 July 2010 (UTC)
 * Agree and will try to add to it. I added a single line to the lead attempting to summarize this section in neutral language. Doc James  (talk · contribs · email) 21:37, 16 July 2010 (UTC)

(undent) Last night I thought this section was too elaborate for this article and decided to move it to SSRI and write a summary here. This morning I did just this - and I did not even read what you had written here (shame on me). Anyway, please revert if you prefer the longer version... Lova Falk    talk   17:20, 17 July 2010 (UTC)


 * I have a concern about this line "However, a few studies show either no such connection or a negative correlation between SSRI prescriptions and suicide rates amongst children. " This is based on a single primary study and is being used to refute the reviews.  If you read the Cochrane review that was used to support this line it says "MAIN RESULTS: Twelve trials were eligible for inclusion, with ten providing usable data. At 8-12 weeks, there was evidence that children and adolescents 'responded' to treatment with SSRIs (RR 1.28, 95% CI 1.17 to 1.41). There was also evidence of an increased risk of suicidal ideation and behaviour for those prescribed SSRIs (RR 1.80, 95% CI 1.19 to 2.72)"Thus I think it supports the association rather than refutes it.  Doc James  (talk · contribs · email) 05:33, 21 July 2010 (UTC)


 * This is another case in which a primary study is being used to refute the conclusions of reviews "and yet other studies found that the widespread use of antidepressants in the new “SSRI-era” appeared to have led to highly significant decline in suicide rates in most countries with traditionally high baseline suicide rates. " It is only one study not studies.  Please see WP:MEDRS  Doc James  (talk · contribs · email) 05:46, 21 July 2010 (UTC)

Amygdala
I quickly searched the page for the word amygdala before writing this just to be sure, but sure enough, no mention of the word. So, for the uninformed, the amygdala is popularly known to be the gland in the brand which directly deals with the thing intellectuals fear the most. Fear itself, and, to a lesser extent, anomie and chaos. Fear and depression have a great deal in common with one another, simply due to the fact that depression results, at least partly, from a negative outlook on the world and subsequently life in general. This is not always the case, but it frequently is. Biologically speaking, fear is a wonderful deterrent for thoughts leading to the conclusion that, "Life is meaningless", which would of course be a typical precursor to suicidal thoughts, which in turn would be prerequisite to suicide, at least of the pre-meditated sort...though un-premeditated suicide is a very dubious idea. The amygdala also has been strongly associated with anger, which is a typical "pal" of depression. Anger is better, arguably than depression, but this is highly debatable. Look, alot of this is cutting edge stuff, that hasn't been fully proven. But please, will some diligent psychiatrically inclined researchers mention SOMETHING about the amygdala? I mean, hello, the meaning of life, fear, suicide, evolution, trauma, anomie, all that shit. It's all evolutionary, put in place for a reason. Anti-biological conclusions result in fear and depression. This is almost common sense in some circles. Mention the amygdala. Love, by the way, is of course the only cure for depression, by the way, but there's no f-ing way I could prove that. SSRI's also seem to be partially effective. Cheers.153.9.84.47 (talk) 21:56, 26 August 2010 (UTC)

Article size is too big
The article is over 140 168 kb and will put most casual readers from reading it all. Several sub-sections of the causes section I feel are too big, per WP:UNDUE, I did mention this a while back when I was advocating for a small section on substance induced major depression but nothing was done. Specifically, this subsection, Major_depressive_disorder and this subsection, Major_depressive_disorder need shortening. I think that some article content should be split off into a new article, causes of depression. What are other editors thoughts?-- Literature geek |  T@1k?  17:08, 13 May 2010 (UTC)
 * I agree. It would be a good idea to move some of the content of the bio and psychological sections to the subarticles.  I do not know if we need a causes section as it will add one more layer of links to get to the final article.  Doc James  (talk · contribs · email) 17:23, 13 May 2010 (UTC)
 * (sigh) we trimmed it quite a bit when it went to FAC. Articles like this often slowly grow over time. I will take a look later today. Luckily we have daughter article to move content to. Also, luckily DSM V has been pushed back to 2013 I heard....Casliber (talk · contribs) 23:21, 13 May 2010 (UTC)


 * Cool beans, it sure needs pruning. I just realised that I was mistaken, I dunno where I got 140 kb from, it is actually 168 kb if you can believe that!-- Literature geek |  T@1k?  23:45, 13 May 2010 (UTC)

To do list
 Treatment:

"Cognitive therapy is a treatment process that enables patients to correct false self-beliefs that can lead to negative moods and behaviors. The fundamental assumption is that a thought precedes a mood; therefore, learning to substitute healthy thoughts for negative thoughts will improve a person’s mood, self-concept, behavior, and physical state." - http://www.aafp.org/afp/2006/0101/p83.html

"Bibliotherapy is a treatment where a depressed patient reads a self help book such as Feeling Good by Dr. Burns in between therapy sessions. Dr. Burns says in the introduction that "more and more therapists are beginning to assign bibliotherapy to their patients as psychotherapy 'homework' between therapy sessions." A nationwide survey of psychotherapists published in 1994 also reported that out of a list of 1000 self-help books recommended for patients listed, Feeling Good was the number-one-rated book for depressed patients." - http://www.jaoa.org/cgi/reprint/103/3/131.pdf

"The most common form of treatment for depression is antidepressant medication plus some form of therapy. The medication allows the person suffering from depression to feel much better and then he or she will be in a position to work on the problems which may be contributing to the depressive state while at the same time receiving professional guidance." - http://www.depression-helper.com/treatment.htmKarlp295 (talk) 07:36, 26 July 2010 (UTC)

Quantification of effectiveness of SSRIs
Another good Cochrane review which I will add soon. Doc James (talk · contribs · email) 04:32, 15 May 2010 (UTC)


 * They also seem to favour sertraline over all the rest  Doc James  (talk · contribs · email) 04:34, 15 May 2010 (UTC)

Leutscher et al.
I've removed the following paragraph (recently added to the Drugs and alcohol section) as I think it warrants further review. Very interesting in light of the cytokine hypothesis of depression, but I have no access to the full text and don't think the authors propose any sort of causal relationship (treatment-emergent doesn't mean treatment-induced). Perhaps the passage could be reworded and readded—or we could wait for this to attract further research.

Similarly combination therapy with interferon-α and ribavirin for chronic hepatitis C virus (HCV) infection may induce major depression. In the study by Leutscher et al, evaluating 325 chronically HCV infected patients undergoing antiviral therapy, it was observed that (1) depressive symptoms among patients undergoing HCV therapy are commonly overlooked by routine clinical interviews, (2) the emergence of depression compromises the outcome of HCV therapy, and (3) the Major Depression Inventory (MDI) scale may be useful in identifying patients at risk for treatment-induced depression. —Fvasconcellos (t·c) 05:20, 10 August 2010 (UTC)

To do
Could someone please explain why there's a big huge chunk of text in the "To do" subpage? What has been done? Why are those issues not in talk page sub-headings? This is a featured article, and there should not be a big to-do list. Sandy Georgia (Talk) 15:19, 16 October 2010 (UTC)
 * As far as I can tell, little to nothing has been done with most (maybe all) of that stuff since it was added a couple years ago when we were preparing the article for FAC. While it seems pretty innocuous to me, I admit that it's quite a clutter. My suggestion would be for somebody (I haven't bothered to figure it out yet) to collapse the list (i.e., using the same markup that's used to tuck away trolling threads). Cosmic Latte (talk) 21:03, 16 October 2010 (UTC)
 * Yes. I think Paul Gene and I wrote in it way bak when we started buffing it up. I think it should be archived into the archives. Casliber (talk · contribs) 22:10, 16 October 2010 (UTC)
 * What ever happened to Paul, anyway? Didn't agree with him on everything, but he sure knew his stuff--I wonder what he'd think of the current version of the article. Cosmic Latte (talk) 23:06, 16 October 2010 (UTC)
 * The "to do" stuff is actually in a subpage called Talk:Major depressive disorder/to do, which was included in this page using a template .  I've copied the contents to the current archive page, and removed the inclusion.  The only thing left is to delete the subpage.  Can I just do that, or does it need to be MfD'ed or something? Looie496 (talk) 23:33, 16 October 2010 (UTC)

Load time
I've replaced more instances of cite journal with because this article is so slow to load. While I was doing this, I noticed that just about NONE of the web sources cited have listed publishers. Concerned about sourcing here, and overreliance on primary sources. Sandy Georgia (Talk) 04:00, 10 September 2010 (UTC)

Update needed
The APA has updated their 2000 guidelines (which we quote) here in 2010. If anyone feel ambitious. Doc James (talk · contribs · email) 20:14, 6 October 2010 (UTC)

in response to the "who" tag / weasel word comments
In response to this edit:. I added the tag to the text "The score on a rating scale alone is not sufficient..." because it is not clear who advocates this viewpoint. Is this a consensus viewpoint of the medical establishment, or an official stance of some large, well-known association? Or is it the viewpoint of the particular authors of that article? Either way I think it is important to identify whose viewpoint it is. I don't currently have access to the full text of that article so I can't check to see if the sourcing is adequate. Diagnosis is one of the key elements of this article, IMHO. The source given is a single review with two authors. That isn't adequate for stating a fact on something controversial like this. Diagnosis of depression is a highly complex and potentially thorny issue, mired in subjectivity and differences of opinion. This is why I thought that was a weasel word...it's sourcing a universal fact with a single article. Cazort (talk) 16:08, 8 October 2010 (UTC)
 * Ah, I get it now. I was confused by the template. I figured you might have meant something like , but my immediate response to that question would have been, "the authors of the review article"--seeing as review articles are considered particulalrly reliable by WP:MEDMOS and WP:PSTS. Still, "the authors of the review article" doesn't indicate the ultimate source of the information, and since I don't have free access to the review article's text, I'll go ahead and add the  tag so that someone who has access to the full review can give the line a more specific attribution. Cosmic Latte (talk) 08:18, 9 October 2010 (UTC)

Deleted sleep deprivation discussion
The mechanisms underlying the antidepressant effects of sleep deprivation and antidepressants both involve serotonin, but this, alone, doesn't comprise a theory of etiology. It was added in December 2008 by User:Mattisse. Anthony (talk) 19:05, 26 October 2010 (UTC)
 * Probably a good candidate for deletion, then. Sandy Georgia  (Talk) 19:10, 26 October 2010 (UTC)
 * Agreed - my vote would be to remove to the biology of depression subpage. Casliber (talk · contribs) 21:54, 26 October 2010 (UTC)

Deep brain stimulation and other ablative treatment options
Here are two full-text reviews that could be used to update the article and remove some marginal sources:

Sandy Georgia (Talk) 19:07, 26 October 2010 (UTC)

Sadock
Well, this was a mess. The CITEREF says 2002, the year says 2003, but the location given corresponds to the 2007 version. Which version are we citing, and is the ISBN I added correct? See the ISBN finder in the infobox on my userpage. Sandy Georgia (Talk) 20:10, 26 October 2010 (UTC)


 * Hmm, what I had at home was the 7th edition (a pale blue one). I also had online access for a while to the sooper dooper big one (forgot what year that was). I'll take a look anon after I deal with some RL stuff... Casliber (talk · contribs) 22:06, 26 October 2010 (UTC)

Nutrition & Reversions to Edit
I had added material on nutrition to this page, and User:SandyGeorgia reverted the edit. Nutrition currently does not have a single mention here, which seems like a glaring omission given that there is a wealth of scientific research on this. This omission is serious enough that omitting it would cause me to question this article's featured article status. As it stands, I think that the article was improved by the edit I made, which is why I am reverting again.

The material I added was sourced. The comments made when reverting, "this is an FA, pls discuss on talk and see WP:MEDRS regarding secondary reviews", do not explain to me what is inadequate about the sourcing I gave, nor was any explanation given on the talk page here, which is another reason I re-reverted. I read the page in question and I don't see what's questionable about the sources. This source: is a systematic review of literature, published in a peer-reviewed journal. The other, is a cohort study and is older, and I think carries less weight than a systematic review of multiple studies, but I don't see a problem with including it to source the statement I included.

