Talk:Major depressive disorder/Archive 5

Placement of evolutionary theories-final compromise?
I would argue that the bulk of the evolutionary theories of depression is best placed into the Psychological theories.


 * These theories are primarily promoted by psychologists, not biologists - hence evolutionary psychology.


 * They deal with psychological mechanisms, albeit those could be biologically inherited.


 * There are different evidence standards for biological and psychological theories. There is no sound biological evidence for increased reproductive fitness from animal models or human genetics. However, there is psychological evidence that the insights based on evolutionary psychology maybe useful in psychotherapy.

Thus I would re-formulate the evolutionary sentence in the Biological theories section based on completely uncontroversial introduction Leon provides in (thank you for pointing that article). However, the psychological bulk of the evolutionary theories is best addressed elsewhere. Paul Gene (talk) 10:55, 1 July 2008 (UTC)


 * Yep, this sounds reasonable to me. Cosmic Latte (talk) 13:32, 1 July 2008 (UTC)


 * To me too. The links between it all are made by neuroscientists/neuropsychologists and evolutionary psychiatry/evolutionary medicine as well as psychology. The dualistic distinction is kind of artifical anyway as I think we noted above (it's almost inevitably a POV which subsection you put things in - even the neurochemical findings depending whether you interpret them as neuropsychology or as neural dysfunction). EverSince (talk) 14:21, 1 July 2008 (UTC)
 * Somehow then, the psych causes bit needs to focus on individual-level psych causes, the bio on the genetic/neuro data, and the sociocultural on the general "species-wide adaptation" angle? EverSince (talk) 09:56, 3 July 2008 (UTC)
 * Sounds like a good approach. I tweaked the wording a bit in both the psych. and bio. sections, in order to remove some ostensible redundancy and (hopefully) to help set the sections on the right track overall. Cosmic Latte (talk) 15:57, 3 July 2008 (UTC)

Epidemiology
This whole section of the article needs to be either redone or cited appropriately. I went looking for a source to fix one of the fact tags, and noticed that, apart from a couple copy-edits (e.g., my own tightening of the last sentence), and apart from a bunch of citations that make it appear as if this information were coming from like 5 different sources, the entire section is quoted verbatim from this page. Cosmic Latte (talk) 00:52, 22 June 2008 (UTC)


 * Wow, a Romanian website. This should be easy to source, another job on the 'to-do'list...Cheers, Casliber (talk · contribs) 03:46, 22 June 2008 (UTC)

Just so you all know, I've touched up the section a bit, and I made one copy-pasted-then-copy-edited passage invisible, in case anyone feels like salvaging it sometime. Feel free to have a look at the section and see what you think. Cosmic Latte (talk) 22:21, 4 July 2008 (UTC)


 * Good work. There is better and more up to date material around. It is a good placeholder for te moment and can be replaced piece by piece. Cheers, Casliber (talk · contribs) 22:38, 4 July 2008 (UTC)

Free full text DSM-IV on Major Depressive Disorder
Hi - I'm new to Wikipedia editing and wanted to solicit recommendations on the most helpful way to let Wiki users take advantage of our recent licensing of ~half of the DSM-IV. Our section on Major Depressive Disorder is here: http://www.mindsite.com/dsm_iv/major_depressive_disorder.

Any feedback on the best way to do this much appreciated.

Mindsite (talk) 02:07, 8 July 2008 (UTC)


 * Cross-posted to Talk:Schizophrenia; please respond there. Sandy Georgia  (Talk) 03:29, 8 July 2008 (UTC)

FAC again?
Well, what do you say? The article has certainly come a long way, to say the least, since the failed FAC more than a year ago. Cosmic Latte (talk) 16:18, 19 July 2008 (UTC)


 * Agree, but...see above. Still away to go. I know from bitter experience these long articles can be a real killer. Cheers, Casliber (talk · contribs) 20:15, 26 July 2008 (UTC)


 * A way to go in what way? EverSince (talk) 20:26, 26 July 2008 (UTC)


 * Here - Talk:Major_depressive_disorder above. Need to reorganize clasification subtypes - psychotic depression is thought of as a subset of melancholia. Won't take too long...Cheers, Casliber (talk · contribs) 21:03, 26 July 2008 (UTC)

The article has improved as compared to what it was. However, the history section contains a lot of superfluous, unrelated and poorly-sourced information. Also the sections on psychological causes and treatments have a bias to rarely-used and marginal treatments and theories. Paul Gene (talk) 22:42, 26 July 2008 (UTC)


 * Speaking of which, I have come across some material on the binary (i.e separate 'endogenous' vs 'reactive') vs continuum model of depression dating from 1920s to present - I have to run now but was musing on wheher better in history section or very slim Causes section before subdivisions. Maybe I will type up and place here and we can figure out. Agree history can be slimmed substantively. We are reaching a point where we need to prioritise to avoid article mutilation at FAC...not a pretty site...been thru it once with vampire (our own fault really but not fun). Cheers, Casliber (talk · contribs) 01:21, 27 July 2008 (UTC)

Agree about the earlier parts of the history section, I was trying to establish before that it needed trimming.

Looking at the psych section, I think it doesn't do justice to CBT vs Meds: A 2004 NICE guidline empirical review concludes "individual CBT is as effective as antidepressants in reducing depression symptoms by the end of treatment. These effects are maintained a year after treatment in those treated with CBT whereas this may not be the case in those treated with antidepressants. CBT appears to be better tolerated than antidepressants particularly in patients with severe to very severe depression. There is a trend suggesting that CBT is more effective than antidepressants on achieving remission in moderate depression, but not for severe depression. There was also evidence of greater maintenance of a benefit of treatment for CBT compared with antidepressants. We recognise that this is a different finding to that of Elkin et al (1989)."
 * (interspersed comment) There are differences of opinion, and results, in effectiveness of CBT in depression, both in the short and long term. I'll have to look at that one again. Cheers, Casliber (talk · contribs) 10:15, 27 July 2008 (UTC)

Regarding the range covered, the NICE guidelines say: "Psychological treatments for depression currently claiming efficacy in the treatment of people with depressive illnesses...include: cognitive behavioural therapy (CBT); behaviour therapy (BT); interpersonal psychotherapy (IPT); problem-solving therapy (PST); counselling; short-term psychodynamic psychotherapy; and couple-focused therapies." It also talks about evidence-based self-help resources. The guideline conclude: "When considering individual psychological treatments for moderate, severe and treatment-resistant depression, the treatment of choice is CBT.
 * (interspersed comment) wow, somewhat different to here. Will need to read this. Cheers, Casliber (talk · contribs) 10:15, 27 July 2008 (UTC)

Incidentally, while the psych section address CBT efficacy in teens, the meds section doesn't mention the issue, around which there has been a lot of controversy and withdrawal of indications of some drugs based on poor risk/benefit ratio. It also says antidepressants should be continued for at least several months "to prevent the chance of recurrence", which is misleading to say the least. EverSince (talk) 09:38, 27 July 2008 (UTC)


 * Good point (WRT teens). I only just realised (and inserted) the key mood symptom of irritability specific to adolescents. Erm, the last bit is tricky to answer Cheers, Casliber (talk · contribs) 10:15, 27 July 2008 (UTC)


 * There are of course differences of opinion & findings re. CBT, and antidepressants, for depression, the above reflects one multidisciplinary overview. The last bit is wrong because it doesn't prevent the possibility of recurrence. Thanks EverSince (talk) 10:57, 27 July 2008 (UTC) btw the NICE guidelines reference the 2000 American Psychiatric Association guidelines, and its empirical review is based on studies and meta-analyses internationally. EverSince (talk) 11:29, 27 July 2008 (UTC)


 * There are questions about the divergence between clients selected for an RCT and what we encounter in real clinical sitiations. Anyway, back to the TV. Cheers, Casliber (talk · contribs) 12:51, 27 July 2008 (UTC)


