Talk:Major depressive disorder/Archive 12

Accelerated aging-like Telomere-related issue, reference
108.195.138.124 (talk) 02:20, 12 April 2012 (UTC)
 * New View of Depression: An Ailment of the Entire Body April 9, 2012;
 * We do not typically use the popular press for medical references. -- Doc James (talk · contribs · email) 01:15, 18 April 2012 (UTC)

Primary research
This article has an huge issue currently which is that it is not based fully on secondary sources per WP:MEDRS. I have just removed 154, 155, and 156. For this article to stay featured these issues need to be addressed. I will take a stab at it eventually unless someone else wishes to begin. -- Doc James (talk · contribs · email) 23:12, 14 April 2012 (UTC)
 * I think "huge issue" is perhaps an overstatement. After your edits I am having difficulty spotting any more. Looie496 (talk) 00:41, 15 April 2012 (UTC)
 * Corrected :-) Doc James  (talk · contribs · email) 00:58, 16 April 2012 (UTC)


 * Ref 216 is a 73 patient study. http://www.ncbi.nlm.nih.gov/pubmed/17453654
 * Ref 105 and 106 have neither a PMID nor an ISBN. I wonder why.
 * Ref 108 is the BBC from 1999 could be better
 * Ref 107 is primary research
 * Ref 116 is a little old (from 1998) and much new literature have been published.-- Doc James (talk · contribs · email) 01:04, 16 April 2012 (UTC)
 * I have addressed issue with 105 and 106. Probably messed up your numbering of some of your references slightly though. :-P I still intend on addressing references in alcoholism article.-- Literature geek |  T@1k?  06:04, 17 April 2012 (UTC)

Might be best to compare article with promoted version and check differences and work from there. Gotta run now but will have a look later. Casliber (talk · contribs) 22:46, 23 April 2012 (UTC)

Update: here is a comparison. Casliber (talk · contribs) 21:18, 25 April 2012 (UTC)


 * " Major depression occurs about twice as frequently in women as in men, although men are at higher risk for suicide." was removed from the lead - anyone recall why? Casliber (talk · contribs) 21:22, 25 April 2012 (UTC)


 * the Drug_and_alcohol_use has been added since FAC -I removed one reference which had nothing to do with the preceding sentence. This webref is used as a reference, and I am not 100% sure about some of the claims within it. Have to hop off now but will examine this segment later. All others welcome to do so as well and discuss here. Casliber (talk · contribs) 04:33, 6 May 2012 (UTC)

Edit request on 7 July 2012
Add Ketamine-infusions (administered solution into the veins) as a treatment for Major-Depression.

http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2600

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000408/?tool=pmcentrez

http://www.nature.com/nature/journal/v475/n7354/full/nature10130.html

It is not yet FDA approved.

Williash03 (talk) 04:37, 7 July 2012 (UTC)

Williash03 (talk) 04:37, 7 July 2012 (UTC)


 * - Edit request not detailed enough. Please make the contents of the edit clear. Egg   Centri  c  18:54, 20 July 2012 (UTC)

Include in the text a few words regarding depression caused by deficiency of light
For example: The deficiency of light might lead to the development of Seasonal affective disorder -- a type of depression known as winter depression, winter blues, summer depression, summer blues, or seasonal depression. Production of serotonin, low level of which is responsible for depression, in the brain is linked to the amount of light the human's eyes being exposed.
 * Please read WP:MEDRS regarding what sort of sources we use. The serotonin hypothesis is not currently accepted BTW. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:10, 31 August 2012 (UTC)
 * Anyway, a few words on this kind of depression caused by deficiency of light definitely must be included in the article. If somebody suffer from this depression and can not find general information on it to look into other articles on it to alleviate his/her suffering, you bear moral responsibility for this. Sorry.--75.3.132.30 (talk) 21:35, 31 August 2012 (UTC)

Edit Request (25 July 2012): re "Reactive Depression"
Hi. In some literature I have seen the term "Reactive Depression" and came to wikipedia seeking definition/explanation about what this specific term means, what are its characteristics, what subset of depression does it specify?

The page "http://en.wikipedia.org/wiki/Reactive_depression" redirects here. However, neither the term "Reactive Depression" nor even the word "reactive" appears on this page. So, I request an edit that provides this missing information. Thanks. — Preceding unsigned comment added by 60.242.228.251 (talk) 00:01, 25 July 2012 (UTC)
 * That's not an "edit request" in the formal sense, but it's certainly a valid point, so thanks for raising it. Looie496 (talk) 02:43, 25 July 2012 (UTC)
 * It's interesting, but reactive depression is different that Major depressive disorder. I don't even believe they are overlapping. But my DSM IV is missing (loaned it to someone, stupidly), but if I recall correctly, a reactive depression is usually a minor depression usually to an event. We might really have to ad an article on reactive depression, and no, I'm not going to volunteer, cause there are real psychiatrists I'm sure who are editors. At least I hope so.SkepticalRaptor (talk) 05:16, 25 July 2012 (UTC)

Name of the condition
I'm new to the talk page, so I'm sorry if I'm putting this in the wrong place, but I would like to see the introduction of this article indicate that MDD is a medical illness. Let's not mince words here: saying that it is a "disorder" is incomplete. It is a medical illness, and it should be referred to as such. — Preceding unsigned comment added by Gredow (talk • contribs) 02:33, 11 August 2012 (UTC)
 * Our tendency here is to use the terminology that is most common in the literature -- in this case that means "disorder". Looie496 (talk) 02:46, 11 August 2012 (UTC)
 * In addition to the above response, I don't think calling it a disorder is "mincing words" at all - there are many other conditions (including non-psychiatric) which would be referred to as disorders. Haemophilia and von Willebrand's disease would both be referred to as coagulation disorders, for example. Basa lisk  inspect damage⁄berate 17:11, 11 August 2012 (UTC)
 * This has been discussed before - there are problems with whatever terminology we use. There would be significant concerns that "medical illness" would be imbuing it with too heavy a biological focus and an assumed homogeneity which doesn't exist. sigh....Casliber (talk · contribs) 22:52, 11 August 2012 (UTC)
 * Historically a disease had to have a method separate from speaking to a person to confirm its existence (labs, imaging, pathology). This is not the case with psychiatric disorders. Thus I would oppose this change. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:54, 11 August 2012 (UTC)

Long Work Hours
Has any research been done on a possible link between depression and long work hours ? — Preceding unsigned comment added by 89.195.193.17 (talk) 19:42, 8 September 2012 (UTC)

"Deprejudice" and the integrated perspective on prejudice and depression
A recent article came out in Perspectives on Psychological Science building upon Beck's cognitive theory of depression, currently covered in the "Psychological" section of this wiki article. The article can be found here: http://pps.sagepub.com/content/7/5/427.abstract And a summary of it is here: http://www.psychologicalscience.org/index.php/news/releases/prejudice-can-cause-depression-at-the-societal-interpersonal-and-intrapersonal-levels-researchers-argue.html  It's an interesting addition that may be helpful for some people reading this page. It talks about how cognitive depression is like "prejudice against the Self", and how lots of prejudice research can be useful in depression. The authors use the term "deprejudice" to describe this depression-caused-by-prejudice. Lyn Abramson (http://en.wikipedia.org/wiki/Lyn_Yvonne_Abramson), an author on the article, is a famous name in depression research. — Preceding unsigned comment added by 128.104.131.63 (talk) 20:43, 18 September 2012 (UTC)

Prognosis
I would just like to say that I have suffered for depression for about eight years without any relief whatsoever despite getting medical help. I would like a mention put in the article that (quite rightly) symptoms of this illness may never recover. Indeed they might actually get worse over time (as I know all too well). --144.124.24.57 (talk) 23:02, 5 October 2012 (UTC)


 * Material added must be able to be sourced to reliable secondary sources, however the article does mention the risk of chronicity as well as recurrence already. I sympathise for your situation and wish you luck in exploring all your options to possible recovery. Casliber (talk · contribs) 23:16, 5 October 2012 (UTC)


 * Thank you. That means a lot to me. --144.124.24.57 (talk) 02:57, 6 October 2012 (UTC)

Refs needed
Commented due to lack of citations. Schizoaffective disorder is different from major depressive disorder with psychotic features because in the schizoaffective disorder at least two weeks of delusions or hallucinations must occur in the absence of prominent mood symptoms.

Depressive symptoms may be identified during schizophrenia, delusional disorder, and psychotic disorder not otherwise specified, and in such cases those symptoms are considered associated features of these disorders, therefore, a separate diagnosis is not deemed necessary unless the depressive symptoms meet full criteria for a major depressive episode. In that case, a diagnosis of depressive disorder not otherwise specified may be made as well as a diagnosis of schizophrenia.

Some cognitive symptoms of dementia such as disorientation, apathy, difficulty concentrating and memory loss may get confused with a major depressive episode in major depressive disorder. They are especially difficult to determine in elderly patients. In such cases, the premorbid state of the patient may be helpful to differentiate both disorders. In the case of dementia, there tends to be a premorbid history of declining cognitive function. In the case of a major depressive disorder patients tend to exhibit a relatively normal premorbid state and abrupt cognitive decline associated with the depression. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:51, 29 October 2012 (UTC)

Addition of text with ref which is none pub med indexed
Depression can be caused by prejudice. This can occur when people hold negative self-stereotypes about themselves. This "deprejudice" can be related to a group membership (e.g., Me-Gay-Bad) or not (Me-Bad). If someone has prejudicial beliefs about a stigmatized group and then becomes a member of that group, they may internalize their prejudice and develop depression. For example, a boy growing up in the United States may learn the negative stereotype that gay men are immoral. When he grows up and realizes he is gay, he may direct this prejudice inward on himself and become depressed. People may also show prejudice internalization through self-stereotyping because of negative childhood experiences such as verbal and physical abuse. 

Inflammatory processes can be triggered by negative cognitions or their consequences, such as stress, violence, or deprivation. Thus, negative cognitions can cause inflammation that can, in turn, lead to depression.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:29, 30 October 2012 (UTC)

SSRI
"Selective serotonin reuptake inhibitors (SSRIs) are the primary medications prescribed owing to their relatively mild side-effects,"

I strongly disagree with this statement. SSRIs have very severe side effects, pertaining particularly, but not limited to sexual function disorders. I suggest that this part of the text be revised in such a way not to minimise the side effects of the SSRIs.
 * Compared to what was used before this is indeed a relatively mild side effect. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:00, 27 November 2012 (UTC)

Doc: I do not talk about what was used before. They used lobotomy in the 60s and in the middle ages they burned women who might just have been depressive. I notice the form of "relatively mild", yet I believe it to be misleading. The side effects of the SSRIs are NOT insignificant. — Preceding unsigned comment added by 89.146.138.109 (talk) 23:11, 27 November 2012 (UTC)
 * The important word here is "relatively". As Doc James said, they are mild relative to previously subscribed medications.  Lova Falk     talk   17:50, 23 December 2012 (UTC)

Perfectionism?
I read the section "causes: personality" and saw no mention of perfectionism. I don't know what the proper term would be for such a thing or if it would even be substantial enough of a claim to be in the article, but I thought I'd mention it. Perhaps if I found some references it could get a little attention? I'm not making a universal statement and I know that original research (or personal experiences) cannot be referenced, but my own depression had largely to do with a huge perfectionist complex, among other things. I've met other victims of depression who have had similar experiences. While I know these things cannot be used as references, my encounters and struggles have made me curious if "perfectionism" (or an unhealthy form thereof, again I do not know what the proper term for this would be) could posssibly be mentioned in the causes section of the article. Great job everywhere else though!Prussian725 (talk) 04:00, 3 December 2012 (UTC)
 * You are quite right, in order to add some text about perfectionism and depression you need to have good sources! I haven't heard about this connection though. Personally, I would associate perfectionism more with anxiety than with depression.  Lova Falk     talk   17:47, 23 December 2012 (UTC)
 * Good point. If I find anything I'll let y'all know. Thanks for the input!Prussian725 (talk) 00:21, 29 December 2012 (UTC)

Caspi findings have not been reproduced
Might it be irrelevant to add to the section "cause" that the findings of Caspi et al. have not been replicated many times, that secondary sources (meta-analyses) have doubted the connection? And what about mentioning gene association and GWAS studies?Tpylkkö (talk) 18:20, 10 December 2012 (UTC)
 * Yes, that might be relevant, however, it is not clear what you refer to. Caspi is mentioned three times in the section Causes.
 * First as a source for "The preexisting vulnerability can be either genetic" which as far as I know is uncontroversial;
 * Second as a source for. "To be specific, depression may follow such events, but seems more likely to appear in people with one or two short alleles of the 5-HTT gene."
 * Third as a source for "In 2003 a gene-environment interaction (GxE) was hypothesized to explain why life stress is a predictor for depressive episodes in some individuals, but not in others, depending on an allelic variation of the serotonin-transporter-linked promoter region (5-HTTLPR." The sentences behind the Caspi findings state that "a 2009 meta-analysis showed stressful life events were associated with depression, but found no evidence for an association with the 5-HTTLPR genotype. Another 2009 meta-analysis agreed with the latter finding."
 * Am I correct to guess you refer to the second time Caspi is mentioned?  Lova Falk     talk   17:33, 23 December 2012 (UTC)
 * Yes, this is the case. Tpylkkö (talk) 10:35, 10 January 2013 (UTC)
 * To answer your question: absolutely! Please add - as long as you have good sources. However, I see now that this is a featured article, so it's probably best to write your text here first.   Lova Falk     talk   10:23, 12 January 2013 (UTC)

Edit request on 22 March 2013
The Management section needs more information to reflect recent studies as it relates to recurrent depression and major depression in general.

In the antidepressant section, more needs to be developed in regards to loss of response to antidepressants and subsequent refractoriness. Also more information is needed in regards to other medical studies pointing to a potential unification of unipolar–bipolar medication treatments. Finally additional studies point to the use of mood stabilizer medication in the treatment of unipolar depression. Please add the following.

Research in 2001 looked at the common loss of response to antidepressant medications. Some patients even developed a resistance to various treatment and modalities. The study goes on to show that using mood stabilizers without antidepressants can lead to sustained improvement. These clinical findings suggest that some refractory depressives represent cryptic bipolar disorders.

Additionally, new research points to a unified approach with unipolar and bipolar depression, especially when the patient has recurrent unipolar depression. Individuals with lifetime diagnosis of recurrent unipolar depression experienced a number of manic/hypomanic items which related to an increased likelihood of endorsing paranoid and delusional thoughts and suicidal ideation. The presence of a significant number of manic/hypomanic items in patients with recurrent unipolar depression seems to challenge the traditional unipolar-bipolar dichotomy and bridge the gap between these two categories of mood disorders.