Perhaps more importantly, if one disagrees with the viewpoints put forth in my edits, perhaps because there is a scientific consensus otherwise based on other work that I was not looking at, I think it's still appropriate to mention nutrition here...just deleting the material is non-constructive. Depression and nutrition has been studied extensively...something about nutrition belongs on this page. If someone thinks the viewpoint I put forth is not a good summary of what is known, then an appropriate response would be to edit and improve it, not revert the edit and remove all the material without adding any mention of the same issues. Cazort (talk) 21:28, 15 October 2010 (UTC)


 * The addition is not properly formatted and could use some work. It lacked WP:DUE and an encyclopedic tone. Once properly written we can add it. Doc James (talk · contribs · email) 21:47, 15 October 2010 (UTC)


 * 1) If it were formatted, it might be more apparent whether a review article is used (please try to take care to preserve the quality of featured articles); 2) it's too long; and 3) why is a primary source included? If a review is used, then a properly formatted and briefly written addition might be warranted, but we shouldn't be reporting cohort studies.  Sandy Georgia  (Talk) 21:50, 15 October 2010 (UTC)
 * I have moved the text here until improvements take place. Doc James (talk · contribs · email) 21:51, 15 October 2010 (UTC)
 * Sounds good, I agree upon further consideration that the primary study is not appropriate in this context. Thanks everyone for the participation, I think we are going to come up with something high-quality, more of my comments are scattered below. Cazort (talk) 15:14, 16 October 2010 (UTC)

Text
Poor nutrition has been implicated as potential risk factors for depression. Nutrients that have been linked include omega 3 fatty acids, folic acid, and vitamin B12. These factors are particularly magnified in pregnant and lactating women, due to the additional nutritional demands of pregnancy and lactation. Poor nutrition has also been implicated as a strong predictor of depressive symptoms in older adults. This knowledge has led to the use of nutritional supplements and changes in diet as a treatment for depression, often combined with other treatment approaches.


 * Adding correctly formatted sources here, so we can evaluate and improve the text:
 * This is a review.
 * I can't see any reason an 11-yo cohort study should be included.
 * The final sentence of the proposed para is uncited; perhaps we can craft something (about two sentences) from the review article. Who has the full text? We don't write from abstracts. Also, that review is five years old, and I would be very surprised if there isn't something more recent. Sandy Georgia  (Talk) 22:01, 15 October 2010 (UTC)
 * The final sentence of the proposed para is uncited; perhaps we can craft something (about two sentences) from the review article. Who has the full text? We don't write from abstracts. Also, that review is five years old, and I would be very surprised if there isn't something more recent. Sandy Georgia  (Talk) 22:01, 15 October 2010 (UTC)
 * The final sentence of the proposed para is uncited; perhaps we can craft something (about two sentences) from the review article. Who has the full text? We don't write from abstracts. Also, that review is five years old, and I would be very surprised if there isn't something more recent. Sandy Georgia  (Talk) 22:01, 15 October 2010 (UTC)


 * A pdf of the review is freely available here. More recent reviews are this paper and, which relates specifically to vitamin D. Looie496 (talk) 22:28, 15 October 2010 (UTC)
 * Thanks-- I've added the PDF to the citation above (and corrected the PMID above, which was missing a 0). Newer review citations:




 * If anyone has full text, we should be crafting new text from these more recent reviews. Sandy Georgia  (Talk) 23:14, 15 October 2010 (UTC)
 * If anyone has full text, we should be crafting new text from these more recent reviews. Sandy Georgia  (Talk) 23:14, 15 October 2010 (UTC)


 * From Melanson (2007):"Population studies have demonstrated that individuals who consume very little fish4 or who have low levels of omega-3 fatty acids in body tissues7,8 have higher rates of depression. Case control studies and cohort studies have also supported positive relationships between omega- 3 fatty acids and reduced risk of depression. 5 Some2,5,9 but not all3,5 clinical trials using omega-3 fatty acids to treat depression have shown improvements alone or in conjunction with antidepressive medications. A growing body of data supports the hypothesis that because pregnancy and lactation place such strong demands on a woman’s omega-3 fatty acid needs, postpartum depression may be related to poor omega-3 fatty acid status.2 Depression is included among the symptoms of overt clinical defi ciencies of several micronutrients (vitamins and minerals). These include ascorbic acid, thiamin, niacin, pyridoxine, cobalamin (vitamins C, B1, B3, B6, B12), folate (folic acid, a B vitamin), and the minerals zinc and selenium. However, relationships between depression and subclinical deficiencies of these nutrients require further research attention. In population studies, low levels of folate and cobalamin (vitamin B12) have been associated with depression, and folate status may be important in determining responsiveness to antidepressive treatments.2,3,11,12 ... Insufficient zinc intakes have been reported for several population groups within the United States.6 Zinc status has been inversely associated with depression in several studies, 2 but its role in the etiology and treatment of depression has not been sufficiently addressed in the scientific literature. ... Although biological plausibility for a role of antioxidants in reducing the risk of depression is strong, this relationship has yet to be investigated. ... ...substantial evidence exists to suggest that poor dietary quality may be linked to depression."
 * This is basically what she says about the reported associations between depression and particular nutrients. If that is too egregious a slab of copyright text, delete it and I'll work on a summary. But I thought others without access in this discussion might want some input. Anthony (talk) 00:27, 16 October 2010 (UTC)
 * I think a key idea that I would like to see included is a note (using this source?) is that "Depression is included among the symptoms...of...deficiencies of several micronutrients.". Cazort (talk) 15:12, 16 October 2010 (UTC)
 * Depression (differential diagnoses) was created by a very enthusiastic but difficult editor a few months back. Some of this certainly belongs there. But whether it belongs here, I'll leave that to others. I'm frying other fish. If anybody wants paywall articles, though, I'm happy to email them. Anthony (talk) 13:56, 17 October 2010 (UTC)
 * Ahh, I was not aware of that article. I see some problems with that article, particularly in the way it opens, but I suppose that's another discussion.  Since differential diagnosis is a process, however, I don't see it as being mutually exclusive with discussing the same conditions raised there as causes of depression on this page.  It seems that all adequately-sourceable material would belong both places, although the nature of the discussion and perhaps the choice of what details to include and how to present it would be very different on the two pages.  There's also something that strikes me as problematically WP:POV with that page; it repeatedly refers to misdiagnosis but it doesn't give a full explanation of how depression (or "misdiagnosis" of depression) is defined.  It seems that we're almost getting into an unresolved etiological and ontological question--if depression is caused by malnutrition, disease, other factors, then is it "really depression" or is it just "depression-like symptoms"?  I don't think there's a clear consensus about this in the scientific literature.  Isn't depression itself just a construct, defined by the confluence of a certain complex of symptoms?  There's a degree to which even psychiatrists admit this arbitrariness...David D. Burns for instance argues that depression and anxiety disorders have ill-defined boundaries and often co-occur.  But, since depression is defined in terms of its symptoms, it seems to make sense to BE the symptoms, and then to discuss all possible causes (which are discussed as causes of major depressive disorder) in the main article...as there would be something inherently WP:POV about separating them out without sources--and even if some sources separate certain causes out like this, in the interest of WP:NPOV, we'd have to include both perspectives.  Cazort (talk) 22:13, 20 October 2010 (UTC)
 * Penckofer (2010) cites a couple of more recent reviews of nutrition/depression, but I've just read one and the tone is rather zealous. I'm going to sleep now. Anthony (talk) 01:27, 16 October 2010 (UTC)
 * The conclusions in this article are pretty bold, particularly: "No matter which mechanism(s) prove to be true, epidemiological data and clinical studies already show that omega-3 fatty acids can effectively treat depression" communicates that this is fairly well-known. There's also some mention of tryptophan, tyrosine, phenylalanine, and methionine.  And it also mentions folate and B12, and in addition, magnesium.
 * I do think that the issue raised in this review needs to be taken into consideration (and possibly explicitly mentioned?) in maintaining WP:NPOV...notably that "Nutritional therapies have now become a long-forgotten method of treatment, because they were of no interest to pharmaceutical companies that could not patent or own them". Perhaps this view should be attributed to the authors of the study but I think it's a view that needs to be included.  Whether it belongs on this page, or on a more general page (because in the "Conclusions" section the authors are talking about mental disorders in general, not specifically major depression) is another question.  Cazort (talk) 15:12, 16 October 2010 (UTC)

Proposed new text
I do not have access to all of the full text sources. Could someone please propose new text here, based on the best reviews, so we can all tweak it? Sandy Georgia (Talk) 15:17, 16 October 2010 (UTC)
 * I would be more careful with that. Reviews in Nutr J. are likely to be more enthusiastic about nutrition interventions. Is there nothing about this in other places? Tijfo098 (talk) 18:13, 26 October 2010 (UTC)
 * I agree that reviews in Nutr J. can (and probably do) exhibit a bias towards nutritional approaches. However, I would also point out that it's just as likely that reviews in psychiatric and pharmacological journals exhibit a similar bias against them.  The current page's citations are virtually dominated by psychiatric, neurological, and pharmacological journals.  I think this journal falls solidly within WP:RS guidelines and represents an essential viewpoint to maintain WP:NPOV, especially if it contrasts with the other viewpoints represented on the page.  Cazort (talk) 16:30, 3 November 2010 (UTC)
 * I believe we listed everything recent we could find above (but no one did any further work on this, to my knowledge). Sandy Georgia  (Talk) 18:18, 26 October 2010 (UTC)

Here is some new text based on the discussion above...let's edit it here and then when we have consensus, make it go live? I propose:


 * Place the text in a subheading of Causes-->Biological after the monoamine hypothesis but before other theories. If people think it's too small we could place it under other theories but I think that section is already a bit too big and encompasses a number of fairly well-developed concepts.

Text:


 * Poor dietary quality and poor nutrition has been linked to depression. Depression is included among the symptoms of deficiencies of a variety of micronutrients, including ascorbic acid, thiamin, niacin, pyridoxine, cobalamin (vitamins C, B1, B3, B6, B12), folic acid, zinc, and selenium.  Population studies have also linked a number of nutrients to depression, including omega 3 fatty acids (particularly eicosapentaenoic acid or EPA), folic acid, vitamin D and vitamin B12.  These factors are particularly magnified in pregnant and lactating women, due to the additional nutritional demands of pregnancy and lactation.


 * The links between nutrient deficiencies and depression has led to the use of nutritional supplements and/or changes in diet as a treatment for depression. There is some evidence from clinical studies suggesting that omega-3 fatty acids, folate, and B12 can effectively treat major depression.  Such approaches are attractive due to ease, low cost, and benefits in terms of overall good nutrition.


 * Cazort, how would you feel about adding the exact quote from the sources you are paraphrasing to the right-hand column below? That would make it much easier and quicker for everybody to assess your proposal and might encourage more input. The statement beginning "These factors..." should only need one source. -- Anthony (talk) 15:43, 4 November 2010 (UTC)

External link to a video
There is a discussion at Talk:Depression_(mood) about adding video as an external link to some depression-related articles. Your input is welcome. Anthony (talk) 06:16, 19 October 2010 (UTC)

I'd now like to add the link. Rather than create an External links section, which attract massive amounts of cruft, I suggest inserting something like this near the lead. Your thoughts on linking to this video, and linking via this template rather than an EL section would be appreciated. Some arguments for and against linking can be found in the discussion at Talk:Depression_(mood). I think this is a fair summary: Cheers. Anthony (talk) 04:59, 26 October 2010 (UTC) Since there's been no comment, I asked at the help desk for someone to position the video box beneath the infobox, and Dismas has obliged  Anthony (talk) 11:59, 27 October 2010 (UTC)
 * Since the video says nothing the article doesn't already say, inserting the link appears to breach WP:ELNO: "Any site that does not provide a unique resource beyond what the article would contain if it became a featured article." The rationale for linking, despite this, is that concentration problems are a feature of MDD, and audiovisual presentation would be more accessible to many of this article's most vulnerable visitors. So the link does provide a unique resource beyond what the article text could provide: accessibility.
 * The reliability of the content has not been disputed.
 * The copyright status, CC-BY-SA, has been confirmed.

5-HTTLPR polymorphism
I see that's not even mentioned here despite this article's "featured" status. Can someone have a look at ? I've added the more famous studies of Caspi and Kendler to the 5-HTTLPR article (these have thousands respectively hundreds of citations). But I don't have on-line access to Brown's more recent review (which is in a more obscure venue). Tijfo098 (talk) 11:17, 26 October 2010 (UTC)

I found better sources, so I've added this. Tijfo098 (talk) 11:57, 26 October 2010 (UTC)

By the way, the JAMA meta-analysis has a ton of comments in both JAMA and Arch Gen Psychiatry. I didn't read them, but they may be interesting. I bet a lot of the authors of the positive studies were unhappy. Tijfo098 (talk) 12:23, 26 October 2010 (UTC)
 * This article is already overly long, and the text you added goes into excess detail and could probably be trimmed by about 50%. If the results have been part of a secondary meta-analysis, we don't need to take so much space on the interim steps in an already overlong article.  Also, because this is a featured article (and citations must be consistent), could you please format the citations using the Diberri template filler for consistency?  Sandy Georgia  (Talk) 12:35, 26 October 2010 (UTC)
 * Feel free to condense it, but this is/was a major research direction. This article had zero information on genetic research on depression. Those papers are all from top science, medicine, and psychiatry journals. Caspi's paper has thousands of citations. Can you say that about most of the other sources in the causes section? I'll format the only non-formatted citation. Tijfo098 (talk) 17:15, 26 October 2010 (UTC)
 * By the way the discussion about circadian rhythms is twice as long, and it's really more appropriate in the SAD article. The fact that non-psychiatry sources are cited there is telling of how much pyschiatrists think that applies to MDD... Tijfo098 (talk) 17:32, 26 October 2010 (UTC)
 * Trimming is needed in lots of places in this article. Sandy Georgia  (Talk) 17:40, 26 October 2010 (UTC)
 * Okay, add the HPA axis paragraph to the "to trim" list. It's entirely based on a weak source. Tijfo098 (talk) 17:50, 26 October 2010 (UTC)
 * The entire article is in desperate need of trimming and removal of primary sources, and I've been saying so for a long time. If it doesn't happen soon, I'd send the article to WP:FAR myself, except that wouldn't be proper since I promoted it.  As a sample, I've formatted the citation correctly and consistently, incorporating the full-text of the meta-analysis and trimming to that text; the same needs to happen throughout this article, so please don't take it personally. I can only watch for new additions that don't exacerbate an already existing problem-- the article should be a broad overview, avoiding excess detail on primary studies. Sandy Georgia  (Talk) 18:05, 26 October 2010 (UTC)

Some helpful links for this task: Sandy Georgia (Talk) 18:08, 26 October 2010 (UTC)
 * WP:MEDRS
 * Wikipedia Signpost/2008-06-30/Dispatches
 * Diberri template filler (but switch to as this article is impossible to load).