 * I, for one, don't see any remaining problems with the history section--I'd say that EverSince and OnBeyondZebrax, in particular, have turned what used to be a rather mediocre section into a very strong passage about the development of the interrelated ideas of melancholy and depression. I also fail to see any bias in the causes and treatments sections, with the possible exception that CB theories might be a tad understated in the causes section (although, IMHO, my addition about the depressive attributional style and the cognitive triad isn't half-bad). And what do you mean by "marginal" theories? Surely, I hope, you're not equating "marginal" with "unscientific"? Both the sciences and the humanities deserve a say here (or don't they?), and I see nothing in there that lies on the margins of both. Cosmic Latte (talk) 16:39, 27 July 2008 (UTC)
 * Well, I've gone ahead and explicitly linked the CB theories to CB psychology, and certainly would have no objections to the further expansion of that section. Cosmic Latte (talk) 16:49, 27 July 2008 (UTC)


 * The history section is just too long. It surely doesn't need to start off with prehistoric trepanning for example, nothing directly linking that to depression.
 * I wasn't personally suggesting bias in the treatments section, just that there are other major review points to add. EverSince (talk) 18:41, 27 July 2008 (UTC)
 * I certainly agree with your second statement there; and, as for the first, I was largely commending your contributions to the history section anyway. My statements here were actually in response to Paul's response to the FAC proposal. Sorry, I guess I should've made that clearer. Cosmic Latte (talk) 18:53, 27 July 2008 (UTC)
 * No I understood, and btw good work building up the article throughout; I just agree with Paul that the history section needs trimming down, especially the longest subsection on medieval, and more generic stuff covered in History of mental disorders. EverSince (talk) 19:15, 27 July 2008 (UTC)

In sociocultural aspects many references pertaining to the MDD among famous people are dubious. E.g. VanGogh had epilepsia, Woody Allen reference to his "depression" is taken out of context - he used it strictly colloquially. The statement that Alfred Lord Tennyson had MDD and wrote that "the sad mechanic exercise" of writing poetry could function "like dull narcotics numbing pain. is supported by a single quotation from an online magazine for the friends and alumni of Dartmouth Medical school: "But for the unquiet heart and brain A use in measured language lies; The sad mechanic exercise Like dull narcotics numbing pain." Etc. etc. Paul Gene (talk) 21:58, 27 July 2008 (UTC)
 * Tennyson was probably bipolar, and he wrote the poem containing those lines during a decade-long bout of what we'd now call "complicated grief." That much is pretty easy to source. His statement is mentioned only to suggest his belief that writing could help one to cope with depressive symptoms; he didn't go as far as J. S. Mill and claim that any sort of literature could cure any particular disorder. (An interesting idea to have come from Mill, by the way, as he was an early proponent of scientific psychology and even had his own theory of "mental chemistry.") Anyway, I cited the page that I did simply because it selectively cites that passage. Another option would be to cite the entire poem, but it's a pretty long poem--nowhere near as convenient for the casual reader. Cosmic Latte (talk) 09:33, 28 July 2008 (UTC)
 * If "Tennyson was probably bipolar" then he probably does not belong here. If you want to include somebody into the list of people with depression, there have to be a peer-reviewed study suggesting that he had MDD. Alternatively, an interview with such a person stating that he has been diagnosed with MDD would probably be OK as well. Otherwise, the article is going to be demolished during FAC. Paul Gene (talk) 10:50, 28 July 2008 (UTC)
 * I added a footnote to the article, giving some sources and additional rationale for mentioning Tennyson. It seems FAC-worthy to me, but if the Tennyson stuff really bothers you then feel free to remove it. Cosmic Latte (talk) 14:52, 28 July 2008 (UTC)
 * What I wanted to prove is that the poor quality of references in "Sociocultural aspects" part will prevent the article from attaining FA status. What about Van Gogh, Woody Allen, Nietzsche? What about all other people listed as having MDD? Maybe they are like Tennyson "would have been technically diagnosable" with something else? Paul Gene (talk) 10:08, 29 July 2008 (UTC)
 * Ah yes, I certainly agree that some better sources are needed. A fabulous essay IMHO (no, I did not write it or even add the references to it) but, true, not an optimal source about who has really had MDD. In the spots where this essay is used as a source for that kind of information, more solid references are certainly needed. Cosmic Latte (talk) 15:50, 29 July 2008 (UTC)


 * I mut add that I do have a problem with alot of the 'diagnoses' of historical figures with various psychiatric disorders on quite scant evidence etc. Some figures have been discussed in peer-reviewed journals, just have to find them...Cheers, Casliber (talk · contribs) 20:35, 29 July 2008 (UTC)
 * I went ahead and removed the possible WP:SPS violations--regretfully, to some degree, because I really admire the source, although I must say that calling Nietzsche "depressed" is probably quite an understatement. And I agree with Casliber that retrospective diagnosis poses problems. But as for the rest of the potential ambiguity about who really had what, I point out three things: 1) Tennyson, like Nietzsche, might well be in a class all his own; but because, in this section, we're talking about broad sociocultural aspects of MDD, and because cultures at large may be primarily aware of the middle "D" and not so much of the surrounding "M" and "D"--that is, they concur with the medical/psychological communities that something called "depression" pagues certain individuals, even if they don't grasp how "major" it can be or aren't acquainted with other specifics of the "disorder"--it should suffice to say that Tennyson, who surely had major depressive episodes regardless of what else he had, pointed out a way in which he tried to deal with his depressive symptoms. 2) The original wording said, "Historical figures who may have had depression include..." (emphasis mine); it never stated decisively that they had MDD. And 3) As for folks like Woody Allen, sure, I don't know what "all kinds of depression and terror and anxiety" actually means in his case. But it's certainly consistent with the possibility of his having MDD, so (still mindful of WP:BLP) I simply qualified the contemporary-figures sentence, so that it ascribes to such figures only possible depression. Hopefully this has helped to improve that section a bit. Cosmic Latte (talk) 13:35, 31 July 2008 (UTC)
 * There are many quite distinct conditions which could lead to a life time of misery - BPD has chronic emptiness/dysthymia...much of what I see reported in history or press appears from the outside to have a more axis 2 (or substance related) origin. but i admit this is in no way diagnostic. Cheers, Casliber (talk · contribs) 14:08, 31 July 2008 (UTC)
 * I suppose the entire section is slightly paradoxical, because it deals with the non-technical use of what the article largely treats as a technical term. If someone can find a peer-reviewed statement about who has actually been diagnosed with MDD (which might be a bit of a challenge, given confidentiality laws, so even a peer-reviewed source would probably have to quote the people's own admission to diagnosis), then that'd be great, but for now I've added a footnote in order to reiterate that the section isn't necessarily asserting clinical diagnosis, but rather is listing people who have been at least "socially" diagnosed or "self-diagnosed"--which may be what a "sociocultural aspects" section needs to do, anyway. I don't know, but hopefully the section should hold water for now, given the minor word changes and the footnotes. Cosmic Latte (talk) 07:29, 1 August 2008 (UTC)
 * So, hopefully my footnote will do for the contemporary-figures passage what the following statement, already added to the section by someone else (i.e., not me), does for the historical-figures passage: "Earlier figures were often reluctant to discuss or seek treatment for depression due to social stigma about the condition, or due to ignorance of diagnosis or treatments. Nevertheless, analysis or interpretation of letters, journals, artwork, writings or statements of family and friends of some historical personalities has led to the presumption that they may have had some form of depression." Cosmic Latte (talk) 11:42, 1 August 2008 (UTC)

Prognosis
Please could you clarify the rationale for removing the sourced information I added to prognosis. I only just realised this had been done - the edit comment didn't specify. I also reworded some of the existing sources in an attempt to reflect what seemed to be their focus and the balance of the range of studies, rather than selective aspects. EverSince (talk) 20:23, 26 July 2008 (UTC)


 * Umm..huh? Which bit are you referring to? (and to whom?) Cheers, Casliber (talk · contribs) 21:04, 26 July 2008 (UTC)


 * Didn't mean you Casliber sorry, was an edit by Paul Gene I think. EverSince (talk) 22:09, 26 July 2008 (UTC)


 * No I just moved it down, and restored the sourced information you removed. Paul Gene (talk) 22:39, 26 July 2008 (UTC)


 * ?? See your edit "Disagree with selective quotation. Discuss on the talk page first". It entirely deleted several paragraphs and sources that I added, which also incorporated the existing info & sources, reworded to reflect what seemed to be their focus and the balance of findings across those and the sources I added. EverSince (talk) 08:03, 27 July 2008 (UTC)


 * The problem here was not the sources you added but the text you deleted. I followed the customary WP course: Edit-Revert-Discuss. You edited the text, but I believe that was not the best edit. So I reverted your edit, and asked for the explanations on the Talk page. I, personally, find that it is more convenient to separate edits of somebody else's text and addition of new information, so it can be discussed (or reverted) separately. Paul Gene (talk) 12:03, 27 July 2008 (UTC)


 * Thanks for clarifying that you did delete what I added. Since the first few sentences and sources were entirely separate, and you have not made an objection to it, I can't see why it was necessary or in line with policy to delete it.