Research has also been done into the efficacy of using bipolar medications with patients as an augmentation agent in treatment of refractory unipolar major depressive disorder. Lamotrigine when used as an augmentation agent in treatment of refractory unipolar major depressive disorder, lead to positive outcomes for about 63% of the patients. The treatment was most effective for patients who had been depressed for shorter periods of time and had failed fewer previous trials of antidepressants. Data also suggested a trend toward increased response for patients with comorbid anxiety disorders and/or chronic pain syndromes. There is also new research into the use of antimanic medications to treat unipolar depression. In the study, olanzapine appeared to be moderately effective as an open add-on treatment in patients with mainly depressive symptoms. Accumulating evidence suggested that olanzapine, and atypical antipsychotics in general, possess mild to moderate adjunctive antidepressant properties.

Stephen Magladry (talk) 08:13, 22 March 2013 (UTC)

reflist
So I can see Casliber (talk · contribs) 11:02, 22 March 2013 (UTC)


 * The sharma paper is a small case series, the lamotrigine is a small case series, the mood spectrum piece is a few structured interviews (which are no substitute for clincial interviews), the olanzapine is a small retrospective series - we need Review Articles. If we did take primary sources we'd want stronger papers than these anyway. Sorry. Casliber (talk · contribs) 11:08, 22 March 2013 (UTC)

Somewhat negative geographic correlation between major depressive disorder, and bipolar disorder?
I scanned through this article, and got to the end, and saw this map: https://en.wikipedia.org/wiki/File:Unipolar_depressive_disorders_world_map_-_DALY_-_WHO2004.svg

I found it strange how America can have so many cases, where Africa seems pretty happy-go-lucky, despite instability and the worry of people and their offspring not surviving or being as successful as they should be able to, which is not present in that way in America. Obviously, this shows that depression doesn't correlate positively with instability of one's country or nation. Although it might have something to do with age- and disability-adjustment.

The name of the image (Unipolar) prompted me to find the equivalent chart for bipolar disorder. The geographical distribution is nearly opposite: https://en.wikipedia.org/wiki/File:Bipolar_disorder_world_map_-_DALY_-_WHO2002.svg

Can anyone informed comment on this? Does bipolar disorder lead to less likelihood of major depressive disorder? Might there be a genetic link in this correlation, or maybe a case of mass misdiagnosis? Whatever the case, I found it quite interesting. --BurritoBazooka (talk) 03:32, 17 April 2013 (UTC)


 * Bipolar disorder leads to zero probability of major depressive disorder. You can't have bipolar disorder without manic episodes, and if you have manic episodes by definition you don't have major depressive disorder.  I doubt that that explains the maps though, and I'm not sure how seriously to take them.  It seems to me that differential diagnosis must play a substantial role here. Looie496 (talk) 05:48, 17 April 2013 (UTC)

Edit request on 1 November 2013
Hello. A concern of mine is, that in the lead section, toward the end of the first paragraph, the text reads, "...around 3.4% of people with major depression commit suicide...". Just a minor gripe here, but I think that since this is an actual medical condition, and it could be worded to better reflect that, something like, "...has about a 3.4% mortality rate, due to suicides...", with the appropriate link to Wikipedia's page on mortality rates. That way, there's also a little juicy nugget of factual content that wasn't there before. Thanks.


 * Red information icon with gradient background.svg Not done: that would radically change the meaning. Mortality rate would be from all causes, while this statement is about a specific cause. Also, please see the article Mortality rate and note that there are several different kinds of mortality rate. Your statement appears not to relate to any of them. --Stfg (talk) 21:53, 1 November 2013 (UTC)


 * Reactivating request, because... - I had it wrong up there, silly me. What I meant was Case fatality rate.--A Goblet and Two Maidens (talk) 23:13, 1 November 2013 (UTC)


 * Red information icon with gradient background.svg Not done: That does not address Stfg's concern about changing the meaning from the percentage who commit suicide to the percentage who die from all causes. Regards, Celestra (talk) 03:13, 2 November 2013 (UTC)

Updates and Transition Edits from New Manual; DSM-5 Replaced Outmoded DSM-4 & DSM-4TR
DSM5 manual has been out since Spring of 2013 for over half a year now, and this article needs to be updated and redrafted to maintain assessment. It is oriented almost exclusively to DSM-4 which is now defunct and superseded. This issue of DSM-5 updates is to become system-wide for Wikipedia during the coming months and is a current concern system-wide. At a minimum, each of these listed items should be addressed on this wikipage.

1) Material in section of "Drug and Alcohol Abuse" is outdated and needs to be updated to DSM-5 standards. Neurochemistry of drug dependency is substantially out of date.

2) DSM-5 protocols for clinical assessment must be incorporated to update outdated references to methods which are even now described as inferior to both ICD and DSM evaluation and assessment. Criteria set by DSM-5 must be given prominence as the most recent and comprehensive presentation of this material as presently absent on this wikipage which is at least ten years old and obsolete by DSM-5 standards.

3) Entire "DSM-4TR and ICD-10 criteria" section must be re-drafted to conform to the obsolescence of DSM-4TR and its replacement by DSM-5 for over six months now. This re-write should seriously assess the integration of this material with the clinical assessment section discussed in item#2 above on "Clinical Assessment". The DSM-5 must be given centrality of presentation for both criteria and assessment as the most current state of responsible medical evaluation at this point in time over six months after the publication of DSM-5. The issue of updates is well overdue to the responsible upkeep of this wikipage assessment.

4) The entire section include almost a half dozen outdated references to DSM-4TR which need to be converted to DSM-5 in order for the wikipage to be medically responsible and for the page to retain its assessment to Wikipedia standards. The entire section is obsolete in its current presentation.

5) Section on "subtypes" must be brought into conformity with DSM-5. All references to methodology must be updated to DSM-5, as well as being replaced by the methodology of DSM-5 as it differs from DSM-4 in crucial respects as described in the new manual for DSM-5.

6) Section on "Differential diagnosis" is lacking attention to template requests for citations already. The section is in desperate need of attention to personality disorders in general as they relate to the clinical diagnosis of depression. The brief discussion of manic-depressive disorder is woefully inadequate, and should be replaced by a comprehensive treatment of all three Clusters of personality disorders in relation to clinical depression. 40-60% of all cases diagnosed as depression are co-diagnosed with a diagnosis of one least one personality disorder. It is and continues to be neglectful of a article on depression to ignore such a broad demographic of suffering patients without including at least one responsible subsection in the Wikipedia article on depression.

7) Management section has unserviced templates requiring attention and outdated by DSM-5 standards. It must be updated to DSM-5 standards. The case of chronic suffering from this psychiatric malady must also be responsibly incorporated into the outdated Wikipedia article if its assessment status is to be maintained.

8) History section is somewhat prosaic and overwrought. The outdated references in the current outdated version of this wikipage made to DSM-4 can be re-assigned to this section if necessary since they must be removed from damaging the contents of the main portion of this wikipage. The DSM-5 has rendered all reference to the out of print DSM-4 as obsolete. BillMoyers (talk) 03:59, 24 December 2013 (UTC)


 * For starters, can you rewrite this sentence into something the average reader does not have to read three times to comprehend and source it? Cas Liber (talk · contribs) 04:34, 24 December 2013 (UTC)
 * The DSM is controversial. Check out All new research is not based on it. For many conditions it has changed little from DSM4 to DSM5  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:01, 24 December 2013 (UTC)
 * Transitioning to DSM5 need not simultaneously involved making the article worse with incomprehensible prose and uncited text. Sandy Georgia  (Talk) 16:48, 24 December 2013 (UTC)

Name
In accordance with WP:COMMONNAME and WP:NATURAL, should this article be renamed to "Depression"? I'm not aware of the medical literature, but depression is, both in colloquial language and according to a quick Google search I did, referring to Major Depressive disorder rather than Depression (mood) 99.199.53.49 (talk) 00:30, 3 February 2014 (UTC)
 * Love to but exactness trumps this - depression as used colloquially could also mean Adjustment disorder, bereavement, chronic dysthymia etc. Cas Liber (talk · contribs) 00:38, 3 February 2014 (UTC)

Vitamin D
... isn't much use 10.1210/jc.2013-3450 JFW &#124; T@lk  20:34, 6 March 2014 (UTC)

Edit request 17 April 2014
I have a student who would like to add information about how different cultures view and treat depression. She will post here her possible sources and wait to see if they are acceptable Greta Munger (talk) 15:40, 17 April 2014 (UTC)
 * Okay Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:10, 17 April 2014 (UTC)

Proposal for Article Edits

I would like to begin the process of adding information regarding depression within specific cultures to this article. My plan is to make edits to the Society and Culture section and summarize how depression varies across cultures. Then I would like to include two sub-sections for Arab Cultures and Asian Cultures and present the current research on depression related to each culture.

I plan to use current, peer-reviewed journal articles and back these articles up with information from textbooks, encyclopedias, and other specialized texts. Below are the sources I intend to use for the revision of this article:

Books:

Andrews, L. W. (2010). Encyclopedia of depression. Santa Barbara, Calif.: Greenwood Press.

Bhugra, D. (2007). Textbook of cultural psychiatry. Cambridge: Cambridge University Press.

Cuéllar, I., & Paniagua, F. A. (2000). Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations. San Diego: Academic Press.

Gotlib, I. H., & Hammen, C. L. (2009). Handbook of depression (2nd ed.). New York: Guilford Press.

Gregg, G. S. (2005). The Middle East a cultural psychology. Oxford: Oxford University Press.

Herrman, H. S., & Maj, M. N. (2009). Focusing on Asia. Depressive disorders (3nd ed., ). Hoboken, NJ: Wiley.

Leong, F. T. (2007). Handbook of Asian American psychology (2nd ed.). Thousand Oaks, Calif.: Sage Publications.

Matsumoto, D. R. (2001). The handbook of culture & psychology. New York: Oxford University Press. Reinecke, M. A. (2002). Comparative treatments of depression. New York: Springer Pub.

Journal Articles:

Overview

Falicov, C. (2003). Culture, society and gender in depression. Journal Of Family Therapy, 25(4), 371-387. doi:10.1111/1467-6427.00256


 * Contributions of gender, class, race to depression

Scott, J., & Dickey, B. (2003). Global burden of depression: The intersection of culture and medicine. British Journal Of Psychiatry, 183(2), 92-94. doi:10.1192/bjp.183.2.92


 * Discusses the disease as a global burden and highlights the Longitudinal Investigation of Depression Outcomes (LIDO) project

Arab Cultures

Abou-Saleh, M. T., Karim, L., & Krymsky, M. (1998). The biology of depression in Arab culture. Nordic Journal Of Psychiatry, 52(2), 177-182. doi:10.1080/08039489850139067


 * Study with Arab participants – biological markers of depression are consistent between Arab and Western populations

Asvat, Y., & Malcarne, V. L. (2008). Acculturation and depressive symptoms in Muslim university students: Personal-family acculturation match. International Journal Of Psychology, 43(2), 114-124. doi:10.1080/00207590601126668


 * Study with Arab-Muslim students – highlights links between acculturation and symptoms of depression

Dwairy, M. (2009). Culture analysis and metaphor psychotherapy with Arab-Muslim clients. Journal Of Clinical Psychology, 65(2), 199-209. doi:10.1002/jclp.20568


 * Therapy methods to use with Arab-Muslims

Hamdi, E., Amin, Y., & Abou-Saleh, M. T. (1997). Problems in validating endogenous depression in the Arab culture by contemporary diagnostic criteria. Journal Of Affective Disorders, 44(2-3), 131-143. doi:10.1016/S0165-0327(97)00037-2


 * Study with Arab participants - highlights need for non-western treatment on depressed Arab patients

Sulaiman, S. Y., Bhugra, D., & De Silva, P. (2001). The development of a culturally sensitive symptom checklist for depression in Dubai. Transcultural Psychiatry, 38(2), 219-229. doi:10.1177/136346150103800205


 * Study with Arab participants – identified symptoms of depression relevant to the culture

Walpole, S., McMillan, D., House, A., Cottrell, D., & Mir, G. (2013). Interventions for treating depression in Muslim patients: A systematic review. Journal Of Affective Disorders, 145(1), 11-20. doi:10.1016/j.jad.2012.06.035


 * Highlights treatments for depression in Arab-Muslim patients

Chinese Cultures

Chae, D. H., Lee, S., Lincoln, K. D., & Ihara, E. S. (2012). Discrimination, family relationships, and major depression among Asian Americans. Journal Of Immigrant And Minority Health, 14(3), 361-370. doi:10.1007/s10903-011-9548-4


 * Study with Asian-Americans – family support associated with lower depression

Gupta, A., Leong, F., Valentine, J. C., & Canada, D. D. (2013). A meta‐analytic study: The relationship between acculturation and depression among Asian Americans. American Journal Of Orthopsychiatry, 83(2-3), 372-385. doi:10.1111/ajop.12018


 * Highlights links between acculturation and symptoms of depression

Kleinman, A. (2004). Culture and Depression. The New England Journal Of Medicine, 351(10), 951-953. doi:10.1056/NEJMp048078


 * Symptoms of depression in Chinese people

Sangalang, C. C., & Gee, G. C. (2012). Depression and anxiety among Asian Americans: The effects of social support and strain. Social Work, 57(1), 49-60. doi:10.1093/sw/swr005


 * Study with Asian participants – family support associated with decreased odds of depression

Sin, M., Jordan, P., & Park, J. (2011). Perceptions of depression in Korean American immigrants. Issues In Mental Health Nursing, 32(3), 177-183. doi:10.3109/01612840.2010.536611


 * Depression is often unrecognized and untreated in minority immigrants


 * Study with Korean participants – lacked understanding of depression

Wong, D., Xuesong, H., Poon, A., & Lam, A. (2012). Depression literacy among Chinese in Shanghai, China: A comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong. Social Psychiatry And Psychiatric Epidemiology, 47(8), 1235-1242. doi:10.1007/s00127-011-0430-4


 * Study with Chinese participants in Shaghai – highlights lack of depression-related knowledge in Asian societies

Wong, Y., Kim, S., & Tran, K. K. (2010). Asian Americans’ adherence to Asian values, attributions about depression, and coping strategies. Cultural Diversity And Ethnic Minority Psychology, 16(1), 1-8. doi:10.1037/a0015045


 * Adherence to Asian values linked with attributing depression to internal causes


 * Reviews coping strategies

Yeung, A., Neault, N. N., Sonawalla, S. S., Howarth, S. S., Fava, M. M., & Nierenberg, A. A. (2002). Screening for major depression in Asian-Americans: A comparison of the Beck and the Chinese Depression Inventory. Acta Psychiatrica Scandinavica, 105(4), 252-257. doi:10.1034/j.1600-0447.2002.1092.x