Also Tijfo098, we have two daughter articles (Biology of depression and Treatment for depression) to place more info in on causes and treatment - my intention for the page was to limit to material which is referred to in the everyday practice of psychiatrists and patients with major depression. You are right about more material which realistically is not part of everyday practice or broad theory and can be moved. I have been pretty busy IRL recently and will be so for another week or two. Casliber (talk · contribs) 18:41, 26 October 2010 (UTC)
 * I would take issue with the idea/practice of limiting material on this page to that which is referred to in the everyday practice of psychiatrists and patients with major depression. This limited scope represents a specific point of view and thus violates WP:NPOV if it is used to the exclusion of other viewpoints that are verifiable in reliable sources.  When there's not enough of such coverage, or if the material is more specialized so that it is not accessible, or is more relevant to a specific page, that's another issue, but I think that the limiting principle you mention is not consistent with Wikipedia's guidelines and policies.  Cazort (talk) 21:36, 3 November 2010 (UTC)
 * Tijfo098, I linked above to an explanation of what vcite is (it's useful on articles with very long load times like this ones), and I also linked to a discussion of why citation style must be consistent in featured articles. Your recent changes use a citation style that introduces inconstent author fields, and doesn't use PMIDs. Also, in spite of the discussion above, and after you said to go ahead and trim, you restored the lengthy text with inconsistent citations, along with an edit summary of "did you think they'd give up so easily".  Would you please AGF; there is much work to be done on this article.  I'm reverting to the trimmed version with correct citation style.   Also see WP:OWN.  Sandy Georgia  (Talk) 19:24, 26 October 2010 (UTC)
 * You misunderstood; there are even newer secondary sources than the 2009 JAMA meta-analysis. It wasn't I who is not giving up. It's the researchers. I'm not related to them in any way. I have not restored the old text (as you say above), but added newer sources. I'll see what changes need to be made so vcite works. Tijfo098 (talk) 19:28, 26 October 2010 (UTC)


 * If you have a newer review that says something different, that's helpful, but the review there has full-text available as an added benefit, so unless the newer ones differ, perhaps we can stick with it? It's the one you added first, so I just cited it correctly and added a link to the full text. Vcite uses a different citation style than cite, intentionally I believe. The documentation is at and the Diberri template filler gives PMIDs and PMCs-- all you have to do is switch to vcite for this article. Full-text is preferred when we have it, as long as it's still accurate.  You also restored all of the older text with incorrect citation style-- could you please discuss on talk (see WP:OWN) to save us all time?Sandy Georgia  (Talk) 19:34, 26 October 2010 (UTC)
 * OK, I see what you've done now; it's still a bit long (not it only-- the entire article), and as Casliber points out, we have Biology of depression where all of this can be explored in more detail. I suggest the entire section (as most of the article) could still be trimmed to that sub-article, and discussing on talk will save us all time because this article is SOOOOOO slow-loading.  Sandy Georgia  (Talk) 19:45, 26 October 2010 (UTC)

Well, if you and Casliber want to keep that section at the Zoloft advert level (even just to say that the ad is wrong), I can understand. There's also for truly complex details. Exceeds even the biology of depression article by a fair amount. It is somewhat useful in weighing the new research areas. The old ones only get a passing mention. Typical of psychiatry research, I should say. Tijfo098 (talk) 20:42, 26 October 2010 (UTC)
 * I'm not advocating to keep anything; I'm advocating to cut about a third of this article. But I'll leave that to those who know the territory better than I do-- I only try to keep it from growing more!  Sandy Georgia  (Talk) 21:16, 26 October 2010 (UTC)

Citation needed in the monoamine section
It should probably be rephrased along the lines of the Nature paper, which has a slightly more conservative and cogent argument:

Although these mono amine-based agents are potent antidepressants, and alterations in central monoamine function might contribute marginally to genetic vulnerability, the cause of depression is far from being a simple deficiency of central monoamines. Monoamine oxidase inhibitors and SSRIs produce immediate increases in monoamine transmission, whereas their mood-enhancing properties require weeks of treatment. Conversely, experimental depletion of monoamines can produce a mild reduction in mood in unmedicated depressed patients, but such manipulations do not alter mood in healthy controls.

Tijfo098 (talk) 21:11, 26 October 2010 (UTC)


 * How about: "Although inherited abnormal central monoamine function may contribute marginally to vulnerability to depression, and drugs that increase the amount of available monoamines are effective antidepressants, the cause of depression is not simply monoamine deficiency. The mood-enhancing effect of MAO inhibitors and SSRIs takes weeks of treatment to develop even though the boost in available monoamines occurs within hours, and although deliberate reduction in the concentration of centrally available monoamines may slightly lower the mood of unmedicated depressed patients, it does not affect the mood of healthy people."? Anthony (talk) 21:53, 26 October 2010 (UTC)


 * You should probably break up a few of those sentences, but otherwise sounds fine to me. Tijfo098 (talk) 22:01, 26 October 2010 (UTC)
 * They're long and could be easier to read but I can't see how to improve them just now. If you can, please feel free. Anthony (talk) 04:41, 27 October 2010 (UTC)

Another quote that might be useful
Collectively, these studies highlight the weaknesses of attempts to generate a ‘unified theory’ of depression. Mechanisms that promote depressive symptoms in response to stress differ markedly between different neural circuits and can also be distinct from changes that underlie depression in the absence of external stress (‘endogenous depression’). In addition, neuroplastic events that are required for antidepressant efficacy need not function through the reversal of stress-induced plasticity, and might function through separate and parallel circuits. Note: this comes after a large section on BDNF that we simply don't have here. I've added a bit on BDNF in the biology subarticle, particularly the recent finding that Val66Met interacts with 5-HTTLPR s, which was highlighted in the Nature review. Tijfo098 (talk) 22:01, 26 October 2010 (UTC)

Intact monoamine system
Re: "An intact monoamine system is necessary for antidepressants to achieve therapeutic effectiveness" Can someone check the source,, to see if there's more context for antidepressants in that statement. It seems odd that the same source would make this claim about anti-depressants in general, and also that they point to antidepressants which don't directly fiddle with the mono-amine system. Besides, it seems very unlikely that such studies were done in humans. Were they referring to knockout mice studies? Based on the abstract alone it appears to be an inferred conclusion rather than based on some experiments: "In conclusion, it is clear that antidepressant agents in current use do indeed require intact monoamine systems for their therapeutic effect." This seems a little speculative to cite here. The more recent Nature review doesn't make this claim. Further, it's not clear what "intact" means, given that phenotypic variation in the system does occur. Tijfo098 (talk) 01:16, 28 October 2010 (UTC)


 * I can't access Journal of Clinical Psychiatry. But I vaguely recall there's a place on Wikipedia where you can request users with access to email a copy of a paywall article, or check a fact. I've asked at Wikipedia_talk:WikiProject_Medicine --Anthony (talk) 04:08, 28 October 2010 (UTC)


 * The abstract here does discuss "healthy volunteers", a term rarely applied to mice. The full text version appears to require registration on psychiatrist.com with Physicians Postgraduate Press, which I have not done. Although they say registration is free, and here they indicate access to supplements is also free with registration. I'm not sure if any of the commercial distribution services carry their serials, but there were no links to them from the PubMed record, which usually means they do not. You might try registering if you're really keen on it. LeadSongDog come howl!  15:48, 28 October 2010 (UTC)
 * Good points LeadSongDog. I gave up when I saw my university doesn't subscribe, but this article is in a supplement and supplements are available to registered users. Registration took 5 minutes. I haven't read it yet but they are talking humans, so I'll be interested to see what the "monoamine depletion paradigm" is. Thanks for all your help. --Anthony (talk) 16:17, 28 October 2010 (UTC)
 * When you're done with that one, you might also want to have a look at and  and this for more recent discussions. Good luck.LeadSongDog  come howl!  16:39, 28 October 2010 (UTC)
 * Brilliant. Again, thanks. --Anthony (talk) 17:23, 28 October 2010 (UTC)

Back on topic
The Delgado 5-page paper is partially a review of the monoamine hypothesis, and partially a summary of his own depletion studies previously published elsewhere; the paper has a couple of pages on the depletion studies by his group. This paper was mis-cited in a couple of two ways (even before I edited here ):
 * it speaks nothing of tianeptine or opipramol (but that can be easily sourced from elsewhere)
 * it doesn't say that 5-HTT depletion (achieved by means of dietary tryptophan depletion) in depressed patients does nothing, on the contrary it says that had a depressive effect, but only if the patients were on SSRI treatment; see the first paragraph in their discussion section, which is in line with the Nature review. Depressed but unmedicated patients or healthy subjects were not affected by serotonin depletion. Also, recently recovered but unmedicated patients were affected by depletion, but less than the medicated patients. (This isn't in the table because it's not Delgado's own work; the table only summarizes those studies; the extra info is on the last page.) This is how the "intact" part in the abstract should be interpreted: patients taking SSRI (and perhaps the recently recovered but unmedicated) need to have enough serotonin precursors. There's no study cited in this paper on "non-intact" serotonin subjects, human or otherwise, understood as having some neurological or genetic damage. Also, this isn't a great quality paper. The writing is muddled in more than a few places and the structural emphasis on distinguishing the work of his group from that of others is distracting. Tijfo098 (talk) 17:51, 28 October 2010 (UTC)

And fairly off-topic
Here's an interesting reading about JCP supplements: : "Because they are printed under the sponsorship of commercial interests, they may be perceived as less than objective. A reasonable step to help improve this perception would be to ensure that supplements are peer-reviewed in the same way as regular articles in the parent journal." Probably explains why less well written reviews appear in supplements, although I see no commercial bias in the particular review discussed in this section. Tijfo098 (talk) 19:10, 28 October 2010 (UTC)
 * Thanks for pointing that out. Anthony (talk) 16:22, 4 November 2010 (UTC)

Interesting figures about stigma
Medscape has a recent article (based on an AJP paper ) which compares the stigma in depression with schizophrenia an alcoholism. The numbers are lower for depression, but still surprisingly high. The AJP article, but not Medscape, also has a figure for the percentage of US public that attribute it to a "chemical imbalance": 80%, up from 67% a decade before. Oddly enough, the "neurobiological conception" which is stated to include to be "chemical imbalance" or genetic was only 67%, up from 54%; this is the number reported in Medscape. It is possible for the "neurobiological conception" percentage to be lower than "chemical imbalance" because of how it was coded: they also asked the respondent if the clinical vignette was a mental illness; "neurobiological conception" coded for "yes" to mental illness and a yes to either of genetic or "chemical imbalance". It's interesting that 72% rated vignettes of depression as mental illness, but 80% as "chemical imbalance". Apparently, ads work best when they are somewhat destigmatizing. Some of the figures are probably worth a mention here in the "Sociocultural aspects" section. Tijfo098 (talk) 16:31, 28 October 2010 (UTC)
 * I think that would be appropriate. Do you want to do it, Tijfo098? If so, can you replace existing text (to keep the page loading time down)? Anthony (talk) 16:41, 4 November 2010 (UTC)

Tianeptine as SSRE
The most recent review in Molecular Psychiatry is very skeptical about that claim. I've updated the main article on tianeptine. Tijfo098 (talk) 00:20, 8 November 2010 (UTC)

Update
This page is in need of an update and refocus on review articles. Much primary research needs weeding. Articles from the 80s and 90s need replacement with something more recent. Doc James (talk · contribs · email) 03:34, 11 January 2011 (UTC)


 * Concur! But...finding the time, for those of us most interested in the topic, will be the challenge. Tom Cloyd (talk) 22:27, 17 March 2011 (UTC)


 * I'm finishing undergrad in Psychology and moving to Grad school next year. I'll keep my ear to the ground, as well as my eyes on relevant articles to make sure current and relevant research is being brought in. Also, I'm new so I haven't quite figured out the syntax for signing these things --Smister (talk) 07:52, 6 August 2011 (UTC)smister

In children
The concept of depression is more controversial in regards to children, and depends on the view that is taken about when self-image develops and becomes fully established. Depressed children may often display an irritable mood rather than a depressed mood, and show varying symptoms depending on age and situation. Most lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness. Depression may also coexist with attention-deficit hyperactivity disorder (ADHD), complicating the diagnosis and treatment of both.