I guess I have to detail the need to balance the summary on recurrence. The first sentence seems to link two separate studies via picking out two selective statistics and framing them in a different more negative way than the studies themselves:

"The rate of recurrence depends on the severity of the first episode, with about a 90% recurrence rate over five years for the severerely depressed and a 70% rate for the average psychiatric patient with major depression." and

The 90% figure isn't in the main reported findings of the source on hitherto untreated individuals, in fact it doesn't mention any secondary analysis of a more severe subset, but reports the main findings which are much lower. The 70% it looks like that was obtained by turning round one of the findings from the source on outpatients, which concludes: "88.4% reached full remission, with the median time to full remission being 11.0 months. Nearly one third (29.3%) had no recurrences, whereas 30.0% experienced 1, 12.9% experienced 2, and 27.9% experienced 3 or more recurrences." By the way this source interprets these as positive findings, saying: "Previous literature on mostly inpatient MDD may have...overemphasized chronicity of MDD."

The second sentence: "A comprehensive population-based study, which included persons who were never treated by a psychiatrist and likely had milder variant of major depression, put the 23-year recurrence rate at 50%. In 15% of the cases, the disorder had a chronic course and did not leave a single depression-free year out of the 23 examined.

This is phrased in a more selectively negative way than by the study, which reports the first finding as "About 50% of first episode participants recovered and had no future episodes". They also report the 15% chronic - but the sample size was less than a 100 so the 15% was actually less than 15 people, not really "comprehensive". Regarding "milder variant" - they didn't actually test this, they just mentioned it as a presumption in passing in the intro. They actually say later on: "This estimate [the recurrence rate they found] is higher than the 40% estimated in the Lundby study, which included a wider range of less severe forms of depression.". They also conclude: "The results are not very different from the results of patient samples from clinics and studies whose samples include cases late in the course." and "the evidence is consistent across a range of studies that about 50% of those with an occurrence of major depressive episode will recover and not have another episode."

All I did was summarize all these studies as indicating that roughly half recover and don't have another episode, and a minority of the rest have long-term recurrence.

I'll address the antidepressant summary after this. EverSince (talk) 18:29, 27 July 2008 (UTC)

So every word of what I wrote is factually correct and correctly reflects the findings in the cited studies. Paul Gene (talk) 21:25, 27 July 2008 (UTC) What "more negative way" do you see in how I wrote about it? Negative in what direction? It is just facts, the more severe the depression is, the higher is the probability of recurrence. Paul Gene (talk) 21:29, 27 July 2008 (UTC)

mild, 66% (55/84) of subjects with moderate, and 88% (59/67) of subjects with severe or psychotic depression(χ2 = 11.75, df = 2, p = .003)." Paul Gene (talk) 22:13, 27 July 2008 (UTC)
 * "Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences." "During the 5-year follow-up, 70.7% (99/140) of subjects had a recurrence (Figure 3B)." "Recurrence was experienced by 56% (5/9) of subjects with

You state that is not comprehensive. Try to follow up >1000 people for 23 years. Or try to find a better study. Paul Gene (talk) 22:24, 27 July 2008 (UTC)


 * Btw I didn't realise it was you who'd added the summary. It is open to a rewording and balancing process in the usual Wikipedia way right? Re., I only meant the "about 15%" out of the 92 initially depressed subset isn't comprehensive - they avoid reporting the actual number or any significance testing but I think that must mean 14 people. As a sidenote, recurrence didn't mean meeting DSM-IV critiera - just recollection of feeling sad, depressed, or blue etc, and some DSM-IV symptoms "even if the particular episode did not reach full criteria for diagnosis." The Lundby study cited by them, was based on 344 initially depressed subset.


 * Re. were severity and comorbidity a combined predictor variable, or both independently? Is that 88% figure a combined one for a range of rates (i.e. some just one recurrence in five years?) What proportion were severe (by DSM criteria?) vs psychotic? I just think a summary of it shouldn't just highlight those stats, but reflect their main conclusion of "The long-term outcome of MDD in psychiatric care is variable, with about one tenth of patients having poor, one third having intermediate, and one half having favorable outcomes." The balance across the sources seems to suggest an overview like that too,  as well as the point you make about degree of severity/type/comorbidity influencing the rate. I shouldn't have reduced the latter to the former when I edited... I think this range of sources gives an excellent basis for the section, including interesting extras about comorbidity, suicide and rate of bipolar switching etc that can also be added in. EverSince (talk) 08:55, 28 July 2008 (UTC)


 * Of course the summary is open to editing. When I wrote it I was trying to get across the following points. The bulk of psychiatric literature insists that MDD is a highly recurrent disorder. and  illustrate this point, both give ~70% recurrence rate over 5 years. (I would imagine the lifetime recurrence rate would be around 80-90%)  At the same time, the population studies like  give 40-50% recurrence rate.  and  address this conundrum pointing out that most of the community MDD is never treated by a psychiatrist, and the more severe cases, which ARE treated by a psychiatrist, have higher recurrence rate. Paul Gene (talk) 10:42, 28 July 2008 (UTC)

Still, the studies that recruited (mostly outpatient) psychiatric patients ( Holma and Kanai) report that nearly all recovered within months, that any further episodes are typically years apart and increasingly mild, and that the prior literature over-estimated chronicity and recurrence because it recruited from selective inpatient sources. The recurrence proportion in the Kanai study was actually 42% by 5 years - it was only approaching 70% when they included subthreshold symptoms. In the Homa study (which is the 88% of severe/psychotic one), even though it was mostly outpatients, most (79%) had at least 2 diagnosed mental disorders and the majority (54%) had 3 or more. (Eaton) recruited from general population but over half of the 92 with onset of depression had previously been treated for depression, and presumably others went on to be within the next 23 years (interestingly it says "...here, and in other studies with more intensive assessment of treatment, there was no obvious long-term effect of treatment for depressive disorder").

I'll try to cover this, & re-add about the average 3-month recovery rate regardless of any treatment. I think the section has to mention how recovery/remission/relapse is defined, especially whether subsyndromal symptoms are included - they are important in the course of MDD and in the general population (though more often mixed anxiety & depression according to ) but using them to define recurrence of MDD is a deceptive move away from a categorical model, which the whole diagnosis is based on, to a more dimensional model that wasn't used for the initial assessments (which if it had been would have resulted in a much wider range of people and outcomes). Also need to qualify any overall recurrence proportions a bit, because they group together a large variation in outcomes and issues, while almost totally ignoring the massively complex personal and social and life context in which they occur. EverSince (talk) 15:08, 30 July 2008 (UTC)


 * A note on (Holma et al). What they did was essentially to take randomly 269 depressed patients "effectively representing psychiatric patients in a Finnish city." There did not look for particularly sick ones. Yes "most (79%) had at least 2 diagnosed mental disorders and the majority (54%) had 3 or more" - but that is what a typical psychiatric patient is. High level of comorbidity is typical for a psychiatric patient. Please mind the difference between psychiatric patients and community depression, and separate these two populations in your write-up. Paul Gene (talk) 01:54, 31 July 2008 (UTC)


 * As for the community depression, I doubt that you can really notice if you are depressed less than 3 months. No wonder those people do not go to the doctors and do not need treatment, and only get picked up in epidemiology surveys. Blame DSM/ICD for the overdiagnosis. Yes, NICE is correct recommending watchful waiting in such cases. Also, the fact that "here was no obvious long-term effect of treatment for depressive disorder" is not surprising. It is still undecided if antidepressants actually do harm. Blame DSM/ICD for the muddled diagnosis leading to indiscriminate prescription of SSRIs to to the people who do not need them. Paul Gene (talk) 01:54, 31 July 2008 (UTC)


