Talk:Major depressive disorder/Archive 2

Archive 1

Complementary and alternative therapies
I'm showing the reasons for my edits to the complementary and alternative medicine section here. bodnotbod (username added by Denni)


 * I'm ading my comments as well, in  this color  Denni


 *  My first reaction on reading what was added was sadness and disappointment. First, the addition is badly flawed in terms of style and composition, and brings an otherwise decent article to a jarring conclusion. Second, it wanders aimlessly in a desert of lower back pain, fish oil, and palliative care, which not only have nothing whatsoever to do with depression but which, in their contexts, come across strongly as excuses for adding this additional component. 

There is a strong association between depression and complementary and alternative medicine.

Poorly worded. One interpretation of this sentence is that clinical depression often follows any foray into the world of alternative medicine (perhaps due to the loss of your hard won earnings). I might be tempted to agree with that but I'm sure that's not what is intended. I suggest:

There are complementary and alternative treatments for depression.


 *  Bodnotbod's interpretation of this sentence is how I would read it as well. I would also agree that such an outcome is a distinct possibility.

''The strongest connection can be found in complementary medicine which is well known for using palliative care to treat cancer patients. Some research has strongly suggested that treating depression in cancer patients extends both their quality of life and survival duration.''

I can't confirm or dispute this, so I'll leave it.


 *  "strongly suggested"? While there may be some benefit to quality of life, it almost angers me to see the implied connection between mood and life extension. May I see citations?

''Orthomolecular medicine, a form of alternative medicine, uses nutritional supplements like fish-oil and vitamins B-12 to affect both physical and mental health. Dr. Malcolm Peet of the Swallownest Court Hospital in Sheffield, England and his colleague found that depressed patients who received a daily dose of 1 gram of an omega-3 fatty acid for 12 weeks experienced a decrease in their symptoms, such as sadness, anxiety and sleeping problems. "Vitamin B12 may be causally related to depression, whereas the relation with folate is due to physical comorbidity," say investigators from Erasmus Medical Centre in Rotterdam, the Netherlands.''

I've read a few articles on B12 and fish oils myself in the past, it's been widely reported. See for eg. I'm unhappy about having the reference to Orthomolecular medicine, however the article does say that critics state diet alone might be better than huge supplemental doses, which would be my argument. But I can't justify deleting this, I guess.


 *  I see no need to delete the references to fish oils and fatty acids. There is a connection between diet and mood, but there is no need to invoke orthomolecular medicine or alternative medicine when mainstream clinicians accept that diet and mood are related. Please note that mood is only a symptom of depression. It is not the illness itself. And there is, unless Mr. N-H can provide supporting documentation, no evidence I am aware of that either of these treatments addresses the underlying pathology.

''The treatment of depression with adjunctive psychological therapy is a well know part of complementary medicine. The Mind-Body or Psychosocial Interventions of alternative medicine are preoccupied with using the power of the mind to affect physical health. Depression has a major effect on both mental and physical health. Researchers have mapped what happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form of psychological treatment aimed at breaking the bad habits of thought that bring people low. Using cognitive behavioral therapy to treat the medical condition called clinical depression is a form of alternative medicine.''

I'm deleting this paragraph since therapy has a section of its own which includes CBT which I don't feel is commonly regarded as an alternative therapy. I've never heard of alternative therapy or complementary medicine being used in the same breath as CBT. And I'm undergoing CBT and have been encouraged by my therapist to read about it, so this isn't just an idle objection.


 * I just love how people reason, I am not aware of it so it obviously is not true. I got the same response in alternative medicine.  Well it is in alternative medicine along with some citations.  I want most of this paragraph back as it is really the most important link. -- John Gohde 08:31, 4 Jun 2004 (UTC)


 * OK. So we have a legitimate debate.  The question being is: is CBT alternative medicine?  You've pointed me to the article alternative medicine which has a lot of citations.  I'd be grateful if you'd put the link or links to the specific citations here so that I can see them.  I say this with genuine interest. --bodnotbod 22:44, Jun 4, 2004 (UTC)


 * My psychotherapist is Jungian, which ought to impress the pants off "alternative" people from the start, but she would take your pseudo-New-Age-crystal-healing-aura vibes-Urantian crap and stick it right up your excretory orifices so far you would complain loudly, Mr. Sock Puppet. I will not dispute you for a =second= if you decided to begin an encyclopedia called "Gullipedia." In the meantime, get your sad ass and your silly sock puppets out of here and see if you can't cadge a few quarters on a streetcorner somewhere. Denni 02:13, 2004 Jun 5 (UTC)


 * I speak in the same breath as Bodnotbod on this one. If mainstream treatment uses certain techniques to achieve certain goals, it serves no purpose to mention in an article unrelated to alternative medicine that alternative medical treatments do the same. And quite frankly, I have a hard time believing this one anyway.

''Many different branches of alternative medicine are famous for treating lower back pain. The researchers, from the University of Alberta, followed a random sample of nearly 800 adults who started out without neck or back pain. They found those suffering from depression were four times more likely to develop intense or disabling neck and lower back pain than those who were not depressed. The treatment of back pain, would be another application of adjunctive psychological therapy, or the Mind-Body / Psychosocial Interventions which are the bread and butter of many fields of alternative medicine (See cited research shown below).''

This is reaching, isn't it? You seem to be leaping on a number of distantly parted stepping stones to get to a very broad and unhelpful conclusion:


 * The first sentence is baffling the reader of a depression article, as it refers only to back pain.
 * You link back pain with depression - but it is really only talking about those in the venn diagram suffering both back pain and depression, so this is not useful to anyone not suffering from both.
 * You then mention psychological therapy which is a controversial use of the words alternative and complementary, and is an area already detailed earlier in the article outside of this section.
 * (passing comment: bread and butter may not be a helpful phrase to the non US/British reader, so I would lose it).
 * You make a sweeping statement which seeks to pull talking therapies into the realm of alt and comp. medicine.

Essentially this whole paragraph is based on one piece of research. There is a vast wealth of research on depression, why pluck this one out of the air? Is it useful? I would say that it should be replaced with something more general for my venn diagram reason: ie use research that concentrates solely on depression not those who suffer depression and pain.


 * The only saving grace of this dog's breakfast of a paragraph is that it mentions my alma mater. Depression nearly killed me, but I never had a moment's back pain. My mother suffered incredible lower back pain, and her bad days were as a consequence of it, not the other way round. I like Bodnotbod's Venn diagram reasoning, and I would further note that if depression and lower back pain go together, it is far more likely that the latter is the cause of the former.

So, to the references:

''Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9. PMID: 12365878 Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12365878&dopt=Abstract) ''

I have absolutely no clue what this means, so I'll keep it and hope someone else throws it out for being unhelpful to the reader.
 * It is intersting that in the article the patients were being treated with usual antidepressants. The study was done by physicians.  Not alternative medicine, just good research. Kd4ttc 20:17, 5 Jun 2004 (UTC)

''Tiemeier H, Van Tuijl HR, Hofman A. Vitamin b(12), folate, and homocysteine in depression: the rotterdam study. Am J Psychiatry. 2002 Dec;159(12):2099-101. PMID: 12450964 Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12450964&dopt=Abstract)''

I don't object to this, although I always think layman's press coverage of subjects is more helpful to the reader, ie the BBC article.

''Kimberly Goldapple, Zindel Segal, Helen Mayberg. Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy. Arch Gen Psychiatry. 2004;61:34-41. Abstract (http://archpsyc.ama-assn.org/cgi/content/abstract/61/1/34)''

Deleted because CBT was discussed earlier in the article before the alternative therapy section appeared, the claim that CBT is an alternative treatment is controversial.


 * Why don't I put it in terms that you can relate to. When your psychologist starts practicing medicine without a license by treating a medical condition with CBT he does it legally as a form of alternative medicine.  Also, need I point out that there is a new field called Health pyschology where psychologists are also practising medicine legally with a license. -- John Gohde 08:37, 4 Jun 2004 (UTC)


 * My therapist (I don't think she would call herself a psychologist) has had training and has achieved qualifications. I'm not qualified to speak about licensing.  Perhaps the legal position is different here in England (where I live and receive treatment) to where you reside.  Your argument is hampered somewhat by the fact that Health psychology is not an article as yet. --bodnotbod 22:50, Jun 4, 2004 (UTC)

''Carroll LJ, Cassidy JD, Cote P. Depression as a risk factor for onset of an episode of troublesome neck and low back pain. Pain. 2004 Jan;107(1-2):134-9. PMID: 14715399 Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14715399&dopt=Abstract)''

Since the paragraph it relates to is now deleted I've deleted the reference, although I think it is interesting and could be used in a different context.

All of the above is just my opinion of course, and I'll be actively canvasing for comments on what I've done.


 * I see nothing to disagree with in Bodnotbod's analysis. The alternative therapies addition to this article has not listed any real alternative therapies, such as, say, crystal healing, and everything else which has been added strikes me a lot like tying a giant tuna to the top of your car. Yes, with difficulty you can do it. But why in heaven's name would you want to?  Denni 17:54, 3 Jun 2004 (UTC)


 * Yeah, the impression I get is that the contributions were more an attempt to get something, anything complementary into this article but were not written with a good knowledge of how the field applies in this case. There is an alternative treatment which has received a lot of coverage.  But first the coverage was very positive and then more recently it was very negative.  I'm talking about St. John's Wort. --bodnotbod 18:37, Jun 3, 2004 (UTC)

--bodnotbod 14:18, Jun 3, 2004 (UTC)

I for one am not receiving any pyschotherapy. You have my condolences. I suggest that you educate yourself, some. I have no duty to educate people who are 30 years out of date. Cheers ... -- John Gohde 07:23, 5 Jun 2004 (UTC)


 * Oh good. At least we know where you stand now.  I have not sought to denigrate you personally, but your comments about my lack of education pretty much mark you out as unlikeable.  Worse, for a Wikipedian, you're unable to write informatively, with grace or with authority.  Rest assured I will not put so much effort into stating why I've removed your edits in the future.  Perhaps you should find an alternative medicine to cure your spite.  --bodnotbod 14:53, Jun 6, 2004 (UTC)


 * Since these science people have only demonstrated bigoted, obnoxious, time wasting behavior towards this WikiProject they are clearly more interested in trolling then in improving Wikipedia. Everywhere we have actually bothered to state our views, our ASBs etc. have been deleted / vandalized. Everywhere where we have wasted time doing what you people have asked for our ASBs etc. have been deleted / vandalized. Do you really think that I am going to waste my time wading through the above garbage that was written by a bunch of ignorant bigots? ::-- John Gohde 14:29, 6 Jun 2004 (UTC)


 * Personally, I have found science more reliable as a guide to predictable behavior than pseudoscience. Neither astrology or entrail-reading have proven too useful, and medical science in particular has brought considerably more benefit than chelation therapy, crystal healing, pyramidal hats, and other nonsense that seems to cause you to to writhe in ecstacy. My suggestion to you is to start your own Wiki. "WikiSilly" and "WikiFoolish" spring immediately to mind, and I have no doubt you could collect a huge following in short order, considering the number of gullible people who seem to collect wherever easy answers to hard questions can be found. I am neither ignorant nor a bigot, but I am absolutely intolerant of deliberate fools. Not pointing any fingers, of course. Denni &hArr; 03:06, 2004 Jun 8 (UTC)


 * Well John, I hope you will see from my contributions that I have not vandalised any of your articles. I hope you'll also acknowledge that the Depression and Alternative Medicine section remains in the article despite the resrervations voiced here.  As for wasting your time wading through the above: I would suggest that if you don't you are likely to waste more of your own time, and more of everyone elses since without debate all that can happen is a) nothing, or b) an edit war without meaningful discussion. --bodnotbod 16:00, Jun 8, 2004 (UTC)

While I generally think alternative medicine is a pile of hogwash, it's arguable that much psychiatry is a similar pile of hogwash. In particular, an increasing number of studies are showing that antidepressants have a long-term effect indistinguishable from "active placebos". More generally, the entire "medical model" of modern psychiatry (the "pill-pusher model", if you wish to be derogatory) is increasingly controversial. This article doesn't really address the controversy, being more of a regurgitation of the DSM, which represents only one particular view (and a somewhat extremist one at that) than an actual encyclopedia article on all sides of the issue. --Delirium 07:00, Jun 8, 2004 (UTC)


 * Well please do add info on those issues, I would be most interested to read them. --bodnotbod 15:56, Jun 8, 2004 (UTC)

Folks, I am really confused here. My understanding of alternative therapies is largely as defined in Alternative medicine. That is something that "diverges from generally accepted medical methods." Whilst there is certainly robust debate about CBT and has been for many decades, CBT follows the accepted scientific process in assessing its effects and is seen as a valid and useful form of therapy by most in the tradtional health professions. In 25 years of working in the field of mental health I have never heard it categorised as alternative. I realise that this is a pretty cold arguement but I have only just come across it. --CloudSurfer 06:41, 12 Sep 2004 (UTC)

Alternative medicine
''This section was largely the work of Mr Natural Health and I've removed it, in part, because of, note the 3 month ban imposed. I do not say it should necessarily all go, but what is worth keeping needs substantial rewriting to keep it relevant to the article I feel. But, at any rate, we can talk it out here.'' --bodnotbod 10:55, Jun 26, 2004 (UTC)

- There are complementary and alternative treatments for depression. The strongest connection can be found in complementary medicine which is well known for using palliative care to treat cancer patients. Some research has strongly suggested that treating depression in cancer patients improves their quality of life.