Is this discussing MDD? --Anthonyhcole (talk) 13:29, 11 January 2011 (UTC)
 * Yes. The irritability is specifically noted in DSM IV TR. Casliber (talk · contribs) 19:26, 18 March 2011 (UTC)

External link to video
On 27 October after proposing it on this talk page here, I inserted a large button under the infobox linking to a 10 minute video about depression. On 11 January, Doc James deleted it. I've learned a bit about MOS since then and am amazed it lasted that long. However, I believe the rationale outlined in the above wikilinked proposal, and the discussion behind it here, justify its inclusion on this article as an external link, so have added it to Major depressive disorder. --Anthonyhcole (talk) 13:43, 31 January 2011 (UTC)

Society and culture (relevant quote)
Hello everyone.

Upon reading the "society and culture" section, a quotation by Charles-Valentin Alkan came back to mind. Probably it is not relevant enough to be included in the article but I am re-transcribing it here just for the sake of it. May it serves to inspire one on the subject. It goes as follows:

"I’m becoming daily more and more misanthropic and misogynous: nothing worthwhile, good or useful to do; no one to devote myself to. My situation makes me horridly sad and wretched. Even musical production has lost its attraction for me for I can’t see the point or goal."

Twipley (talk) 18:19, 18 March 2011 (UTC)

The use of the Van Gogh picture to create an image of depression
Hello, I think the current picture painted by Vincent Van Gogh should not be up. Van Gogh did suffer from depression, but the thing is he killed himself in the end with a gun. I know when I was depressed and saw this painting on wikipedia, the image stuck to me and I thought of it if I ever got down.

But the fact that Vincent Van Gogh committed suicide in the end should mean that it should not remain up, IMO. The painting is a portait of depression, and what happened in the end to the painter is not very good. Anyone else agree?--Dcfb111 (talk) 18:44, 28 March 2011 (UTC)
 * I don't understand what you are saying. Are you saying that the image should not be there because it might lead readers to think that depression is harmful? Looie496 (talk) 23:44, 28 March 2011 (UTC)
 * No. He is saying since the man who painted this portrait committed suicide that it gives a pessimistic outlook on recovery from depression. In wiki language, he believes too much WP:UNDUEWEIGHT is being given to the suicidal outcome of depression which is not the most common outcome. I disagree though that too much weight is given because most readers will not be familiar with the painting or the artists suicide. I am open though to suggestions of other possible images.AerobicFox (talk) 03:42, 29 March 2011 (UTC)


 * I also believe it's inappropriate. You wouldn't see that painting on a textbook or (dare I say) encyclopedia giving a description of depression. 216.252.86.130 (talk) 07:06, 1 April 2011 (UTC)
 * Depression (mood) is illustrated by Albrecht Dürer's engraving Melencolia I. --Anthonyhcole (talk) 17:56, 1 April 2011 (UTC)
 * I like the image and thing we should keep it. It illustrates the issue well. Doc James  (talk · contribs · email) 17:59, 1 April 2011 (UTC)
 * This article has been difficult to illustrate. The painting has been discussed elsewhere as portraying a depressed person. I think it adds more to the article than detracts. Casliber (talk · contribs) 19:45, 1 April 2011 (UTC)
 * I disagree that it would not be used on a textbook. Psychology textbooks, including Abnormal Psychology textbooks, which discuss depression often use various art images on their covers and in their articles.  Annaskyfox (talk) 23:00, 15 April 2011 (UTC)
 * I agree with AerobicFox that the majority of readers will be oblivious to the artist's suicide. I find that the illustration is appropriate and prefer it to Dürer's Melencolia I, though I would also be open to other possibilities. -- Tea with toast  (talk)  00:42, 17 April 2011 (UTC)
 * Casliber above is a Wikipedia administrator who by profession is a psychiatrist and not an art historian. He is quite mistaken in his assertion that the painting depicts a depressed person (its provenance is discussed below here). The painting has no place in this article and should be removed. Skirtopodes (talk) 02:26, 13 January 2012 (UTC)

Treatment Discussion
It would be beneficial to discuss the controversy surrounding treatment of MDD, and come to a consensus on the most unbiased way to present current research. The current wording on the article sounds as if antidepressants offer no benefit at all. Even Kirsch admits that antidepressants are better than not receiving treatment, regardless of whether or not they separate from placebo.

Also, there is no mention of the critiques of the current research. i know that there was a panel of researchers who wrote a response to Kirsch's paper from '98, but I didn't see that anywhere in the Wiki article. I'm not sure if that should be placed in this article per se, but it could be useful to highlight that these findings are controversial, and be very clear about what the findings actually say. --Smister (talk) 08:02, 6 August 2011 (UTC)


 * I agree that it would be beneficial to discuss this but for exactly the opposite reasons to the above user. Irving Kirsch's book concludes that there is no evidence at all for the Bio chemical imbalance theory of depression and states that not only is there no evidence for it (that bears scrutiny) but there is "overwhelming" evidence against it. To give just one example of the evidence against it: there is a drug licensed and marketed as an anti-depressant in France as Stablon and it is is a Selective Serotonin Re-uptake"italic text" Enhancer ie. it has the exact opposite chemical effect of modern anti-depressants and is yet equally effective. Kirsch demonstrates with a comprehensive review of the evidence that this is because anti-depressants are Active Placebos (in other words their side-effects cause trial participants to break blind and it is this that causes them to appear to be more effective than the Passive Placebos they are compared in trials with. LarsPetersson (talk) 21:58, 14 March 2012 (UTC)
 * LarsPetersson, I think that you are being a bit over-simplistic. According to citations in this article, Selective serotonin reuptake enhancer, the drug you mention increases, brain-derived neurotrophic factor. Drugs which increase BDNF are often associated with an antidepressant effect. Antidepressant mechanisms are much more complicated than one neurotransmitter; modulation of one neurotransmitter will have knock on effects on a large number of other systems in the brain.-- Literature geek |  T@1k?  02:27, 17 March 2012 (UTC)

To do
Material for Causes of depression Post traumatic stress disorder has been mentioned as a source of depression, as has exposure to large explosions such as are present on a battlefield. While I have read about both as contributors to depression in other sources, I did not see them in the article nor do I feel competant to add them my self. But they should be considered and added if appropriate.article to be placed here until article created.76.111.4.135 (talk) 19:13, 15 September 2010 (UTC)john harrison yr.201076.111.4.135 (talk) 19:13, 15 September 2010 (UTC) Social rejection also predicts later depression, and adolescents who are victimized by peers are more vulnerable to developing depressive symptoms if it impacts on the development of their identity, although family cohesion and emotional involvement are protective factors.

Social isolation has also been found to predict onset of a first episode.

A study in Providence, Rhode Island following children from birth found that family disruption and lowsocioeconomic status in early childhood were linked to an increased risk of major depression in later life. The same researcher found a year earlier in another study on the same Rhode Island subjects, that this effect was  independent of later adult social status and related to various social inequalities, the consequences of which may be more severe for women.

There is mixed evidence regarding the role of social capital (features of social organization including interpersonal trust, civic engagement and cooperation for mutual benefit).

Two good studies on bullying this and.

In adulthood, a correlation between stressful life events and the onset of major depressive episodes has been found consistently and is likely causal, although the specific mechanisms are unclear. Negative events such as assault, divorce or separation, legal issues, major problems with work, finances, housing, health, or friends and confidants, have been found to precede episodes if they represent a long-term threat, particularly if the threat is of a loss or humiliation that devalues an individual in a core role.

Existential and humanistic approaches are generally grouped together, representing a forceful affirmation of individualism. American existential psychologist Rollo May stated that "depression is the inability to construct a future". From the existential perspective, in order to construct a future, individuals must be acutely aware of both their mortality and their freedom to act, and they must exercise their freedom within the explicit framework of an acute awareness of their mortality. This awareness produces "normal" anxiety, whereas the lack of awareness leads to neurotic anxiety, self-alienation, inauthentic living, guilt,  and depression. Humanistic psychologists argue that depression can result from an incongruity between society and the individual's innate drive to self-actualize, or to realize one's full potential. American humanistic 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.

could go in history subpage(?)

Both William James and John Stuart Mill found relief from their depression in literature. For James, who was nearly driven to suicide during his depression, the choice to believe in free will was instrumental in overcoming this condition. This choice was inspired by an essay about free will by French philosopher Charles Bernard Renouvier. Upon reading this essay, James no longer felt that "suicide [was] the most manly form to put [his] daring into," and declared, "now I will go a step further with my will, not only act with it, but believe as well; believe in my individual reality and creative power." Mill took solace in the work of English poetWilliam Wordsworth. Mill wrote that, "What made Wordsworth's poems a medicine for my state of mind, was that they expressed, not mere outward beauty, but states of feeling, and of thought coloured by feeling, under the excitement of beauty."

Treatment:
"Cognitive therapy is a treatment process that enables patients to correct false self-beliefs that can lead to negative moods and behaviors. The fundamental assumption is that a thought precedes a mood; therefore, learning to substitute healthy thoughts for negative thoughts will improve a person’s mood, self-concept, behavior, and physical state." - http://www.aafp.org/afp/2006/0101/p83.html

"Bibliotherapy is a treatment where a depressed patient reads a self help book such as Feeling Good by Dr. Burns in between therapy sessions. Dr. Burns says in the introduction that "more and more therapists are beginning to assign bibliotherapy to their patients as psychotherapy 'homework' between therapy sessions." A nationwide survey of psychotherapists published in 1994 also reported that out of a list of 1000 self-help books recommended for patients listed, Feeling Good was the number-one-rated book for depressed patients." -http://www.jaoa.org/cgi/reprint/103/3/131.pdf

"The most common form of treatment for depression is antidepressant medication plus some form of therapy. The medication allows the person suffering from depression to feel much better and then he or she will be in a position to work on the problems which may be contributing to the depressive state while at the same time receiving professional guidance." -http://www.depression-helper.com/treatment.htmKarlp295 (talk) 07:36, 26 July 2010 (UTC)

New meta-analysis
I stumbled across this and think it should go in the article.. Since omega 3 oils are apparently effective against depression, I assume if folk agree it should be added to the article that it should go in the antidepressant section or should there be a seperate section? Literature geek |  T@1k?  13:29, 9 November 2011 (UTC)
 * We have to be very careful how we present this. The article does not imply, nor is would it be proper, to imply that these oils are, by themselves, effective in treating all depressions, serious depressions etc.  Furthermore, the article clearly stated that Omega 3 oils weren't useful, but only fractions, probably EPA.  We do not want people running down to their local GNC and think they're going to treat their depression.  It's not going to happen, especially at the doses that may be required.  Oh, and of course, there's conflicting publications.  In fact, I can find a lot of trials that completely dispute any effect at all for EPA or other fractions of Omega-3 or its fractions.  But there is one critical point....why would these oils have an effect based on what we know about what causes depression?  Without a knowledge of the causal pathway, we cannot even begin to accept this study as supportive of something here.   Orange Marlin  Talk• Contributions 09:10, 12 December 2011 (UTC)
 * Well, nobody yet knows the causal pathways by which ECT or total sleep deprivation affect depression, but clearly they do. We don't need to know causal pathways if the direct evidence is strong enough.  (Which I don't think is the case for omega 3 agents, though.) Looie496 (talk) 16:53, 12 December 2011 (UTC)
 * Looie...point taken. But this is my anti-woo defense mechanism always pops up, even where we don't really have to know the mechanism (hell, most of treatment of depression is magic).  OK, omega 3 is far above magical water cures, I admit.   Orange Marlin  Talk• Contributions 17:23, 12 December 2011 (UTC)

(outdent) There is a possible theoretical mechanism and perhaps I am straying into synthesis or medical hypothesis territory, but no rule against it acccording to WP:TALK! :-P This recent review paper covers how dietary factors including omega 3 influence mood and wellbeing, by for example reducing or increasing proinflammatory cytokines. Proinflammatory cytokines are involved in major depression,, and many antidepressants via their mechanism of actions can reduce neuroinflammation. Very interesting finding the systematic review paper OrangeMarlin that came to an opposing conclusion, thanks for adding it to the article; it may be that omega 3 is indeed ineffective in treating depression, but perhaps it works as a preventative. Perhaps omega 3 just isn't potent enough or its mechanism is not the same as antidepressants to treat depression. I would still say don't throw out the baby with the bath water or more to the point don't throw out that salmon and mackerel just yet! :-) Whether something is natural or synthetic is irrelevant, what matters is does the compound(s) exert a demonstratable pharmacological and therapeutic effect. For what it is worth I have tried fish oils recently and did not notice any significant change in my mood but still probably gonna take them as a possible preventative and for possible general health benefits or treat myself to fish a few times a week, which ever is cheaper or I feel like. :P-- Literature geek |  T@1k?  00:03, 13 December 2011 (UTC)

Vincent van Gogh's painting "At Eternity's Gate"
Why is Vincent van Gogh's painting "At Eternity's Gate" illustrating this article? The painting is not a depiction of depressive disorder.