 * I agree and didn't mean that Holma et al. was biased, I wanted to note that the figures are not just about the depression itself but about the context again - in this case the context of many ongoing psychological disorders/difficulties (linked to who knows what). The rate of spontaneous recovery in months, with findings of average duration varying, has been assessed in primary care in the WHO studies and by psychiatric services/studies, e.g. in, with non-treatment due to a variety of reasons. But I agree it's also important to fully recognise the substantial proportion of people who* nevertheless have ongoing difficulties and much need for support and interventions (plural). And agree re need to clarify whether studies recruited from only treatment-seekers, or from general population (which includes but is not necessarily limited to people in treatment). EverSince (talk) 10:50, 31 July 2008 (UTC) p.s. *or who have a more severe episode (though even mild or subsyndromal depression & anxiety where better functioning is somehow maintained is nevertheless associated with significantly lowered quality of life etc that could be helped in appropriate ways). EverSince (talk) 11:14, 31 July 2008 (UTC)

Bot report : Found duplicate references !
In the last revision I edited, I found duplicate named references, i.e. references sharing the same name, but not having the same content. Please check them, as I am not able to fix them automatically :) DumZiBoT (talk) 16:10, 1 August 2008 (UTC)
 * "pmid972328" :

This paper sums up some of the problems
Here is a fairly good summary of the dilemma of the classification, Parker and Hickie are two high profile professors here in oz, both of whom have written and published oodles of stuff. Cheers, Casliber (talk · contribs) 20:22, 2 August 2008 (UTC)
 * Great paper. I found something in it to cite in this article's intro. Also, it explains pretty consisely the (historical) distinction between endogenous/melancholic depression and reactive/neurotic depression in the 1950s, followed by the further division in 1980 "into major and minor disorders." This info is already in the history--I added a bit myself earlier--but because Parker summarizes it so well, he might be a useful source for the upcoming revision of the history section, helping it to be stated more concisely. Just a little suggestion--but the paper itself is full of fascinating stuff. Cosmic Latte (talk) 13:39, 3 August 2008 (UTC)


 * I would like to find some material on the taskforce for dsm-III led by Spitzer and controversy around bringing in the diagnosis in 1980, that would be great for the development of the name as well. I was going to ferret around and see if anyone had done a flowchart of names too. Cheers, Casliber (talk · contribs) 20:35, 3 August 2008 (UTC)

Yeah there's already various sources relating to this in history & in sociocultural aspects, and this point of view could add another dimension. It's advisable to add within the article first, and then the intro summarizes each section. EverSince (talk) 10:10, 4 August 2008 (UTC)


 * Agree - I am very keen on succinctly capturing the 90 year old headache that is the unitarian/binary split and controversy around it. Cheers, Casliber (talk · contribs) 10:36, 4 August 2008 (UTC)

Insulin shock therapy
Perhaps "Insulin shock therapy" should be placed in a "historic treatment section" and not in "alternative methods of treatment". Surely, no one does this now. Snowman (talk) 14:52, 6 August 2008 (UTC)


 * Yep. Good point. Removed as not really specific to MDD even when it was used. Cheers, Casliber (talk · contribs) 05:27, 7 August 2008 (UTC)
 * I think it should be kept in the article but clearly described as an ancient treatment. Snowman (talk) 01:36, 8 August 2008 (UTC)

Vincent van Gogh
Gogh's illness appears to be rather difficult to diagnose and I think that is is too simplistic to say that he had a "major depressive disorder" or "depression". I think that the infobox caption needs amending. Snowman (talk) 14:06, 6 August 2008 (UTC)


 * This was discussed earlier. Van Gogh had epilepsy complicated by his abuse of absinthe. As a result he suffered from bouts of depression. It was not MDD but the caption does not say MDD, so there is nothing to amend. Most of the editors here felt the picture is too good to remove. Paul Gene (talk) 02:13, 7 August 2008 (UTC)
 * But the caption should be changed, as it oversimplifies his complex illness, which you seem to be aware of, as least in part. There appear to be many opinions on his illness and to me the caption is misleading. See also WP:CCC. Snowman (talk) 07:56, 7 August 2008 (UTC)
 * Looking back at Talk:Major depressive disorder/Archive 4 a see that there is disquiet about the caption and the use of "depression" that wrongly over simpyfies and implies that depression was his diagnosis. I feel that my edit to the caption with was largely in line with archived discussion and should not have been reverted. Snowman (talk) 11:22, 8 August 2008 (UTC)
 * Agree completely. I am just going to remove most of the caption. That would still implicitly suggest that VanGogh had MDD though... Paul Gene (talk) 10:50, 9 August 2008 (UTC)

Exercise
Exercise as treatment for depression is entirely conventional and is recommended in the NICE guidelines for the UK. Exercise in management is currently placed in the wrong heading, "Alternative treatment methods". Snowman (talk) 14:32, 6 August 2008 (UTC)


 * No, it is just a general recommendation, not a treatment: "Patients of all ages with mild depression should be advised of the benefits of following a structured and supervised exercise programme of typically up to 3 sessions per week of moderate duration (45 minutes to 1 hour) for between 10 and 12 weeks". Similarly, NICE guidelines state: "Patients with mild depression may benefit from advice on sleep hygiene and anxiety management." But nobody suggests that "advice on sleep hygiene" could be a treatment for depression. Paul Gene (talk) 02:06, 7 August 2008 (UTC)


 * No, it is a strong recommendation in NICE in "general measures", which says "Patients of all ages with mild depression should be advised of the benefits of following a structured and supervised exercise". Further, "supervised exercise" is available as an organised treatment option in some regions. An entire heading "General measures" is missing in the article under "treatment". Snowman (talk) 08:04, 7 August 2008 (UTC)
 * The edit summary made by User Paul Gene at 17.20 31 July 2008 "Exercise may help but not firmly estblished or recommended by guidelines, hence not conventional" is incorrect as shown by NICE guidelines, and I would be grateful if the changes that were made with that edit are reverted. Snowman (talk) 18:25, 7 August 2008 (UTC)


 * A meta-analytical review of this topic in BMJ states: "RESULTS: All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)). CONCLUSIONS: The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up." Paul Gene (talk) 00:10, 8 August 2008 (UTC)
 * But you are quoting 2001 data. NICE has a team of about 500 to review data and they have recently put exercise in the UK guidelines. I am sure that they would have been aware of the 2001 paper that you have quoted. The NICE guidlines were updated in 2007 and the evidence for exercise is rated at "C". Exercise is included in the UK national guidelines. Snowman (talk) 00:39, 8 August 2008 (UTC)
 * Well, I would include exercise into general recommendations for the treatment of any psychiatric disorder (save anorexia). But the same goes about sleep hygiene, for which NICE has C-level evidence. Neither have demonstrated specific effects on MDD. Remember, placebo treatment has excellent record, especially for mild MDD. Paul Gene (talk) 10:40, 8 August 2008 (UTC)


 * (outbreak) Looking back at the archives at Talk:Major_depressive_disorder/Archive_4 I note that the criteria for the headings was discussed. It seems that a conventional treatment at that time was considered to be one where there is evidence of use, or one which is approval by the regulatory bodies. With the new 2007 NICE guidelines exercise can now be moved to a conventional general treatment measure. Surely, if it is a "should" in national guidelines then it is conventional. I would like to quote; your edit of 22 June 2008 on this topic # Snowman (talk) 11:38, 8 August 2008 (UTC)


 * I insist that general recommendation is not a specific treatment. And we are concerned with specific treatments in that chapter. For example, patients with depression with anxiety would benefit from being given a tranquillizer, but we do not include tranquillizers into the treatment chapter. Including general health recommendations would bloat the article immensely at the expense of specific treatments. Should we now include sleep hygiene and anxiety management into depression treatments because NICE in the same chapter and with the same level of evidence recommends them? NICE: "Patients with mild depression may benefit from advice on sleep hygiene and anxiety management." Should we include recommendation not to overeat? - Patients with atypical depression are certain to benefit from that. What about washing your hands before meal? - That will help prevent GI infections among depressed patients. Paul Gene (talk) 10:40, 9 August 2008 (UTC)
 * The heading is "Treatment" and not "Specific treatment". All of the management is treatment. The most modern UK guidelines emphasize general management (or treatment). This follows an earlier trend of over prescribing which this article appears not to have moved on from. Snowman (talk) 11:15, 9 August 2008 (UTC)

Research diagnoses
Given the size of the article, I am thinking about some bits which maybe need culling (as I think ther is stuff which still needs adding (!):

Under Major_depressive_disorder - we have Minor depressive disorder and Recurrent brief depression, neither of which are diagnoses in DSM IV TR (although may be in the future. As such they are not clinical entities or diagnoses in a DSM IV/clinical paradigm. I feel sad chopping them out but technically they aren't differential diagoses clinically.