- According to a recent survey, 4.5% of the adult American population ( p9) use complementary and alternative medicine to treat anxiety or depression. "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons" (page 4). These mind-body therapies along with product based therapies, that use St. John's Wort (12% of population, table 2 on page 9) for example, are the CAM treatments that are most effective against anxiety/depression as shown below. Consistent with previous studies this study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine. - - Orthomolecular medicine, a form of alternative medicine, uses nutritional supplements like fish-oil and vitamins B-12 to affect both physical and mental health. Dr. Malcolm Peet of the Swallownest Court Hospital in Sheffield, England and his colleague found that in depressed patients who were on antidepressants improved when given ethyl-eicosapentaenoate for 12 weeks. This is a good example of basic research being brought to clinical benefit. However, ethyl-eicosapentaenoate was not studied alone. The study was in patients already on antidepressants. The compound used, ethyl-eicosapentaenoate, is not what is commonly knows as fish oil. This is an example where the distinction between complementary medicine and mainstream medicine are blurred. - - The American Psychiatric Association's American Journal of Psychiatry has published studies showing a relationship between depression levels and deficient vitamin B12 blood levels in elderly people in 2000 and 2002. Folate deficiency and anemia were not associated with depression. - - Chiropractic, Osteopathic, and Manual Medicine MDs are practioners of manipulative therapy. The purpose of manipulative therapy is to reduce mechanical dysfunction of spine and articulations and correct soft tissue pathologies (tight muscles, trigger points, etc.), thereby returning the body to its normal neurological tone. The depression-causing mechanism appears to be disturbances of normal neurological tone in the viscera which occur due to inflammation, trauma, and dysfunctional reflex in the nerve centres.

end of MNH stuff, though some of it was further edited by others and I'm sorry if this mass removal offends them --bodnotbod 10:55, Jun 26, 2004 (UTC)

Citations to alternative medicine research

 * Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9. PMID: 12365878 Abstract
 * Tiemeier H, Van Tuijl HR, Hofman A. Vitamin b(12), folate, and homocysteine in depression: the rotterdam study. Am J Psychiatry. 2002 Dec;159(12):2099-101. PMID: 12450964 Abstract

--bodnotbod 11:06, Jun 26, 2004 (UTC) (signing cos I moved them from the article, not because I had anything to do with them, let me be clear on that).

png?
All I'm getting for the .png is a black rectangle. Mintguy (T) 10:06, 27 Jun 2004 (UTC)


 * Yes it's the same for me, I don't know what the problem is. --bodnotbod 20:06, Jun 28, 2004 (UTC)


 * Hopefully I've fixed it, but it's more by luck than judgement. Putting the width in pixels in seems to have cured the problem for me. Can you both see it now? theresa knott 07:27, 30 Jun 2004 (UTC)

"Melancholia"
I've removed some stuff saying approximately "melancholia is the worst form of major depression". Please can we stick to using generally recognized clinical terms, please? Otherwise, we'll be saying things like "lunacy is the worst form of bipolar disorder".

To counterbalance smipping this text out, I've added a small section to mention melancholia and other historical concepts, with a link to the article on melancholia.


 * I approve. --bodnotbod 20:26, Jun 30, 2004 (UTC)

Chiropractic for depression
Hello I am new to this site and have not studied the protocols for submission yet. I need help to learn proper procedures and I welcome corrective criticism. There are many different points of view here and I realize that a lot of people will violently disagree with my post as I disagree with a number of theirs. The orthodox medical and psychological theapy is very well covered and nicely done. I think for the sake of completeness an alternative medcine section should be included. I am a Chiropractic physician and have worked side by side with Medical doctors for 42 years. I have many pts. that I treat for back problems and simultaneously treat psychological problems such as depression, anxiety,panic attacks, suicidal tendencies,anorexia,bulemia. The results are breath-taking these people usually with the advice of their doctor eliminate or reduce medication. If anyone would like to edit my post to improve the sense of the article-please do. I would appreciate it if you don't eliminate the article because you don't agree.

Lou (new member)


 * Lou, your contribution was removed by another editor, who invited you to do better. Please see Welcome, newcomers, Avoiding common mistakes, and Verifiability.  Also, if you register for a username, it will be easier to communicate.  --Zigger 18:44, 2004 Jul 11 (UTC)

Zigger

I would like to discuss with the editor what was wrong with the article. I would think it would be a matter of courtesy to at least explain the errors to me or edit it in someway, but to just eliminate it without comment seems rude.

Lou

DSM rants
Is this truly necessary, at least how it is worded: "The DSM IV list of criteria is controversial because one may be suffering really badly from four of the symptoms, and someone else quite mildly from the required five symptoms. Who then gets treatment? If the clinician keeps strictly to DSM IV, only the latter." First of all, all of the DSM is "controversial", but I don't think it needs to be discussed in every other mental health article. At the very least, it is worded poorly - it sounds like somebody's personal ramblings, not an objective sentence. We should leave the DSM rantings on a DSM page. -- Marumari 04:17, 19 Jul 2004 (UTC)


 * I agree entirely, it's a very poor contribution. --bodnotbod 10:17, Jul 19, 2004 (UTC)


 * I have replaced this with: Andrew Solomon in his book The Noonday Demon (p.20) states that the DSM IV list of symptoms is, "entirely arbitrary [and] having slight versions of all the symptoms may be less of a problem than having severe versions of two symptoms". I think the wording is now better (it's mostly Solomon!) Solomon's point relates directly to this list of symptoms and is, I think, a very important one.

BioMechanical-Neurological causes
This entry by 80.116.217.117 on 13 June 2004 troubles me.

"Excessive stimulation of the neuroloigical system may lead to clinical depression. The degree and persistence of the depression is directly related to the degree and persistence of the stimulation. This neurological reflex is part of the bodies natural defenses,that have evolved through evolution,to protect itself from harm. Over work,physically or mentally, may over stimulate the neurological system which reflexively responds by creating a sense of tiredness mentally and physically-the desire to do anything is much reduced."

It reads like a 19th century tract on "nerves". I feel more inclined to delete it than to correct the typos. Can anyone substantiate this entry? Isidore 00:04, 25 Jul 2004 (UTC)


 * Well, I went ahead and removed it and added a sentence about stress under "Life experiences". Isidore 19:06, 27 Jul 2004 (UTC)

Recent Edits by CloudSurfer
Having justs contributed several edits to this page I find they have been reverted by Denni without explanation. This page is somewhat jumbled, at times repetitive and otherwise unclear. Others have noted that it needs some rewriting. Anyone intersted can view my changes in the page history. For the moment I will pause my rewriting until this issue is clarified. --CloudSurfer 21:23, 12 Sep 2004 (UTC)


 * Hi CloudSurfer, it looks to me as though Denni intended to restore the heading and the roll-back went too far. I've restored your changes, and what I believe Denni intended with his.  -- sannse (talk) 21:46, 12 Sep 2004 (UTC)


 * Thanks for that. You have added unipolar to the list which of course makes perfect sense.  I also now understand Denni's reasons.  I have tried to be NPOV while at the same time attempting to clarify some of the issues.  --CloudSurfer 21:50, 12 Sep 2004 (UTC)

Types of Depression
OK folks. Under the heading Types of Depression we have two subheadings, Unipolar depression and Bipolar depression. Under the first heading we then have a description of subtypes of depression. Since some of these subtypes can occur in both unipolar and bipolar depression it seems to me that a better structure for this section would be:
 * No subheading of Unipolar depression with the text down to the second heading as is. This then follows the main heading of Types of Depression.

Unipolar vs bipolar disorder

 * Bipolar disorder is a cyclical illness in which moods fluctuate between mania (extreme happiness or giddiness and frantic activity) and clinical depression. Bipolar disorder has also been commonly called "manic depression", although this usage is now unpopular with psychiatrists, who have standardised on Kraepelin's usage of the term manic depression to describe the whole bipolar spectrum that includes both bipolar disorder and unipolar depression; they now usually use the term bipolar disorder. This then leaves the term unipolar depression which is used to differentiate it from bipolar disorder.

--CloudSurfer 22:02, 12 Sep 2004 (UTC)
 * Since there has been no comment on this suggested change I have gone ahead and made the changes. --CloudSurfer 04:00, 15 Sep 2004 (UTC)

I feel that unipolar depression is hardly even mentioned in this section, its as if it didnt exist as a medical condition. I propose a new section on Unipolar disorder, or that it be more explicitly explained. I'm not a good enough wikipedian for some perhaps, maybe someone is willing to do it?--Grappo6x6 22:07, 26 Nov 2004 (GMT+1)

"Small"?
CloudSurfer removed the adjective "small" from the description of ECT because he felt that it was NPOV. I think that is highly extreme; surely NPOV still allows us to note that skyscrapers are "tall", Antarctica is "cold", and dosages of current applied medically to the central nervous system are "small"? However, it might be best to replace it with a more precise descriptive adjective: low-wattage? low-voltage? low-amperage? -- Antaeus Feldspar 02:18, 13 Sep 2004 (UTC)
 * My logic was as follows. Small compared with what?  Since there is no implied comparison as there is with skyscrapers or continents (the examples you have given) the only reason I could see for "small" was to qualify it with a value judgement.  The previous version is below.
 * Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs a small and carefully controlled current of electricity to induce an artificial epileptic seizure while the patient is under general anesthesia.
 * I changed it to:
 * Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs a carefully controlled current of electricity to induce an artificial epileptic seizure while the patient is under general anesthesia.
 * It still reads that it is a carefully controlled current and that is the crucial point. As a psychiatrist who wholeheartedly supports ECT for the appropriate indications I am not in any way trying to undermine support for it. I can assure you that if ever I was seriously depressed that I would want to receive ECT. It is however a subject that raises the ire of some and is thus best put in NPOV terms as much as possible.


 * As a side point, I have once or twice collected bit of that electricity while administering ECT and it is not what I would regard as a small current compared with other shocks I have had in my life (and I live in a 240 volt country). It gives a kick not unlike that from an electric fence and it should be pointed out that I only got side currents. The voltages used are in the range of 150-400 volts after all. --CloudSurfer 04:47, 13 Sep 2004 (UTC)


 * I still do not think it's a problem from an NPOV perspective, but what you've told me about the voltage makes me think that "small" may be an inaccurate adjective, if they can actually be higher voltage than wall (mains) current. I concede.  -- Antaeus Feldspar 05:33, 13 Sep 2004 (UTC)

Will really untreated clinical depression resolve from 6 to 24 months?
CloudSurfer has made a number of nice contributions to the article, but one particular sentence strikes me, it is the following one
 * Although if left untreated it will generally resolve within six months to two years treatment can shorten the period of distress to a matter of weeks. While depressed the person may damage themselves socially (e.g. the break up of relationships), occupationally (e.g. loss of a job), financially and physically, treatment of depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life saving.

I am in no way a doctor, and he said he is a psychiatrist. But, is this always true? Can't clinical depressions persist indefinitely? Can't they get worse and/or become chronic? --xDCDx 12:55, 13 Sep 2004 (UTC)
 * Six years running for me. I disagree with this passage, the whole point of clinical depression is that you usually just don't snap out of it without help. I'm excising it, with a note to discuss here. CloudSurfer? Any comment? --Golbez 16:40, Sep 13, 2004 (UTC)


 * I am restoring it, since you apparently did not understand its meaning when you excised it. As xDCDx quoted, the key word is "generally".  Xdcdx asked "is this always true?" and the twofold answer is "of course not, and it was never claimed that it was."  Clinicial depressions can persist indefinitely, they can get worse and they can get chronic, they can persist for six years and this in no way falsifies a statement about the course they generally run.  That's why it's "generally", not "universally".  If you have a reason for opposing CloudSurfer's statement on the general course that depressions take, then bring it up here and edit.  But what you've provided so far isn't it. -- Antaeus Feldspar 17:18, 13 Sep 2004 (UTC)


 * (via edit conflict) I've being told that this is so for the majority - not a case of "snaping out of it", but a natural recovery in 6 months to 2 years.  That was the pattern before medication was widely available and studies have shown this to be the likely course since - perhaps Cloudsurfer may have a reference?.  But, of course, that is for the majority, not for all (and I'm one of the minority it seems - three years for me).  I think that the view on-line is probably somewhat distorted because those who do recover in a relatively short time are less likely to be as vocal as those of us still suffering after several years.  (Antaeus, you could have said the above in a more friendly manner you know) -- sannse (talk) 17:25, 13 Sep 2004 (UTC)


 * Fair enough. I don't revert such changes, and I acted too quickly. --Golbez 17:50, Sep 13, 2004 (UTC)


 * My apologies if I offended. Re-reading what I wrote without the headache that I had when I wrote it, I can see how it might come off as too brusque.  I was, truth be told, annoyed that the word "generally" was right there in the quoted material but its significance was never looked at before making the change.  -- Antaeus Feldspar 18:56, 13 Sep 2004 (UTC)

The reason I put that point in is that it is my understanding of what happened in the days before effective treatment. That most people with depression would come out of it after six months to two years. The entire section reads:
 * "Although if left untreated it will generally resolve within six months to two years treatment can shorten the period of distress to a matter of weeks. While depressed the person may damage themselves socially (e.g. the break up of relationships), occupationally (e.g. loss of a job), financially and physically. Treatment of depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life saving."