Its provenance is very well known and very thoroughly researched. It began as a lithograph study made in van Gogh's student days as a painter at Arnhem, at a time when van Gogh himself was in good health. It was always simply and merely a study of an old man, one of a group. Van Gogh himself refers positively to the old man as a "fine sight" in a letter of the time.

The painting itself was made towards the end of van Gogh's life years later, while he was recovering from his nervous breakdown and self-harming incident in an institute at St. Remy, France. It is an exact copy of the lithograph and is one of a group of colour studies made at the time. There has never been any suggestion by academics that van Gogh was attempting to project some private desperation of his own in the painting. It is not included in a list of works from that time suggested by his most authoritative archivist, Jan Hulsker, as possibly indicative of his state of mind at the time.

But it is (or was - I refuse to look at the article again) documented as such in the Wikipedia bio of van Gogh by a cabal of contributors (including a Wikipedia administrator who is a practising psychiatrist in Australia and who I suggest ought to know better), who for some agenda of their own wish to depict Vincent van Gogh as suicidally depressed in the last three months of his life, what is simply not true or at any rate is documented as such. The quite disgraceful story of that is documented here @ http://www.gutclean.com/wpvangoghdarkdebate.html. The fact is, as is agreed by all scholarly biographers, there were no indications of van Gogh suffering from depression in the last months of his life, nor indeed is there any agreement as to the nature of whatever mental illness van Gogh did suffer from. One can add that in the past year plausible evidence has been put forward in a new book from a respected source that van Gogh was in fact the victim of a manslaughter.

I ask that this illustration be deleted forthwith. — Preceding unsigned comment added by 31.6.61.254 (talk) 01:04, 13 January 2012 (UTC)
 * It is a great picture that illustrates the topic well. Doc James (talk · contribs · email) 03:30, 13 January 2012 (UTC)


 * Well, that's your judgement. But the fact is that van Gogh did not mean to portray a depressed person and on that ground alone it is out of place. But it also makes a subtle judgement about the nature of depression, that it is necessarily associated with despair of the sort arguably portrayed here. If the article must have a fine art illustation, then I suggest Durer's Melancholia, as was originally used, is much more appropiate. 31.6.53.248 (talk) 03:44, 13 January 2012 (UTC)
 * We are not the only one who use it for this purppose http://www.washington.edu/news/archive/id/56102 and this ref supports our use http://books.google.ca/books?id=7yqTnHyTbfAC&pg=PA214 Doc James  (talk · contribs · email) 22:20, 13 January 2012 (UTC)
 * That the Washington Post uses it in the same way is not justification in the absence of reliable sources that van Gogh meant the painting to represent depressive disorder (and incidentally sorrow, the title van Gogh himself appears to have given these works, is not a clinical condition). The same remark applies to your other source, a mere glance at whose content moreover suffices to establish that it is in fact a scholarly article about stereotypes, precisely the kind of stereotypes we should wish to avoid in an encyclopaedic article such as this. 31.6.61.199 (talk) 22:48, 13 January 2012 (UTC)
 * I personally feel that the van Gogh painting is more suitable than the Durer painting, regardless of its history. Looie496 (talk) 21:15, 14 January 2012 (UTC)
 * And we have another good comment here  Doc James  (talk · contribs · email) 23:22, 14 January 2012 (UTC)
 * I replied thus:


 * No. The painting is at the Kroller-Muller in Holland (the original lithograph is apparently lost). The title "At Eternity's gate" is not van Gogh's but some traditional title and it is exhibited at K-M as "Sorrowful Old Man: At Eternity's Gate" http://www.kmm.nl/object/KM%20111.041/Sorrowing-old-man-At-Eternitys-Gate?artist=Vincent%20van%20Gogh%20%281853%20-%201890%29&characteristic=&characteristic_type=Painting&van=0&tot=0&start=63&fromsearch=1. The same collection has an accompanying lithograph from the period of the original lithograph with a title beginning "Sorrowful woman ... " and in addition there is another lithograph from that period depicting the same old man reading a book with concentration and not displaying any signs of strong emotion. It's not clear what van Gogh's theme was at the time (his letters of the time are concerned only with the technicalities of producing these lithographs) but it's clear that at most he was concerned to depict sorrow, which I expect your trained psychiatrists you mention will concede is not a clinical condition. It is in fact only the subjectivity of the viewer who introduces the idea of 'sorrow' looking at this picture, let alone a diagnosis of depressive disorder your trained psychiatrists apparently make.


 * If the trained pyschiatrists you mention were writing a book on depressive disorder and wished to illustrate it with a dust-jacket depicting this painting, they would have to seek the permission of the trustees of the Kroller-Muller museum and it is far from clear to me that the trustees would wish to grant that permission. As trustees of the estate and moral rights of one of our greatest ever artists, they would undoubtedly wish to see that his work was viewed freely without stereotyping or mythologising the artist and might very well look askance at this attempt to make, quite gratuitously, the painting an iconic representation of depressive disorder and the more so given the considerable difficulty in assessing to what degree illness played a part in the painter's life and indeed what the nature of that illness was.


 * What your trained pyschiatrists are really doing with this painting are peddling sterotypes and myths. It is absolutely disgraceful and a matter of concern to all art lovers, 'trained' or otherwise. When you consider further, as every beginning student of art history knows, that van Gogh himself wrote intelligently about the relationship between insanity and artistic creation (he took a view that was to become fashionable decades later, that society 'labelled' artists as mad and so indeed they did eventually become) it becomes little short of outrageous, because that labelling is precisely what your trained psychiatrists are doing with the subject of this painting. Skirtopodes (talk) 00:50, 15 January 2012 (UTC)


 * And I have replied again, see the page. Basa lisk  inspect damage⁄berate 01:31, 15 January 2012 (UTC)


 * And I thus:


 * No again. It is you who deny an issue and you do it in the time honoured way of accusing me of misunderstanding the 'real' issue.


 * However, I shall take you as face value and treat what you decribe as the real issue - that the painting is a good representation of MDD (Major Depressive Disorder). I did notice, incidentally, that this last reply of yours moves to the royal wikisodality 'we'. Are we by any chance young and naive - a student perhaps? High school?


 * Whatever, will you please explain what it is about the image that makes it a good illustration of MDD? That the man is old? That he is holding his knuckles to his face in an apparent gesture of depair? What makes you say the image accurately portrays that suicide attempts and suicidal thoughts are amongst the most severe and prominent symptoms of depression (or so you characterised them for my instruction)?


 * Above all, will you please quote reliable sources, as should be the Wikipedia way, that attest this painting as a good image of MDD. Who are these 'trained pyschiatrists' you mention? It looks likes OR (original research) to me. Skirtopodes (talk) 02:39, 15 January 2012 (UTC)

I seem to recall us having this debate before and there being a commentary that linked the image to depression...only 11 pages of archives to sift through.... Casliber (talk · contribs) 05:32, 15 January 2012 (UTC)
 * Or alternatively, see my most recent comment here. Basa lisk  inspect damage⁄berate 15:53, 15 January 2012 (UTC)


 * @ Basalisk. And I record my reply thus:


 * I have been away. You are quite juvenile. You cannot even distinguish between p -> q and q -> p. The whole point is that this merely a painting of a sorrowful old man. Just because an old man is sorrowful does not imply that he he is clinically depressed whereas indeed it may be true, as I presume you mean to instruct me, that an old man who is clinically depressed is necessarily sorrowful, nevertheless the two are not equivalent. I wonder what your mentor Casliber's professional association would make of this attempt to stereotype the old and sad as clinically depressed and in need of treatment?


 * I shan't notice any response you make. I have to say that if your would-be profession of choice involves the care of patients, then I can only hope that you were entirely unsuccessful in the examinations you mention. Skirtopodes (talk) 00:17, 7 February 2012 (UTC)


 * Hard words, Skirt, but hard luck too - I passed my finals. Since your argument has degenerated to a huge tl;dr WP:IDIDNTHEARTHAT, I think the discussion is over. The next time you embark on a tirade of vitriol like this, or the speech below, I'll report you for personal attacks (that's if one of the admins watching this page doesn't block you anyway). Finally, I'm not a psychiatrist. I've never talked to Casliber. He's not my mentor. Everyone who disagrees with you is not in a cabal. Get over it. Basa lisk  inspect damage⁄berate 06:52, 9 February 2012 (UTC)
 * Oh, he was a troll after all. Too bad, wrestling with pigs and all that... Basa lisk  inspect damage⁄berate 07:46, 11 February 2012 (UTC)


 * @ Casliber: well I would be grateful if you can point me to the debate. I asked a Wikipedia expert to find me the original edit and she tells me that it was made by a user called 'Sonjaa' on 28 May 2006 at this address http://en.wikipedia.org/w/index.php?title=Major_depressive_disorder&diff=next&oldid=55164823. The original text read ""Vincent van Gogh, who himself suffered from depression and commited suicide, painted this picture in 1890 of a man that can emblematise the desperation and hopelessness of depression." As far as my friend can see it was never subsequently challenged though the text was eventually edited.


 * I think you will agree that the original falls far short of scholarly standards. Quite apart from the need to cite a reliable source for "emblematise the desperation and hopelessness of depression" there is a problem that you yourself, a practising psychiatrist so I understand, should be acutely aware of and that is that there is no consensus of what Vincent's mental illness (if that is what it was) actually was. I don't doubt that in ordinary terms he suffered depressions but this is an article about clinical depression and whether Vincent was clinically depressed is simply not clear. I repeat there is nothing in his letters of his last three months to indicate that he was depressed, let alone suicidal. It's indeed no longer clear that in fact he committed suicide (but was rather the victim of a manslaughter).


 * For the last time I ask you, a Wikipedia administrator as well as a psychiatrist, to delete this image that is such a disgraceful and quite unwarranted discourtesy to the memory of Vincent van Gogh. His desperately tragic story, as that of his brother Theo, is almost unbearable to read and it is not served at all well by these pathetic and pitiful romanticisations by a clique of misguided Wikipedia editors. In his own life Vincent struggled against this kind of stereotyping and wrote eloquently and intelligently about the link between creativity and madness, which he thought merely a social construct. His own sister Wil, an early champion of feminism, was hospitalised for much of her life (four decades) on the questionable gounds of suffering dementia, a condition that apparently presented in her case in her late thirties. I take it you aware that there is a flourishing van Gogh family who are the direct decendants (through Theo) of his family? It is a disservice to them as well.


 * Do I really have to petition the art world on behalf of Vincent in this matter? The Kröller-Müller museum for a start might express an interest.


 * In the meantime I am making an edit to insert the correct title for this painting as it is currently displayed at Kröller-Müller i.e. "Sorrowing old man ('At Eternity's Gate')" http://www.kmm.nl/object/KM%20111.041/Treurende-oude-man-At-Eternitys-Gate?lang=en. The popular name 'At Eternity's Gate' is really another romanticisation, carrying roughly the same degree of authenticity as Beethoven's title 'Moonlight Sonata'. It appears on on of the early lithographs he made and nowhere else. The painting itself, as I note above, was merely a colour study he made as he was convalescing at Saint-Remy from his breakdown (the ear incident, though again it's no longer clear that in fact he mutilated himself). Your original contributor Sonjaa might care to reflect that Jan Hulsker, Vincent's most esteemed archivist and critical authority, thought not to include this painting in a list he made of paintings at the time as possibly reflecting Vincent's state of mind and thus presumably would take issue with "emblematise the desperation and hopelessness of depression".


 * What a complete disgrace and how utterly pathetic and pitiful your editors' responses. Skirtopodes (talk) 23:01, 6 February 2012 (UTC)

@ CasLiber: Skirtopodes has been blocked by Risker. That makes twice he has been blocked, once by you and once by her.

He posted first on your talk page on 13 January 2011 raising the issue of 'Sorrowing Old Man', the first time he has posted on Wikipedia on this issue. Your reply is above, saying it had been discussed before and that a commentary had been found linking the image to depression. Skirtopodes asked you to point to that commentary, but you did not reply.

I have looked through the archive and can find no such commentary. The only source I can find is the one quoted above, but that, as Skirtopodes pointed out, is in fact an academic paper to do with sterotypes which in no way seeks to support the thesis that van Gogh suffered from clinical depression.

There is no "commentary". That is a fiction.