My idea would be to place them on the Mood disorder page, which itself needs expanding. thoughts? Cheers, Casliber (talk · contribs) 13:23, 7 August 2008 (UTC)

For a start, the Differential diagnoses section still needs a note on conditions which may mimic depression eg hypothyroidism. unsigned by Casliber 13:35, 7 August 2008 (UTC)
 * I would have thought that the history would make a new page. I think that a differential diagnosis could be anything vaguely similar given the variability of presentation. Snowman (talk) 13:45, 7 August 2008 (UTC)


 * Well, er yes. differentials can be hypothyroidism, and anaemia of whatever cause come to mind, also CFS/fibromyalgia..etc. Cheers, Casliber (talk · contribs) 13:59, 7 August 2008 (UTC)


 * I don't find the article as a whole to be excessively long, at least, but if I were to trim some sections, I'd probably go with Diagnosis (which does, of course, include the Differential diagnoses subsection) and Treatment (after the ECT subsection). (I would avoid moving the history section for two reasons: 1) Sorry for riding my eclectic hobbyhorse again, but the topic inherently calls for input from both the sciences and the humanities, and if the history is trimmed then the humanities angle might be understated; and 2) the classification of depression is such a difficult and longstanding problem, that if we trimmed the history much more than EverSince already has, then we'd be cutting out a vital aspect of this dynamic concept.) Cosmic Latte (talk) 16:55, 7 August 2008 (UTC)
 * Where is the length of the article is kilobytes listed? This number should indicate if the article is too long or not. The history sections seems to me to be an obvious portion to remove and make a linked page. The holistic aspects need not be excluded from the scientific portions. Snowman (talk) 18:31, 7 August 2008 (UTC)


 * I really do not think that you can cut the diagnoses as is suggested, because under ICD10 equivalents are working diagnoses for different types of depression. Snowman (talk) 18:49, 7 August 2008 (UTC)

(outdent) ok, the ceiling at FAC is about 50kb of readable prose. There is a tool somehwere which I will get to see what this one measures at. copyediting has been fruitful and I think we can trim quite a bit more yet (as there is more stuff to go in - see below). Cheers, Casliber (talk · contribs) 00:06, 8 August 2008 (UTC)

Alright - from SandyGeorgia's talk page:

Good, room to move :) Cheers, Casliber (talk · contribs) 00:29, 8 August 2008 (UTC)


 * Manual of Style (medicine-related articles) specifically states that ICD-10 is to be used for illnesses. Snowman (talk) 09:08, 8 August 2008 (UTC)

Name of page
I am not sure why the article name was changed from "Clinical depression" to Major depressive disorder". Snowman (talk) 18:49, 7 August 2008 (UTC)


 * Because DSM IV-TR is the current overriding classification used worldwide. The entity is generally defined as such and all teh research/prognosis/treatment/causes/etc.etc. uses DSM IV-TR as a definition. No-one I know calls the entity 'clinical depression', which is merely 'depression' with a 'clinical' tacked onto it so people can distinguish it from vernacular use of depression for low mood. Sorry if it sounds abrupt, you are right to ask about it, and I should be able to defend or explain every decision I make. Cheers, Casliber (talk · contribs) 00:02, 8 August 2008 (UTC)


 * PS: I would haev preferred major depression, but that is not what it is officially called, even though that is what most call it in everyday practice. Cheers, Casliber (talk · contribs) 00:03, 8 August 2008 (UTC)


 * I think WHO classification would be more appropriate than American classification, and the page name becomes "Depressive episode". Snowman (talk) 00:48, 8 August 2008 (UTC)


 * A fair point, although DSM is used alot more widely - here in Oz it is the standard. Need to check elsewhere. The two classifications are supposed to be heading toward a synthesis at some stage...I need to read up on this. Cheers, Casliber (talk · contribs) 00:57, 8 August 2008 (UTC)
 * ICD-10 is used in UK and sometimes the DSM equivalent is quoted alongside, if there is an equivalent. I think the ICD-10 equivalents should be given on this page for every diagnosis. Why not call the page "Depression"? Snowman (talk) 01:20, 8 August 2008 (UTC)

(outdent) OK, on looking at page views we have depression vs major depressive disorder, and I suspect alot of those views will be us editing it. (sigh) need to ponder this. I guess then the question for the general viewing public WRT disambig pages etc is:


 * Is major depression or mdd what folks mean when they hear the term depression?

I know this may mean another page change but would be nie to get it right and get the page where most of the public expect to find it. wow, was I wrong... Cheers, Casliber (talk · contribs) 03:19, 8 August 2008 (UTC)


 * On reflection, I think that Depression probably should be kept as a dab page. You have linked page hits charts for May, but a hits chart for June 2008 is available. Snowman (talk) 09:01, 8 August 2008 (UTC)


 * All disease headings should be in line with Manual of Style (medicine-related articles). This states that ICD-10 should be used. The current heading in confusing and has no meaning to people throughout Europe who use IDC-10. I think the article should use ICD-10 and not American based classification. Snowman (talk) 09:16, 8 August 2008 (UTC)


 * Although DSM IV is American in origin, it is pretty worldwide in scope. I think we may have to look at the guidelines. Problem is, the equivalent would be somewhere between "moderate-" and "severe depressive disorder", equally meaningless to both laypeople and clinicians outside England. I need to check what is used in Europe. Furthermore, the bulk of research uses DSM IV criteria, so if we gave it an ICD10 name, much of the material on the page would be invalid. I think the depression as a disambig pge is better on reflection as conditions such as Adjustment disorder with depressed mood would easily fall under the lay term of depression. Cheers, Casliber (talk · contribs) 10:24, 8 August 2008 (UTC)


 * PS: Holy crap! what happened to the page hits??? June's for MDD have skyrocketed...surely that can't be all of us?! Cheers, Casliber (talk · contribs) 10:26, 8 August 2008 (UTC)


 * To Snowman: Clinical depression was lame, it is not in ICD nor in DSM. To Cas: I believe, stats grok does not count redirects. Or does it? You would want to e-mail its author to find out. Paul Gene (talk) 10:31, 8 August 2008 (UTC)


 * I have not said that Clinical depression was a good name for this page, but I do not know why the current name, "Major depressive disorder", was chosen. I agree that Clinical depression is not a good name for the page. Not being used to DSM, it is useful to know that this page is aiming to be about "moderate-" and "severe depressive disorder", or somewhere between. Perhaps this page should be split into the two topics, "moderate depressive disorder" and "severe depressive disorder", so we know what the pages are meant to be about. WHO is an international system, and many non-English speaking nations use WHO, so lets stick to WHO and wiki naming conventions. Snowman (talk) 10:37, 8 August 2008 (UTC)


 * If you want to know how the current name was chosen please see archives. Then you can re-initiate the discussion, without repeating the previous arguments pro- and contra-. (You will also find the VanGogh picture discussion there.) MDD can be mild and moderate, so there is no need for any split. Please remember, this is English language Wiki, and so we needn't to be overly concerned with other countries. They can reflect their specifics in their own versions. Paul Gene (talk) 10:50, 8 August 2008 (UTC)


 * (sigh) I just realised the same debate could arise at borderline personality disorder...sorry Snowman, I don't know if you work in the area (mental health), but certain terms have a much wider currency. The corresponding icd 10 page has a separate page - we could do the same here and any icd 10-related research can go there, though that wouldn't be particularly helpful. Don't worry, I am still very unhappy about the Conure/Parakeet debate too. I am going to ask some senior researchers in the field about terms. As it stands, I feel pragmatically this is the most appropriate page name, and we may revisit the MOS on WP:MED. Cheers, Casliber (talk · contribs) 11:16, 8 August 2008 (UTC)