Ayahmed17 (talk) 15:19, 18 April 2014 (UTC)
 * Study with Chinese participants – the Beck Depression Inventory and Chinese Depression Inventory have comparable effectiveness


 * Good. You may find that, to do justice to the topic, you need to write more than can fit in this broad overview article. Consider starting a new article - Depression and culture or similar, summarising it here in one or two paragraphs, and linking to it in your summary. If you need any help with anything or have any queries, ask at WikiProject Medicine or ask me at my my talk page. If you want to start "Depression and culture" just click here and start typing. --Anthonyhcole (talk · contribs · email) 19:42, 18 April 2014 (UTC)
 * Please made sure you only use secondary sources per WP:MEDRS. If you are not sure what a secondary source is feel free to ping me for further explanation. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:54, 18 April 2014 (UTC)
 * Starting a new "depression and culture" page sounds like a good idea. About only secondary sources, I thought for psychology related articles careful use of some peer-reviewed research was appropriate (following this advice).  Perhaps the emphasis on the research will be easier to see in a new page. Greta Munger (talk) 13:36, 22 April 2014 (UTC)
 * It seems like you have a lot of good sources, and a lot of variety in terms of what you want to talk about. Since you do seem to have such a variety of research I agree with the above comment that it might be a good idea to start a new "depression and culture" page. That would allow you to delve into more detail than you will be able to in a subsection of this article. One thing I am confused about after reading your proposal is the title of your sub-section on depression in Asian cultures. Is this section going to refer to Asian cultures in general, or specifically China? It looks like, based on your sources, it would be best to broaden it to Asian cultures in general. I also think that if you started a new article, you might want to include a section specifically on non-western treatments for depression, or treatments that have been effective outside of Western culture. It seems like you already have some research on that topic in the Arab culture and Asian culture section. I don't know if there is any information on this in the books you referenced, but a section on depression in immigrant populations might be interesting. Overall, I think your proposed edits look great! Good job! Katie Lloyd (talk) 18:02, 25 April 2014 (UTC)

Hello, I was reading the description of lithium as a treatment option under Antidepressants in the Management section of the page and I noticed there was very little written. I know there is another Wiki page devoted to talking about lithium as a medication and how it should be monitored, but for safety reasons, I thought this information was worth mentioning on this page as well. I am proposing that the following 2 sentences are added after the existing sentence discussing lithium as a treatment option:

There is a limited range of effective dosages of lithium. Anyone who considers taking lithium supplements should be monitored by a physician because overdoses can be fatal. Thank you. --EHatch (talk) 22:11, 18 April 2014 (UTC)
 * 1) Nolen-Hoeksema, Susan. (2014) "Treatment of Mood Disorders". In (6th ed.) Abnormal Psychology p. 196. New York: McGraw-Hill. ISBN-13: 9780078035388.


 * Hi EHatch. Could you possibly copy here the passage/s from Nolen-Hoeksema that you are relying on to support this? --Anthonyhcole (talk · contribs · email) 04:21, 19 April 2014 (UTC)

Meditation
This ref does not appear to be about MDD. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:14, 29 April 2014 (UTC)
 * Can you direct me to objective measures of the difference between depression and MDD? Otherwise, you know it's horribly subjective (more by DR than patient).  The review says "Findings  After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months)..."32cllou (talk) 00:19, 30 April 2014 (UTC)
 * Agree, and the music therapy reference seems to be about depression the symptom rather than MDD. I have therefore removed both. Yobol (talk) 01:07, 30 April 2014 (UTC)

Justification
Jmh, please justify your relegation of specific other treatments (bright light, for example) to a jumbled 3 paragraphs. Some are evidently as important to outcomes as meds and psyc interventions. They therefore deserve equal billing (proper heading being important).
 * No they do not deserve equal billing as the evidence gives them less weight. We also do not do one sentence paragraphs. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:05, 29 April 2014 (UTC)
 * Agree with Doc James, the "other" therapies are not standard of care, nor do they have as much research supporting them, so they deserve less coverage. Yobol (talk) 01:08, 30 April 2014 (UTC)

I don't think your word "medical" applies to many psych interventions. "Clinical" does (both med and psych).32cllou (talk) 16:49, 29 April 2014 (UTC)
 * Sure will change back Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:05, 29 April 2014 (UTC)

I'll read the full text of Therapeutic use of sleep deprivation in depression before making those changes to depression.32cllou (talk) 17:11, 29 April 2014 (UTC)
 * So did I. It is based on a few small trials and thus the evidence is not great. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:05, 29 April 2014 (UTC)

I found three more usable reviews, in case anyone else is reading this talk see [][], and a blockbuster! []. "demonstrate good efficacy in the treatment of illness episodes. They include manipulations of the sleep-wake rhythm (such as partial and total sleep deprivation, and sleep phase advance) and of the exposure to the light-dark cycle (light therapy and dark therapy). In recent years, an increasing literature about the safety and efficacy of chronobiological treatments in everyday psychiatric settings has supported the inclusion of these techniques among the first-line antidepressant strategies for patients affected by mood disorders."32cllou (talk) 00:21, 30 April 2014 (UTC)

Chronobiological therapy
There are 4 reviews on CBT, and I propose adding that as a new section in Management.

Are any of these not usable? [] [] [] []

I also think the 2002 review discussed above is valuable, because it finds benefit from combining bright light and SD. But the 4 reviews should suffice if they are OK.32cllou (talk) 16:45, 30 April 2014 (UTC)

Does anyone know of other valuable information regarding CBT?32cllou (talk) 16:47, 30 April 2014 (UTC)

Can't use just CBT in the section, it's more commonly cog beha ther.32cllou (talk) 18:01, 30 April 2014 (UTC)

Effectiveness of SSRIs/TCAs
We have a number of high quality refs that support the effectiveness of SSRIs. There are others that do not support the effectiveness except in the most severe cases. How should we balance these? Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:09, 4 May 2014 (UTC)
 * Defer to cochrane where possible I think - if I get some time I will look through all these. Cas Liber (talk · contribs) 01:37, 5 May 2014 (UTC)
 * We have a 2010 JAMA meta analysis which states "The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial."
 * We have a 2008 PLoS meta analysis that states "Drug-placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients."
 * This 2013 metaanalysis states "This systematic review provides evidence for the efficacy of both SSRIs and TCAs in the treatment of chronic depression and showed a better acceptability of SSRIs." [https://www.ncbi.nlm.nih.gov/pubmed/22963896[
 * The 2009 Cochrane review concludes "Both TCAs and SSRIs are effective for depression treated in primary care." Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:36, 5 May 2014 (UTC)
 * Only two of them break the effectiveness down by the severity of disease thus we currently have "The effectiveness of medication appears to be significant only in the most depressed" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:37, 5 May 2014 (UTC)

James, looking thru the articles, the 2010 JAMA had a relatively small pooled sample and the difference in the severely depressed was skewed by big differences in a few patients. The other articles show statistically significant differences, it's the magnitude that's in question. They also seem to mention the limitations of the primary publications repeatedly. I think including the word "only" in the summary may be misleading based on the current data. Maybe, "Medication appears to be effective, but the effect may only be significant in the severely depressed" or "Medication appears to be effective, but the effect may be insignificant in mild to moderate depression"??? Ian Furst (talk) 00:19, 6 May 2014 (UTC)
 * Yes I like that wording. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:46, 6 May 2014 (UTC)
 * I'd go with your first alternative Ian. Cheers, Cas Liber (talk · contribs) 01:54, 6 May 2014 (UTC)

Request: edit or clarify reference to "clinical significance" in opening paragraph
The opening paragraph of the article refers to "other mood conditions without clinical significance," but the wiki page for "clinical significance" only defines it as a description of treatments, not conditions. Therefore, as written, I don't understand what the sentence in the original article is saying (which is unfortunate, since it seems like an important sentence). Can someone with some knowledge fix this? Is there another definition of "clinical significance" which applies to conditions rather than treatments? If so, maybe someone could add this information to the clinical significance article? (And to be clear, I am not disagreeing with any particular classification of conditions.) Thanks! Lewallen (talk) 21:40, 8 May 2014 (UTC)
 * Clarified Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:33, 8 May 2014 (UTC)

Van Gogh Picture
Is it really necessary or insightful to include a picture of a Van Gogh painting on the page of a medical article? I request that this be removed. Wiki.correct.1 (talk) 19:59, 26 May 2014 (UTC)
 * clearly somebody thought it gave insight and resonance. please provide a reason why you would like to removed.  thanks.Jytdog (talk) 20:56, 26 May 2014 (UTC)


 * Van Goh was an artist who had extreme depression issues, and eventually killed himself. He viewed his work as horrific yet he is remembered as one of the greatest painters of all time. The work shown is... him being depressed. Both in what the work represents as well as the artist behind it, at least in my opinion, the work is an exceptional example of what depression is. - MaJoRoesch (talk) 10:30, 29 July 2014 (UTC)

Air pollution and daily emergency department visits for depression.
In Toronto positive and statistically significant associations of sulphur dioxide with migraine ED visits were obtained: all ages, OR = 1.04 (95% CI: 1.00, 1.08); age group [15, 50], OR = 1.05 (95% CI: 1.01, 1.09). In Ottawa positive correlations were observed: all ages, OR = 1.05 (95% CI: 0.97, 1.13); age group [15, 50], OR = 1.06 (95% CI: 0.97, 1.15). The results suggest that female migraine may be affected by ambient sulphur dioxide.


 * http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317030/

— Preceding unsigned comment added by Ocdnctx (talk • contribs)


 * Thanks, but migraine is not depression, and that source doesn't meet WP:MEDRS anyway -- it's a primary source. Looie496 (talk) 15:36, 17 August 2014 (UTC)

Serotonin's role in depression pathophysiology
In a very recent study, mice with a gene knockout for an enzyme responsible for the rate-limiting step for the synthesis of serotonin in the CNS were tested for depression and showed almost no symptoms of it compared to wild-type mice. This is potentially a revolutionary finding and may tremendously alter the research in this field, which has traditionally focused on the serotonergic hypothesis of depression. http://pubs.acs.org/doi/abs/10.1021/cn500096g

It behooves the Wiki community to make the public aware of such a study and its potential ramifications for the direction of research in this disease state. — Preceding unsigned comment added by 148.177.1.215 (talk) 18:08, 28 August 2014 (UTC)
 * Thanks, but this is not relevant to Wikipedia. Jytdog (talk) 18:15, 28 August 2014 (UTC)
 * Please see WP:MEDRS Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:21, 28 August 2014 (UTC)

Audio files
I am supportive of the idea of machine read audio files. Maybe in the external links section? Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:47, 6 October 2014 (UTC)
 * most computers and even smartphones can read websites for you. i don't see the value in an audio version of the article - captured at some unknown point in time - being linked to the article. (however, this recording is kind of cute, with birds chirping behind the computer-generated voice) (on the other hand, for someone with hearing issues those birds could be a bad thing) Jytdog (talk) 21:14, 6 October 2014 (UTC)
 * "Most computers and even smartphones" You think this is true all over the world? I found it much easier to have this page read when clicking on the link.
 * Agree the birds should go. Also IMO this should be done in a more automated fashion. Ie a new file automatically created each month or something. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 21:20, 6 October 2014 (UTC)
 * automation and date-stamping of the capture date, yes. computer/phone reading a webpage? that technology has been around for what, twenty years now.  i would imagine that even the cheapest devices can do that, but I have zero knowledge of the ww dissemination of computer technology.  do you know? Jytdog (talk) 21:33, 6 October 2014 (UTC)
 * I will make another without the birds. It was a setting I forgot to take away. I listen to these things all the time on my iphonbe, but I see a lot of sophisticated people who don't get into the technology for some reason,. But they would click on the sound file. I will revert so others can see it. I don't know why people are so quick to delete new things. Ex-nimh-researcher (talk) 22:10, 6 October 2014 (UTC)
 * User:Ex-nimh-researcher rather than simply try to place these again into main space at this point in time, lets discuss the concept.
 * For example IMO we should have a button beside read that says "listen". When people click it, it plays the Wikipedia article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:12, 6 October 2014 (UTC)
 * posted on project medicine Wikipedia_talk:WikiProject_Medicine Jytdog (talk) 22:48, 6 October 2014 (UTC)

A bit of help needed with references
The references needed more work towards what the edit-banner calls "consistent citation style". Since I don't have access to DSM-IV, I hope someone can fill in the page number for ref [129]. And I wonder if there is any ambition to move to DSM-5? We are told that there are individual DOIs for each chapter, but one needs online access so see them. Finally, ref [161] seems weak to me.Layzeeboi (talk) 11:39, 12 November 2014 (UTC)

rTMS
Started to add some info on rTMS to the article, as appears to be legitimate therapeutic option. Very active area right now with more than 20 meta analyses showing up in the literature over last 2 years. I wrote the following text as a starter description of the technology, but since I am not real familiar with this area and this is a Featured Article, thought I would put it here first for comment.

Transcranial magnetic stimulation
Transcranial magnetic stimulation (TMS) uses electromagnetic induction to induce activity in specific or general parts of the brain. An electromagnetic coil is held against the forehead and short electromagnetic pulses are administered through the coil. The magnetic pulse easily passes through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region. A variant of TMS, repeated transcranial magnetic stimulation (rTMS), has been studies as treatment for a variety of psychiatric and neurological disorders.

A commercial device for treating depression with TMS was approved for marketing in the United States in 2013. A 2014 meta analysis of rTMS for the treatment of treatment-resistant depression identified 18 sham-controlled clinical trials of good or fair quality. rTMS treatment was associated with a 4.5 point improvement in the Hamilton Depression Scale and a 5-fold greater likelihood of achieving remission than sham treatment. Another 2014 meta analysis covering the use of rTMS to treat major depressive disorder reviewed 29 trials conducted in both first line and treatment resistant depression. Overall, 29% of those treated with rTMS responded vs. 10% of those receiving sham treatment; 19% achieved remission compared to 5% of those receiving sham treatment. rTMS is less effective than electroconvulsive therapy.