I did find this from you Talk:Major_depressive_disorder/Archive_4

"Yeah, good point. The painting is rather a good one (of a sad person, that is), unfortunately Van Gogh had other mental health symptoms suggesting problems other than depression. OK, let's leave it open for a little bit but removing I think I agree with. Cheers, Casliber (talk · contribs) 21:39, 24 May 2008 (UTC)"

So why is it still here, why did you change your mind?

Looking at Talk:Major_depressive_disorder/Archive_4 I get the impression (the large downer smiley) that you consider the whole business a bit of a joke. Is that so?

I am trying to understand your motives here. Do you perhaps regard yourself as something of an authority on Vincent van Gogh? On his health? Perhaps you have published a dissertation or an academic paper? Or perhaps you regard yourself as something of an art critic? Do you perhaps post in Wikipedia on the visual arts? Do you have any association with editors who do that might lead to conflicts of interests? Perhaps you have patients who are artists or art critics that might lead to similar conflicts of interests? In short, what is this all about?

I trust you will agree there has been adequate time for you to respond here and that if you do not do now respond adequately, then the assumption must be that you do not intend to.

I am posting this on the IP address that Risker blocked and I will copy to your talk page.

Thank you. 31.6.53.252 (talk) 23:25, 12 February 2012 (UTC)


 * Why are we still debating Van Gogh's mental health when it doesn't make the blindest bit of difference to the appropriateness of the image in this article? Whether Van Gogh was depressed, schizophrenic, manic, a psychopath or completely normal, the picture is still a good illustration of despair and sorrow. That's all that matters. Let's just move on from this, further discussion is not accomplishing anything. Basa lisk  inspect damage⁄berate 09:40, 13 February 2012 (UTC)
 * I agree the painting is emblematic of the topic, whether Van Gogh intended it to be such or not. (Off topic:There is a short interview with Steven Naifeh, one of the authors of Van Gogh: The Life here.) --Anthonyhcole (talk) 03:00, 17 February 2012 (UTC)

IF people spent more time helping and talking to each other instead of arguing what painting describes what and blah blah blah, we would be a much happier world. The painting is beautiful and so is everything else in the universe, love. — Preceding unsigned comment added by 99.254.240.157 (talk) 10:51, 25 February 2012 (UTC)


 * I should be curious to know from the user Basalisk above why the painting is a good illustration of despair and sorrow. It was meant to be an illustration of mortality and the divine (see my post below). Even were it a good illustration of despair and sorrow (and that's not what I see), then why should that be an icon for a psychiatric condition? Is it a mental illness to feel despair and sorrow? RobvanderWaal (talk) 07:14, 8 April 2012 (UTC)
 * Whatever it was intended to portray, what it does actually illustrate as with any artwork is up to interpretation and based on the body language it clearly represents depression very well.LuciferWildCat (talk) 00:33, 18 April 2012 (UTC)

A selection from Picasso's Blue Period would be a good alternative, like The Old Guitarist. I read at one time that Picasso was suffering from depression during this period, thus the subject matter and use of colour. I'd need a source for that, which I will try to find to add it to the article Picasso's Blue Period, if it's true it's useful info that's not explored in detail there yet. Anyway, that's my suggestion... Picasso's Rose Period, when he recovered from the depression and went into more cheerful, pink tones and subject matter, followed the Blue Period. Maybe show a selection from both periods of his artwork as an illustration and contrast... that'd be cool.OttawaAC (talk) 01:16, 21 April 2012 (UTC)

Van Gogh's painting "At Eternity's Gate" not a depiction of sorrow
I have made a substantial edit of the article  At Eternity's Gate explaining this painting's genesis.

It was never meant to be a depiction of sadness or sorrow. In the two acknowledged catalogue raisonnés it was listed respectively as Worn Out: At Eternity's Gate and Old Man with His Head in his Hands. It was not until it passed into the collection of the Kröller-Müller Museum in 1970 that it was given the fanciful name Sorrowing Old Man, probably because they already had a drawing of a woman burying her face in her hands that they had named Mourning Woman Seated on a Basket.

The genesis of this painting is known in some detail and it is one of the rare examples where van Gogh actually made his intentions clear.

The inspiration for the original drawing, entitled Worn Out, was a print by the British graphic artist Hubert von Herkomer depicting a Chelsea pensioner slumped dead at Sunday service, a fellow beside him anxiously checking his pulse. This print was enormously popular and Herkomer worked it up into an oil painting with the sentimental title The Last Muster, which was exhibited at the Royal Academy 1875 and which cemented his career. Van Gogh certainly saw this when he was in London and his letters include several references to the print, which he admired greatly.

In 1882 van Gogh was looking for a subject that too would draw attention to him as a serious graphic artist and he elected on mortality as a theme. His drawing (and subsequent lithograph) was entitled Worn Out and was the basis of his later painting. In his letters he makes it clear that he was at pains to express the divine in his drawing, 'something on high' as he expressed it, quoting Millet, and later he wrote that he wanted to express the special mood of Christmas and New Year.

The later painting of 1890 was done at Saint-Rémy either during or directly after his longest and most acute episode of mania, which lasted some nine weeks. Generally speaking he was unable to paint or draw, or even to write letters, during his attacks, but on this occasion he was able to paint a few souvenirs of the North as he called them i.e. scenes from memory of Holland. Whether this painting was one of them or not is not known, if not it was painted directly afterwards.

Of course it's very curious and unsatisfactory that it has apparently become an icon of mental anguish and despair. RobvanderWaal (talk) 04:33, 8 April 2012 (UTC)
 * Not sure why it is unsatisfactory that it is an icon of mental anguish but this discussion is probably best at  At Eternity's Gate Doc James  (talk · contribs · email) 19:21, 8 April 2012 (UTC)
 * The article  At Eternity's Gate is about a painting and not an article about a psychiatric condition that the painting is purported to represent. If you look at the various international wiki articles linking this painting, it's clear that the painting is now iconic for depiction of mental anguish in a way it was never before and wikipedia is quite plainly responsible for this. Of the various scholarly sources I have examined for this painting, none suggest it is a depiction of despair and anguish, precisely because of course scholars are aware that in fact van Gogh was on the contrary concerning himself with the themes of mortality and the divine. I was asked to provide an edit describing its genesis and I have done that. I merely wish to point out here that representing the painting as a depiction of despair and anguish is entirely misconceived. Since this is where that painting is so represented, it seems reasonable to me this is where to point that out. I did consider consider adding a section in the painting's article about wikipedia's iconisation of the painting but was advised by my editor that self-references of this kind in wikipedia is not advised.


 * There is no discussion needed here because the issues involved are simple matter of facts and I have nothing further to add for myself beyond noting that I will be following the development of this painting as a cultural icon as a matter of historical interest.


 * Thank you. RobvanderWaal (talk) 21:15, 8 April 2012 (UTC)


 * It doesn't matter whether the image was initially intended to represent despair or sorrow; the fact remains that that is the way it looks. The painting is a good visual representation of despair and that's all that matters. The article makes no mention of van Gogh's intentions and thus discussion over said intentions is irrelevant to this article's talk page. Basa lisk  inspect damage⁄berate 22:13, 8 April 2012 (UTC)


 * I asked you above to explain to me why this image was a good image of despair and sorrow and all you do here is repeat your opinion that it is. Do you in fact have an argument to back your assertion or not?


 * I do not see this image at all as being about sorrow or despair. On the contrary I see it exactly as we know van Gogh intended it, as an image of frailty and resignation, consistent with the context of other studies he made of Zuyderland at the time such as F1002 Saying Grace.


 * If you wish to advance a drawing in which van Gogh unequivocally wished to make a representation of sorrow, or something of the sort at any rate, then I suggest you choose his famous study F929 of his partner Sien Horrnink at this time at The Hague, actually entitled Sorrow by him in English (in deference by the way to the British graphic artists of the time he so much admired) although I suspect that if his English had been better he might have chosen a word such as "desolation". Even in that image we know, because of another rare pronouncement of his intentions he made, he was also at pains to depict life's struggle, and again I would ask why you would wish to illustrate a psychiatric condition with a representation of a perfectly normal emotion, without which we would in fact not be healthy, possibly indeed the sort of desensitized pyschopath, if that indeed can be properly represented as a pyschiatric condition, you ludicrously include in a list you make above of the possible conditions van Gogh suffered from.


 * Of course it matters. I shan't make an excursion into explanations of the function and purpose of art, such as that put forward by Heidegger I personally espouse, but briefly it is to teach us a way of viewing the world:[Art] gives things their look, and human beings their outlook.
 * Van Gogh quite literally did do just that with his work, precisely why images such as The Starry Night F612 are quite so popular. Popular taste is an uncertain referee of works of art, but in the case of van Gogh's major paintings (of which the color study in question here is decidedly not, whatever the merits of the original drawing) I doubt any serious art critic or historian would doubt its verdicts.


 * Do you in fact know van Gogh's figure drawing dating 1881/82 at The Hague? Few artists, if any, have ever embarked on a study of the human figure with the same intensity as Vincent brought to bear on his task at that time, in fact decisively ruining himself in the process. I am currently preparing an article in my sandbox on his Hague studio for Wikipedia and you might to like to glance through the finished article when I upload it a few weeks hence. I can't help but think if you did know this work in the context of his other works of the time, you would not be quite so insistent that the drawing in question here represents sorrow and despair.


 * As I understand, or at any rate as it was represented to me and I have no reason to suppose it was unfairly represented, the origin of all this here was a plainly neurotic post a few years ago suggesting van Gogh's painting can be taken as an icon of mental suffering. All I wish to do here is record the facts and note that I will be following its development. I think I'm entitled to aver the situation is unsatisfactory. While I'm happy to debate any serious argument about what is portrayed by this painting, I'm afraid I don't see any point in entering discussions which essentially deny the facts of the matter and merely repeat personal points of view.


 * I hope you will agree I have given generously of my time here, and I thank you for yours. Thank you. RobvanderWaal (talk) 09:00, 9 April 2012 (UTC)

Note: RobvanderWaal has been blocked as a sockpuppet of User:Rinpoche. Basa lisk inspect damage⁄berate 03:10, 10 April 2012 (UTC)
 * I have substituted van Gogh's 'Sorrow' image as per RobvanderWaal's suggestion. I trust this will be satisfactory to all parties and we can move on here. RUCloseYet? (talk) 05:13, 10 April 2012 (UTC)


 * I've reverted it. Please do not repeat this change; it is clearly against consensus and has been for ages (check previous discussions about this). In fact, I'm redacting RvdW's comments as he is a sock of a banned user. Basa lisk  inspect damage⁄berate 08:25, 10 April 2012 (UTC)


 * Please do not refactor Talk pages per WP:RTP. I shall ask for eyes if you persist. RobvanderWall, a valued editor in the Visual Arts, is appealing his block initiated by you. I ask that his edit above be kept as evidence. It is not in your remit, as apparently some sort of injured party in a dispute, to act like this. Thank you. 31.6.27.228 (talk) 11:43, 10 April 2012 (UTC)


 * Fair enough, I apologise for removing the comments. Give me a break, though, I didn't "initiate" any block. I just raised concerns that RvdW and Skirt were the same person as Rinpoche, and turns out they were. That's not my fault; I didn't block anyone. This doesn't matter now anyway as RvdW has "retired". Basa lisk  inspect damage⁄berate 13:18, 10 April 2012 (UTC)


 * No, no breaks here for you Basalisk. RobvanderWaal, Skirtopodes and Rinpoche are all different people. I know them well. Rob is simply defeated. One of the nicest people I know. Congratulations. But relax. No one is going to come after you. No one is going to sue you. Enjoy your little moment of triumph. LHirsig (talk) 15:19, 10 April 2012 (UTC)

Note To get a long standing image changed you will need to get approval through a WP:RfC. Cheers Doc James  (talk · contribs · email) 16:47, 10 April 2012 (UTC)
 * Rob wasn't trying to change the image here. He wasn't trying to edit the article. All he was at pains to do was to point out that At Eternity's Gate isn't about sorrow or despair. It's about mortality and dying. Anyone with eyes and a modicum of sensitivity to painting can see that. The title makes it clear it's about mortality. And Rob's edit at At Eternity's Gate wasn't about original research. It's well known what this painting is about and his edit is meticulously cited. All it needed was a knowledgable opinion to set it right. He left it to you to put it right (it does need putting right) and this was how you treated him. Nor is it as if Skirtopodes was the first to raise the issue of the painting's suitability here. It was raised here before, acknowledged as pertinent and then just ignored. This isn't something that should need a WP:RfC. It's just plain wrong and you and your co-editors here are in denial. An image of mortal frailty illustrating a psychiatric condition noted for its suicide risk? Come on ... It's bizarre and not a little creepy. What can you be thinking? LHirsig (talk) 21:41, 10 April 2012 (UTC)
 * Nevertheless I've added a WP:RfC. Perhaps it will give one you boys (we are talking boys here, right?) a nudge. LHirsig (talk) 23:36, 10 April 2012 (UTC)
 * And I've WP:DENYed it below. Sockpuppet, see   Dennis Brown   (talk)  01:10, 15 April 2012 (UTC)

Lead image
♦ Should the article continue to be illustrated by Vincent van Gogh's At Eternity's Gate now it has been unequivocally established that this painting, as its title suggests, is a depiction of mortality and dying and not sorrow? Thanks. LHirsig(talk) 23:36, 10 April 2012 (UTC)

Yes we should keep this image

 * 1) This book appear to state that this image represents depression. Thus I support I keeping it.-- Doc James  (talk · contribs · email) 00:05, 11 April 2012 (UTC)


 * The book (Gilman, Sander L. - Seeing the Insane) does not say that in the Google selection you link. It says that in At Eternity's Gate van Gogh portrays an individual driven to the brink by society's inhumanity and that is all he says about the painting. Mostly the excerpt, and it is only an excerpt, is about Sorrow, the van Gogh image RobvanderWaal suggested should illustrate the article.