 * (outdent) Previous discussion in section "Major depression vs clinical depression" on the name of the page is not very conclusive. I think that wiki guidelines on page names should be followed. How is this page going to get further than a "B" without including WHO classification? I do not know which is used across the world the most, WHO or the USA classification, but I would not be surprised if it was WHO. I expect many different language nations use WHO, and so wiki pages should use the same classification also across many different language wikis. This is so that the diagnosis is transferable across the world, and it would be illogical to just use the USA classification in one language and not the other languages. There is no need to revisit Med:MOS as it is obvious that WHO classification should prevail Snowman (talk) 11:55, 8 August 2008 (UTC)


 * No it is not obvious at all. It is transferable round the world as is as DSM IV is becoming lingua franca. Fact is even UK consensus papers are noting both, interestingly with DSM IV mentioned first, and here is an Italian-origin paper usiing DSM IV terminology throughout. As I said, I will talk to some people both on- and off-wiki (i.e. professors etc.) about the state of play here. We are not about to drop everything and change because you drop by and say so. I have heard your request so there is no need to repeat it again. Cheers, Casliber (talk · contribs) 13:27, 8 August 2008 (UTC)


 * FWIW I have left a note at WT:MED (and alerted the psych and neuroscience wikiprojects) as it also pertains to borderline personality disorder Cheers, Casliber (talk · contribs) 14:06, 8 August 2008 (UTC)
 * I am not sure why you are concerned about the BPD page, which seems to me to be irrelevant to the discussion here, because The World Health Organization's ICD-10 has a comparable diagnosis called Emotionally unstable personality disorder - Borderline type (F60.31). Snowman (talk) 15:51, 8 August 2008 (UTC)
 * Because the DSM in that case has overwhelming usage compared with the ICD 10, and a rewrite would (for a slightly different reason), have an article name 'X' and discussion all about 'Y'. Cheers, Casliber (talk · contribs) 21:57, 9 August 2008 (UTC)
 * I will talk to some people. Snowman (talk) 22:51, 9 August 2008 (UTC)

Tighten diagnosis section and/or move stuff into Major depressive episode?
I have no problem with the diagnosis section, but if we're looking to tighten the article, this might be a good place to look. You might notice, as I have, that the intro paragraphs in that section basically describe a big chunk of the differential diagnosis process. This, along with the explicit "differential diagnosis" subsection, could be combined and drastically trimmed. The "rating scales" subsection, while great, may be a bit too detailed for an overview article, and could perhaps be combined with the "DSM IV-TR criteria" subsection and then trimmed as well. Also note that there is a good, but so far short, Major depressive episode article, so it would certainly be possible to move a bunch of stuff from this section (and perhaps stuff from elsewhere in the article) into there. Cosmic Latte (talk) 21:20, 8 August 2008 (UTC)


 * MDE should be a simply redirect page to here since it is the same as MDD. Paul Gene (talk) 10:45, 9 August 2008 (UTC)


 * You could always WP:AFD it, but it might be a bit of a challenge to get consensus. Cosmic Latte (talk) 23:33, 9 August 2008 (UTC)


 * I am not too worried at the moment as we have room to move sizewise...Cheers, Casliber (talk · contribs) 23:42, 9 August 2008 (UTC)

Treatment to new article
In past discussions here, a number of us suggested making Treatment into a new article to reduce the size of this one and to properly deal with the povfork Depression and natural therapies. This article has evolved a great deal since those discussions (good job on all the work here!), so I wanted to see if others still thought it a good idea. --Ronz (talk) 14:34, 30 July 2008 (UTC)
 * Past discussions in Talk:Major_depressive_disorder/Archive_3 and in Talk:Major_depressive_disorder/Archive_3, which immediately follows the first discussion. --Ronz (talk) 14:44, 30 July 2008 (UTC)
 * This is an intriguing idea, and I support it to a large extent--but only for part of the treatment section here. Specifically, I would recommend converting only the "Alternative treatments" subsection into a summary for inclusion in this article (making sure that the summary still mentions light therapy and includes the pretty picture that I added! /devious chuckle :-)), and somehow combining the full-text version (i.e., the pre-summary one that we have right now) with the Depression and natural therapies article already in existence. Additionally, simply change its page title (using the "move" tab) so that instead of "natural," it says "alternative" or "unconventional"--and make sure to explain in that article what these are alternatives to (i.e., what the conventions are: psychotherapy and antidepressants), and then both the length of this article, and the POV-ness of that one, will be reduced. How does this sound to you folks? Cosmic Latte (talk) 16:15, 30 July 2008 (UTC)
 * I can see the positives, though I feel the orthodox treatments are about as summarised as they can be here, so a treatments age would allow for expansion. It is odd how the alternative section is the size it is but I can see how it happens. Need to think about it but definitely renaming fork article treatment of major depressive disorder, much like the Treatment of schizophrenia article is a good idea. Cheers, Casliber (talk · contribs) 19:59, 30 July 2008 (UTC)
 * Yeah, I'd leave the section on orthodox treatments as-is in here, and would apply Ronz's suggestion exclusively to the alternative-treatments section, which to me poses a slight WP:WEIGHT issue ("slight" because it's just a really long list, nothing qualitatively over-the-top, but still...) Cosmic Latte (talk) 20:07, 30 July 2008 (UTC)
 * That's the challenge isn't it? How to reduce but avoid it being listy...Cheers, Casliber (talk · contribs) 20:18, 30 July 2008 (UTC)
 * This article is overly long because of the overly long History part. I think we should start with moving most of the history part into the new article. Paul Gene (talk) 01:21, 31 July 2008 (UTC)


 * Agree. Much of the history is general for mental illness and cannot be ascribed to Major Depression per se. I am also mindful of the fact we need to have a definition and brief discussion of treatment resistant depression somewhere (prognosis), and I have some material on endogenous/reactive depression and successive DSMs to add (as succinctly as possible). Cheers, Casliber (talk · contribs) 02:23, 31 July 2008 (UTC)
 * The history is rather long indeed, although if the main contributors (EverSince and OnBeyondZebrax) are willing to take on the task of tightening it, I'd let them do their stuff before jumping in myself. In any case, because MDD is a relatively new diagnosis, I suppose that the history should give due weight to the past century, although it's also important to trace the history of melancholy, beginning with the ancient Greeks and humourism, because even though MDD is a relatively new diagnosis, it certainly reflects some longstanding phenomena of which prior thinkers have been aware. Besides, the history already mentions the point at which "depression" explicitly began to supercede "melancholy" in terminology (beginning with "The term 'depression' was derived from the Latin verb deprimere..." and going through the Adolf Meyer bit)--and I think it should retain these passages, at least, in full. So: Greeks, Meyer and friends, and recent decades = keepers IMO. As for the rest, I'd like to see how EverSince and/or OnBeyondZebrax would go about tightening it. Cosmic Latte (talk) 03:28, 31 July 2008 (UTC)
 * Agree on keeping melancholia and deprimere and the third one too. Cheers, Casliber (talk · contribs) 04:22, 31 July 2008 (UTC)
 * I can move some stuff to history of mental disorders (there's also a source with more specifics on how the older usage differed from the newer) I'll just wait a bit in case OnBeyondZebrax wants to do it or has any objection. EverSince (talk) 08:53, 31 July 2008 (UTC)
 * (new tabbing)Hi, I agree that the depression History part should be trimmed. Perhaps a short intro paragraph sketching the ways that depression-like illnesses have been dealt from medieval "melancholia" thinking to the 18th century, and then start the History section with the first psychiatrists who proposed the "depression" nametag. The danger in having an over-long history section is that, even if it sourced, it has OR-ish elements, in that I/we have been raking in general mental illness content and then speculating that the source may have been referring to a depression-like illness. What would be acceptable, though, is if we have modern sources who are arguing that older mental disorders may have been the modern equivalent of depression. For example, if Professor X has written a 2003 article that claims that King Saul's melancholy state exhibits x,y, and z traits of MDD, this might be a good addition. Thanks for all of the thoughtful comments and re-writes, and I think that the exercise (of trying to do a history of MDD) was still worthwhile! OnBeyondZebrax (talk) 17:16, 11 August 2008 (UTC)

Oh looky, I found Refractory depression - though I think it should be renamed to reflect the scientific literature. I am proposing that on the talk page. Cheers, Casliber (talk · contribs) 02:32, 31 July 2008 (UTC)

Just so you all know, I've put in a request for input on OnBeyondZebrax's talk page, so hopefully he and/or EverSince will be able to trim the history section soon. Cosmic Latte (talk) 22:16, 1 August 2008 (UTC)