 * rTMS is a treatment alot of people would like to see be effective, especially as an alternative to ECT. There have been trials on it running for years. Despite this, it still isn't in mainstream armamentarium for general use, which makes me wonder about claims of effectiveness. This is a situation where sticking to the usual practice which is secondary sources is prudent. Metaanalyses are primary sources (albeit good ones), are the reviews proper Reviews then.....I have written this without looking at the refs yet (and before coffee). Cas Liber (talk · contribs) 19:29, 16 November 2014 (UTC)


 * Right, having looked - some are listed as Review articles. On thinking about it this is a bit of a tough one, yet I think it is common enough that people would like info in a core article on MDD. It might be better placing the large section (this above) into Management of depression and a more truncated one into this article. Maybe list as a small section under ECT. Cas Liber (talk · contribs) 20:03, 16 November 2014 (UTC)

Semi-protected edit request on 11 February 2015
A medical device that uses H-coil for deep transcranial magnetic stimulation (Deep TMS) as a noninvasive treatment for depression, schizophrenia, and other neurological disorders, depending on licensing in different countries. https://en.wikipedia.org/wiki/Brainsway

Germanbrother (talk) 08:25, 11 February 2015 (UTC)
 * High quality ref per WP:MEDRS needed Doc James  (talk · contribs · email) 08:51, 11 February 2015 (UTC)
 * I notice that the Brainsway article has a disturbingly promotional tone. Looie496 (talk) 16:33, 11 February 2015 (UTC)

Effectiveness of antidepressants
Ref my edit, the quote I used is here. It seems from the summary of the citation that their view was a largely negative effect rather than a limited positive one (hence their pointed title). I know it's a minor point. Regards, Tony Holkham (talk) 16:00, 23 February 2015 (UTC)
 * That url does not open for me. We are talk about "The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration" from 2002 by Kirsch yes?
 * Conclusion is "To summarize, the data submitted to the FDA reveal a small but significant difference between antidepressantdrug and inert placebo. This difference may be a true pharmacological effect, or it may be an artifact associated with the breaking of blind by clinical trial patients and the psychiatrists who are rating the severity of their conditions. Further research is needed to determine which of these is the case." Doc James  (talk · contribs · email) 16:11, 23 February 2015 (UTC)
 * That's the study, yes. Thanks for your clarification. The researchers' title was a little sensational, then - not the first time I've seen that... Cheers, Tony Holkham (talk) 16:21, 23 February 2015 (UTC)
 * Yes titles often do not match the text inside. Doc James  (talk · contribs · email) 19:02, 23 February 2015 (UTC)

DFW' article "The Depressed Person"
PMFJI and adding the url to the above article. I know the reference is not placed correctly and who am I ... except the short story quoted shows it all in its ugly, hurting light. SmozBleda (talk) 06:46, 17 April 2015 (UTC)
 * Could you try to say that a bit less tersely? Looie496 (talk) 14:23, 17 April 2015 (UTC)
 * The section you added it to is for sources that are used in the article. Thus removed. Doc James  (talk · contribs · email) 19:46, 17 April 2015 (UTC)

sleep deprivation
This content was added today - is based on 2 very old sources (one of them primary), and the last paragraph is obviously copy/pasted from somewhere. It also overplays the potential benefits.

===Sleep deprivation and phase advance=== Studies show that sleep restriction has great potential in the treatment of depression. Those who suffer from depression show a number of disturbances in their sleep patterns. For example, they have earlier occurrences of REM sleep with an increased number of rapid eye movements. Therefore, monitoring patients' EEG and awakening them during particular points of their sleep cycle (usually during the second half of the night or every time theu enter REM sleep) appears to have a therapeutic effect, alleviating depressive symptoms. As many as 60% of patients, when sleep-deprived, show immediate recovery, although most relapse the following night. The effect has been shown to be linked to increases in the brain-derived neurotrophic factor (BDNF). The relapse frequency can be significantly decreased if sleep deprivation is combined with phase advance, anothe well-known sleep intervention, which implies an earlier scheduling of sleep time (i.e., going to bed at 18:00 instead of 22:00). It has been shown that chronotype is related to the effect of sleep deprivation on mood in normal people: those with morningness preference become more depressed following sleep deprivation while those with eveningness preference show an improvement in mood. A comprehensive evaluation of the human metabolome in sleep deprivation in 2014 found that 27 metabolites are increased after 24 waking hours and suggested serotonin, tryptophan, and taurine may contribute to the antidepressive effect.

The incidence of relapse can be decreased by combining sleep deprivation with medication.[77] Many tricyclic antidepressants suppress REM sleep, providing additional evidence for a link between mood and sleep.[78] Similarly, tranylcypromine has been shown to completely suppress REM sleep at adequate doses.

happy to discuss, but this is not ready for showtime. Jytdog (talk) 19:37, 6 August 2015 (UTC)
 * Refs are a little old and some do not work. One is a review but the other is not. Doc James  (talk · contribs · email) 06:53, 8 August 2015 (UTC)


 * is a 2015 review dealing with precisely this topic. I can't access it though.  I think the added material is a bit misleading -- sleep deprivation is very effective in the short term for around 60% of patients but isn't usable as a long-term treatment because of the side effects. Looie496 (talk) 13:48, 8 August 2015 (UTC)
 * Yeah, I have not heard of it being used in clinical practice in Australia anyway. Be good to find some review material reporting on this. Cas Liber (talk · contribs) 20:07, 8 August 2015 (UTC)

Semi-protected edit request on 5 April 2015
Please change the line 'Major depressive episodes often resolve over time whether they are treated' to 'Major depressive episodes often resolve over time whether or not they are treated', so as to increase clarity.

FlameLightFleeNight (talk) 15:21, 5 April 2015 (UTC)
 * Yes check.svg Done  Kharkiv07 Talk  15:33, 5 April 2015 (UTC)

DSM-IV-TR and ICD-10 criteria
"The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines" (currently Ref 126) links to an inappropriate document (http://www.who.int/entity/substance_abuse/terminology/ICD10ClinicalDiagnosis.pdf). Please replace with http://www.who.int/classifications/icd/en/bluebook.pdf Dr Olive (talk) 18:53, 24 August 2015 (UTC)
 * Thanks User:Dr Olive and done. Doc James  (talk · contribs · email) 19:02, 24 August 2015 (UTC)

Explanation of revert
I have just reverted an edit by, and would like to say why. The edit added several sentences. The first added sentence stated, "Research suggests that CBT is more effective than any type of therapy including medication", and cited a Cochrane review as support, but I can't see anything in the cited source that supports that statement. Another added sentence states, "Overall, research suggests that CBT is the most effective treatment for promoting recovery and preventing relapse in children and adults", but doesn't supply any source to substantiate this change. I haven't checked all the other added sentences, but for at least one of them, the reference is formatted in a seriously incorrect way. Given these problems I suggest that the changes be made one at a time, or even better, discussed here before being implemented. Looie496 (talk) 17:45, 27 November 2015 (UTC)

"Commit" vs "die by" suicide
I just edited three instances of "Commit suicide" to "die by suicide" in line with the Time To Change Media Guidelines. "Commit" refers to criminal acts and risks further stigmatising people affected by suicide and self-harm. Abt21 (talk) 17:49, 30 December 2015 (UTC)
 * Fair point. Sounds a reasonable change to make. Cas Liber (talk · contribs) 20:20, 30 December 2015 (UTC)

Typo in first sentence
There is a typo in the first sentence of the article: Major depressive disorder (MDD), often simple called depression.... It should be SIMPLY instead of simple. — Preceding unsigned comment added by 68.8.128.168 (talk • contribs) 20:28, 1 April 2016‎ (UTC)
 * fixed, thanks. Jytdog (talk) 23:26, 1 April 2016 (UTC)

Screening
USPSTF recommendation 10.1001/jama.2015.18392 JFW &#124; T@lk  08:21, 27 January 2016 (UTC)
 * Added. Cas Liber (talk · contribs) 10:05, 27 January 2016 (UTC)
 * Hi, folks ( Cas Liber, JFW ). Checking in here before making this edit. The USPSTF specifies that screening should be implemented "with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up." Additionally, "all positive screening results should lead to additional assessment that considers severity of depression and comorbid psychological problems (eg, anxiety, panic attacks, or substance abuse), alternate diagnoses, and medical conditions." Because about 7-22% of depression-positive people may have bipolar depression, follow-up screening for bipolar disorder should occur, including in primary care settings. . . . Also to add reference to screening tools. I will clean up the references. Drdaviss (talk) 03:43, 19 July 2016 (UTC)

External links modified
Hello fellow Wikipedians,

I have just added archive links to 1 one external link on Major depressive disorder. Please take a moment to review my edit. You may add after the link to keep me from modifying it, if I keep adding bad data, but formatting bugs should be reported instead. Alternatively, you can add to keep me off the page altogether, but should be used as a last resort. I made the following changes:
 * Attempted to fix sourcing for http://www.psychnet-uk.com/dsm_iv/major_depression.htm

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Cheers.—cyberbot II  Talk to my owner :Online 10:24, 31 March 2016 (UTC)


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

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

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


 * Hello PermStrump. You make a couple of good points. I am also concerned that this gives readers the impression that non medical doctors, such as clinical psychologists are not trained or are inept in identifying depression. Again, certainly not the reality, nor what the source being used says. How would you approach these issues from here.Charlotte135 (talk) 04:14, 27 May 2016 (UTC)
 * Does it give the accuracy among psychiatrists? Doc James  (talk · contribs · email) 03:57, 21 July 2016 (UTC)


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


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


 * Finally, addressing Charlotte135's comment about this statement implying that non-physicians (eg, psychologists) are "inept", I do not read or infer anything at all about the abilities of non-physicians to diagnose depression in this section. The section is titled Non-psychiatric physicians, so it does not address non-physicians at all, nor does the cited study address the capabilities of non-physicians. Furthermore, the first sentence of the Diagnosis section does mention psychologists as being able to diagnose depression.
 * Drdaviss (talk) 12:52, 21 July 2016 (UTC)
 * I like Drdaviss's suggestion. It's in spirit of what the source is saying, as opposed the wording I pasted above which seemed overly accusatory. —PermStrump  ( talk )  17:08, 21 July 2016 (UTC)


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

Awesome, Permstrump and Charlotte. Good consensus development. I am not sure what the etiquette is for who executes a consensus edit. I will be "bold" and do it, but if this is a faux pas, I will accept correction. Drdaviss (talk) 16:50, 22 July 2016 (UTC)
 * Thanks, ! I had kind of forgotten about this. —PermStrump  ( talk )  19:24, 22 July 2016 (UTC)


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

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


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

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

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

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

central nervous system disorder
All mental disorder are also CNS disorders. We do not need to place this in the lead or every mental disorder article. Doc James (talk · contribs · email) 20:53, 26 September 2016 (UTC)
 * While it's probably true that all mental disorders involve a structural/functional abnormality in the CNS, there are widespread misconceptions that certain psychiatric disorders lack an organic basis in the brain. The fact that there are a number of recent pubmed-indexed medical articles which argue that addiction isn't a "brain disorder" is a perfect example of what I mean. Regardless, I don't see why it's an issue to state that depression is a CNS disorder.  Seppi  333  (Insert 2¢) 18:12, 27 September 2016 (UTC)
 * All mental illnesses have a basis either structurally or functionally in the CNS. That can go in the body IMO. Doc James  (talk · contribs · email) 03:31, 28 September 2016 (UTC)

Neuroticism

 * User:EdmundSr (contribs), in this diff, added the following to the causes:biological" section:

"Meta-analytic work shows that the strongest vulnerability marker for the development of major depression is a highly neurotic personality."


 * User:Field2020 (contribs) in this dif 12 November 2016, added the following:

"...often via personality.."

User:SauropediaXXL (contribs) in this dif at more-or-less restored the content as follows:

"High neuroticism is a strong and robust prospective vulnerability marker for the development and onset of an episode of depression, also after adjustment for current symptoms and psychiatric history."

Something hinky is going on here, especially with the focus on neuroticism across several related articles, per the contribs linked above. A class? A sock? Unclear.

But in any case, biomarkers and co-morbities are not causes. This content doesn't belong in this section. Not sure where it belongs at all.

Jytdog (talk) 21:52, 12 November 2016 (UTC)

Dear Jytdog, I think personality is important in the development of mood disorders, and you were quite rigorous. But I never intended to start an "edit war" or to be annoying, and therefore shall not edit anymore.SauropediaXXL (talk) 22:09, 12 November 2016 (UTC) I already dropped the topic after your first deletion.Field2020 (talk) 22:23, 12 November 2016 (UTC)


 * User:EdmundSr, User:SauropediaXXL, User:Field2020 I guess one could define a personality type as a risk factor. Jyt your thoughts? Doc James (talk · contribs · email) 23:45, 12 November 2016 (UTC)
 * These are obviously one person. Will open an SPI Jytdog (talk) 00:18, 13 November 2016 (UTC)
 * Or they are a class. Would you be okay with stating neuroticism is a risk factor for MDD? Doc James  (talk · contribs · email) 00:58, 13 November 2016 (UTC)
 * interestingly we don't have a section on risk factors. Jytdog (talk) 01:14, 13 November 2016 (UTC)
 * neurosis and neuroticism have been phased out of DSM over 30 years ago, so these terms have been superceded. Risk factors are (sort of) covered in Causes section - very hard to pinpoint direct causes of most psych problems, only discuss theories etc. Cas Liber (talk · contribs) 02:15, 13 November 2016 (UTC)
 * thank you!! I thought these were kinds of fringe-y terms anymore.   was hoping somebody who knows psych would chime in. User:Casliber would you please have a look at the contribs by these three, because pretty much  all the three accounts have done is add stuff about neuroticism to WP.  Thanks  Jytdog (talk) 08:55, 13 November 2016 (UTC)
 * I had a look. I need to think about what we do with that article. The material itself is ok, but the terms are moving into historical usage. I'll ask some colleagues this week. Cas Liber (talk · contribs) 09:15, 13 November 2016 (UTC)
 * The term is by no means fringey or obsolete, but its primary use is in scientific psychology, not medicine. In psychology, neuroticism is a personality trait, basically reflecting how strongly negative inputs evoke fear and avoidance.  Almost every popular model of personality includes a neuroticism component -- in particular it is one of the Big five personality traits, probably the most influential scheme used by personality psychologists to describe personality.  It has been validated as a meaningful construct by a great mass of studies, and a number of reliable instruments to measure it exist. In my view if there are strong MEDRS-compatible studies finding a correlation between neuroticism and MDD, a mention in this article would be entirely appropriate. Looie496 (talk) 15:40, 13 November 2016 (UTC)
 * Maybe a section under causes called "risk factors" to put it in. Doc James  (talk · contribs · email) 15:44, 13 November 2016 (UTC)


 * Cas Liber is right. These things have no place in a medical article. It seems we are dealing with a case of ref spam. I stumbled over this Jeronimus 2016 in the German Anxiety disorder and kicked it out. I now also kicked it out from the English Anxiety disorder. If you look at Neuroticism you find - in the Introduction (!) - a remarkable statement like this one: "High neuroticism indexes a risk constellation that exists prior to the development and onset of any of the "common mental disorders",[3][4] such as depression, phobia, panic disorder, other anxiety disorders, and substance use disorder—symptoms that traditionally have been called neuroses.[4][5][6][7][8]]]". I strongly suggest that we keep out such ideology from medical articles. --Saidmann (talk) 19:56, 13 November 2016 (UTC)