 * Is this your only source, an excerpt from a single Google book, and are you incidentally denying the theme of this painting is mortality and sanctity, as van Gogh expressly said it was? LHirsig (talk) 00:50, 11 April 2012 (UTC)


 * This source also states that the painting gives the impression of despair. I think it's a good illustration; I feel that this image has been used successfully for a long time and what van Gogh intended to convey through the painting is irrelevant - the point stands that it illustrates despair and depression well. This RfC is the result of a single editor (who is, in my view, very likely a sock puppet of another blocked user) trying to use wikipedia as a soapbox to make a point about modern art. The objection has nothing to do with trying to improve the Major depressive disorder article. Basa lisk  inspect damage⁄berate 06:48, 11 April 2012 (UTC)


 * Come on, Bailisk. It's a blog from the Tokyo Times making unsourced and uncited assertions, not a RS and it's not even primarily about van Gogh. I should think the sources of the author's assertion is Wikipedia itself (this indeed being what RobavanderWaal is currently tracing in his investigations into the development of this icon: I should think he's probably contacted the author by now :)). LHirsig (talk) 08:44, 11 April 2012 (UTC)
 * "Your source is not reliable"; the last bastion of the tendentious editor. Basa lisk  inspect damage⁄berate 10:37, 11 April 2012 (UTC)
 * And the second pillar of Wikipedia I believe, but naturally I am pepared to defer to a physician who contributes such a lot to Wikipedia. LHirsig (talk) 01:37, 12 April 2012 (UTC)

No we should not use this image

 * The editors should use van Gogh's image Sorrow instead, as RobvanderWaal suggested. It's plainly bizarre and unsatisfactory that the article is presently illustrated by a painting whose theme, as its title suggests and van Gogh's own letters confirms, is mortality and death. LHirsig (talk) 01:03, 11 April 2012 (UTC)
 * Even though depression carries a high mortality rate? Basa lisk  inspect damage⁄berate 06:53, 11 April 2012 (UTC)
 * Well yes absolutely, good point. Rob kept away from this issue because he didn't want to pass himself off as physician. While you may not be sensitive to it, the image nevertheless conveys subtle messages about an old man quietly facing his passing with calm resignation (that is after all, what the title suggests and what van Gogh says he was trying to express). Is that really suitable for an article on depression? The issue has been raised before here. I'm not going through these archives again, but they were expressly raised, acknowledged by an administrator (a physician like you) with eyes on this page,and nothing ever done about it. LHirsig (talk) 08:44, 11 April 2012 (UTC)
 * If you've raised this before, several times, others acknowledged what you were saying, and yet failed to act on it, then don't you think it's time to accept the possibility that you're the only person who thinks this way? Whether or not you are sensitive to it, the image conveys completely unsubtle messages about a man who looks in visible despair. This is not rocket science; we don't need to supply sources stating that this looks like a man in despair any more than we need to supply sources to say the clothes he is wearing are blue - it's just an obvious, intrinsic fact of the painting. Why should we sacrifice that which is obvious for that which is obscure, particularly as there are indeed sources to support the most obvious interpretation? Basa lisk  inspect damage⁄berate 10:58, 11 April 2012 (UTC)
 * First of all I haven't raised anything here before. Secondly, and I'm sure as a busy physician working long hours in the public service you will be the first to acknowledge this, only the most immediately involved editors generally have time for a Talk page topic. I can assure you that there are lots of people I know who are concerned, or at least interested, by this issue and I ask you to accept this in good faith. I should also be grateful if you were to be slightly less agressive and patronising in your remarks. I appreciate that physicians sometimes have to be blunt in their dealing with patients, but I am not one of your patients.
 * I repeat, this is not an images of a man in despair. I do not see it as such, art citics in general do not see it as such and van Gogh did not intend it as such, quite the contrary. In recent times it has become an icon of despair only because of Wikipedia (I see the corresponding Dutch article notes this). The origin of it, as far as we can see, is the Kröller-Müller's somewhat gratuitous retitling of the painting when they took possession of it in 1970, and I know Rob is currently chasing that up.
 * Without getting bogged down in a long discussion no one will read anyway, I suggest there are two factors at work here: first of all the generally ambiguous nature of sorrow itself, the most motile and reserved of our emotions, and secondly the narcissism of our present age, its present tendency to distance itself from, or even to deny, the fact of death, and the present day disinterest in the sacred, the "something on high" Vincent wrote about, quoting Millet. As a physician of course, you will be aware that we see is not a given but a matrix we work on.
 * I am surprised that a physician such as yourself is quite so blithely unconcerned by the possibility that an article dealing with depression, with its known suicide risk, is illustrated by a painting which essentially celebrates death as a passage to eternity.
 * A related issue that was raised in the past, and again never satisfactorily addressed, is that most depressions are in fact not accompanied by manifestations of acute despair as you claim the painting depicts. As a physician you will be aware all too often of suicides that present without any indications of mortal despair. In the UK there was just such an example a few months ago of a noted celebrity hanging themself just hours after appearing relaxed and happy on television. Don't you worry that a sufferer of depression seeing this illustration might conclude that it's not depression they're suffering from but something else and refrain from seeking treatment? LHirsig (talk) 01:37, 12 April 2012 (UTC)
 * Since you seem to be seeking my medical opinion, I'll tell you you are completely incorrect - despair and hopelessness are virtually universal symptoms of major depression. You can have a look at the NICE guidelines if you don't believe me. I am indeed aware of cases whereby patients commit suicide without appearing publicly depressed, but in private these kind of feelings are a constant in depressed patients. Please heed my advice when I tell you that your persistent argument that depressed people do not suffer from feelings of despair is simply incorrect.
 * As for the painting: look, I understand that, with your knowledge of the world of art, you have a different interpretation of the painting to what it's being used for here, but you have to accept that your interpretation differs from the common one. Two sources have already been supplied to support the views of the majority of editors here, namely that the painting depicts a sorrowful man. This is the only reason why the image is appropriate - it gets the message across to the majority of readers. Basa lisk  inspect damage⁄berate 09:18, 12 April 2012 (UTC)
 * Yes, I very much doubt that a well conducted survey among the general public would find that people generally felt the subject of the painting was in a happy position! I think that's the basis for its inclusion here. Of course, there is much more to be seen and said about the painting than that, but this is not a page about Art. —MistyMorn (talk) 09:40, 12 April 2012 (UTC)
 * Yes that is my point entirely. I'm sure there is much more to the painting than what the layman sees, but that is beyond the scope of this article and should be taken up on the painting's article. Basa lisk  inspect damage⁄berate 09:42, 12 April 2012 (UTC)
 * And of course an understanding of the artist's intentions is just one aspect of art history and criticism. The clothes may appear celestial, but the posture speaks of grief—as almost anyone who sees this painting will immediately feel. I think that's sufficient editorial justification for this particular illustration. —MistyMorn (talk) 10:07, 12 April 2012 (UTC)

@Bailisk

I was not seeking your medical opinion.

Despair and hopelessness are not 'virtually universal' symptoms of depression. If that were so the article would surely say so, but it does not. The NICE guidelines you reference says nothing of the sort. Nice CG90 references WHO ICD-10 which lists hopelessness only three times as one of a constellation of key features in schizoaffective disorders (F25.1), post-traumatic stress disorders (F62.0), and depressive conduct disorders of childhood (F92.0) and certainly not as a universal vector, and lists depair only in acute stress reaction (F43.0).

The situation, which as a recently qualified physician you surely must know (or at any rate ought to know), is that suffering from depression makes it difficult to deal with feelings of despair and hopelessness, but the subject need not feel despair or hopelessness. This is especially true of children and teenagers: "Children and adolescents may display mood that is cranky or irritable rather than mood that appears sad or despondent" (NICE CG90 and cf. the article here). It is also culturally dependent.

Your talk page says you are Welsh. As a Welsh pysician you will therefore surely know of the distressing epedemic of teenage suicides in Bridgend. Most of these teenagers appeared to have no personal issues involving unhappiness at the time. A plausible theory about possible causes were that that they were signing onto internet sites romanticizing suicide, just as this image in question does of van Gogh, and of depression in general. I find it quite extraordinary in the circumstances that you dismiss the point made (not by me, I am merely repeating it) earlier on this Talk page and, as I say, acknowledged but never addressed.

To repeat: the painting depicts an old man on the threshold of leaving life and facing his end with resignation and dignity. No doubt it is misunderstood today for the reasons I sketch above but nevertheless that is what its intent was, and who is to say how much of that might still be subconsciously conveyed, for example, to an impressionable youngster? If I might suggest, Vincent's vision is likely more acute and enduring than yours.

@ MistyMorn

The blue color is merely the color of the bomabazine suits worn by almshouse pensioners such as the model Zuyderland (the linked article is one of the stubs provided by Rob while he was editing). I don't think there is any color symbolism in this painting. I should imagine the blue was Cerulean blue, a rather cold blue, recently discovered, that Vincent liked. The painting is an entirely unremarkable, frankly pedestrian, color-study exploiting the contrast between the cold blue of the suit and the warm red of the fire. Its interest lies in the figure, but that is an exact copy of his 1882 drawing (and subsequent lithograph) Worn Out (F997). You might like to look at the article At Eternity's Gate, largely contributed by Rob and the noted Visual Arts editor Modernist, for its backgound.

You are wrong I think to imply the body language is sorrow (grief). In sorrow you have a shielding or covering of the face, but in this painting the subject is simply holding his head in his hands in fatigue, his arms resting on his knees. The other major characteristic of sorrow is collapse, but there is no collapse here.

The issue here isn't of art history. It is rather of seeing things as they really are, ultimately of being free to see things as they really are.

Thank you for your input.

LHirsig (talk) 21:01, 12 April 2012 (UTC)


 * Well, thank you for your civil comment. I did of course peruse the article, which I found interesting, and actually made a very small copyedit. My point wasn't primarily about the blue, as I think you gathered. I have thought carefully about this question and believe that the illustration sends a very valid message to visitors to this page, without providing misleading information about van Gogh. I do think this picture elicits a strong emotional response related to grief (certainly that's my own quite involuntary response!), and is an effective way of communicating something important about the subject matter of this page which words don't easily carry. At the same time, I agree that the picture is not an illustration of a "disorder" as such—rather of an experience related both to that disorder and to major life events involving intense emotional pain. I've suggested that the caption could clarify the reason for the illustration's inclusion. However, the present caption does correctly report the title of the work, so I can't see any form of disinformation—something which would of course be quite wrong even on a page not related to art. In brief, I've come to think this is a very effective illustration: it's highly communicative and has a real-world feel which people spontaneously relate to. —MistyMorn (talk) 23:08, 12 April 2012 (UTC)


 * Skirtopodes was certainly only concerned with what you might term Vincent's moral rights. I don't know what the situation is there. I might seek to open a discussion in Wikipedia about it when I'm through here. It seems to me whereas Wikipedia can assert its right to reproduce a faithful image of a work of art out of copyright, it can't ignore the artist's moral rights in doing so. For example if Wikipedia was in the funeral homes business, it couldn't use Vincent's painting here to advertise its business, and I don't really see why that same principle shouldn't apply to an encyclopedia.


 * However I know nothing about that and I might simply be just plain wrong.


 * But Vincent's moral rights aren't really my concern. I asked Rob to contribute his edits because I wanted truth to prevail. That's all. I've gone the Wikipedia way of asking for sources and I think a dispassionate observer will agree they simply haven't been provided. I expect Rob will eventually supply elsewhere a history of this icon (and once we have that to cite we will provide an article about it in Wikipedia). Basilisk's naive remark that not everything needs to be cited is wrong-headed. If it's challenged, and we are challenging it, then it must be cited, otherwise Wikipedia's verifiability model collapses and truth is on a hiding to nothing.