My thoughts in putting this in were to show why treatment was a good idea and really the only sensible thing to do. However, I wanted to show the alternative which was to leave it and wait months or years for it to resolve, during which time the person's life may have been damaged significantly. It is important that depressed people have a choice in the matter. Also, any relative or friend reading this is less likely to say, "Forget about those pills. You'll be all right." The previous version had said something like "treatment was imperative" but had not really given a full justification for this view. We have to remember that many people are out there resisting the idea of treatment for themselves and their relatives and friends. I hope I have put the whole thing in a NPOV framing that will allow people to make a choice that reduces the suffering.

However you have all made a very good point about chronic depression and I have edited the section to that effect. The relevant changes now read:
 * "If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. Treatment can shorten the period of distress to a matter of weeks."

I have also added a section on treatment resistance under the heading of Treatment.

This is the joy of this collaborative process. Well done all.

--CloudSurfer 18:23, 13 Sep 2004 (UTC)


 * I asked because, to me, 'generally' seemed a too broad percentage, but probably sannse is right and the online view of depression is somewhat skewed. Many people want to, by all means, avoid going to the doctor and prefer not to be treated, and choice of the patient is important, of course, but reading the phrase before actually made me think "Forget about those pills. You'll be all right". In my opinion, it is better now, after CloudSurfer tweaked it. --xDCDx 20:24, 13 Sep 2004 (UTC)


 * It is of the UTMOST importance to realize that while some may "snap out" of depression within six months to two years, many, many people "snap out" of depression by committing suicide. The WHO cites, and has cited with persistence the past several years, that suicide as a result of depression is the second most common cause of death following heart disease. This "snap out" argument is as specious as the one used by employment statisticians calculating the unemployment rate, who fail (for whatever reason) to calculate in those who have simply given up looking for work. For many seriously depressed individuals, it is an issue of having given up looking for a rewarding life. Denni &#9775; 01:03, 2004 Sep 14 (UTC)


 * Denni, if you read the entire section then it should be clear that what I have written does not support the idea of waiting to "snap out" of it. This is an encyclopaedia article, not an article aimed at people suffering with clinical depression. There are other sites for that purpose. It should be balanced and contain relevant facts. What I have added mentions the damage that depressed people sometimes do to themselves because of their illness. Suicide is certainly mentioned and says "suicide which is otherwise a common and tragic outcome." No one who has contributed to this talk is advocating leaving depression untreated and that is certainly not my view. The WHO does indeed stress the disability caused by depression and suicide from depression. (This brings up the whole concept of disability ajusted life years (DALYs) and years lived with disability (YLDs) which are not mentioned in this article.)


 * I have just had a quick look at the article on suicide and the word depression occurs only twice and on the second occasion it is in the negative! This article clearly needs some additions to clarify the role of depression as a cause.


 * I think we are all batting on the same side on this issue. --CloudSurfer 06:54, 14 Sep 2004 (UTC)


 * I think the description of this as a "snap out of it argument" is misleading. There is quite a difference between being told to "snap out of it" and being told that, in general, most people will naturally recover from depression in time (if, of course, they to manage survive that long).  That's not to say that, in that time, they will not experience considerable distress and long-term damage in several ways.  And it's not to say that it is not better to get treatment than to suffer through those months or years.  But I think that we should remove the idea that reporting the facts of the condition's prognosis is in anyway endorsing either refusing treatment or endorsing the idea that depressed people can somehow simply choose to be well. -- sannse (talk) 13:47, 14 Sep 2004 (UTC)


 * How about this suggested edit? Original as at --CloudSurfer 04:14, 15 Sep 2004 (UTC)
 * If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. Treatment can shorten the period of distress to a matter of weeks.
 * Suggested change:
 * If left untreated it will generally resolve spontaneously within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. There is no evidence to suggest that people can, by an act of will, produce this remission. However, active treatment can shorten the period of distress to a matter of weeks.
 * The main shaky part of this is the claim that there is no evidence for this. I have not seen evidence but that doesn't mean there is not evidence. Please comment and let's try to get this section sorted out.--CloudSurfer 04:14, 15 Sep 2004 (UTC)


 * I completely agree that the Suicide article needs some more emphasis in depression being a frequent cause leading to killing one self. --xDCDx 14:47, 14 Sep 2004 (UTC)

That version sounds fine to me CloudSurfer. -- sannse (talk) 18:49, 15 Sep 2004 (UTC)

Electroconvulsive Therapy (ECT)
The paragraph states that, "Like all forms of psychiatric treatment, electroshock can be given without a patient's consent, but this is subject to legal conditions dependent on the jurisdiction. In Oregon patient consent is necessary by statute."

First of all, this is a contradictory sentence. All forms of psychiatric treatment can be given without patient consent (but not Oregon)? Can psychiatric treatment be given without patient consent everywhere else?--Heyitspeter 07:24, 2 May 2007 (UTC)

Self-medication pov issue
I have removed everything under self medication and replaced it with a short definition. I have done this because of the horribly pov and unsourced crap that was there before.

" Some people with clinical depression may attempt to dull their feelings of despair by consuming alcohol, tobacco, or illicit psychoactive drugs for their mood-altering effects. Although this might be widespread, these substances merely mitigate symthoms and are of no clinical value, and extensive use may bear serious health damage and/or other deleterious consequences, esp. legal.

"Comfort foods" are also used by some. Some foods like chocolate contain psychoactive substances. " This is wrong in so many ways. The first problem is the claim that self-medication is an attempt to dull feelings of despair.  In the case of opiate self medication many people find that they only true normality they experiance is with opaites.  It also cites no sources and is extremely biased.  This has no place on wikipedia, I cannot rewrite that section at the moment, but should I remember I will make an attempt.  If anyone else feels they can improve it please do so. Remember pub med is a great source.  Take a look at the following links. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16756582&query_hl=3&itool=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17202003&query_hl=3&itool=pubmed_docsum Foolishben 19:41, 9 April 2007 (UTC)

Cognitive Behavioral Therapy
HOW IS THERE NO DISCUSSION OF COGNITIVE BEHAVIORAL THERAPY FOR TREATMENT OF DEPRESSION??? It has been well proven that for almost any psychiatric disorder, a mix of both pharmacotherapy and cognitive behavioral therapy is the most effective method of treatment. Check out this wiki and the "cognitive behavioral therapy" wiki: http://en.wikipedia.org/wiki/Cognitive_behavioral_analysis_system_of_psychotherapy

Can someone make an addendum to this Depression article? The preceding unsigned comment was posted at 18.06 on 01 Jan. 2007 by 72.68.139.43

Depression with catatonic features
How come their is no longer a main article that deals with depression with catatonic features?

Brain scan
In this article (I thought it may be in a similar one, there was a listing of a picture of a brain of a patient with depression (or GAD, etc) and a person without it... Does anyone know where that was?

(This was likley removed because there are no brain scans that can definitively "diagnose" depression. Any attempts to create this impression by adding brain scans to the site was likely intended to mislead.)

Minor edit
I just changed the diognostic criteria from "loss of interest or pleasure" to "loss of interest or pleasure in nearly all activities" I know we dont want to just be copying from the dsm but the criteria seemed a bit confusing out of context. "Loss of pleasure" doesnt really make sense in my head but I may just be over tired.

Discussion
I have edited the electroshock section to edit out claims of brain damage. This is not scientifically proven, therefore should not be in an encyclopedia. For direct evidence please check google scholar and search for the American Psyhiatric Association for their research on ECT and brain damage.


 * "Scientifically proven" is a very slippery concept in psychiatry. A biological cause of depression has yet to be specifically proven but that doesn't stop psychiatrists from assuming that it's the truth.  The American Psychiatric Association is not encyclopaedic -- they are extremely biased in favour of the biomedical model of mental illness and tend to disregard the considerable research that flies in the face of it.  There is a lot of evidence for long-term memory problems after electroshock.  Whether or not this consitutes brain damage is arguable.  Francesca Allan of MindFreedomBC 05:50, 5 December 2005 (UTC)

the Electroconvolsive therapy section isn't NPOV, and not in encyclopedic tone. I also wonder how general some of the comments are (such as that it usually happens 8 AM MTW). I hesitate in mentioning this, as it would be helpful to many people, but it isn't very encyclopedic. Themissinglint 21:06, 5 May 2005 (UTC)

Unless someone comes up with a good reason not to, I'll be refactoring the "selective noradrenaline reuptake inhibitor" bit. Venlafaxine is a strong inhibitor of serotonin reuptake, and a weak inhibitor of noradrenaline reuptake. Venlafaxine is therefore an SNRI (serotonin-noradrenaline reuptake inhibitor), whereas Reboxetine is a NARI (noradrenaline reuptake inhibitor).

Also, this section makes no mention of Tianeptine and Amineptine. The former is a serotonin reuptake enhancer (SRE), and the latter is a dopamine reuptake inhibitor (DRI) which is schedule II.

Electroconvolsive therapy
I totally agree with the previous comment about Electroconvolsive therapy. This tone is not what you can expect from an encyclopedia. Do you think we should add a NPOV tag? --Cinoche78 17:59, 8 May 2005 (UTC)


 * I say we just delete the whole POV part (starting at the second paragraph, as of this writing). It's basically an advertorial and I don't see any information that could be extracted from it by making it NPOV. Lawrence Lavigne 19:48, May 8, 2005 (UTC)

Can we stop the ax-grinding? I'm referring to the appeal to unnamed authority that "A minority of the US psychiatric establishment view ECT as having more benefits than drawbacks." I'd like to actually see the figures which support that statement, especially since I think an actual doctor would not answer that question unless given context about the patient -- ECT has drawbacks, but it produces results in some cases where every other modality has failed. Asking a doctor to judge a treatment like that out of context is like asking them to judge the merits of amputation without telling them the condition of the limb in question. -- Antaeus Feldspar 11:54, 20 May 2005 (UTC)

Removal of "atropinic shock" and enema stuff
I have removed a lot of rather peculiar material about "atropinic shock" (which has ZERO Google hits, except for this article), and about enemas. -- Karada 22:20, 19 Jun 2005 (UTC)


 * There are several Medline references to Atropine shock treatment. -- ElBenevolente 22:57, 19 Jun 2005 (UTC)


 * Well, if we are to put it in the article, it should be done with caution, and copious cites, as this does not appear to be a widely-accepted treatment, and all of the cites given above are very old, and do not even give abstracts (the most recent one above is 1964), suggesting it is no longer in use. -- Karada 23:30, 19 Jun 2005 (UTC)


 * A brief mention of the therapy in the article would probably be sufficient as a former treatment method. ElBenevolente 23:55, 19 Jun 2005 (UTC)

Large turnback
Eh, don't you think that you've removed TOO much? Almost everything I've added, including things I've fixed:


 * Why tricyclics are still used
 * Antipsycotics for augmenting antidepressant blood concentrations
 * Light therapy and exercises
 * Ugly nameless link to Dr. Ivan's depression Central was fixed by me, but now it's ugly again
 * Link to Wikibooks - Demystifying Depression removed (this was not added by me)

And more. Don't you think it's a good idea to think before destroying someone's else work?

Yes, thanks to someone from 81.218.179.183 - i don't see any more changes in whole Wikipedia from this one. I think we must revert. What do you think?

Varnav 12:09, 20 Jun 2005 (UTC)

Reverted
Okay, I've reverted back to the edition before mr 81.218.179.183 made a big cleanup without any comments. Now, you complain about that some methods are not actual anymore and article is too large. And, we can not say that ECT is a replacement for atropinic shock method - these are two completely different methods. Insulin shock method is considered old now, but It's still used. So, it's probably a good idea to make a cleanup (not so radical)

Varnav 13:11, 20 Jun 2005 (UTC)

Where is insulin shock still used? Anywhere in North America? Just curious. Francesca Allan of MindFreedomBC 02:51, 29 November 2005 (UTC)

Wikibook: Demystifying Depression
Some of us have started a wikibook on the subject of depression, based on a two-part series I had written for Kuro5hin. Would you consider adding a link to it?

The book still needs some cleaning up, but it is already quite useful. Moreover, it does cover into detail subjects which most web pages (including this Wikipedia entry) neglect -- the issue of exercise and depression, for example. (Which, by the way, you should probably also address into more detail in this article: too much exercise can worsen a depression!)

Here is a link to the book: 

Name of Feather 6 July 2005 18:55 (UTC)


 * Speaking of books, I added John Bentley Mays' memoirs, "In the Jaws of the Black Dogs," to the list near the end of the article. This is a fairly well-known account of life-long depression and I was somewhat surprised that it wasn't listed before. --Todeswalzer 19:22, 14 August 2006 (UTC)

Just a break-up of the paragraphs
I just broke up the paragraphs in one section because it was becoming a little hard to read...Considering also that depressed people may seek out this article for information on the illness and treatments, I felt also (don't scoff) that, quite frankly, they would find such blocks of text daunting. And considering some of these people may kill themselves if they don't get help - its good to do all that can be done to give them info. Besides, it's just good practice, in today's short-attention-span world!

A Plea: make information more concise but don't cut it
As someone familiar with depression I'd just like to suggest to everyone to try to be generous with the amount of info you provide. Depressed people need all the help they can get - and if they don't get it, they may very well kill themselves. So my suggestion is, think really carefully before limiting the information (read: help) you give them. If it's adding to the clutter, prune the words, not the help.

05:26 14 July 2005 EST

Wikipedia provides a helpful resource
I find that a google search on depression, as well as many of the links at the end of the wikipedia article are pretty crummy, but that's just my opinion.