 * The ref spammer has now been blocked. Had 62 sockpuppets. --Saidmann (talk) 18:55, 14 November 2016 (UTC)

Simple edit request:
Add this right beneath the heading Management →Antidepressants:


 * — Preceding unsigned comment added by 92.194.82.80 (talk • contribs)
 * ✅ Looie496 (talk) 15:27, 30 November 2016 (UTC)

Cause section
WAY too heavy on one side of the monoamine hypothesis, WP:POV, WP:WEIGHT — Preceding unsigned comment added by Petergstrom (talk • contribs) 03:39, 1 December 2016 (UTC)

Request
First time contributor so apologies in advance if my submission appears non-compliant. Major depressive disorder can negatively affects a person's family, work or school life, sleeping or eating habits, and general health. Suggest the following: Major depressive disorder can negatively affect a person's personal, work or school life while also impacting sleeping and eating habits and overall health.IShara (talk) 01:19, 4 January 2017 (UTC)
 * User:IShara sounds good and done. Doc James  (talk · contribs · email) 10:43, 4 January 2017 (UTC)

Cause VS mechanism
Under the cause, the monoamine section is actually really a mechanism. I want to take that out and split it into two sections, Cause and Mechanism. If nobody objects...Petergstrom (talk) 09:05, 8 January 2017 (UTC)

Recent edit
Jytdog, what is the plan with this edit?Petergstrom (talk) 01:14, 26 January 2017 (UTC)
 * The accretion of content added here and not to Biology of depression needs to blended into the article there, the LEAD there needs to be made an actual LEAD, and the sourced LEAD there needs to be copied here. You have created a thorny mess in which WP fell out of WP:SYNC with itself. I'll finish doing this tonight. This kind of meta-editing across articles is essential. Jytdog (talk) 01:22, 26 January 2017 (UTC)
 * Ok, but did you need to move instead of copy that section? You could have merged/copied back when you're done.Layzeeboi (talk) 11:51, 26 January 2017 (UTC)
 * Content will be back here by tomorrow. Jytdog (talk) 17:43, 26 January 2017 (UTC)

Revert by Petergstrom at 16:55, 30 January 2017
Peter, thank you for your contribution but I have some questions about your revert of my latest revision.
 * Can you please elaborate on what your wishes are here? I summarized a perfectly acceptable WP:MEDRS-compliant review (https://www.ncbi.nlm.nih.gov/pubmed/27750060), adding two other studies cited within the review, without making any opinions.
 * I based my revision on the full review (not just the abstract), which I studied before writing the revision. I obtained the full article directly by contacting the authors. You can email me for a full copy if you'd like.
 * I noticed you put your edit summary in quotes. Are you quoting the study? Perhaps it's a clause I missed. Are you saying we should include that clause (your edit summary in the quotes) in the text? Please clarify what you're doing. Without clarification or any other WP policy or guideline-based citation in your edit summary, it looks like you're making an opinion-based judgment on the edit, which I believe should not be cause for removing it. Thanks, --Michael Powerhouse (talk) 17:16, 30 January 2017 (UTC)


 * "a 2017 review of studies concludes that there is evidence of an increased risk of depression in people who are vitamin D deficient"
 * This sentence doesn't accurately summarize the limitations that led the authors to conclude "There remains a need for empirical studies to move beyond cross-sectional designs to undertake more randomised controlled longitudinal trials so as to clarify the role of vitamin D in the pathogenesis of depression and its management, as well as to establish whether currently suggested associations are clinically significant and distinctive."


 * "For example, one study in 2013 evaluated the relationship between depression and vitamin D deficiency and showed a positive association between depression and lower vitamin D levels."
 * Stating vitamin D may have a causal relationship contradicts the conclusion "Our analyses are consistent with the hypothesis that low vitamin D concentration is associated with depression, and highlight the need for randomised controlled trials of vitamin D for the prevention and treatment of depression to determine whether this association is causal." One newer ref is all that is needed instead of a tautology using an older ref.


 * "The 2017 review also concludes that taking vitamin D supplements can benefit people with depression who are already deficient in vitamin D."
 * Placement should be in the management section


 * "For example, one 2016 study suggests that vitamin D should be used along with an antidepressant medication for treating depression"
 * Generally "for example" is used to support an argument, not the concrete statement of the conclusions of the "2017 review" Again should go in the treatment

Petergstrom (talk) 20:48, 30 January 2017 (UTC)


 * Thanks for your feedback.


 * I am willing to amend and shorten the text to state the following, if you would find this sufficient:

"A 2017 review of studies found that there is evidence of increased risk of depression in people who are vitamin D deficient, and suggested that vitamin D could be used along with an antidepressant medication for treating depression. However, the study's authors concluded that there should be empirical studies to undertake more randomized controlled longitudinal trials to gather more evidence in this area."


 * Source:
 * Parker GB, Brotchie H, Graham RK. "Vitamin D and depression." J Affect Disord. 2017 Jan 15;208:56-61. https://dx.doi.org/10.1016/j.jad.2016.08.082 (https://www.ncbi.nlm.nih.gov/pubmed/27750060 )


 * What do you think? If you find it sufficient, where do you suggest placement in the article?


 * As for my original text, the table below shows the source text from the study listed above, and how I summarized each passage. I'm still getting used to summarizing academic journals (not an easy task), so if I made any errors those are my fault. I can provide you with a copy of the study if you would like by emailing me.


 * --Michael Powerhouse (talk) 19:25, 31 January 2017 (UTC)


 * The content you addd is irresponisible hype of the possibilities with zero discussion of risks which is typical of the dietary supplement industry. Please read about Selenium and Vitamin E Cancer Prevention Trial and please never try to add this kind of content to Wikipedia again. Thanks. Jytdog (talk) 21:37, 9 February 2017 (UTC)

Jytdog - Revision as of 21:35, 9 February 2017
I am not going to revert your revert, instead carrying the issue here on the Talk page. Please engage in a polite discussion so that I may better understand your dismissal of my content.

For other users reading this, here is the language that Jytdog erased (after I had reworked the language on the Talk page with another user):

In your edit summary, you wrote the following (in quotes). Below each quote are my rebuttals and some questions.

"typical promotional language" - Please clarify how it is "typical" and what the language is "promoting". It would be promotional if the language were promoting a product or company that sells vitamin D supplements. Vitamin D is available as a pharmacy grade prescription that physicians prescribe and that pharmacies dispense. It's also available free from exposure to the sun.

"used in dietary supplement industry" - Please provide an example. The citation is an academic review and has no stated connections to the supplement industry. I studied the full journal article, not just the abstract. From last page of study: "Acknowledgements: This study was supported by an NHMRC Program Grant (1037196). There are no relevant conflicts to disclose."

"hyping preliminary evidence" - Please explain how the how the language is "hyping" preliminary evidence. "Hyping" implies exaggeration and salesmanship. My phrase "suggested that vitamin D could be used along with an antidepressant medication for treating depression" is hardly "hyping" anything. I wrote completely objective, factual based content based on the what the source says. Additionally, the language clarifies that empirical studies are needed to further clarify the findings. Not exactly something that someone "hyping" something would include.

"not OK." - Please explain how it is "not OK?" Please back up your accusation with Wikipedia policies that prohibit the content I added. The study complies with WP:MEDRS, is relevant to the article, and is neutral.

Thank you for your time, --Michael Powerhouse (talk) 17:07, 13 February 2017 (UTC)
 * I said nothing about the source, but the content summarizing it. The source says both in its abstract and conclusion, "there is increasing evidence of an increased risk of depression in those who are vitamin D deficient and that vitamin D supplementation is of benefit for depressed individuals who are vitamin D deficient.   Issues with the content:
 * the limitation "who are vitamin D deficient" is entirely missing from the content.
 * The discussion talks about the limitations of the "increasing evidence" which are significant and are not present in the content
 * about "further research"
 * the discussion section of the paper says "clarifying whether there is any therapeutic role will require large randomised, placebo-controlled trials". The abstract says: "There remains a need for empirical studies..."  Those statements are both very different statement from the content, which a) advocates for further trials, "there should be..." (followed by something garbled, which issue I have not commented on yet) and b) claims that the author of the review advocates, which is not accurate.
 * WP:MEDMOS specifically says "avoid useless statements like "More research is needed"; it says that because a) this is true about everything and meaningless; b) is basically the backend, of a front end making promotional claims.  (There is evidence for X but more research is needed" is that kind of statement that we reject over and over and over)  It is essentially marketing hype for a product, more research funding/attention, etc.
 * this was added to the diagnosis section, but has stuff in it about treatment and research. OFFTOPIC.
 * even if it were in the correct location, which would be research, there is the larger issue of WEIGHT. A very brief sentence along the lines of "Clinical studies of vitamin D supplementation in people with low levels of vitamin D have produced mixed results" or the like would be kind of OK.  The research section really should be sourced to reviews of research into MDD treatment, not one offs about various approaches (the botox content that is there now is not great).   Jytdog (talk) 22:11, 13 February 2017 (UTC)

Semi-protected edit request on 12 April 2017
3.Pathophysiology In Paragraph 2, it seems that the second sentence "The theory postulates that insufficient activity of monoamine neurotransmitters in the primary cause of depression." should be changed to "The theory postulates that insufficient activity of monoamine neurotransmitters is the primary cause of depression." because there is an error of grammar in the original sentence. Asceticabard (talk) 01:26, 12 April 2017 (UTC)
 * Yes check.svg Done  JTP (talk • contribs) 02:30, 12 April 2017 (UTC)

Not cause but mechanism
"One theory regarding the cause of depression is that it is characterized by an overactive hypothalamic–pituitary–adrenal axis (HPA axis) that resembles the neuro-endocrine response to stress. These HPA axis abnormalities participate in the development of depressive symptoms, and antidepressants may serve to regulate HPA axis function. "

Not sure about this as a source. Other thoughts? Maybe it could go at "biology of depression"? Doc James (talk · contribs · email) 19:33, 12 April 2017 (UTC)

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elderly
one part of the page says that there's probably less depression in old people, and another claims that it increases — Preceding unsigned comment added by 74.65.215.149 (talk) 03:36, 19 July 2017 (UTC)

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Semi-protected edit request on 4 December 2017
Spotted two typos (though instead of thought) in the last two sentences of section 2.2.

"called postpartum depression, and is though to be the result of hormonal changes" should become "called postpartum depression, and is thought to be the result of hormonal changes"

"associated with seasonal changes in sunlight, is though to be the result of decreased sunlight" should become "associated with seasonal changes in sunlight, is thought to be the result of decreased sunlight" Nazorus (talk) 20:02, 4 December 2017 (UTC)
 * Confirmed and fixed. TylerDurden8823 (talk) 20:16, 4 December 2017 (UTC)

Avolition
Should Avolition be mentioned here? Benjamin (talk) 10:57, 27 December 2017 (UTC)

sp edit request in section 2.1 to simplify terms
"Other genes that have been linked to a GxE interaction include CRHR1, FKBP5 and BDNF"

should be changed into

"Other genes that have been linked to a gene-environment interaction include CRHR1, FKBP5 and BDNF"

to eliminate jargon and to make it more understandable to laypeople. Quidquidlatetadparebit (talk) 19:09, 5 January 2018 (UTC)

Done

Semi-protected edit request on 7 February 2018
I have five weeks to spend working on my honors english product, and in that time I am not going to be able to establish an audience for our website. We are planning on keeping track of how many visitors we get to impress out english teacher, by showing her how many people we help. It would be insanely appreciated to hyperlink our website somewhere where it would fit. Please consider our request. Dont kill urself (talk) 19:44, 7 February 2018 (UTC)
 * Red information icon with gradient background.svg Not done: I'm sorry, this amounts to advertising for your site, and Wikipedia is not for advertising or other types of promotion, even if it's for a good cause. You should consider going elsewhere for this.  Anon 126   (notify me of responses! / talk / contribs) 20:08, 7 February 2018 (UTC)

Diagnostic and Statistical Manuel criteria
It would be good if this article listed the criteria for depression as stated in the American Psychiatric Association' Diagnostic and Statistical Manuel, including difficulty sleeping, loss of appetite, complaints of inability to think or to concentrate and loss of interest in usual activities. Vorbee (talk) 18:07, 28 May 2018 (UTC)
 * I have a copy of the DSM-V criteria and can add it if there is consensus for this (although I'm bad at content edits, so someone will need to suggest where the best place to put them is). However, I should note that the criteria for Major Depressive Disorder are merely that you have had a Major Depressive Episode that isn't explained by certain other disorders, and that you also have never had any type of manic episode (which would make the correct diagnosis Bipolar instead). I assume you are actually wanting the criteria for a Major Depressive Episode. That may be more appropriate on the article thereof. —Compassionate727 (T·C) 19:06, 28 May 2018 (UTC)
 * Actually, it just occurred to me that we cannot do this because the DSM is copyrighted. —Compassionate727 (T·C) 15:38, 2 June 2018 (UTC)

Semi-protected article edit request April 5, 2018
Hello, I am part of an editing party attempting to incorporate Cochrane Reviews into Wikipedia health content. Here is some content I recommend for inclusion in this article under Management:

"Collaborative Care for Depression and Anxiety Collaborative care provides a patient with a number of health professionals to work with to manage their symptoms. It may involve a medical doctor, a case manager and a mental health specialist. A 2012 Cochrane Review of 79 randomized controlled trials that included 24,308 patients worldwide found that compared to routine care, collaborative care is better than routine care in improving symptoms of depression and anxiety for up to two years. The review also found that patients under collaborative care increased the number of patients who used medication as per current guidelines and may improve quality of life related to mental health." Mcbrarian (talk) 18:23, 5 April 2018 (UTC)
 * I think it would be WP:UNDUE to give this more than a sentence, something like, "There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care," with the Cochrane review cited as source. Also I feel that I should point out that your passage contains several grammatical errors. Looie496 (talk) 17:11, 23 May 2018 (UTC)


 * I performed this edit as per Looie496's suggestion.JenOttawa (talk) 00:47, 21 June 2018 (UTC)

Semi-protected edit request on 3 June 2018
Genetics (note: complete rewrite - this section is correctly flagged as outdated, and I was asked by the International Society for psychiatric Genetics to update)

The genetics of MDD is very complex, requiring about five times more samples to identify the same number of genes as another complex mental disorder, schizophrenia (Wray et al., 2018). Using >135,000 cases and >340,000 controls in a genome-wide association study (GWAS- make it link to https://en.wikipedia.org/wiki/Genome-wide_association_study), 44 genetic loci have been associated with MDD in 2018. This study also identified low educational achievement and obesity as causal risk factors for depression, while polygenic scores (link to https://en.wikipedia.org/wiki/Polygenic_score) confirmed previous reports of overlap of genetic risk with schizophrenia. Well published candidate genes from previous studies were not confirmed: In particular, the short allele of the promoter region of the serotonin transporter promoter gene (5-HTTLPR) has been associated with increased risk of depression in the presence of life stress, an association that has been inconsistent, with three recent reviews finding an effect and two finding none.[41][45][46][47][48] Other genes that have been linked to a gene-environment interaction also failed to be identified in this large study, including CRHR1, FKBP5 and BDNF, the first two of which are related to the stress reaction of the HPA axis, and the latter of which is involved in neurogenesis. Whether the non replication is due to lack of incorporation of environmental factors in the GWAS analysis, or in the case of 5-HTTLPR the lack of testing this variation - as it can't be well imputed from GWAS data and was hence not measured - is unclear. Large genetic studies in models that take the environment into account, such as the well characterized stress during mnedical internship (https://www.ncbi.nlm.nih.gov/pubmed/20368500) have not yet been published.