 * The origin of all this was a neurotic post suggesting Vincent's painting can "emblematise" (I think that was the word) the suffering of depression. But that simply misunderstands the painting. You can misunderstand paintings in the same way you can misunderstand a novel or a mathematical equation. An article suggesting Winnie the Poo is about gay rights or that Einstein's mass-energy equation E = mc^2 is about dieting wouldn't, I suppose, last very long in Wikipedia. Why should it be different for a painting?


 * The reason people are seeing this painting as an icon of mental anguish is because Wikipedia is telling them to see it as such. That's all.


 * There are also cogent medical concerns here as well. I frankly think it beyond appalling that the medical community (I mean the real medical community) is not addressing the issues raised here and never have. . It worries me that the community building this article is not addressing the issues raised here and never have. They have all been raised before and simply ignored, fobbed off with a downer smiley.


 * Have a look at this image of van Gogh's that Rob suggested. That is incontrovertibly about sorrow. Wouldn't that be a better image? LHirsig (talk) 01:02, 13 April 2012 (UTC)
 * You're free to take this question elsewhere. Please note that the remark about the "real medical community", and others you've made above, could be found offensive (see WP:CIVIL). You'll find I did reply above to your suggestion about "Sorrow". I've finished here. —MistyMorn (talk) 07:35, 13 April 2012 (UTC)
 * I took a coffee break and when I returned, I found you had revised your edit! To deal first with your reproach about the "real medical community": that wasn't a personal attack (I see you sometimes edit on medical matters) and I'm sorry if it offended you, I really didn't mean to. I simply meant the medical community who are building this article.


 * You originally remarked that you doubted I had a case concerning moral rights. I thinks that is indeed probably so. Just to clarify, those aren't my own concerns here. They were Skirtopodes's concerns. We had in mind something like the Visual Artists Rights Act in US jurisdiction, but those aren't granted posthumously. That is not to say Wikipedia should not extend these rights posthumously. I shall probably draft in an expert to raise the issue, who will in due course be banned as a sock of Rinpoche :).


 * Thank you again for your time. Appreciated. LHirsig (talk) 09:01, 13 April 2012 (UTC)


 * Thank you for striking that sentence, which I felt could be offensive to some well intentioned and hard working editors on this page. I struck my observation about legal issues as I was not sure how to interpret your remarks. Obviously, non-disruptive, civil, good faith discussions on the Wikipedia site about issues of legality are acceptable, but to prevent potential misunderstandings when raising legal questions I guess it is really important to bear in mind rather carefully the issues outlined in WP:THREAT. I cannot comment about questions of sockpuppetry (other than noting the existence of WP:CheckUser). I have given my editorial opinion, as requested, and do not have anything further to add in that regard. Sincerely, —MistyMorn (talk) 10:36, 13 April 2012 (UTC)


 * No, I certainly didn't mean to be offensive. Nor would we be raising any sort of legal threat in raising the question of moral rights. Copyright issues are often debated on Wikipedia without, as far I know, necessarily invoking legal threats. I mean the issue we would raise is whether Vincent has some moral rights to his work and reputation after his death. From a legal point probably not, but we are talking his moral rights in themselves and not any legal protection that may or may not exist. For example, Vincent is an example of a historical figure for whom some sort of case can in fact be made out for his being bisexual. Adding a GLBT category to his bio is the sort of things that Wikipedia characteristically debates at some length and the issue in the end is protecting the individual's moral rights.


 * I wasn't trawling you for on opinion about the vexed problem of Rinpoche's sock-puppetry! He's retired now anyway. Others continue the thankless task :). He was simply a conduit, active on that thing he was doing long, long before Wikipedia came on the scene.


 * Kind regards. LHirsig (talk) 11:44, 13 April 2012 (UTC)


 * Without wishing to take sides or enter into any of the details, could I just add that WP:JUSTICE may indeed be of relevance to this sort of longstanding and deeply felt issue? Thanks, —MistyMorn (talk) 12:45, 13 April 2012 (UTC)


 * No, I don't agree. As I remarked before it's just plain wrong to label this image as an image of sorrow. Easy mistake to make, the Kröller-Müller Museum apparently made it in 1970. Even Skirtopodes, who happens to own a few of these things, didn't really know the facts. Rob wasn't indulging in any OR. He replied immediately to my initial email of enquiry setting out the facts of the matter. It's well known.


 * For the last time, we are not setting any great wrongs right here. We are not telling the editors what they should do (although we have made a reasonable suggestion as a compromise) and we have not attempted to edit the article. We are not frantically enlisting support from some 40 at least associates of ours who have Wikipedia accounts. We will move on here if we cannot accomplish what we wish. Eventually there will be a RS published pointing out the facts and we will return then.


 * Why all the resistance? It's not like some enormous paradigm shift we are talking here. LHirsig (talk) 13:06, 13 April 2012 (UTC)

Pretty well through here until our RS appears. I'm sorry, and frankly unimpressed, that the medical community have not responded here. There is of course one final salient issue raised very early one on by retired User AnmaFinotera and that is why is this image here at all? Accepting momentarily that it might evoke thoughts of sorrow and despair when placed in this context, why is it given prominence as a lede image when in fact sorrow and despair are only fleetingly referenced in the article? That does seem to be contrary to the spirit of Images.

Perhaps our resident Welsh physician might care to comment on behalf of the medical community.

And while you're at it Eddy, Joel (whomever), would you care to explain the meaning of "I'm a doctor, bitches". I happen to be a woman. Would that be what I am to you then? A bitch? I would like an explanation please on behalf of my gender. Thank you.

I will be back probably :). LHirsig (talk) 06:07, 14 April 2012 (UTC)


 * Whatever is this cryptically worded link is supposed to refer to? The edit/diff you cite as "I'm a doctor, bitches" is a tiny format change connected with WP:IRL. There are settings where stuff like this can be used to send a veiled message in real life. Obviously, I do trust there is no implied threat here. But I think you need to be much more careful in the wording of your remarks and their potential interpretations. Cryptic personal remarks are always unpleasant. —MistyMorn (talk) 10:24, 14 April 2012 (UTC)
 * Ok, I've just spotted the "bitches" reference in the edit summary of that diff, but in practice this question has caused me concern and eaten up an hour of my morning. I really don't think this is an appropriate way of communicating on Wikipedia. To an innocent eye, it looked like it could have been a threat and that concerned me. Please be more careful about how you express yourself. That personal issue had absolutely nothing to do with the subject of this page anyway, and this Talk page is not the right place to raise such matters. —MistyMorn (talk) 11:38, 14 April 2012 (UTC)
 * Just thought I'd respond, as while I don't believe Hirsig is being truthful about his gender, he does raise a valid point. The diff he posted was from the day I got my exam results (I passed my finals), and naturally I was pretty happy about this. Hence the zealous edit summary. For the record, my name in real life is Joel. Back to the discussion in hand... Hirsig, I suspect no one is responding to you because you don't listen to what other people are saying unless it's what you want to hear. Nothing productive ever comes of talking to you. I've already made my point, there's nothing left to say. Basa lisk  inspect damage⁄berate 12:23, 14 April 2012 (UTC)


 * Same here. I've said what I had to say, and tried to restrict the drama. But I've found myself getting caught up in it myself by accident, and will now quit. —MistyMorn (talk) 12:36, 14 April 2012 (UTC)


 * I'm not concerned about my anonymity (though I am with my privacy). My name is Leah Hirsig. I am an art teacher and a woman. Rinpoche's name is William Boyd (he is happy for me to give out this information, which is indeed available on his IP talk page). He is a retired mathematics teacher. He has a family connection with Vincent van Gogh and indeed with me, though that goes back generations. Skirtopedes is a Swiss art collector. RobvanderWaal (a pseudonym) is an Amsterdam auctioneer. It was William who tipped me off about this image early last year in connection with one of his I agree rather frequent dramas on Wikipedia. I happened to mention it casually to Skirtopedes around the summer of last year. I had no idea he had an account on Wikipedia until he emailed me to say he had been banned, explaining the circumstances. I contacted Rob about the background and he immediately replied with the information he sketched above. I suggested he provided an edit for At Eternity's Gate and he did so, as well as all the other edits he subsequently made.


 * I do hope this helps allay your feeling of threat, which I have to say seem somewhat developed to me. Why did you originally call yourself Eddy? Why 'bitches' please? Are you going to respond to the points I make that sorrow and despair is only fleetingly addressed in the article? To the remark I make about the Bridgend teenage suicides, which must surely be a matter of concern to you as a Welsh physician? Can I ask you what input you have made to this article itself (not the Talk page, the article)? The list of contributors is rather long and I couldn't find you, but I perhaps do you a disservice. Finally, don't you think that if you elect to pass judgements on clinical matters (especially when they are in fact false) as you did above, then you ought not to remain anonymous so that you are available for peer review and oversight by your professional body? LHirsig (talk) 13:36, 14 April 2012 (UTC)
 * I thought this obvious by now, but you don't seem to understand, so I shall make this clear - I disagree with what you're trying to argue about the painting. I've explained why many times over. For a brief summary, see the "Yes we should use this image" section above. I have no desire to discuss anything other than this issue (such as my professional standing) with you, and I have said everything there is to say in this regard. There is nothing left to say, and I won't be responding to your comments any further. Basa lisk  inspect damage⁄berate 14:00, 14 April 2012 (UTC)


 * We are not arguing anything about the painting. Just stating what is a simple matter of fact, videlicet that far from being a depiction of sorrow it is in fact a depiction of a tired old man contemplating his passing from this life with dignity and resignation, and thus probably not so fantastically suitable for an article about a psychiatric condition with a known suicide risk. But I do appreciate, Joel, that as you venture out on those first crucial steps in your professional career as a Welsh physician working long hours, 80 hours or more a week typically I understand when you start out, you will have less and less time for Wikipedia so I shan't press you. It's been a fascinating exchange of views I must say! I do wish you could perhaps put your name and practice details on your userpage so that those of us in Wales can make better informed choices about their preferred physician (I mean really that wouldn't count as advertising and would be quite acceptable I think, honest).


 * I do sense a certain reservation in your leave taking and I'm sorry for that. I want to wish you all the best, Joel, and indeed make you an offer. If that work-load does get too much and you need some help and advice with difficult presentations, do feel free to post on my talk page and I will look it up myself on NHS Direct and Wikipedia for you and post it back. That should be really useful.


 * Pob hwyl! (Bless x - Leah) LHirsig (talk) 16:55, 14 April 2012 (UTC)


 * Oh well. I have tried to reason with you, but I'm bored of this now. You can go explain yourself at ANI. Go troll someone else. Basa lisk  inspect damage⁄berate 17:07, 14 April 2012 (UTC)


 * LHirsig wrote: ...don't you think that if you elect to pass judgements on clinical matters ... then you ought not to remain anonymous so that you are available for peer review and oversight by your professional body? Again, this deeply ambiguous (albeit quite implausible) suggestion seems to me to be very unfortunately worded and also, to my knowledge, completely out of line with Wikipedia policies on the right to maintain anonymity. Please desist. —MistyMorn (talk) 14:09, 14 April 2012 (UTC)

Other comments
Comment - I don't think this issue should be a big drama. I think it's important to remember that the main focus of this article is Medicine and Psychology rather than Art. From that standpoint, I think the current illustration -- unlike Van Gogh's more symbolic portrayal of Sorrow -- has the not inconsiderable advantage of communicating intuitively to a general readership (for which Wikipedia is primarily written) the real-world suffering of despair inherent in a condition which, like most psychiatric conditions, still tends to be stigmatized. At the same time, I can also understand how an art critic may question the correspondence between the subject of the painting and the specific topic of the article. My own feeling is that the page illustration does not do any violence to the reputation of the artist. Suggest: Maybe the caption could be expanded to clarify the reason for its usage here? 2 cents, —MistyMorn (talk) 14:13, 11 April 2012 (UTC)

Comment I stumbled across the article before I saw the dicussion, and I have to say that my first impression was "what is that picture doing in the lead?". I have no idea if the lead should have an image or not, but it isn't a topic I would be expecting one, and this one seems out of place. I have no desire to get into a debate on the image, but again, does Wikipedia NEED an image here at all? Does it add understanding of the topic? I don't have the answer to that. Dennis Brown  (talk)  17:39, 14 April 2012 (UTC)

Include more emphasis on DSM-IV's criteria
Hello all,

This is an excellent article. Nevertheless, since MDD is diagnosed in the medical and psychological community with criteria from the DSM-IV rather than through questionnaires and scales, it might improve the article if in the introduction there is a clear breakdown of the most recent criteria for diagnosing MDD.

In addition, the section on children and MDD can be improved. The current DSM-IV criteria include three cardinal symptoms for children. In order to qualify, the child must endorse one of the three for more days than not in a two-week period. These cardinal symptoms include a sad/down/empty mood, loss of interest or inability to enjoy most activities, and irritability.

Thanks for your time! Velvsop (talk) 17:31, 2 March 2012 (UTC)
 * The DSM 4 criteria are copyrighted by the APA and they have asked us not to use them. -- Doc James (talk · contribs · email) 19:22, 8 April 2012 (UTC)