Personally, I believe that scientific discussion of the possible origins of depression, still a very controversial matter, to be very theraputic. Learning about the disease makes treatment more likely to work. The stigma surrounding depression, as well as the claim that it is a necessary by-product of a thoughtful and creative mind are based in ignorance. These fallacies prevent many from seeking effective treatment.

Online support groups?
Should we be linking to online support groups? If so, should we be linking to one that just reached its first month online? -- Antaeus Feldspar 22:58, 27 July 2005 (UTC)


 * According to External links, there is no reason not to link to online support groups. I took a look at the new site secretworld and found it to be informative, and not too POV. I'd say let it stay. Gbeeker 15:10, 28 July 2005 (UTC)

Why was the reference to Prozac "poop out" removed?
The knowledgebase of large psychiatric practises indicates that for most chronic ailments, it is necessary to increase the dose of an ssri to maintain effectiveness, or switch to a different medication or a cocktail.

Suprisingly, there is little or no literature on this topic. However, when I thumbed through an evidence based pyschiatric medicine book, this topic is discussed (without any primary reference, of course).

Googling Prozac poop-out retrieves a psychology today article with comments from Donald Klein, an eminent psychopharm guy. Almost half the article is dedicated to Prozac poop-out.

This topic seems a little too important to ignore. Conflict of interest within the funding mechanisms for psychiatric research might be at work here.


 * This info must be placed in Antidepressants or Prozac, not in this article 81.195.222.220 11:56, 11 August 2005 (UTC)
 * Where do these rules come from? People who receive treatment for depression with antidepressants (the most widely used treatment option) should be aware of tachyphylaxis, since there is some likelihood that their doctor isn't.  There is also a very strong social stigma attached to having to take more than the normal dose.


 * No one makes "rules", a consensus is drawn, which is what these Talk pages are for. Althouhg, in this case, the suggestion may be warranted.


 * Secondly, without referential evidence, making a broad statement like this is problematic.


 * Lastly, meds always need to be adjusted up or down, but there is no definitive tredn toward increase over time. And, if patients have a problem with taking more than theraoeutic dose (most patients don't even know what that is, BTW), then they shouldn't be sharing that information with others...a stigma takes two. --DashaKat 12:28, 24 August 2007 (UTC)

Evidence based CBT / IPT
Does this exist?
 * Very definitely. Check PubMed, Cochrane reviews, or see e.g.  --Cedders 12:56, 24 April 2006 (UTC)

Transwiki from Wikibooks
Depression is used to refer to : (1) A mental state characterized by pessimistic views (2) A despondent inactivity.

The drugs traditionally used in the treatment of depression include: (a) Lithium traditionally used to treat Bipolar Disorder(manic depression) (b) Tricyclic Antidepressants aid the activity of serotonin and noradrenaline (c) SSRI Antidepressants aid the activity of serotonin (d) SNRI Antidepressants aid the activity of serotonin and noradrenaline

Almost all antidepressants are only available with a prescription from a doctor.

Depression is a clinically recognised condition of the brain. Its symptoms may include prolonged depression of mood or feelings of unhappiness, thoughts of suicide or self harm, change in sleeping patterns (increased or decreased sleep), loss of appetite and loss of sex drive as well as feelings of hopelessness, guilt and anxiety. The most common type of depression is called major depression with symptoms including but not exclusive to those listed above. Physiologically, major depression is manifested largely through decreased levels/effectiveness of the brain's neurotransmitters serotonin and noradrenaline. The other most common type of depression is called Bipolar Disorder or Manic Depression. It's symptoms involve mood swings between symptoms similar to Major Depression and/or a state of mania including elation, hyperactivity, anxiety and paranoia.

The causes of depression are not entirely known but the condition may be induced by stress, grief, taking of narcotics or other drugs of abuse or genetic suseptability.

(cur) (last) 02:30, 13 July 2005 24.226.91.89 (cur) (last) 14:50, 9 June 2005 80.46.202.53 (cur) (last) 14:48, 9 June 2005 80.46.202.53 (cur) (last) 19:30, 12 December 2004 83.146.62.183 (cur) (last) 02:49, 24 November 2004 4.240.165.130 (cur) (last) 02:45, 24 November 2004 4.240.165.130 (cur) (last) 00:32, 22 November 2004 70.69.232.39 (cur) (last) 01:46, 7 November 2004 212.158.194.142 (cur) (last) 01:44, 7 November 2004 212.158.194.142 (cur) (last) 01:43, 7 November 2004 212.158.194.142 (cur) (last) 01:42, 7 November 2004 212.158.194.142 (cur) (last) 21:11, 18 September 2004 203.115.89.23

"Post-Vacation-Depression
Let's say someone comes back from vacation. Then they want to return to their vacation spot. It gets to the point where it depresses them. It stays that way for longer than usual (let's say about two weeks). Could this be considered clinical depression? Scorpionman 02:14, 20 August 2005 (UTC)


 * It could be only if symptoms of clinical depression are present. There are different triggers for certain people. --Dysepsion 02:22, 20 August 2005 (UTC)


 * What you propose sounds like an unlikely trigger for clinical depression (as opposed to informal just-feeling-blue "depression") but not at all impossible. Context is highly important; if they come back from vacation to a work situation where they feel trapped, unappreciated and helpless, then yes, it could be the trigger for clinical depression. -- Antaeus Feldspar 21:23, 20 August 2005 (UTC)

How about "post-holiday depression"? I seem to be suffering from this myself right now. Scorpionman 00:39, 4 January 2006 (UTC)


 * Both of the these are references to post-euphoric melancholia, and do not constitute...nor would they be likely to activate...a clinical definable depression. Mjformica 12:25, 4 January 2006 (UTC)


 * Why the link...post-euphoric melancholia is a fancy way of saying "the crash after the high". It's self-explanatory. Mjformica 03:13, 17 January 2006 (UTC)

Depression
Depression can be a life threating illness. It prevades every aspect of an persons life. Things once pleasurable no longer matter. Every day normal events become by rote or simply don't get done. It's costs to family, employers, society cannnot be calculated but must be high. It is one of leading causes of suicide.

(There is no evidence that depression constitutes an illness in the medical sense any more than burning your hand on a stove could be called a "disease". Just as a description "injury" would be a little closer... or even something akin to a "fever" in a response to infection ... at least as an analogy.)

Alternative Therapies
I know St. John's Wort as treatment is listed in a lot of magazines and in some studies. Granted it is not an "official treatment" by some opinions, but I think it should be mentioned because things people commonly see on the subject should be addressed here. I think this reasoning should follow for other therapies as well, including older ones that are not used anymore.

Also, when I did a lot of reading into depression I came across an article in a mainstream health or exercise magazine that quotes a study. The study warns that taking St. John's Wort reduces the effectiveness of birth control pills. Perhaps it might be wise for someone to find this reference and mention it? (I'm trying but hoping to have some help). Especially since getting unexpectedly pregnant might not be a positive boon to someone's depression! --Kat 07:58, 24 October 2005 (UTC)


 * What reduces the effectiveness of birth control pills? St John's Wort or depression? --bodnotbod 09:49, 24 October 2005 (UTC)


 * St.John's Wort. (I re-edited my post for clarity). --Kat 12:17, 17 December 2005 (UTC)

Under "Treatment", is the mention of CHOCOLATE really relevant? It can improve a person's mood temporarily, but so can many other things that aren't considered actualRulingatlife 08:31, 20 February 2007 (UTC) "treatments..."


 * Yes, it's really overestimating the effects of chocolate. Also the description of the possible mechanism is ridiculous and the source were clearly misinterpreted. First, serotonin doesn't cross the blood-brain barrier. Also, the 1st source directs another source (relating to serotonin), which is a topic on BBC news website, and which says chocolate's mood-elevating properties could be due to its tryptophan and even then it says "many scientists are sceptical that chocolate could produce mood-altering effects in this way. Chemicals like tryptophan and phenylethylamine, which are also found in many other foodstuffs, are present in chocolate only in very small quantities". The case reports talk about increased serotonin levels at the skin area (which doesn't mean it reaches the brain's 5-HT receptors). —The preceding unsigned comment was added by Xxx-Xtazy (talk • contribs) 13:50, 21 March 2007 (UTC).

Definitely not NPOV
This article seems biased against people that aren't depressed. Such sayings as "Normal people can't understand how depression is" seems like a large point of view from one side.--Pichu0102 15:27, 10 November 2005 (UTC)

Not when its for depressed people.


 * Since when is a Wikipedia article supposed to be for someone? Isn't a wikipedia article supposed to be an unbiased place of information, not an opinion place?--Pichu0102 05:21, 12 November 2005 (UTC)

I greatly disagree.


 * What, so you think a non-diabetic can truly understand what it's like to have diabetes, or someone who's never had cancer can know what it's like to suffer in that way? misanthrope 13:06, 30 December 2005 (UTC)

STOP THOSE EDITS!
Who in there right mind would even think that Electroshock has no side effects. Just think about it when they use Electroshock they are driving electric waves thru out your but body and also in to your brain. Isn't that the same thing as the electric chair? Yea thank about it, and also like when a child puts something metal in a "plugin" ... So yes of course Electroshock has side effects! why dont you look at the people in the mental hospitals!!!![unknow][2-15-07][s][2:22pm]

Electroshock has no side effects??? You have GOT to be kidding me. Francesca Allan of MindFreedomBC 05:03, 15 November 2005 (UTC)


 * This is certainly not constructive discussion of article content. Will you please behave? JFW | T@lk  22:38, 15 November 2005 (UTC)

Jfdwolff: you are so off-putting. I totally sympathize with Francesca. I also don't think her comments were that offensive. Rather, you seem way to uptight about somebody speaking passionately.

I apologize for my earlier tone but your smug statement offended me greatly. Electroshock has devastating side effects (both short and long-term) and your dismissal of this well documented phenomenon is likewise certainly not constructive to a well-balanced article. Francesca Allan of MindFreedomBC 00:37, 16 November 2005 (UTC)


 * You must be mistaking me for someone else. I have not edited this article for a while (1 October to be correct). I was simply stating that Wikipedia has civility guidelines, and your use of invective and incredulity does nothing for the article. JFW | T@lk  00:42, 16 November 2005 (UTC)

I'm sorry I confused you with another editor. Civility is a funny thing. It's okay to write dangerous trash (such as electroshock is harmless) but keep your language ladylike. Very enlightened. Francesca Allan of MindFreedomBC 09:15, 21 November 2005 (UTC)


 * So you are still accusing me of writing "dangerous trash", despite my reassurance that I have not edited this article for well over a month? Or do you mean that civility is more important than WP:NPOV? Well, describing other POVs as "dangerous trash" is not conductive to agreeing on article content. JFW | T@lk  00:15, 22 November 2005 (UTC)

Look, I already apologized in my comment above. And whoever claimed that electroshock is harmless is indeed posting dangerous trash on wikipedia. Just to clarify: I realize that wasn't you. Acknowledging the brutality of electroshock isn't really a POV issue. Electroshock survivors describe being harmed in the short and the long term. Francesca Allan of MindFreedomBC 01:14, 22 November 2005 (UTC)


 * ECT has both advocates and opponents. There are many patients who swear by ECT treatment.  The most frequently cited side effect is short-term memory loss.--24.55.228.56 04:24, 29 November 2005 (UTC)

Yes, and a less common (but certainly not uncommon) side effect is permanent memory loss and brain damage. And less common still (but still significant) is death. Some people swear by crack cocaine, too. That's hardly an endorsement. Francesca Allan of MindFreedomBC 04:26, 29 November 2005 (UTC)

Want to CAUSE depression? Just witness others' being "treated" with shock. About 15 elderly people line up for their treatment, and when they come out they don't recognize anyone, don't remember where they are, why they are there, their room number, anything. I was struck by a speeding truck and suffered a skull fracture and brain damage. When I came around two weeks later I was cheerful too - its just a normal brain reaction to recovering from damage, and what is essentially a "reboot." But the long term results are something else entirely. People need to remember the origins of this "treatment." It was not something arrived at through research, not the result of medical theory - it came about when electricity was new and novel and people invested it with magical powers - there were numerous quack devices sold to produce shocks to "envigorate" you, regrow hair, etc. as if electricity was a vitamin or a miracle cure for everything. THAT is how electroshock therapy came about.


 * Your version of the history is interesting, but please adhere to WP:NPOV when editing articles. JFW | T@lk  00:21, 27 December 2005 (UTC)

It's more than "interesting," JDW. The four week recovery from closed head injury of electroshock is well-documented. As for the history of electroshock, it was derived from pig slaughterhouse procedure. The sicko that decided it would be good idea to inflict this on mental patients was awarded a Nobel prize. Francesca Allan of MindFreedomBC 18:20, 27 December 2005 (UTC)


 * Francesca, we know your opinion. JFW | T@lk  08:12, 28 December 2005 (UTC)

It's not merely my opinion, JFW. Moniz won the Nobel prize for his work. And the negative effects of electroshock are well-documented but simply ignored. Francesca Allan of MindFreedomBC 15:48, 28 December 2005 (UTC)


 * But it's just dramatics. The best medications are derived from poisons. Warfarin is a good example. As for the negative effects: I'm still waiting for your references to serious research confirming your "minor head injury" analogy. JFW | T@lk  18:17, 28 December 2005 (UTC)

My two cents: Jfdwolff is not constructively contributing to this discussion but rather is passive-aggressively sidetracking discussion. Jfdwolff--you should learn to interact with others in a more conciliatory and constructive fashion, rather than in such impersonal, condescending fashion.