Wray et al https://www.ncbi.nlm.nih.gov/pubmed/29700475 - link already in the note about updating MMargalit (talk) 21:13, 3 June 2018 (UTC)
 * User:MMargalit can you use literature or systematic reviews of the topic in question per WP:MEDRS? Best Doc James  (talk · contribs · email) 21:24, 3 June 2018 (UTC)
 * Some fly-by nitpicking (I'll take a closer look at the entire suggestion later): I don't like beginning with the statement "the genetics is very complex," which is peacockery. I suspect there are some other prose issues likely requiring clean up, but I should look at that when my brain is working. —Compassionate727 (T·C) 23:30, 3 June 2018 (UTC)
 * Red information icon with gradient background.svg Not done for now: Per unanswered concerns raised by and .  Please continue the discussion here, and continue contributing to Wikipedia elsewhere and you'll soon be able to edit this article yourself. &#8209;&#8209; El Hef  ( Meep? ) 18:18, 22 June 2018 (UTC)
 * Okay I have added "A 2018 study found 44 areas within the chromosomes that were linked to MDD. " For obesity better refs than this is needed. Doc James  (talk · contribs · email) 18:39, 22 June 2018 (UTC)

Overly complicated
This is overly complicated for the lead "a population-attributable risk for suicide attempt of 28% for those with the disorder"

Plus it is too similar to the ref.https://books.google.ca/books?id=9jpsAwAAQBAJ&pg=PA254

Doc James (talk · contribs · email) 12:36, 6 August 2018 (UTC)

Edit request, 8 August 2018
"Depressive disorders are more common to observe in urban than in rural population and the prevalence is in groups with stronger socioeconomic factors i.e. homelessness."

As you are giving an example, you want "e.g." rather than "i.e.", and it should have a comma before it. 2.24.117.46 (talk) 13:36, 8 August 2018 (UTC)
 * . Though, I've inserted a comma before and after "e.g." since the article is written in American English, not British. -- ChamithN   (talk)  13:47, 8 August 2018 (UTC)

Paraphrasing
It is perfectly reasonable to paraphrase "50 to 70%" to about 60% in the lead IMO. Doc James (talk · contribs · email) 15:15, 8 August 2018 (UTC)


 * What value does this add to change the numbers? As I've stated, saying 50-70% is what the source says and it makes the explanation no more complex or hard to understand and its being as honest, truthful and factual as possible. Also, I see no reason why you keen removing the fact that the 5-7% figure in the introduction is, as stated by the source, what "estimates suggest". Leaving it as is makes it sound as though the 5-7% is a straight up fact, when its not. Helper201 (talk) 07:43, 9 August 2018 (UTC)


 * We paraphrase content we do not use it verbatim. Your changes make it to similar to the source. Doc James  (talk · contribs · email) 08:07, 9 August 2018 (UTC)


 * It's literally two extra words and correcting a figure, it would barely make a difference in terms of source similarity, except that it would make what is stated more factually accurate. When giving statistics we should be as accurate and specific as possible. This isn't just flowery language. Helper201 (talk) 08:11, 9 August 2018 (UTC)


 * Not thrilled on the source of this. I'll look into it. For the record, I do not think ~60% and 50-70% are convertible. There is a range that is likely integral to the understanding of the range/uncertainty. Cas Liber (talk · contribs) 08:14, 9 August 2018 (UTC)


 * The source that gives the 5-7% suggested estimate could also do with possibly being updated by another source, as these figures are cited from works published in 1998 and 2000, so the figures could be outdated and have changed since. Helper201 (talk) 08:19, 9 August 2018 (UTC)
 * We have a more recent book that says up to 8%
 * Doc James (talk · contribs · email) 08:26, 9 August 2018 (UTC)
 * We also have a 2018 review that states "Half of all completed suicides are related to depressive and other mood disorders" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068947/
 * Updated to that. Doc James  (talk · contribs · email) 08:33, 9 August 2018 (UTC)


 * I think we should try to find a way to incorporate this 8% figure into the introduction. Helper201 (talk) 08:56, 9 August 2018 (UTC)
 * Added Doc James  (talk · contribs · email) 20:48, 9 August 2018 (UTC)
 * For the record, per WP:LIMITED, we can give the exact percentages. I don't like the idea of changing what sources state on matters such as that. Flyer22 Reborn (talk) 21:01, 9 August 2018 (UTC)

Medical terms
Why is it that when editing a medical topic, such as this one, there are a multitude of medical terms that are underlined in red (indicating a spelling problem)? Even well known words such as neuroimaging, paralimbic, hypoactivity, etc. Why can't all these terms be added to the dictionary? CryMeAnOcean (talk) 06:17, 25 August 2018 (UTC)
 * You can add them to your dictionary easily. Cas Liber (talk · contribs) 07:17, 25 August 2018 (UTC)
 * Thank you, Casliber. I thought it was Wikipedia itself telling me that all these words are misspelled. CryMeAnOcean (talk) 07:21, 25 August 2018 (UTC)
 * I use Google Chrome when editing and these words are all recognised. Maybe try a different browser. Waddie96 (talk) 11:23, 25 August 2018 (UTC)

Van Gogh?
It seems very confusing to have a large anchoring work of art by Van Gogh at the top of this page. They really have nothing to do with each other. — Preceding unsigned comment added by Akteta (talk • contribs) 15:41, 30 August 2018 (UTC)
 * A lot of articles in the Emotions series have art as a description, not photos of real people.

https://en.wikipedia.org/wiki/Depression_(mood) https://en.wikipedia.org/wiki/Anxiety https://en.wikipedia.org/wiki/Horror_and_terror https://en.wikipedia.org/wiki/Wonder_(emotion) — Preceding unsigned comment added by CryMeAnOcean (talk • contribs) 19:25, 30 August 2018 (UTC)

Possible information move
I seem to recall someone mentioning a while ago that a source from a section of the page depression (mood) may be referring to major depressive disorder, instead of depressive mood and so the information should be moved from there to here. I was wondering if a discussion could be held here on people's thoughts of whether this information should be moved over to this page or left where it is. The section is titled Gender identity and sexuality with the following citation -. Hopefully analysis of the source will provide a consensus. It will also have to be determined where to integrate the information into this page without breaking this articles flow, if a move is determined to be the correct decision. I have little doubt there have been further studies done on this matter for which this one sentence could also be expanded upon, regardless of whether or not it should be moved, although I think that should be determined first.

--Helper201 (talk) 04:54, 18 September 2018 (UTC)
 * Unfortunately it is not clear in the source, which uses the term "depression" in the review. The sense that it is used suggests strongly that it means MDD, but this is not explicitly stated. In which case it is safest to leave it where it is. Cas Liber (talk · contribs) 14:11, 18 September 2018 (UTC)

Add hotline
Hotline needed on top of article to depression therapists and/or suicide prevention hotlines. We should add this since other browsers also do this, so it is normal that online encyclopaedia should be able to have this. There is also a chain of comments on the talk page of the suicide article. Oshawott 12 ==== Talk to me!  07:48, 2 December 2018 (UTC)
 * Yes this kind of thing has been discussed at the suicide page a lot, (see its archives (e.g this search) and the community has consistently decided against it. It comes down to a WP:NOT thing. Jytdog (talk) 10:02, 2 December 2018 (UTC)

Exercise as tx for MDD
Have you considered including "exercise" as one of the tx's for MDD? This source, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/ or something more recent. This paper showing no difference between medications, therapy, and exercise. MedicalEdits (talk) 17:20, 10 December 2018 (UTC)
 * Thanks for noting this . This is a review article from 2013. An ok source as per WP:MEDRS for background info (if stronger sources are not available), but not a strong source to add a claim that a particular treatment is good or bad IMO. Are there any systematic reviews or clinical guidelines that substantiate this claim?  JenOttawa (talk) 02:55, 12 December 2018 (UTC)

Depression
A Detailed description of depression is a mood disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies. It can either be short term or long term depending on the severity of the person condition.Tpsx (talk) 20:04, 13 February 2019 (UTC)

Counseling/Psychotherapies
I just changed the title from Counseling to Psychological therapies as that's what the section was covering. I needed somewhere to linked to it from Cognitive behavioral therapy. Notgain (talk) 05:23, 30 July 2019 (UTC)

Hi Doc James, The reason I changed the subheading from Counseling to Psychological therapies was that the each one of the sources in that section all refer to Psychotherapy, CBT or psychological therapies, not Counseling. Maybe I missed something. Notgain (talk) 10:53, 30 July 2019 (UTC)
 * User:Notgain Those are all forms of counselling. Doc James  (talk · contribs · email) 10:55, 30 July 2019 (UTC)


 * I can see in the history that the subheading was changed from Psychotherapy to Counseling back in 2016. As far as I am aware from the literature on depression treatment, Counseling and Psychotherapy are quite different. The two approaches listed under Counseling in this article are both commonly referred to as psychological therapies. CBT is sometimes referred to as a psycho-social treatment. See for example: See also: Management_of_depression Notgain (talk) 12:06, 30 July 2019 (UTC)
 * The NHS uses the term "Talking therapies" which I guess we could aswell. Doc James  (talk · contribs · email) 12:18, 30 July 2019 (UTC)
 * I think "talking therapies" might be a UK term whereas psychotherapy is a US term.  Notgain (talk) 12:32, 30 July 2019 (UTC)
 * Psychotherapies is a little bit more widely used but Talking therapies definitely easier for (some) laypeople to follow. I prefer either of these to counselling as they imply some sort of aim.Cas Liber (talk · contribs) 20:23, 30 July 2019 (UTC)
 * Also, according to this meta-analyses in larger trials, CBT and interpersonal therapy is more effective than supportive counseling and psychodynamic psychotherapy. Maybe the title could be "Psychological (Talking) therapies"? Notgain (talk) 01:36, 2 August 2019 (UTC)
 * Usually best to keep the title shorter. Have changed it. Doc James  (talk · contribs · email) 14:21, 2 August 2019 (UTC)

Psychedelics (ketamine, mdma) as quickly progressing promising treatment for depression
Is it still too ongoing to add it to the page?

I personally feel like the research and evidence behind effectiveness of ketamine therapy would well merit adding a mention.

Asmageddon (talk) 14:12, 11 April 2019 (UTC)


 * I think this ought to be two separate discussions. Esketamine is now FDA approved and can be considered a totally legitimate depression treatment and should be included under the section on antidepressants . Probably ketamine as well. Psychedelics (MDMA, LSD, psilocybin) I think are too experimental to add at the moment.SSyntaxin (talk) 13:36, 3 September 2019 (UTC)

Adding most recent research
I added a couple paragraphs in the Genetics subsection under Cause, from peer-reviewed sources, and matched interwiki links as closely as possible. Please let me know if you see issues and I will gladly resolve them. I am merely trying to add up-to-date information, and I did not alter anything else. Librarian lena (talk) 15:41, 6 March 2019 (UTC)

Could someone update the global incidence/frequency (listed as reference 6)? There's not an edit option for me on this page (just created an account yesterday), but I found the same source as previously used (updated for 2017). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext Goatgirl920 (talk) 03:58, 24 October 2019 (UTC)

Add paragraph to Stigma
I wrote a paragraph that I would like to add to the Stigma section:Although many efforts have been made to reduce stigma, research shows it still has significant effects. An article published in the journal Psychological Science in the Public Interest in 2014[1] discusses the complex elements of stigma and how it impacts participation in care through self, public, and structural components in the United States. The article establishes two classes of stigma barriers, personal-level barriers and provider and system-level barriers, both of which have numerous ways in which they impact seeking and participating in treatment. The article suggests multiple approaches to address each type of barrier, including education, peer support, through legislation. Here is the link to the article.https://journals.sagepub.com/doi/10.1177/1529100614531398#_i22 Goatgirl920 (talk) 19:38, 3 December 2019 (UTC)

Song that refers to this article
The authors of this article might enjoy knowing that it is referred to in the song "Vincent" by the indie rock band Car Seat Headrest (https://www.youtube.com/watch?v=bEsItsZphwQ, more than one million views at time of writing). "They got a portrait by Van Gogh / On the Wikipedia page / For clinical depression." 2601:47:4204:5F60:C14F:A13D:D019:267B (talk) 02:18, 8 April 2020 (UTC)

Semi-protected edit request on 15 May 2020
Healthylivin4u (talk) 06:35, 15 May 2020 (UTC) i want to update citations
 * Red information icon with gradient background.svg Not done: this is not the right page to request additional user rights. You may reopen this request with the specific changes to be made and someone will add them for you, or if you have an account, you can wait until you are autoconfirmed and edit the page yourself.  JTP (talk • contribs) 07:06, 15 May 2020 (UTC)

FA review needed
These issues have not been addressed. Sandy Georgia (Talk)  15:46, 20 November 2020 (UTC)

Management
... section is getting stubby ... lots of short paragraphs and information that needs to be merged or possibly removed. I see student editing here. (Also found info chunked in to the lead that was nowhere in the body, so fixed that.) Sandy Georgia (Talk)  18:50, 17 August 2020 (UTC)

Elderly
This section looks also like it was chunked in as an afterthought. It duplicates some management information, which can be merged to Management or deleted, and the rest of it can go within the other sections as appropriate (prognosis or epidemiology?). Sandy Georgia (Talk)  19:08, 17 August 2020 (UTC)

Terminology
This section is not "terminology" and some of it looks undue; relevant content can be merged elsehwere. Sandy Georgia (Talk)  19:11, 17 August 2020 (UTC)

Stigma
Out of whack, and looks like people are just chunking in random factoids here, rather than following WP:WIAFA. "There has been a continuing discussion of whether neurological disorders and mood disorders may be linked to creativity," has WHAT to do with stigma? The section is not very well written. Sandy Georgia (Talk)  19:13, 17 August 2020 (UTC)
 * Sigh....I'll compare current with featured version in the first instance for structure etc. Cas Liber (talk · contribs) 23:25, 17 August 2020 (UTC)
 * That section dates right back to the FAC. I can see it there almost unchanged in December 2008. So I think I might be the guilty party on that one. :P - I do think we need to do something about the length of the article and updating etc. Am looking now.Cas Liber (talk · contribs) 01:20, 18 August 2020 (UTC)
 * If you are guilty, so am I;) Sandy Georgia (Talk)  01:37, 18 August 2020 (UTC)

First talk message - 4th year American medical student updating the page
'''Hello! I am planning to update this article over the coming days with some updated language and diagnostic criteria. While this is part of a class, I have devoted much of my time in medical school to learning about the field of psychiatry and plan to complete post-graduate psychiatric training. Please let me know if you have further suggestions.