 * Well I've had a go at the earlier sections, keeping anything specifically mentioning melancholia/depression & adding a few bits; any probs with particular things/removals just revert of course. EverSince (talk) 10:04, 4 August 2008 (UTC)


 * Great work! The section doesn't seem to stray at all from melancholia and depression now, so I imagine that this will work. Although I suppose it'd still be possible to move even bigger chunks to History of mental disorders, I'd probably advise against it, because once that article provided an equally rich history of all significant disorders, then that article would get out of hand in terms of length. Again, good work. Cosmic Latte (talk) 08:49, 5 August 2008 (UTC)


 * Agree, history section looks really good now, only problem is I have stuck some material at the top of causes, which clearly overlaps...so I will try to bring it down. Cheers, Casliber (talk · contribs) 14:31, 6 August 2008 (UTC)

I'm not seeing as much concern for the size of this article as previously. I still think treatment of major depressive disorder would solve multiple problems and prevent the pov problems that we already have. Alternatively, we could just fold in what little there is in Depression and natural therapies that is well-sourced and balanced. --Ronz (talk) 15:14, 7 August 2008 (UTC)

Churchill
Well, this is odd. I see some sources saying that he had BPD, others MDD, and others simply "depression." Does anyone know precisely what he was (or would have been) diagnosed with? Cosmic Latte (talk) 00:44, 10 August 2008 (UTC)

In any case, I'd argue that the reference needs to be in there, because of the relevance of the phrase, "black dog"; Cas might know more about this, but the Black Dog Institute appears to be a major Australian organization that funds research/education/etc. into MDD and other mood disorders. Cosmic Latte (talk) 01:01, 10 August 2008 (UTC)


 * The Black Dog institute is headed by Professor Gordon Parker who has written alot about the evolution of the terminology etc. and has published stacks of papers (>400?). I recall teh name arising from Churchill's term. Cheers, Casliber (talk · contribs) 06:12, 11 August 2008 (UTC)

Sociocultural aspects verification

 * W. James: "After graduation, however, James's health deterioriated further, and he became deeply depressed" (Hergenhahn, p. 311). And, for good measure, "Going through periods of severe depression and other illnesses, including a weak heart, James may have turned to mental science..." (M. R. Michau, http://web.ics.purdue.edu/~mmichau/james-and-depression.pdf).
 * Watson: "As an adult Watson was often depressed, and when he got depressed he sometimes had to sleep with the light on" (Cohen, p. 7, also quoted in Hergenhahn, p. 364). Cosmic Latte (talk) 19:47, 9 August 2008 (UTC)
 * H. James: "A long spiral downwards into deep depression began. He ceased to write" (http://www.pbs.org/wgbh/masterpiece/americancollection/american/genius/henry_bio.html). Cosmic Latte (talk) 19:58, 9 August 2008 (UTC)
 * W. James (caption): "My first act of free will shall be to believe in free will....Hitherto [...] suicide seemed the most manly form to put my daring into; now I will go a step further with my will, not only act with it, but believe as well; believe in my individual reality and creative power" (Vol. 1, pp. 147-148, also quoted in Hergenhahn, p. 311). Pretty classic stuff, really.
 * Mill: Paul's edit looks good and certainly works for me. Cosmic Latte (talk) 23:18, 9 August 2008 (UTC)
 * Female poets: See http://www.apa.org/monitor/nov03/plath.html. Cosmic Latte (talk) 00:27, 10 August 2008 (UTC)
 * Tennyson: Probably BPD. My argument for keeping the reference to him had become slightly convoluted, so I'll go along with the removal.
 * Churchill: ?!?!? (See the following section.) Cosmic Latte (talk) 00:50, 10 August 2008 (UTC)


 * Female poets problem. The reference states: "In a second analysis of 520 eminent American women, he again found that poets were more likely to have mental illnesses and to experience personal tragedy than eminent journalists, visual artists, politicians and actresses--a finding Kaufman has dubbed "the Sylvia Plath effect" after the noted poet who had depression and eventually committed suicide. The findings appear in The Journal of Creative Behavior (Vol. 35, No. 1)" The abstract of the article in The Journal of Creative Behavior states essentially the same. However, we discuss here only MDD not just any type of mental illness. So, without direct support in the reference, the statement that "The relationship between depression and creativity appears to be especially strong among female poets." is a conjecture and original research since the original paper is concerned with he relationship between mental illness and creativity. That is why I was interested if in the full text they perhaps considered a subgroup of women poets with depression. If not, than this sentence have to be removed. Paul Gene (talk) 12:28, 10 August 2008 (UTC)
 * He seems careful to avoid retroactive diagnosis insofar as it could be too assumptive (about individuals), but yes, he does hone in on depression, e.g., "Why would this issue only significantly affect female poets? Perhaps because of their predisposition to depression and lower self-esteem" (Kaufman, p. 47). Cosmic Latte (talk) 14:10, 10 August 2008 (UTC)


 * Lincoln: "at least two major depressive episodes" (http://info.epmhmr.org/poc/view_doc.php?id=2941&type=book&cn=5). Cosmic Latte (talk) 01:26, 13 August 2008 (UTC)

Comments
Casliber, thanks for asking my opinion. I think this is an excellent article, very readable and comprehensive. You might also want to consider:
 * Comorbidity: Alcohol abuse ✅
 * Diagnosis: "Early dementia may present with depressive symptoms in older patients." This deserves a citation, maybe, . The relationship between depression and dementia in the elderly is complex (for example ) and might warrant a paragraph in its own right. ✅ sort of - may need tweaking
 * Differential diagnosis: depressive personality disorder (and borderline PD?)
 * Causes - psychological - stress. I might have missed this but is there a reference to the Brown & Harris study? See for example  ✅ as direct quote; feel free to paraphrase. (Cosmic)
 * Causes - psychological - psychoanalytic: The relationship between depression and loss. See for example and  (although this is touched on in the "history" section, it isn't really explained). ✅ in causes section, but wouldn't object to further elaboration, perhaps in the history section (Cosmic Latte)
 * Treatment - how about a section on treatment of children and adolescents? Here are some references if you want them: Whittington et al (2004) Selective Serotonin Reuptake Inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet 363 (9418) 1341-5. March J, Silva S, Petrycki S et al (2004) Fluoxetine, cognitive behaviour therapy and their combination for adolescents with depression: treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA 292 (7): 807-20. National Institute for Clinical Excellence (September 2005) Depression in children and young people: identification and management in primary, community and secondary care. http://www.nice.org.uk/Guidance/CG28. Cheung A, Zuckerbrot R, Jensen P et al (2007) Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management. Pediatrics 120; e1313-e1326. Birmaher B and Brent D (2007) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders Journal of the American Academy of Child and Adolescent Psychiatry 46 (11) 503-26. Goodyer I, Dubicka B, Wilkinson P et al (2007) Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial.  BMJ 335(7611): 142. Tsapakis E, Soldani F, Tondo L et al (2008) Efficacy of antidepressants in juvenile depression: a meta-analysis. British Journal of Psychiatry 193, 10-17.
 * Epidemiology - is it worth commenting on the gender difference? (yes! - done a bit. may need to embellish slightly)

Good luck, Anonymaus (talk) 12:46, 14 August 2008 (UTC)


 * Thanks for that, my inclination is to skip the research-only depressive personality disorder, but certainly elaborating on the chronic dysthymia and suicidality of BPD warrants something. Now o work on incorporating some material...(f-f-freezing here in Sydney, so jealous of those in warmer climes...) Cheers, Casliber (talk · contribs) 13:19, 14 August 2008 (UTC)


 * Excellent suggestions, Anonymaus. Pretty cool user name, too. Cosmic Latte (talk) 14:16, 14 August 2008 (UTC)

Game Plan
OK folks, been thinking about this (I hate doing these huge articles sometimes as can really get lost in them...). I did a bit of copyediting to trim text, and we do have some room to move text wise so no need to panic just yet. Continuing to find sources as references is an ongoing task, but otherwise a suggested plan would be: Cheers, Casliber (talk · contribs) 06:19, 11 August 2008 (UTC)

Comprehensiveness

 * ''What else are we missing? - both big things and little bits - please add here. also what else should go (not so important just yet)

Once we are all satisfied we (1)have the content right, and (2) have all or almost all references, and (3) have formatted refs and (4) checked MOS, then (5) copyedited, then PR or GA I guess. Anyone else have comments?