I've already provided links elsewhere to Breggin's research. As it disagrees with your POV, you won't deem it "serious." That's not how research is judged. My point was not dramatics. Electroshock wasn't "derived" but merely transferred from the slaughterhouse to the lunatic asylum. Francesca Allan of MindFreedomBC 15:14, 30 December 2005 (UTC)


 * Francesca, I'm sorry but I'm must correct you on the historical aspect of ECT. ECT isn't the toy of some cowboys experimenting with the all-new electricity magic. It came from the clinical observation (late XIX, early XXth century) that people experiencing epileptical seizures we're somehow shielded from psychosis (hallucination, delusion and the like). So those clinicians started to experiment on ways to cause seizures in patients suffering from severe schizophrenia, using for many years chemicals like camphor since they felt it was easier to administrate in a controlled way. Psychosis was somehow lessened, but it is the depressive symptoms who where the most affected by this. This is how it came to be used for depression. In time, electricity (first AC and bilateral, now DC and usually unilateral) came to replace drugs since it is generally safer. It is still widely in use for severe, medically refractory depression, or severe depression with psychotic symptoms. Don't get me wrong, it is not used frequently for the average, my-mother-in-law-has-it type of clinical depression. It is used mainly on those who are very severely incapacitated by their depression, who do not respond to treatment, either pharmaceutical or psychotherapeutical, or who exhibit psychotic symptoms. It is not used in first line, but it produces results, and its side effect are way less severe than 50 years ago, and way under the effects of being severely depressed and psychotic. As such, it's place is discussed in every medical cursus, along psychopharmacology and psychotherapy.  Duf_Sherby 15:57, 3 may 2006 (EAT)

Not according to answers.com, among other NPOV websites: www.answers.com/topic/electroconvulsive-therapy  208.181.100.47 17:27, 6 June 2007 (UTC)

Internal contradiction
These two apparently contradictory sentences appear nearly next to each other (in the section "Signs and symptoms", in the paragraph beginning "Because of this profound..."):
 * Because of this profound and often overwhelmingly negative outlook, the depressed individual is unlikely to recover on their own without some sort of treatment.
 * If left untreated [depression] will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely.

Neither of these statements is sourced. I think this whole paragraph should be removed and replaced with a sourced figure (or range of figures) estimating the likelihood that untreated depression will resolve itself. --Delirium 00:52, 16 November 2005 (UTC)


 * The "six months to two years" bit was discussed at Talk:Clinical_depression/archive 2. When I was first told this, I was told that there were studies that show that to be true - but I don't have information on the pages.  Ideally we need those references.  I think the first bit ("unlikely to recover") may be referring to the risk of suicide or those people with long-term or recurring depression.  But I'm not sure, and it's not what I understood to be the usual course of the illness. -- sannse (talk) 21:17, 28 December 2005 (UTC)

recent change by dr. raymond lam
The word electroshock is not only used by detractors. It is also used by people who are neither for nor against the procedure but who simply support the honest use of language. As for there being no neurobiological proof of brain damage from electroshock, it's always amusing to compare the differing standards that psychiatry employs. There is no neurobiological proof of mental illness but that doesn't stop psychiatrists from incarcerating, force drugging and electroshocking anyone deemed mentally ill. Why do you (and the majority of medical doctors) disregard anecdotal evidence? I have been harmed by electroshock and so have thousands of others. Your arrogance is simply breathtaking. Francesca Allan of MindFreedomBC 04:40, 30 November 2005 (UTC)


 * Francesca, please remain civil, assume good faith and make no personal attacks. You are not being fair to an editor who has just made his first edit to Wikipedia and is simply working his POV into the article according to his understanding. There are less abrasive ways of enlightening Dr Lam.


 * As for the neurobiology: this is actually a fairly academic thing. About 65% of all medical treatments that are used have no identifiable evidence base. But ECT does work, at least according to those studies that the psychiatric community relies on. And results count, in the long run. JFW | T@lk  13:19, 30 November 2005 (UTC)

Sure, JDW. electroshock "works." So does being smacked in the head with a log! The psychiatric community is notorious for disregarding anything that runs counter to their paradigm. Why aren't patients listened to? I am almost 2 years post-electroshock and I *still* have not recovered. It's hard to stay civil when somebody assures me that I wasn't harmed when it's quite clear that I was. Each electroshock treatment lasts for about 4 weeks, the same amount of time it takes to recover from a mild head injury. What about the neurobiological proof issue? Why do I have to prove neurobiologically that my brain was damaged? Why isn't psychiatry held to the same standard, i.e. provide proof that mental illness is a neurobiological disorder? Francesca Allan of MindFreedomBC 15:24, 30 November 2005 (UTC)

I can't seem to make it clear here that the distinction between psychiatry and the rest of medicine is that psychiatrists are legally allowed to incarcerate, force drug and electroshock unwilling patients. Francesca Allan of MindFreedomBC 15:33, 30 November 2005 (UTC)


 * You are fully entitled to your POV and sympathise with your distress, but perhaps you shouldn't have projected it on unsuspecting Dr Lam.


 * Again, in the large studies patients are definitely being listened to. Otherwise there could never have been a comparison with the control group as to cognitive side-effects etc. But let's not try to rehash the discussion; if you can provide adequate resources (e.g. Breggin's work or major websites), there is reason why the negative patients' view should not be included in the article. JFW | T@lk  16:27, 30 November 2005 (UTC)

Well, Dr. Lam shouldn't write such statements if he doesn't want to be slammed for them. And, no, JDW, patients are NOT being listened to. If they were, we would have a vast range of voluntary, humane and effective options for the mentally ill. Wendy Funk, electroshock survivor, permanently lost her entire pre-shock memory. In the process, when she pointed this out to her doctor, his response was "What difference does it make?" and that's the title of her magnificent book. Francesca Allan of MindFreedomBC 01:06, 1 December 2005 (UTC)


 * So why would it not be possible to say: Mental health professionals say... etc. However, some previous recipients of ECT counter that many patients do indeed suffer severe after-effects, including [...]. Source: Breggin/Funk etc. This is the way NPOV works. Rather that trying to make one view look like the total and absolute truth, simply repeating what each side says makes a page truly neutral. Everyone always debates the facts; Wikipedia is not an arbiter to say who's correct and who's incorrect. JFW | T@lk  01:30, 1 December 2005 (UTC)

Because Breggin IS a mental health professional and he is not alone in his concerns. Your wording above, despite your obvious good intentions, will give the impression that professionals think electroshock is safe and effective while lunatic scientologists believe otherwise. Francesca Allan of MindFreedomBC 01:43, 1 December 2005 (UTC)

Paraphrasing somewhat, of course. :) Francesca Allan of MindFreedomBC 01:45, 1 December 2005 (UTC)


 * Okay, but Breggin is a vocal but not numerical minority. So the text should be: "Most psychiatrists [...] some say [...]". NPOV is full of weasel terms, whatever the critics may think. JFW | T@lk  02:01, 1 December 2005 (UTC)

How about "other psychiatrists ..." or "a minority of psychiatrists ..." or "however, some psychiatrists ..."? By the way, JDW, have you read Breggin's article? Francesca Allan of MindFreedomBC 03:51, 1 December 2005 (UTC)


 * Can't say that I have. JFW | T@lk  09:04, 1 December 2005 (UTC)

Well, I hope you consider reading it at some point because he makes a great case for the abolition of electroshock. Francesca Allan of MindFreedomBC 15:11, 1 December 2005 (UTC)

Francesca you should edit the borderline personality page.

Commercial Violation
References to the website fishoilblog.com keep cropping up in this article as a reference. It is a commerical website designed to get readers to subscribe to a newsletter where fish oil is sold. This is clearly a violation of Wikipedia standards for neutral references. No doubt the owner has used this ploy to improve his search engine postion by getting links from Wikipedia.


 * You are correct. If it is your assessment that these are commercial links they may freely be removed. There is lots of spam on Wikipedia. I remove it on sight, although the discussions can be tedious. JFW | T@lk  11:18, 11 December 2005 (UTC)

Use of unproven statements
While there are probably more present in this article, given the nature, I am at the moment only taking issue with this particular statement (given that it's the only one I've spotted as of yet):

"People that accept satisfactory outcomes in lieu of "the best" outcome tend to lead happier lives." (under Causes for depression)

While such a statement makes sense, it is at present only justifiable in that it appeals to common sense. However, this statement cannot be proven, and because it cannot be proven, it has not been proven, and because it hasn't been proven, it has no place in this article (see Wikipedia's page on verifiability, although whoever penned the above statement shouldn't in reality need to read that, given that the verifiability page should be familiar to any editor). Given the nature of this article, I think it's in need of a re-evaluation of its conforming to standards... 72.140.7.191 02:30, 16 December 2005 (UTC)

Accuracy in reporting and bifurcation
"Clinical Depression" and diagnoses falling on the Depression spectrum are not the same thing. As this section has exceeded the recommended limit for content, may I suggest separating the two topic areas? Mjformica 13:15, 31 December 2005 (UTC)

Enemas???
I've removed this whole subsection to talk, as, without supporting cites, I find it highly dubious.
 * Enemas and colon hydrotherapy
 * Severe clinical depression is often accompanied by constipation. Tricyclic antidepressants themselves also tend to produce constipation as a side effect.  Laxatives reduce the absorption of an antidepressant in the small intestine, thereby reducing its bioavailability and clinical efficacy.  Warm water enemas, on the other hand, do not interfere with antidepressant absorption, and may have a slight antidepressive effect by increasing serotonin production in thick bowel wall and temporarily raising serotonin level in the bloodstream. 

-- Karada 01:03, 2 January 2006 (UTC)

Request for Comment: User Conduct

 * Mcman Legal threats, hostile revisions, failure to collaborate, gaming the system (WP:POINT), assuming bad faith(WP:AGF), uncivil behavior (WP:CIVIL), harassment (WP:STALK), ignores consensus (WP:CON), and engages in personal attacks (WP:NPA). --Mjformica 16:38, 6 January 2006 (UTC)


 * I would respectfully request that other users and contributors disregard this formal RFC, as I believe that Mcman and I have come to a point of resolve without the need for outside intervention. If you care to comment here, I, personally, would consider it an academic exercise that may bear on the community at large, but would not bear on the resolution to which I feel my Wiki-colleague and I have come. --Mjformica 13:19, 7 January 2006 (UTC)

Apology to contributors
Before mjformica posted the above, I had asked an independent mediator to step in to resolve issues between myself and mjformica.

For the record, mjformica deleted my contributions with public comments that included "palpibaly incorrect" and "wrong again." Then he posted me a piece of hate mail saying I "am not a clinican" and to cease writing for Wikopedia.

For the record, I have bipolar disorder and depression is a constant in my life. I have been awarded a major award by the Connecticut Psychiatric Association for my writing on depression and bipolar disorder and Harper Collins will be publishing my book in November. I have 25 years of editorial/journalism/publishing experience. I have a reputation for writing on complex matierial in a very clear manner. I have written full-time on mood disorders for nearly seven years. I am very respectful of clinicians and researchers and they have been very gracious to me. My minor contributions on Wikipedia are based on interviews with the leading experts, as well as their writing.

Now I notice that mjformica has accused me of "legal threats, hostile revisions," etc. All this is wholly untrue. I did tell him he had no right question my credentials or delete my contributions or make the public comments he made. Nevertheless, he continued to delete my contributions.

Then I requested independent mediation.

I am hoping independent mediation will work. Until the matter is settled by a mediator, however, I trust that mjformica respects my writing and does not once again delete my contributions.

Once again, I am sorry for putting all of you through this.


 * Unfortunately, I do not believe that the request for independent mediation follows the protocols for RFC, as noted in the Wikipedia policies and procedures, whereas the above post does. Conflicting editors are first to request contributor arbitration from members on the section talk page, then, if that conflict cannot be resolved in that forum with the participation of at least 2 other contributors, a request for formal arbitration via the Admins may be requested, although it may not be accepted.


 * In addition, I did not delete Mcman's posts, but edited, revised and expanded them. I thought that was the idea.  You will note that all of the information contained in his writing is contained within my revision, along with requests for specific citations as requested by one of the Wiki-Admins.  Therefore, I would argue that it is he, not I, whom is guilty of wholesale deletion.  Mcman is also of the opinion that my language is too dense for Wikipedia.  If someone would comment on this, it would be appreciated.


 * Finally, I would quote Mcman here...


 * Now I notice that mjformica has accused me of "legal threats, hostile revisions," etc. All this is wholly untrue. I did tell him he had no right question my credentials or delete my contributions or make the public comments he made. Nevertheless, he continued to delete my contributions.


 * I did not question McMan's credentials, as an expert patient. He has no credentials as a clinician, and I made a statement -- albeit somewhat forcefully -- to that effect, in light of what I perceived to be some of his gaming and POV -- my opinion.  Although his standing within the patient, and possible within portions of the professional, community may be substantial, and he is, and I quote myself, "...doing good work as a patient advocate and educator...", he is still not a clinician.


 * I will grant there has been hostility and rancor in some of my editorial tags. I publicly apologize for that.


 * Secondly, if (quoting McMan's private posts to me) "...wholly libelous...", and "...serious consequences..." do not constitute legal threats and menacing, then I don't know what would.