My first opportunities to edit showed themselves in the opening paragraphs of the Lead Section. Here is my suggested update:'''

Major depressive disorder (MDD), also known simply as depression, is a mental disorder characterized by pervasive low, or depressed, mood and/or anhedonia, a lack of interest in normally enjoyable activities.[1] In order to meet the diagnostic criteria for MDD diagnosis, one must experience two or more weeks of depressed mood or anhedonia, along with 4 or more of the following symptoms (for a total of 5 symptoms): unintentional changes in weight, dysruption to regular sleep patterns (sleeping more or less), becoming physically slowed or fidgeting uncontrollably, having low or no energy, experiencing an increase in feelings of guilt or worthlessness, disruption in concentration or volition, and thoughts of suicide.[1] Those affected may also occasionally have delusions or hallucinations. Some people have periods of depression separated by years, while others nearly always have symptoms present. Major depression is more severe, significantly affects, daily function, and lasts longer than sadness,[2] which is understood to be a normal part of life.[1]

The diagnosis of major depressive disorder is based on the person's reported experiences and a mental status examination.[3] There are no diagnostic laboratory tests for the disorder, but testing may be done to rule out physiologic conditions that can cause similar symptoms. Those with major depressive disorder are typically treated with counseling and antidepressant medication. Medication appears to be effective, but the effect may only be significant in the most severely depressed.[4] (add that citation) Dozens of psychotherapies have emerged and shown themselves to have variable efficacy, including cognitive behavioral therapy, interpersonal therapy, and behavioral activation therapy.[5] Additionally, electroconvulsive therapy (ECT) and other forms of neuromodulation may be considered if other measures are not effective.[6] Besides ECT, emerging neuromodulatory therapies include repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS).[7] Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes.


 * References

1) Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (5th ed ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN 978-0-89042-554-1. OCLC 830807378. 2) Patton, Lauren L.; Glick, Michael, eds. (2015-10-19). "The ADA Practical Guide to Patients with Medical Conditions". doi:10.1002/9781119121039.

3) "APA Dictionary of Psychology". dictionary.apa.org. Retrieved 2020-11-13.

4) Munkholm, Klaus; Winkelbeiner, Stephanie; Homan, Philipp (2020-08-27). Naudet, Florian (ed.). "Individual response to antidepressants for depression in adults-a meta-analysis and simulation study". PLOS ONE. 15 (8): e0237950. doi:10.1371/journal.pone.0237950. ISSN 1932-6203. PMC 7451660. PMID 32853222.

5) Cuijpers, Pim; Karyotaki, Eirini; de Wit, Leonore; Ebert, David D. (2020-04-02). "The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review". Psychotherapy Research. 30 (3): 279–293. doi:10.1080/10503307.2019.1649732. ISSN 1050-3307.

6) Moreines, Jared L.; McClintock, Shawn M.; Holtzheimer, Paul E. (2011-01). "Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: A review". Brain Stimulation. 4 (1): 17–27. doi:10.1016/j.brs.2010.01.005. PMC 3023999. PMID 21255751. Check date values in: |date= (help)

7) McGirr, Alexander; Berlim, Marcelo T. (2018-09). "Clinical Usefulness of Therapeutic Neuromodulation for Major Depression". Psychiatric Clinics of North America. 41 (3): 485–503. doi:10.1016/j.psc.2018.04.009. Check date values in: |date= (help)

8) Bair, Matthew J.; Robinson, Rebecca L.; Katon, Wayne; Kroenke, Kurt (2003-11-10). "Depression and Pain Comorbidity: A Literature Review". Archives of Internal Medicine. 163 (20): 2433. doi:10.1001/archinte.163.20.2433. ISSN 0003-9926.

SingingPsych (talk) 12:02, 20 November 2020 (UTC)

Hi ; welcome to Wikipedia and thank you for approaching the talk page of the article before editing. You might want to know that you can copy proposed text from your sandbox to article talk with the actual inline refs, and add after it so that the actual citations will be placed on talk automatically without you having to copy them in. There are quite a few issues with your proposed text and I hope we can orient your good work towards edits that are more likely to stick. So, in terms of the specific issues: this article does need some work and some parts of it have fallen out of date, but starting by rewriting the lead is not a recommended approach even for experienced Wikipedians. It is always better to work on the body of the article, and later rewrite the lead as a summary of the most important parts of the article. Rewriting a lead without having first written the body of the article takes the body out of sync with the lead. Please have a careful look at WP:LEAD.
 * My first concern is whether your instructor (, who has never edited Wikipedia) or or  explained to your course that students are discouraged from editing Featured articles (FA) as they are a very hard place to start learning about Wikipedia guidelines, policies and conventions. There was no talk page notification here that you planned to edit, so I regret that your effort may have been wasted, as most of your proposed changes won't work.  This particular FA is curated by an experienced Wikipedian who is also a practicing psychiatrist  and you might enjoy collaborating with Cas on future endeavors here.
 * Please have a look at WP:MEDMOS, WP:WIAFA, WP:LEAD, WP:OWN and WP:TECHNICAL as they are the background for some of the issues with your proposed text.
 * 1) We would not typically introduce a word like anhedonia in the lead.  Leads are supposed to be more accessible to layreaders than the rest of the article, and that is not a word we need to teach readers right off. See WP:MTAU.
 * 2)  We would not typically use a dictionary definition in a featured article as a better source is likely to be available.
 * 3) When citing the DSM, you should give a page number (yes, I know, that hasn't been done throughout other Featured articles, but see WP:OTHERSTUFFEXISTS.  Ditto for books.
 * 4) FAs require a consistent citation style. (See WP:WIAFA). This article uses the Diberri Boghog citation filler tool that generates a citation from a PMID and uses Vancouver author format.  (You have generally provided no PMIDs.)
 * 5) Listing out the diagnostic criteria in detail the lead is not an appropriate summary. It burdens the lead with excess detail.  The lead gives an overview that hopefully will entice the reader to continue reading.


 * Prose issues and WP:MOS issues:
 * In order to meet the diagnostic criteria for MDD diagnosis, ... in order to is almost always redundant ... see Tony1's writing exercises in the Advice section of this link.
 * along with 4 or more of the following symptoms (for a total of 5 symptoms): ... this breaches WP:MOSNUM (digits less than ten are spelled out in most, not all, circumstances). That sort of thing is fine for articles that are not Featured, but provides an example of why it is harder to begin editing with a featured article.
 * See WP:ENGVAR. This article uses American English, not British ... dysruption to regular sleep patterns ... followed in the same sentence by a switch back to ... disruption in concentration or volition,
 * Your proposed first para covers diagnosis, yet so does the second. Leads need to be organized in a way that the main points are covered in a broad summary.
 * Additionally, electroconvulsive therapy ... see Tony1's writing excercises ... additionally is redundant.

These are only intended as samples to show you why your effort, which would be an exemplary start on an article that is not already assessed at the FA level, cannot be implemented in an FA. My recommendation is that you start work on an article that is not an FA, or you work on the parts in the body of this article that need updating, so that those improvements can later be summarized to the lead. Best regards, Sandy Georgia (Talk)  15:28, 20 November 2020 (UTC)


 * Should you decide to continue working at this page, I suggest the list at the top of this talk page, under FA review needed are issues you might want to tackle. Alternately, if you still wish to work on DSM criteria, that would be at Major depressive disorder, realizing that we have to take great care in how protective DSM is of their copyright. Sandy Georgia  (Talk)  15:49, 20 November 2020 (UTC)

this Featured article has now been tagged by another course:. Sandy Georgia (Talk)  15:52, 20 November 2020 (UTC)


 * Dear ,


 * Thank you for the warm welcome and the thoughtful, comprehensive feedback. I've learned quite a lot from the information that you've shared. In reading and completing edits to my sections, I will say that I found myself feeling disappointed by the article's current disrepair, despite its being a featured article. I would hope that the DSM-IV citations would eventually be cleaned up and that the language default to the most current edition (published in 2013); there is even an article from the American Journal of Surgery (citation 23), which does not appear to be related to the information to which it is attached. I did complete a similar review of the Symptoms & Signs section and have chosen to leave that work, below. I hope that my work will inspire updates to this highly-trafficked page. Alternatively, you may view these updates on my sandbox page: https://en.wikipedia.org/wiki/User:SingingPsych/sandbox


 * Kind regards,


 * SingingPsych (talk) 19:45, 21 November 2020 (UTC)


 * Yes, the article is in need of updating, so I don't want you to feel discouraged :) It's just that you picked a hard place to start, and editing the lead first is backwards :)  When you get a chance, have a look at this edit in edit mode, so you can see how to introduce paragraphs, and how to indent subsequent responses by adding one colon more than the previous post. That is, edit this page, and then scroll back to see how I have formatted this post. I will next look at your other proposal. Good talk page practices will allow us to better collaborate, which I look forward to! Sandy Georgia  (Talk)  19:56, 21 November 2020 (UTC)


 * Recommended edits to the Symptoms & Signs section:


 * Depression affects many aspects of an individual's life, and, in turn, is affected by many aspects, such as race, ethnicity, disability status, and comorbid medical conditions.[10] For example, there is a relationship between symptoms of depression and difficulty maintaining family and personal relationships;[9] however, research has also shown the presence of social bonds to be protective.[8]


 * A person having a major depressive episode usually exhibits a low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities.[1] These symptoms can also be characterized as persistent irritability in some patients.[1] Depressed people may be preoccupied with—or ruminate over—thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness or hopelessness.[1] In severe cases, depressed people may have symptoms of psychosis.[1] These symptoms include delusions or, less commonly, hallucinations, which are usually unpleasant, though this association is confounded by attribution bias; mood-incongruent psychosis is often attributed to a primary psychotic disorder, such as schizoaffective disorder.[12] Other symptoms of depression include disruptions to sleep (with insomnia being more common, hypersomnia is a feature in many patients), changes to energy level, poor concentration and memory, withdrawal from social situations and activities, and thoughts of death or suicide.[1]


 * There is also a strong relationship between depression and patient-reported pain.[11] A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems.[13] Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.[1] Family and friends may notice that the person's physical movements to be either agitated or slowed, termed psychomotor agitation and retardation, respectively.[1] Older depressed people may also have more notable cognitive symptoms of recent onset, such as forgetfulness, as a result of comorbid neurological decline associated with aging.[14]


 * Children with affective disorders often display an irritable mood rather than a depressed one, necessitating consideration of the diagnosis disruptive mood dysregulation disorder.[1] Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness."


 * References
 * 1) Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (5th ed ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN 978-0-89042-554-1. OCLC 830807378.


 * 2) Patton, Lauren L.; Glick, Michael, eds. (2015-10-19). "The ADA Practical Guide to Patients with Medical Conditions". doi:10.1002/9781119121039.


 * 3) "APA Dictionary of Psychology". dictionary.apa.org. Retrieved 2020-11-13.


 * 4) Munkholm, Klaus; Winkelbeiner, Stephanie; Homan, Philipp (2020-08-27). Naudet, Florian (ed.). "Individual response to antidepressants for depression in adults-a meta-analysis and simulation study". PLOS ONE. 15 (8): e0237950. doi:10.1371/journal.pone.0237950. ISSN 1932-6203. PMC 7451660. PMID 32853222.


 * 5) Cuijpers, Pim; Karyotaki, Eirini; de Wit, Leonore; Ebert, David D. (2020-04-02). "The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review". Psychotherapy Research. 30 (3): 279–293. doi:10.1080/10503307.2019.1649732. ISSN 1050-3307.


 * 6) Moreines, Jared L.; McClintock, Shawn M.; Holtzheimer, Paul E. (2011-01). "Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: A review". Brain Stimulation. 4 (1): 17–27. doi:10.1016/j.brs.2010.01.005. PMC 3023999. PMID 21255751. Check date values in: |date= (help)


 * 7) McGirr, Alexander; Berlim, Marcelo T. (2018-09). "Clinical Usefulness of Therapeutic Neuromodulation for Major Depression". Psychiatric Clinics of North America. 41 (3): 485–503. doi:10.1016/j.psc.2018.04.009. Check date values in: |date= (help)


 * 8) Santini, Ziggi Ivan; Koyanagi, Ai; Tyrovolas, Stefanos; Mason, Catherine; Haro, Josep Maria (2015-04). "The association between social relationships and depression: A systematic review". Journal of Affective Disorders. 175: 53–65. doi:10.1016/j.jad.2014.12.049. Check date values in: |date= (help)


 * 9) Saris, I. M. J.; Aghajani, M.; van der Werff, S. J. A.; van der Wee, N. J. A.; Penninx, B. W. J. H. (2017-10). "Social functioning in patients with depressive and anxiety disorders". Acta Psychiatrica Scandinavica. 136 (4): 352–361. doi:10.1111/acps.12774. PMC 5601295. PMID 28767127. Check date values in: |date= (help)


 * 10) Rhee, Taeho Greg; Steffens, David C. (2020-10). "Major depressive disorder and impaired health‐related quality of life among US older adults". International Journal of Geriatric Psychiatry. 35 (10): 1189–1197. doi:10.1002/gps.5356. ISSN 0885-6230. Check date values in: |date= (help)


 * 11) Bair, Matthew J.; Robinson, Rebecca L.; Katon, Wayne; Kroenke, Kurt (2003-11-10). "Depression and Pain Comorbidity: A Literature Review". Archives of Internal Medicine. 163 (20): 2433. doi:10.1001/archinte.163.20.2433. ISSN 0003-9926.