 * And lastly, in the interest of putting this whole thing to rest, anything Mcman writes from this point forward is fine with me. Good, bad, or indifferent, I won't touch it without asking, and I would ask the same of him.  To that end, McMan, would you kindly review and revise -- then send along, should you be obliged -- the copy that you deleted which included your work and mine...for which I believe you thanked me, initially.


 * I sense at this moment Mcman believes he has proved his point, and won the day. Regrettably, power goes to the one who yields...Sun Tsu. --Mjformica 12:58, 7 January 2006 (UTC)

I note your comments
Thankyou, Mjformica. I accept your good faith. I trust that the same consideration you extend to me you will extend to all the other contributors. McMan


 * This is not a courtesy, it is a compromise, and one I am pleased that you are willing to accept. It applies specifically to our relationship.  To the best of my knowledge, no one else has a problem with me...quite the contrary.


 * That said, would you kindly review the section that I posted to you privately containing your initial work, my expansions, and my edits for readable at your suggestion, then comment. Thank you. --Mjformica 13:43, 8 January 2006 (UTC)

Causes of Depression - Heredity
"The tendency to develop depression may be inherited; there is some evidence that this disorder may run in families."

This is very vague. Can we get this expanded on? Or at the very minium, a resource link??--Jaysscholar 16:47, 24 January 2006 (UTC)


 * Kendler et al 2006 Am J Psych 163(1):109-14 found heritability estimates of 42% in women and 29% in men, but there's plenty of literature on this topic.--Coroebus 13:50, 17 February 2006 (UTC)

HYPOMANIA :The definition I found almost elswhere is totally diferent than the one on this article,in fact as the names suggests is a form of mania: " The clinical features of mania reflect a marked elevation of mood, characterized by euphoria, overactivity and disinhibition mania ",far from the state of depression and anxiety,and panick attacks definition on this site. Any clues?


 * You are correct. The individual who initially contributed this section was operating from a POV that focused on the anxiety-depression connection, and overlooked the inclusion of a clear definition.  No harm, no foul.  Check the re-write.  Mjformica 12:17, 29 January 2006 (UTC)

It is easy to see the depression in heridity. So the society/state will not see any resposibility for their mistakes. To see their mistakes mean to make a social programm, what they don`t want. --Fackel 00:05, 1 June 2006 (UTC)

The above is a political statement and runs contrary to the WikiNPOV. I have removed the line in this paragraph relating to religion running in families. This is a loaded statement and lowers the tone of the facts being presented there. Edie1060 11:16, 29 December 2006 (UTC)

Broken Link
Under External Links, I deleted the MADRs test because the link is broken. 14:27, 25 February 2006 Spikedupback529
 * Link readded with new source. [[Image:Monkeyman.png]]Monkeyman(talk) 19:45, 25 February 2006 (UTC)

External links cleanup
The external links section looks to have a lot of 'dubious quality' links, and far too many links in general. I'm going to do some trimming. Barrylb 20:35, 28 February 2006 (UTC)


 * I've replaced the myriad of links with a single link to a directory (dmoz). Barrylb 13:30, 1 March 2006 (UTC)

I've asked User:Lex Mons to desist from adding a recent set of external links because they are not of high enough value to include:
 * http://www.depression.com - a pharma company site
 * http://www.psycom.net/depression.central.html - an arbitrary, poor-quality-looking site run by an individual
 * http://www.philosophicalsociety.com/Archives/Philosophy%20And%20Depression - a broken link and a site that has been linkspammed to several articles by 68.104.183.247 who has also made edits to the external links in this article
 * http://www.medicinenet.com/depression/article.htm - some arbitrary site about depression
 * http://www.ndmda.org/ - redirects to http://www.dbsalliance.org/ - some arbitrary support site

-- Barrylb 15:09, 4 March 2006 (UTC)

magnesium
I am moving the magnesium entry here because this site says that magnesium glutamate and magnesium aspartate can worsen depression, and one manufacturer adds glutamate.
 * Magnesium has gathered some attention.

What should we do? Should we write it as,
 * Magnesium has gathered some attention, although there is an anecdotal report that magnesium glutamate and magnesium aspartate can worsen depression.

? --Mihai cartoaje 22:28, 28 February 2006 (UTC)

POV Identifier...
Question on protocol. Can just anyone, including an anonymous user, just float in and drop a POV or NPOV tag on an article. And, if so, once done, who has the right/authority to remove said without it being considered vandalism. I'm not certain this one was justified. --Sadhaka 19:17, 7 March 2006 (UTC) Talk to me

The Psychonutritional Treatment of Clinical Depression
I'm a little skeptical of this section. I think it's OK to mention well-established (or research-backed) "alternative" treatments, but they should be clearly labeled as such. Stephen Barrett's Quackwatch has this to say about it (emphasis mine):
 * Today's "fad" diagnoses used to explain various common symptoms are chronic fatigue syndrome, hypoglycemia, food allergies, parasites, "environmental illness," "candidiasis hypersensitivity," "Wilson's Syndrome," "leaky gut syndrome," and "mercury amalgam toxicity." The first four on this list are legitimate conditions that unscientific practitioners overdiagnose.  OhNo  itsJamie Talk 05:24, 9 March 2006 (UTC)


 * I've moved it here for a rewrite. -- Barrylb 05:46, 9 March 2006 (UTC)

I have re-written the artilce and placed on the main page Jurplesman 02:04, 11 March 2006 (UTC)

With the second advert tag I have now removed the article altogether and I do not intend to contribute to Wikipedia anymore. Jurplesman 05:12, 11 March 2006 (UTC)

Why has this been removed???
It is rather ironic that you should mention Dr Stephen Barrett, the great self-appointed defender of organized medicine in America. I hope this is not going to be a sign of your personal bias against alternative medicine. More than half of medical consumers are consulting alternative medical practitioners See: Alternative medicine. Plus Bensousan.

Thus a lot of readers will be interested in an alternative approach to the treatment of depression.

My approach stems from my experiences as a Probation and Parole officer, having worked over 30 year in the field of psychotherapy and Clinical Nutrition. I use a combination of Clinical Nutrition and psychotherapy as explained in my book Getting off the Hook.

Although Clinical nutrition is often classed as Alternative Medicine it is an evidence based medical science, supported by numerous studies. See: Research Evidence for Hypoglycemia.

Can somebody explain to me why this article has been removed from the main article?? Jurplesman 03:39, 10 March 2006 (UTC)
 * The editor who moved your content here said, "moving to talk - needs rewrite" in the Edit summary field. It could also be because of this WP:NOR.  [[Image:Monkeyman.png]]Monkeyman(talk) 03:47, 10 March 2006 (UTC)

I have rewritten the article and placed on the main page. Jurplesman 02:05, 11 March 2006 (UTC)


 * I've added an 'advert' tag against your contribution because your writing style sounds like an advertisement and still needs work. -- Barrylb 02:46, 11 March 2006 (UTC)

I have removed the article altogether and I do not intend to contribute to Wikipedia anymore.Jurplesman 05:10, 11 March 2006 (UTC)

Useful Link
We have just added article and video content created by key opinion leader Physicians as well as government health organizations and would like to be considered as a useful resource for this page. We are hosting an online symposium on mental health and spirituality and think this would also be a valuable contribution to the community.

Thank you,

Ryan [http://www depressiontreatment com Depression Treatment] —This unsigned comment was added by Ryanandrew (talk • contribs).


 * You've already been blocked once for commercial link spamming. What makes you think this is different?  OhNo itsJamie Talk 00:30, 22 March 2006 (UTC)

Recent links
Someone recently added these links. They seem like good sites but is this leading to our links section getting too big? Do these sites deserve special mention? -- Barrylb 05:35, 29 March 2006 (UTC)

http://www.cci.health.wa.gov.au/resources/consumers.cfm (Excellent self help resource for the treatment of mood disorders including depression, low self-esteem and social anxiety)

http://moodgym.anu.edu.au (Interactive Free online program offred by reputable Australian university for the treatment of depression)

http://bluepages.anu.edu.au

Depression is not a state of sadness
Sadness is an emotion. Depression is blockage of emotion! Here's one take... Sadness	vs	Depression

Expression of emotion	vs	Repression of emotion

Cure	vs	Illness (Solution)	vs	(Problem)

Loss of love	vs	Lack of love

Feel alive	vs	Feel dead

Healthy	vs	Sick

Passes with time	vs	Persists with time (self-alleviating)	vs	(self-perpetuating)

Cause-effect close and known	vs	Cause-effect distant and often unknown (e.g. death in family)	vs	(e.g. hereditary)

Attracts sympathy	vs	Attracts scorn

Selfless	vs	Selfish

Draws others closer	vs	Distances others

Widely understood	vs	Widely misunderstood


 * What on earth is this??? Dcteas17 01:24, 7 April 2006 (UTC)
 * It's an unsigned comment presumably meant to help editors distinguish features of two meanings of 'depression' for contributing to the respective articles. This distinction is made fairly clear (despite the potential for overlap) in depression (mood), certainly as regards adaptive/maladaptive distinction and presence of known cause.  (Perceived) 'selfishness' or need and availability for social support is possibly a tricky point that should be covered in one or both articles if the contributor writes again; I have some articles on the subject too but they might apply to both subjects. --Cedders 13:36, 24 April 2006 (UTC)

Adding to the biological/physiological causes of depression
I don't know if this is too theoretical to post, but as a grad student interested in the biology of depression, I am frequently surprised as to how little the new biological basis of depression is being discussed.

I spent about 6 months with an antidepressant lab, and there are 3 new theories for the biological causes that are not discussed here:

1. HPA axis and depression 2. Neurotrophin theory of depression 3. Depression and neurogenesis

1. Briefly, stress causes an increase in the hpa axis: CRF -> ACTH --> cortisol. This was found to occur in patients with depression (Nemeroff) High levels of cortisol are associated with, among other problems, a decrease in the volume of the hippocampus, and damage to the cells in the hippocampus (Sapolsky and McEwen). This finding is still contravercial though, it has been replicated by some, but not other scientists. Excess levels of cortisol have been repeatedly shown to decrease brain derived neurotrophic factor (BDNF) in the hippocampus.

2. Antidepressants as well as exercise have been shown to increase the levels of BDNF in the hippocampus (Duman). To paraphrase one article "BDNF does to the brain what sunlight and water do for plants"; i.e. it is essential for normal growht and functioning.

3. More recently, it has been shown that cortisol decreases the number of formation of neural stem cells that normally actively divide in the hippocampus, as well as the number of new neurons that they produce (Duman). Antidepressants and exercise can counteract this loss (Duman).

Scientists are still debating how significant these biological factors are to the actual feeling of depression itself (Duman, Sapolsky).

I might write this up more formally later (with references) on when I have more time. But briefly this comes from the work of Ron Duman at Yale, Robert Sapolsky and Bruice McEwen at Stanford and Rockefeller, and Charles Nemeroff at Emory. Of those four people, I have personally met two, and exchanged e-mails with the other two. —The preceding unsigned comment was added by 71.134.206.170 (talk • contribs). 15 April


 * Sounds good, particularly Sapolsky as source; there's as much evidence for involvement of HPA axis and other neuroendocrine systems as there is for monamines. --Cedders 13:23, 24 April 2006 (UTC)

Editing down?
I'm seeing the warning that the article is getting a little long, just as I'm adding a little more to it. Even if there weren't the concerns of the person making the pleas above, there is no reason to cut stuff, but it could be moved to create a betetr article. Firstly, I'd suggest that the section on antidepressants could be merged with the introduction of the article with the same name, since at the moment that article is a bit technical and could do with a clearer historical introduction; and the text included here is mostly to do with differing modes of action and side-effects which are common to treating other conditions and not solely relevant to this article. There's also no obvious link to the 'other' overview article on antidepressants.

Secondly the two sections on anxiety and hypomania seem to be a bit out of place and unclear, so could perhaps be made into a separate article. While it's an interesting thesis and some mention must be made of comorbidity between anxiety and depression, the linking of hypomania with depression will be very confusing for some readers. ICD-10 defines hypomania as 'persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency' which is clearly the opposite of clinical depression. I'm not sure what is meant by 'Another important point is that hypomania is a diagnostic category that includes both anxiety and depression' - superficially this is false, so I wonder how much of the text to preserve. I think it would suffice to say that positive and negative affect are sometimes considered orthogonal (or the same in better English), or a state of agitation and 'upset' has some of the features of a wider definition of hypomania, i.e. sympathetic arousal. --Cedders 13:23, 24 April 2006 (UTC)

possible copyvio
http://www.depression-tips.com/

The types of depression section appears to be a cut and paste of this site. —The preceding unsigned comment was added by 210.15.254.45 (talk • contribs).


 * Looking back in the history of the article all the way back as far as 2003, that section has grown organically over a period of time. Since the web site in question is claiming copyright from 2005, I would suggest that the site's content is possibly a copyright violation of this article, rather than the other way around. --GraemeL (talk) 00:36, 16 May 2006 (UTC)


 * The section in question was created with this edit and evolved from there. --GraemeL (talk) 00:45, 16 May 2006 (UTC)


 * ..and it looks like credit has since been added at the bottom of that page as coming from this article; whether that appeases copyright violation rules I don't know, too lazy to read into it, but there you go. 66.94.9.51 05:54, 23 May 2006 (UTC)

Deleted edit - biological/psychological
I removed the following text, added in a recent edit by User:66.81.158.60.


 * In 2006, Aiven Andrians , an independent researcher (not a proffesional psychologyst)in the field of psychology classified depression in two distnict catagories of :


 * 1- Biologycal Depression caused by biologycal factors in the brain and / or the body. Usualy treated with medication by a trained Psychiatrist.
 * Common prescribed medications are : prozac, Paxil , Zoloft ,
 * Also treated with St. Johns Wort in the case of minor depression in the Europe.


 * 2- Psychologycal Depression caused by negative chilhood events and / or current negative life events . Usually treated by a trained Psychologist.

Obviously it would need some copyediting no matter what, but it struck me as suspicious on three counts (to my knowledge anyway, please correct me if I am wrong):
 * I believe the biological/psychological distinction is far older than 2006 and has been discussed by psychologists and other researchers at length.
 * I believe that the distinction between biological and psychological origins of depression is largely deprecated these days, on the basis that it is not easy to determine, is not an either/or dichotomy, and is not as helpful for treatment plans as the included text would suggest.
 * A Google search for Aiven Andrians didn't provide any relevant hints, casting doubt on the accuracy.

If I'm wrong on any or all of the above three counts, then please feel free to revert (or better still, reinsert an edited version) of the text. Paddles TC 09:53, 11 August 2006 (UTC)

treating depression
any word on which country is the best at treating depression

You would have to define what you mean by that. Do you ask which country has "recovered" the most people in its population that are depressed, or which country has the lowest rate of depression in the first place?--Agent of the Reds 16:36, 30 March 2007 (UTC)

Intro wording
"'clinical depression is a clinical diagnosis and may be different from the everyday meaning of 'being depressed'. Many people identify this feeling as 'being blue', 'feeling sad for no reason', or 'having no motivation to do anything'.'"

I think this is rather confusing: what does "this" refer to, clinical depression or the everyday meaning? I was bold and changed it to:

"'clinical depression is a clinical diagnosis and may be different from the everyday meaning of 'being depressed'. Many people identify the feeling of being depressed as 'being blue', 'feeling sad for no reason', or 'having no motivation to do anything'. Clinical depression is generally acknowledged to be more serious than normal depressed feelings.'"

I'm sure it could be worded better, but I think this clears it up a little, at least. If you can word it better please do :-) — E ditor at L arge  ( speak )  19:13, 25 November 2006 (UTC)

monty don?
Why is there a link to the Monty Don page on the external references section?-Mysticfeline

History = Horrible
"The Ebers papyrus (ca 1550 BC) contains a short description of clinical depression. Though full of incantations and foul applications meant to turn away disease-causing demons and other superstition, it also evinces a long tradition of empirical practice and observation."

Okay, first of all, that papyrus didn't contain a description of "clinical depression" it contained a description of something much different which you're interpreting as similar to clinical depression. The second sentence is so bad, I can't even make sense out of it. Actually I'm going to cut this. — Preceding unsigned comment added by 130.58.237.227 (talk) 05:04, 18 December 2006
 * If this is true, I have no problem getting rid of it. But just make sure you include an edit summary when you change articles, especially when you delete stuff and when you're anonymous. When I first saw your changes, I thought at first that it was a bit of small drive-by vandalism. -- Tim D 15:22, 18 December 2006 (UTC)

Good article Review
This article is being reviewed at WP:GA/R for possible delisting of its Good article status. --Ling.Nut 04:12, 19 December 2006 (UTC)

Delisted, not all concerns fixed. Too many lists, unreferenced facts, stubby sections. Sumoeagle179 12:18, 31 December 2006 (UTC)

Whole Psychiatry
"It is well accepted that the combination of medication and psychotherapy induce full remission of depression in, at most, 50% of patients. Thus it is necessary to look at other scientifically grounded ways of treating depression. Whole psychiatry is an integrative approach that takes the best of traditional psychiatry and in addition, assesses other aspects of the persons functioning, such as spirituality, family systems, nutrition, digestion, absorption, immune function, hormonal function, detoxification, mitochondrial function, oxidative stress, and genetics. See www.wholepsych.com. 66.134.106.27 22:18, 26 December 2006 (UTC)

NPOV problems
Seems broken. Any paragraph that starts with a dictionary definition seems suspect.

Roadrunner 05:04, 31 December 2006 (UTC)

=="Diagnosis"==

According to Merrian-Webster, a "diagnosis" is "the act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data." Because the cause of clinical depression is not known, a diagnosis is not actually possible. Why the psychiatric community does not use the more accurate terms "label" or "category" is not clear. A check-list of symptoms is not a diagnosis. A "label" or "category" is made when an individual meets a sufficient number of the symptom criteria for the depression spectrum as suggested in the DSM-IV-TR or ICD-9/ICD-10. Depression, then, is a syndrome, not a distinct pathophysiological entity. A diagnosis is made when an individual meets a sufficient number of the symptom criteria for the depression spectrum as suggested in the DSM-IV-TR or ICD-9/ICD-10. An individual is often seen to suffer from what is termed as a "clinical depression" without fully meeting the various criteria advanced for a specific diagnosis on the depression spectrum. Possible causes of depression are not taken into account in diagnosis, unless it may be due to an existing medical condition.

It is important to understand that there is no blood test or brain scan for depression. Therefore the term "clinical depression" can be misleading to those who erroneously believe that there is a medical test for this disorder. Laboratory tests can provide medical data for diseases such as diabetes and heart disease, but currently not for depression, bipolar disorder, schizophrenia and other mental disorders.

Remove Unsourced material
There is a lot of unsourced material in this article for which no citations have been provided in a while. I suggest removing all material so marked in the near future. DPeterson talk 15:46, 14 February 2007 (UTC)

You really think whoever put it there is going to say "Source: My Own Illness." ?--Dezza91 05:25, 17 March 2007 (UTC)

I'd hope not. No original research Shui9 08:13, 17 March 2007 (UTC)


 * I think it is now time to remove the statements that are not attributable to a reliable source.  DPeterson talk 15:38, 18 March 2007 (UTC)

DSM-IV Classification
How come the DSM-IV classification isn't listed along with the ICD? -- R'son-W (speak to me/breathe) 07:37, 21 February 2007 (UTC)
 * No idea. I would think it should be.  Sorry for making this useless comment, but... I like your sig. :) (Oh, actually I just found something relevant: Template talk:Infobox Disease.  Hope this helps, still like the sig.) --Galaxiaad 07:58, 21 February 2007 (UTC)

Darwinian Psychiatry
I think this section needs to be made clearer. I've got a degree in biology, as well as special interests in evolution and depression, and I can't understand it. I think that's setting the bar a bit high for the average reader. The sentences seem to degnerate into lists of terms, such that it becomes hard to follow the relationships between different (lists of) terms. Also, the 15% Prinicple is mentioned, but it's not clear how said principle is applied, much less what it is.

Could someone that understands this section perhaps make it a little more reader-friendly? Orange32 01:33, 24 February 2007 (UTC)

I agree with you. Yoda921 14:31, 1 May 2007 (UTC)Yoda

Not only was it vague and difficult to read, it also really didn't describe any particular mechanism by which depression might offer an evolutionary advantage (the other subsections all offered specific theories). I went ahead and pulled it, but if anyone thinks it could be reworked somehow (or maybe cited) to enhance the value of the article, please edit and/or discuss. --User:Damzam 08:23, 9 May 2007 (UTC)

Evolution: Potential adaptive advantages of clinical depression
[edit] Evolutionary biological hypotheses of depression Evolutionary biological hypotheses of depression: Evolutionary analyses usually consider possible functions for depressed mood as well as clinical depression.

What is this talking about? Is it referring to biological evolution? If so, the link is not even stated. The section should be deleted if it isn't expanded. Yoda921 14:31, 1 May 2007 (UTC)Yoda

Based on the examples beneath it, I think it's safe to assume the section is discussing theories and hypotheses as to how clinical depression as a response to environmental stimuli might offer an adaptive advantage for the individual or for the society (see group selection). It might have been somewhat confusing that it was lumped in with 'Causes of clinical depression'. I pulled it out, made it a section unto itself, and changed the title and first sentence in the hope of making it more clear. --User:Damzam 08:23, 9 May 2007 (UTC)

Self-medication
"People become dependent on drugs and alcohol because of a genetic predisposition, not a conscious choice to use them for some specific purpose."

I took this statement out, as it's not a fact. Wikipedia's own entry on addiction lists several proposed models for dependence. Orange32 21:31, 18 March 2007 (UTC)

External link
I removed a link to, because it appeared to me to be mostly advertising their 'Depression Recovery Program', and was therefore inappropriate under WP:EL. There is other free information on the site, but to me it seems biased and unreliable. But the link was added back by another editor, and I don't want to get into a revert war. I don't think the link is appropriate, does anyone else agree? Cheers, Eve 11:30, 28 March 2007 (UTC)

Medication section
Whereas I think #1 definitely helps readability and to me #2 helps much as well, no hard feelings if anyone wants to revert to sorting by historical development.Badgettrg 04:53, 1 May 2007 (UTC)
 * 1) I grouped subsections to facilitate reading.
 * 2) I also reordered the sections in descending order of rough frequency of use; rather than historic development.

Causes of Depression/Evolution Sections
In addition to breaking out the section on potential evolutionary advantages, I also removed the redundant bullet points (where for each subsection there had been identical titles and then single bullet points). I thought this was more pleasing aesthetically (and also consistent with the rest of the article), but I'm wondering if, perhaps it would be more readable if the subsections were each bullet points and not headers. I also tried to clean up the language and structure (and changed the 'Causes' section names from Organic/SocioPsychological to Physiological/SocioPsychological). Please edit/discuss if you think it could be improved further (or if you think the first step towards improvement is reverting my edits :) --User:Damzam 08:40, 9 May 2007 (UTC)


 * I think a great deal of the information in this section is a bit 'fringe' science or pseudo-science. Mathchem271828 01:07, 14 July 2007 (UTC)


 * Given that the articles cited are coming out of the University of Michigan, which has one of the strongest psych/soc departments in the country, you're going to have to come up with a somewhat more of a substantial argument than just an opinion.


 * I would agree that it is "fringy" work, but it's coming from an, at the very least, reliable source. --DashaKat 22:17, 14 July 2007 (UTC)

Meditation
I recall adding a small section regards Meditation as a method to treat depression quite a long time ago alongside some expoundings on other methods. Someone added "In some cases, meditation may make the sufferer worse." - this comment is uncited and seemingly untrue. Thus where does it come from? Should we find sources or merely remove the sentance altogether? -- D-Katana 01:21, 29 May 2007 (UTC)

Link to Diabetes
"Chronic depression or depression that worsens over time may cause diabetes in older adults, according to new Northwestern University research," as reported 24 April 2007. Is there a way this information can be worked into the article? --Halcatalyst 00:05, 4 June 2007 (UTC)


 * This is a classic example of research based on non-sensicle correlation. The idea that the presence of depression can increase the incidence of diabetes is beyond the pale.  That depression and diabetes may be co-occurring based on the idea that both are related to hormonal imbalance is more plausible, but a causal relationship?...Puh-Leeze!!!  --DashaKat 01:12, 4 June 2007 (UTC)


 * PS -- and before anyone jumps in with, "..but it's published!"...one of my professors at Yale once got a journal article published backwards, just to prove a point.


 * Excuse me. I referred to a news report, which indicated the scientific research was published April 23 in Archives of Internal Medicine. I would expect you, or any other responsible person, to read that article before dismissing this finding as a "classic example of research based on non-sensicle [sic] correlation." --Halcatalyst 01:50, 4 June 2007 (UTC)


 * You're excused. I read the article.  It's [retract:bad] [read:suspect] research.  Correlative research is always suspect.  For example, you ask two people if they smoke, one says, "Yes", one says, "No".  The person who said "Yes" steps off the curb and gets hit by a bus.  Now, 50% of the people interviewed reported being smokers, and there is a relationship between cigarette smoking and traffic related injuries.


 * There's a little book I give to all my students before I begin my Quantitative Analysis class every semester. It's called "How to Lie with Statistics"...brilliant.  --DashaKat 17:40, 4 June 2007 (UTC)


 * Why? --Halcatalyst 20:44, 4 June 2007 (UTC)


 * There are entirely too many confounding variables. Linking two diseases both predicated on hormonal imbalance and saying there is a causal relationship is a very slippery slope.


 * Look, I'm not trying to be obnoxious or anything here. I used to work for the National Science Foundation and part of my role there was to be something akin to the Devil's Advocate on steroids.


 * I think including the content would be a good idea, I'm only advising caution. While my initial reaction may have been a bit over-the-top, I'd just like to see more than one study pointing in this direction.  Blessings.  --DashaKat 22:08, 5 June 2007 (UTC)


 * While I'm not convinced that this content belongs in this article as yet, I have to take some issue with the suggestion that Correlative research is always suspect. Sure correlation is not ideal, and it's very easy to chant "correlation is not causation" like a mantra, but it's not like we can randomly assign people to depression (well actually we could, but that sort of thing doesn't fit so well with modern ethics). As for your little thought experiment about traffic-related accidents, I believe that's why n=2 and a between-Ss variables don't work so well. You'd need about 3 smokers to be hit by a bus in a sensible analysis, and that pretty improbable (perhaps 1 in 20 improbable, even). That's not to say that evidence from observational studies is perfect, and I agree that another study pointing in this direction (and ideally in a different country by different researchers with different instruments) would substantially bolster the argument. --Limegreen 23:59, 5 June 2007 (UTC)


 * The "thought experiment" was to make as point. And don't lecture, it's poor form, old chum...it's likely I've been teaching Quantitative Analysis longer than you've been on the planet.  Cheers! --DashaKat 00:19, 6 June 2007 (UTC)


 * I would hope, if in fact you have been teaching Quantitative Analysis for longer than I have, that you suggest to your students that they discuss the merits of the argument, and not to use rhetorical strategies or appeals to authority.--Limegreen 01:26, 7 June 2007 (UTC)

On Medication
In the paragraph about Medication I find: "...Early effects also shown to have secondary effect of reducing absolute reduction in HDRS score by 50 percent. Even more recent studies, published by the Archives of General Psychiatry note that 25% of so-called clinical depression does not meet a disease criteria and should be considered to be ordinary sadness and adjustment to the difficulties in life."