 * 12) Nelson, J. Craig; Bickford, David; Delucchi, Kevin; Fiedorowicz, Jess G.; Coryell, William H. (2018-09). "Risk of Psychosis in Recurrent Episodes of Psychotic and Nonpsychotic Major Depressive Disorder: A Systematic Review and Meta-Analysis". American Journal of Psychiatry. 175 (9): 897–904. doi:10.1176/appi.ajp.2018.17101138. ISSN 0002-953X. Check date values in: |date= (help)


 * 13) Baek, Younghwa; Jung, Kyungsik; Kim, Hoseok; Lee, Siwoo (2020-12). "Association between fatigue, pain, digestive problems, and sleep disturbances and individuals' health-related quality of life: a nationwide survey in South Korea". Health and Quality of Life Outcomes. 18 (1): 159. doi:10.1186/s12955-020-01408-x. ISSN 1477-7525. PMC 7254742. PMID 32460755. Check date values in: |date= (help)


 * 14) "Cognitive Difficulties Associated With Depression - Psychiatric Times". web.archive.org. 2009-07-22. Retrieved 2020-11-21.


 * I have removed the excess markup (bolding) from your post above (discouraged as it makes talk pages harder to read), and hatted off the references section, which are adding unncessary bulk to the talk page. You can put your proposals on talk, with actual citations, followed by a   Will look at your proposed text once I get these formatting issues under control for ease of reading :) Sandy Georgia  (Talk)  20:01, 21 November 2020 (UTC)


 * I left a message on your talk page about how to better format your article talk page posts; we can talk about that over there. On your proposed text:
 * Have a look at Manual of Style/Medicine-related articles relative to the sections that already exist at this article and how this article is organized. The first paragraph in your proposed text goes beyond what would typically be in "Signs and symptoms" to text that is normally included in other sections.
 * ... however, research has also shown the presence of social bonds to be protective ... has two problems. Prose is expected to be of professional quality on FAs, and the  overuse of however is a frequent issue, along with in total, additionally, in order to, also and subsequently.  Have a look at How to improve your writing and Redundancy exercises.  Wikipedia writing has a very different tone than typical student essay writing, and even journal writing; see  Manual of Style/Medicine-related articles.  If you had not picked an FA to start, this would not be a big issue, but on a Featured article, prose quality matters.  The second issue is that we would rarely say "research has also shown", because FAs should rely only on high quality sources, and we can typically either state something as a fact or not ... without having to buttress it with editorializing, except in rare instances.
 * A person having a major depressive episode usually exhibits a low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities.[1] These symptoms can also be characterized as persistent irritability in some patients. The second sentence says "these symptoms" but it refers back to only one symptom, low mood.  We avoid "patients"; again, to start at the FA level, you should be familiar with all of Manual of Style/Medicine-related articles.
 * though this association is confounded by attribution bias; mood-incongruent psychosis is often attributed to a primary psychotic disorder, such as schizoaffective disorder. ... is more appropriate to a section on Differential diagnosis rather than Signs and Symptoms. We understand precisely what "confouned by attribution bias" means, but our readers are not likely to-- that would need to be rephrased.
 * Generally your writing is VERY high quality, so I don't want you to feel discouraged ... just explain why we encourage students not to tackle Featured articles first.  It seems like what you really want to do is update the Diagnosis section to DSM-5, so why not give that a try first? Sandy Georgia  (Talk)  20:25, 21 November 2020 (UTC)

Depression and sick leave / return to work
I intend to update the page with information from a recent Cochrane Review as follows:

Depression may affect people's ability to work and it is the third most common cause of disability.(1) A Cochrane review found that the combination of care and help with return to work reduced sick leave with 24 days over de period of one year.(2) This meant a 15% reduction of sick leave. In addition, the participants in the study had fewer depressive symptoms and their work capacity increased. Simply helping patients to return to work without a connection to clinical care did not have this effect. Other interventions additional to the care that the patients already received also reduced sick leave. The addition of psychological treatment, such as online cognitive behavioural therapy, to the care that the patients already received reduced sick leave by 15 days. Improving the organisation of care by streamlining care or adding specific providers for depression care, also helped to reduce sick leave but this was only the case in well-conducted studies.

1)GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7. Epub 2018 Nov 8. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. PMID: 30496104; PMCID: PMC6227754. 2) Interventions to improve return to work in depressed people. Nieuwenhuijsen K, Verbeek J, Neumeyer-Gromen A, Verhoeven AC, Bültmann U, Faber B https://doi.org/10.1002/14651858.CD006237.pub4

Jos Verbeek Joshver (talk • contribs) 15:13, 14 December 2020 (UTC)
 * Thank you for suggesting this improvement . I have a few small formatting changes and suggestions to simplify/share the conclusions of the study without describing the study. Rarely do we need to explain the study in Wikipedia, except in the case where different high-qualilty sources report different findings. Suggestions:
 * Depression may affect people's ability to work and it is the third most common cause of disability. The combination of care and help with return to work may reduce sick leave by 15%, lead to fewer depressive symptoms, and lead to an improved work capacity. Simply helping people with depression to return to work without a connection to clinical care has not been shown to have this effect. Additional interventions including the addition of psychological treatment such as online cognitive behavioural therapy to the care that the patients already received, also reduces sick days. Improving the organisation of care by streamlining care or adding specific providers for depression care, may also help to reduce sick leave.
 * Please let me know what you think and verify that my interpretations are correct.
 * JenOttawa (talk) 11:59, 17 December 2020 (UTC)
 * I would be happy to make this edit, or if you prefer that is great as well!JenOttawa (talk) 12:01, 17 December 2020 (UTC)


 * That proposal would need to be copyedited for redundancy reducing (too much also and additionally and fluff like simply) and I believe the articles use AmEng.
 * Depression may affect people's ability to work and is the third most common cause of disability (after X and Y). The combination of care (what does the generic word care mean here ?) and help (What kind of help?) with return to work may reduce sick leave by 15%, and lead to fewer depressive symptoms and improved work capacity. Helping people with depression to return to work without a connection to clinical care has not been shown to have this effect. Interventions such as adding online cognitive behavioral therapy also reduce sick days. Streamlining care or adding specific providers for depression care may also help to reduce sick leave.
 * Also, WP:CITEVAR (Diberri-Boghog format) so cleanup isn't needed (see WP:WIAFA). Sandy Georgia  (Talk)  14:19, 17 December 2020 (UTC)
 * Thanks for the great suggestions Sandy to improve this. I do not understand the citation comment. I just added the citations provided by Jos using the normal "cite" tool that is provided for Wikipedia editors and autopopulates the field using the doi or PMID (I believe that I used the DOI for these). The tool seemed to work fine, other than sometimes it muddles the date. I did not mean to change the format. Thanks again for reviewing!JenOttawa (talk) 14:45, 17 December 2020 (UTC)
 * Reading your link, I see that the citation tool should not be used? "consistent citations: where required by criterion 1c, consistently formatted inline citations using footnotes —see citing sources for suggestions on formatting references. Citation templates are not required." JenOttawa (talk) 14:49, 17 December 2020 (UTC)
 * Hello! I reached out to this contributor and they are having technical difficulties replying here. Sandy, your content-related suggestions are greatly appreciated. They have written the following in response to your suggestions. Once we decide on content, I can add back in the references. I may not have time to return back today, but I will be back soon! Thanks again.JenOttawa (talk) 13:24, 18 December 2020 (UTC)
 * Depression may affect people's ability to work and is the third most common cause of disability after low back pain and headache. The combination of usual clinical care and support with return to work probably reduces sick leave by 15%, and lead to fewer depressive symptoms and improved work capacity. Support actions for return to work include interventions like working less hours or changing tasks. This combination of clinical and work-directed care reduces sick leave by 25 days over a year. Helping people with depression to return to work without a connection to clinical care has not been shown to have an effect. The same review found that additional psychological interventions such as online cognitive behavioral therapy led to fewer sick days compared to only care that persons with depression usually receive. Streamlining care or adding specific providers for depression care may also help to reduce sick leave.JenOttawa (talk) 13:24, 18 December 2020 (UTC)


 * Thanks, Jen ... it is quite wordy ... I will work on it later today from a real computer (iPad typing now). Sandy Georgia (Talk)  16:16, 18 December 2020 (UTC)

Thanks for doing this, JenOttawa ... I propose:


 * We don't need to mention the review; facts are facts. Additional problems in this text: the second sentence belongs in Epidemiology, while the rest goes maybe in Prognosis (?), so some separation is needed. It is also unclear to me if further separation of this text is needed, to place some of it in Management/treatment.(This is another recurring problem I find with Cochrane-based text insertions ... sorting it all out is time-consuming ... we can't usually just drop all of Cochrane text in to one place, which is almost always done.  This text needs to be worked in properly to the existing sections.) Sandy Georgia  (Talk)  19:18, 18 December 2020 (UTC)
 * Added sentence on epidemiology here: https://en.wikipedia.org/w/index.php?title=Major_depressive_disorder&type=revision&diff=999093127&oldid=996469387&diffmode=source JenOttawa (talk) 13:09, 8 January 2021 (UTC)
 * Moved section about work to prognosis section. https://en.wikipedia.org/w/index.php?title=Major_depressive_disorder&type=revision&diff=999095216&oldid=999093127&diffmode=source JenOttawa (talk) 13:26, 8 January 2021 (UTC)

Formatting and inserting the citations in this FA article
The article uses the Diberri-Boghog format, which is Vancouver style authors, with more than five authors truncated to three plus et al (although someone, grrr, has been switching that to six). Whenever working on a featured article, one should check which citation style is used, and on Wikipedia's featured article it is almost always Diberri, and almost never the horrid cite tool provided by the software, which does NOT populate PMIDs, while Diberri DOES populate DOIs from PMIDs. That tool is here. You'll see it doesn't generate long dreadful strings of author names to have to edit around, and it does populate all the needed fields.This, for example, is horrible to edit around: |last=James|first=Spencer L|last2=Abate|first2=Degu|last3=Abate|first3=Kalkidan Hassen|last4=Abay|first4=Solomon M|last5=Abbafati|first5=Cristiana|last6=Abbasi|first6=Nooshin|last7=Abbastabar|first7=Hedayat|last8=Abd-Allah|first8=Foad|last9=Abdela|first9=Jemal|last10=Abdelalim|first10=Ahmed|last11=Abdollahpour|first11=Ibrahim ) compared to:  |vauthors= James SL, Abate D, Abate KH, et al  Not only is that a dreadful and unhelpful string to have to edit around, it produces a clunky and long author result in the sources, compared to Vancouver authors favored on most of our medical content. The cleaner Diberri format is the one used for most of our medical featured content, and indeed, the format established by WP:CITEVAR on most of our medical content, as almost all of the founding WPMED editors used it. By using it, we don't make other editors have to go and look up the PMID to find what kind of source is being used (that is, whether it is a review); note that the second source given above does not include a PMID, which I have had to go look up (where I found confusion). I have the custom of separately adding |type= Review parameter so I can keep track of which I have checked. So, for example:
 * And, there are problems with the Cochrane review being cited. See this Pubmed search ... which one is the review being used, where's the PMID, and why is there no 2020 review listed at PMID?  In other words, no PMID, so I can't use the Diberri tool to format the citation (and will have to manually correct it), and I've now spent about half an hour on citation cleanup (hence, WP:CITEVAR). When citations are added to medical articles using the (inferior) citation style provided by the software to a Featured article, it causes a lot of work for other editors. Switching to the Diberri format is recommended :) Sandy Georgia  (Talk)  15:50, 17 December 2020 (UTC)
 * And, there are problems with the Cochrane review being cited. See this Pubmed search ... which one is the review being used, where's the PMID, and why is there no 2020 review listed at PMID?  In other words, no PMID, so I can't use the Diberri tool to format the citation (and will have to manually correct it), and I've now spent about half an hour on citation cleanup (hence, WP:CITEVAR). When citations are added to medical articles using the (inferior) citation style provided by the software to a Featured article, it causes a lot of work for other editors. Switching to the Diberri format is recommended :) Sandy Georgia  (Talk)  15:50, 17 December 2020 (UTC)


 * On a separate but related issue, the need for page numbers on long journal articles is now being enforced on medical articles, as it is for all other content areas, so please add specific page numbers or section headings when adding new content (even if only as an inline comment). A page range like 1789–1858 (69 pages!) is more than we accept for meeting WP:V. If an exact page is not available, a section heading, chapter name, or table name suffices. See complete blood count, Buruli ulcer, and dementia with Lewy bodies for correctly citing page nos per verifiability policy. Sandy Georgia  (Talk)  15:58, 17 December 2020 (UTC)
 * Thanks for taking the time to explain this and provide examples. I have reached out to Jos (above) to see if they have further suggestions for clarifying the content. JenOttawa (talk) 16:00, 17 December 2020 (UTC)
 * My pleasure :) I took the extra time here because I have already done this now three times (two previous at WT:MED and with other new Cochrane editors), and made no progress :)  Boghog and I just go clean them up ourselves ... Sandy Georgia  (Talk)  16:02, 17 December 2020 (UTC)
 * Thanks. I think that it is definitely difficult for new users to Wikipedia, as it is a more complicated editing process than using the cite tool and learning to transition between the visual editor and code-based editor if they prefer the visual editor. It is great that you cleaned those up. Thanks. WP:MEDHOW calls this "another method". Should FA articles be highlighted here as requiring this if this is the consensus versus using the citation tool? I wonder if we can link to the approprate citation creation tool in the FA warning message that comes up when you try to edit this article, for example. Do you have a suggestion of how a newer editor (who has expertise in a field to interpret evidence but is not as comfortable with code-based editing) can learn this and what the work-flow would be for editing? JenOttawa (talk) 16:41, 17 December 2020 (UTC)
 * I could play around with the editnotice, to see if I can work in mention of citation style, but I suspect it wouldn’t get read, since no one reads anything. I don’t use (hate) the visual editor, so do not know how it is contributing to this problem, but we do see it with most new editors. I also find the cite tool horrible to use, but have noticed that it causes inferior citations being added across featured articles, not just medical. I believe pages like MEDHOW came about during the period when WPMED became unconcerned with developing or maintaining the project’s featured articles, which has been a shame, as most of our top and most-viewed content has fallen into complete disrepair and inaccuracy as a result. Sandy Georgia  (Talk)  16:50, 17 December 2020 (UTC)

5-HTTLPR
The article refers to "the 5-HTTLPR gene, which codes for serotonin receptors". That's not what the 5-HTTLPR article says. The latter says 5-HTTLPR is part of the gene which codes for serotonin transporters. I would edit this article but I don't know whether this article is wrong or the other one! Neither has a reference to back up its statement. Bruce Mardle (talk) 16:42, 24 March 2021 (UTC)