The first sentence I quote seems garbled; plus, it's the first reference to HDRS, which is not explained as referring to the Hamilton Depression Rating Scale (which, in turn, was not mentioned in the Diagnosis section).

The next sentence seems a refugee from elsewhere.

I'd make changes, but I'm new and feel intimidated about it all. Anybody? --User:Jeremy56

Hepatitis as a medical cause of depression?
Section 5.1.3 claims that certain illnesses, such as hepatitis, may contribute to depression. From my reading of the literature, it would seem that hepatitis does not contribute to depression. Rather, interferon therapy (used to treat hepatitis) may contribute to depression. Does anyone care to discuss this distinction? Ehb 23:17, 9 July 2007 (UTC)


 * Sure. The statement in the article is nonesense.  I've had several "frequent flyers" at the hospital at which I consult who have been receiving Interferon therapy for everything from Hep C to MS, and they are all dragged into a state of depression and/or triggered into a recurrence of a standing condition. --DashaKat 23:58, 9 July 2007 (UTC)


 * Thanks! I'm new (well, not experienced) to wiki, so I'm not precisely sure on the protocol for making changes...  But based on my reading and the comment by DashaKat, it would seem that the statement in question should maybe be modified?  Ehb 02:20, 1 August 2007 (UTC)

Improving the initial description of depression.
I am a recovering Major Depression sufferer. I apologize for using myself as an example, but I don’t know that there is anything unique or special about me, although luckily, I don’t suffer from anxiety problems as most depressed people apparently do. I am writing to express my concern about the definition of depression given at the beginning of the Wikipedia article about depression. It is:

"Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living."

Although a low mood or state of dejection that does not affect functioning is often colloquially referred to as depression, clinical depression is a clinical diagnosis and may be different from the everyday meaning of "being depressed." Many people identify the feeling of being clinically depressed as "feeling sad for no reason", or "having no motivation to do anything." A person suffering from depression may feel tired, sad, irritable, lazy, unmotivated, and apathetic. Clinical depression is generally acknowledged to be more serious than normal depressed feelings. It often leads to constant negative thinking and sometimes substance abuse. Extreme depression can culminate in its sufferers attempting or committing suicide."

My points are two - First, depressed people will read Wikipedia to investigate whether the way they are feeling is a recognized or treatable problem. The definition needs to be clear and intelligible to people who are not thinking well. This message is insufficient.

Second, and more importantly, the definition is wrong. I, and many of the depression sufferers I have met, are not, or not always, intensely sad, melancholy or despairing. Even if we were, those emotions are understood in English to be about some event or circumstance. Speaking for myself, and what I have observed in others, I was not depressed or sad or despairing about some specific thing. When I finally sought treatment, and was invited to use therapy to work out any issues I had, I didn't have any. My life was going really well, even as I slowly and steadily lost my ability to do my career work, and to experience emotions.

Major depression is not a mood. It is, in part, an impairment of the ability to experience moods. It wasn’t until treatment progressed and normal emotions began to reappear, that I recognized that they had been gone for several years. Being in a good mood, or being saddened by the death of a relative, are examples of emotions which suddenly popped up. During the depression I wouldn't have said I was sad, I would have said I was happy (although I did eventually come to realize that nothing provided me with enjoyment any more), but the people who had to deal with me knew that I was unreasonably and uncharacteristically grouchy and irritable, especially when asked to do something I couldn't deal with, such as dealing with people, job-related work, making a decision, etc.

Other symptoms included loss of energy, apathy, hopelessness, and the conviction that there was likely no way out of my situation except eventual suicide.

Sometimes I see the descriptions of depression which include "inability to concentrate". This is the key consequence of the harm caused by depression, but it cannot be stated so simply. It must be described so that a depressed person can recognize him or herself. I lost the ability to do my job, slowly and steadily over many months and even years. My mind supplied a fictitious explanation for this, namely that I was tired of the work I was doing, I no longer felt comfortable with the firm I was at, etc. In fact, I had always liked the work I was doing and the people I was doing it with, and the firm made me a partner at an early age, pretty much left me alone, and paid me very well. After a while I could not bring myself to do mentally challenging tasks like my work as a lawyer and my taxes, but I could continue to concentrate on my hobbies (although they ceased to be much fun and my skill levels slipped). The ability to do one thing and not others is not encompassed in the unqualified idea of loss of concentration. It might be clearer to say "easily distracted from some types of tasks".

Also, my family and friends see me concentrating on hobbies and not working, and feel that I am just being lazy. This is not an unreasonable view; it is what I thought about myself for most of the illness. I didn't realize that, seen objectively, a type A person who has five professional degrees and a busy and challenging legal career, is simply not going to get chronically lazy, and that something is physically wrong. Even after I got help, it took the psychiatrist several months to persuade me that I had an illness. My friends whisper to each other "but he seems so normal", and encourage me to get a job.

As a quick aside, I have read that depression can involve measurable shrinkage of brain parts. Actually testing for that does not seem to be part of the psychiatric treatment. But even if the scan result had no clinical use (how can that be ?), it would, vitally, help firm up the support of insurers, family and friends to know that 15 percent of the patient’s hippo campus is gone and that the malady is “real”.

There is one more point about inability to concentrate, which is that I didn't know that I couldn't concentrate, even as I had work to do and somehow less and less did it (this went on for years). It never occurred to me that I couldn't do my usual tasks. On the contrary, I knew that I could do them, right after I had done something else, opening the mail, going to the grocery store, having lunch, etc. There is no sensation which goes with the impairment of this work capacity. When you strain a muscle, it hurts, and you know something is wrong, and don't expect full use of the muscle. When your capacity to do some kinds of mental tasks diminishes there is no corresponding signal, at least not one that doesn't feel like an ordinary sign like fatigue or distraction. It can be difficult and unpleasant to push the limitations on capacity to do work, but it needs to be pointed out to the depressed person to look for this selective disability, so they make the association by looking for the absence of something. This point became clearer to me as I regained some of my energy and enthusiasm for legal work, and I recognized how long postponed, hasty, and substandard my work during untreated depression had been.

This is why I recommend that the description of depression give a more precise definition about the lost mental capacity. I know that as I floundered around I did occasionally look up depression to see if it had anything to do with me, but I concluded it didn't, because it seemed I had to be unhappy about something, and because I didn't recognize the loss of concentration because I could concentrate, but not on everything and even then not so well. Also, to me concentration implies a higher degree of attention than the ordinary degree of doing everyday work. But even the everyday capacity is curtailed.

Please don’t cause depression sufferers to pass on getting help, just because they don't see themselves in the definition. Not recognizing the problem has cost me an awful lot. Please keep the knowledge that depressed people will be depending on you in mind, as you assemble the material on depression, and that they need to be spoon fed. You have a great opportunity here to help people, and I thank you for doing so.

If you made it this far, thanks for reading this. Even though my mind was clear enough today to write this, I should instead have been preparing my overdue tax returns, making phone calls I have been postponing, and trying to find a job. I am sure I can do these things, but I wanted to write this first. I'll do them after lunch. And a workout. Etcetera.

Hypomania
In this paragraph you write a lot about anxiety and depression but hypomania is mostly a pleasant experience for the patient. jmak 12:55, 16 August 2007 (UTC)


 * This is a very good point. In fact, one of the difficulties in getting BiPs to stay on their meds is that they get bored.  I had this exact conversation with a patient yesterday.  Maybe this issue could addressed (with cites, of course) in a sensitive fashion somewhere in the article. --DashaKat 22:59, 16 August 2007


 * 1. In your article you write about UNI-polar depression not BI-polar."BIP"


 * 2. I still don´t understand your writing about hypomania together with anxiety and depression. That´s not hypomania but "mixed state" - a form av "BIP". I would consider total rewriting and radical shortning of your "Hypomania" paragraph. Personaly I would remove it alltogether - out of topic. jmak 14:27, 18 August 2007 (UTC)

The missing link: A bacterial infection.
"Many Lyme patients were firstly diagnosed with other illnesses such as Juvenile Arthritis, Rheumatoid Arthritis, Reactive Arthritis, Infectious Arthritis, Osteoarthritis, Fibromyalgia, Raynaud's Syndrome, Chronic Fatigue Syndrome, Interstitial Cystis, Gastroesophageal Reflux Disease, Fifth Disease, Multiple Sclerosis, scleroderma, lupus, early ALS, early Alzheimers Disease, crohn's disease, ménières syndrome, reynaud's syndrome, sjogren's syndrome, irritable bowel syndrome, colitis, prostatitis, psychiatric disorders (bipolar, depression, etc.), encephalitis, sleep disorders, thyroid disease and various other illnesses. see"

Source: Canadian Lymes Association

This material may apply to a variety of illnesses. Like my research has suggested the testing for this one possible cause is difficult, and if overlooked then the patient has very little chance of cure.

It is hoped that someone who has more time than I do, will use the key words to find relevant links and information to expose that this missing link, is ignored, for the simple reason, it is too simple, too easy to treat and cure ?

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 03:32, 1 September 2007 (UTC)

Removed material from dietary supplement section
Because of the controversial nature of many dietary claims relating to depression, it is particularly important that any dietary claims are supported by cites from the medical literature. Therefore, I've removed the following uncited material from the dietary supplement section:


 * There is a complex relationship and synergistic effect that involve a multitude of vitamins and minerals, such as magnesium, zinc, calcium, selenium, Vitmamin B6, Vitamin B-12, Vitamin D, and many others. Often a depletion or overconsumption of one can cause a depletion in another, or affect it's absorption, which can lead to a deficiency.  For example, Vitamin D is required to absorb calcium, which may lead to a calcium deficiency, but treating it with calcium alone may not effectively cure the deficiency.  Because of this, in order to treat depression that may be a result of a deficiency, a broad spectrum of minerals and vitamins may be required to treat it effectively.

Can anyone provide a cite from reliable sources to back up these assertions? -- Karada 08:17, 18 July 2007 (UTC)

Just wanted to add that as a mentally interesting person myself I find the whole concept that it's "just a dietary thing" to be as offensive as humanly possible. It's this kind of prejudice that is a major contributory factor to mental illnesses not being considered a serious problem by the public. (I also find the term "depressed" when used to just mean "not deliriously happy" also terrible. You want to grab that person and slap them violently whilst yelling that they haven't a clue what real depression is. Meh) VonBlade 22:16, 21 July 2007 (UTC)


 * What exactly do you find offensive about the fact that depression may be caused dietary deficiencies? There are many studies now which look at amino acid depletion through dietary intervention with sometimes drastic results. If a dietary deficiency was the cause of depression, would you ignore it because you find it offensive?--Funkbrother3000 08:41, 3 September 2007 (UTC)

More methods of treatment
I suggest adding paragraphs about yoga, bibliotherapy and computer-assisted psychotherapy under "Other methods of treatment". Something like:

Yoga

Yoga practice can help alleviate depression by reducing the physiological manifestations of stress and by raising the levels of endorphins. Like meditation, yoga requires a long-term commitment since it does not produce fast results.

Bibliotherapy

Bibliotherapy is using books to overcome emotional problems. These books can provide a relief by helping understanding the problem and presenting alternative ways of thinking and action. Bibliotherapy can also be used as a complementary therapy to speed up the recovery along another type of therapy.

Computer-assisted psychotherapy

There are computer programs now available that provide psychotherapy. Like bibliotherapy, such a treatment lacks human communication, but it helps users to organize their thoughts and actions and may contribute to healthier thinking and behavior. These programs are usually based on cognitive behavioral therapy (CBT). —Preceding unsigned comment added by Natural123 (talk • contribs) 21:02, 26 September 2007 (UTC)
 * I suggest that you find references before adding such content. Thanks, OhNo itsJamie Talk 21:04, 26 September 2007 (UTC)


 * These links point to research about suggested therapies.

yoga

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15055096&dopt=Citation http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16185770&dopt=Citation

bibliotherapy

http://www3.interscience.wiley.com/cgi-bin/abstract/102527282/ABSTRACT http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9086697&dopt=Abstract http://www.mja.com.au/public/issues/176_10_200502/jor10311_fm.html

computer-assisted psychotherapy

http://www.finddepressiontreatment.com/depression-software.html This page is an overview of computer-assisted psychotherapy and it ranks number 1 on Google for "computer-assisted psychotherapy depression". It also contains links confirming efficiency of this therapy. Natural123 15:01, 27 September 2007 (UTC)

The ONLY real cure for depression is not drugs, yoga, therapy, etc. The only cure is to remove the cause. People are depressed because something (or a number of things) has gone wrong with their lives and thus the only way do cure it is to solve their problems. The reason why people are cured by drugs and such is because it allows them to get their act together and solve their problems rather than sit there feeling sorry for themselves and letting the problems deteriorate.24.118.227.213 05:31, 28 September 2007 (UTC)