 * In the to-do list there's a request to add something about treatment-resistant depression. There's already a ridiculously short stub of a stub on treatment-resistant depression, but I'd say, let's copy-paste that stuff into here, and the stub might as well become a redirect to the MDD article--unless someone thinks there's potential to expand the stub significantly. Cosmic Latte (talk) 14:03, 11 August 2008 (UTC)
 * Yeah I know, I put it there..and it's annoying as the term only has a vague definition - I had a paper somewhere complaining about the lack of consensus on this. Need to look at both again...Cheers, Casliber (talk · contribs) 14:33, 11 August 2008 (UTC)


 * I'd say depressive realism also deserves a spot. Cosmic Latte (talk) 14:25, 11 August 2008 (UTC)
 * Interesting but pretty esoteric. where would a mention of it go? Cheers, Casliber (talk · contribs) 21:03, 11 August 2008 (UTC)
 * I'm thinking, maybe as a brief addendum to the cognitive-behavioural passage in the Causes section? After the mention of the cognitive distortions put forth by Beck, a sort of balancing statement, like, "Many cases of milder depression, however, have been associated with what has been called depressive realism, a view of the world that is relatively undistorted by positive biases." I'd have to check my sources to confirm all the details, but something along those lines? Cosmic Latte (talk) 00:45, 12 August 2008 (UTC)


 * Hmmm...interesting. Look, I am happy for you to havea play with it and we can see how it pans out. I am receptive (sorry, this sounds like I am claiming ownership of the article...) Cheers, Casliber (talk · contribs) 00:50, 12 August 2008 (UTC)
 * I added it with this diff. Does it look okay? Cosmic Latte (talk) 01:14, 12 August 2008 (UTC)
 * Still musing on whether it is better as a socio-cultural rather than clinical material. But will read again and figure that out. Cheers, Casliber (talk · contribs) 03:36, 12 August 2008 (UTC)
 * I was thinking of the sociocultural section, too, but then had a hard time figuring out just how depressive realism might be of much cultural significance. It strikes me as more of an individual, psychological phenomenon than as a social or symbolic one--and although I'm no clinician, I imagine it might be helpful in some clinical circumstances to help the patient tease apart the melancholy view of melancholy realities, on the one hand, and negative beliefs without negative bases (i.e., Beck's cognitive distortions), on the other hand. Anyway, that's just my own two cents' worth, and I'll leave it up to you. I just figured depressive realism should be mentioned somewhere in the article. Cosmic Latte (talk) 09:38, 12 August 2008 (UTC)

Treatment to new article?
We never came to a clear consensus in the recent discussion Talk:Major_depressive_disorder on whether Treatment of major depressive disorder should be a new article. Related to this is what to do about the povfork, Depression and natural therapies. --Ronz (talk) 16:39, 13 August 2008 (UTC)


 * We sorta made an interim I think. The latter should be renamed, and we are seeing how we are for space when all material added. we are still ok at the moment. Cheers, Casliber (talk · contribs) 21:57, 13 August 2008 (UTC)


 * PS: I have made the proposal over there. Cheers, Casliber (talk · contribs) 02:02, 14 August 2008 (UTC)

Article created: Treatment of depression
I was bold and renamed Depression and natural therapies to Treatment of depression. I've copied the Treatment section from here, and am currently merging the article. The treatment section here can now be trimmed back and summarized. --Ronz (talk) 15:44, 17 August 2008 (UTC)

Reviews
The feedback provided (below) by Anonymaus is outstanding, but I have one further suggestion: It might also be helpful to seek review by someone without a background in the subject matter. I think it's actually a standard practice at major publishing companies, because there might be certain things that make perfect sense to us, but might come across as poorly explained or too confusing to someone without a background in psychology or psychiatry. Just a thought... Cosmic Latte (talk) 14:32, 14 August 2008 (UTC)

Touching base -tradenames for drugs
We have some drugs listed with them and some not. Many have more than one name, and change from country to country. I guess for consistency we should remove them all, or do we want to find a trade name for all of them. Cheers, Casliber (talk · contribs) 12:52, 16 August 2008 (UTC)


 * We had a long debate about trade names on WP:MEDMOS. There was consensus that generic and brand names should be mentioned at least on first reference, and I think the preferred style would be standard JAMA style: "fluoxetine (Prozac)". Even the New England Journal of Medicine adds trade names now, when they're necessary to make the article easier to read. We should definitely not remove all brand names, because ordinary people, who are the target audience for Wikipedia, wouldn't be able to understand it. WP:MTAA. Many, perhaps most, people who take drugs know the brand name of their drug but not the generic. How many people could identify fluoxetine?


 * The disagreement in WP:MEDMOS is how often to use trade names. I think they should be used as often as necessary to make the article clear. I think it makes an article much more difficult if somebody has to look for the first reference to find out that fluoxetine is Prozac. And these articles are already fairly technical and difficult. Nbauman (talk) 19:25, 16 August 2008 (UTC)


 * Okay, thanks for the heads up. Cheers, Casliber (talk · contribs) 21:25, 16 August 2008 (UTC)


 * I would just use the one or two most common trademark names (a quick search for hits on Google or in a medical/psychological database would do), and only the names that are formally indicated in the treatment of MDD. (I think this is what most textbooks do, anyway.) For instance, I removed Zyban and kept Wellbutrin for bupropion, because only the latter brand name is "officially" used for MDD. Cosmic Latte (talk) 21:46, 16 August 2008 (UTC)


 * Might be good to double-check with Paul though, given that he is (I believe) a psychopharmacologist. Cosmic Latte (talk) 15:10, 17 August 2008 (UTC)


 * Yes, I was agreeing with NBauman in that discussion. There are also cultural issues since doctors and patients in the US, I believe, use the brand names much more often that those living in the UK. In order to counteract the problem of multiple names, a note such as in Tourette can be used: "Medication trade names may differ between countries. In general, this article uses North American trade names." (If it is OK with you) 05:22, 18 August 2008 (UTC)

B12 deficiency, intestinal problems can cause depression.
B12 deficiency, intestinal problems can cause depression.

Many 'diseases' can cause depression related to B12 deficiency, intestinal problems....

Just a lead, I may come back and do more research, but I have to finish my book...

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 15:37, 15 August 2008 (UTC)


 * Thanks for the input, but can you provide a source that clearly and thorougly associates these things with depression? The Mayo Clinic paper was intriguing, but it mentioned depression so peripherally that it's hard to know what to make of it. As an aside, as someone with a psychology degree, who has been diagnosed with both MDD and a digestive problem, I'm extremely interested in what you have to say about this. We just have to be sure that the sources cover the topic in some depth. Cosmic Latte (talk) 15:48, 15 August 2008 (UTC)


 * As someone who had an undiagnosed 'intestinal infection' I am a fairly reliable 'experiment' on this subject. I hope this provides you with an insight you can pursue...I have to finish 'the book'...

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 16:01, 18 August 2008 (UTC)

Here is a link. B 12 Link

The logic goes like this....intestinal problem, chemical malabsorption problem, depression, as in depressed energy resources.

You have to remember 'the businesses' of treating depression, are gigantic as to the 'research' to find its cause, simple as it might be, in some cases a 'false negative' test for known infections, or a unknown infection.

Its too simple, in a time and space where complexity is rewarded.

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 16:15, 18 August 2008 (UTC)

Another classic example of half-truth, yes original reearch to some degree...

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 16:18, 18 August 2008 (UTC)


 * Interesting, but still a bit far-out. The paper even states that, regarding B-12 deficiency as a cause, "most doctors would never consider such a possibility." Regarding B-12 as a treatment, the ref s in there to a double-blind stud ies y might at least qualify it for mention in the "alternative treatment methods" subsection of the article, and I, for one, don't imagine myself objecting to a mention of it there refers to subjects with chronic fatigue, not MDD. By the way, be sure not to be too ambitious about inferring causes from treatments. Lattes (even cosmic ones) may make me happy, but that doesn't mean my sadness is caused by a coffee-and-milk deficiency. Cosmic Latte (talk) 09:02, 19 August 2008 (UTC)


 * Observation

Doctors are being trained as 'pharmaceutical salesmen" and given that vitamins are non patentable there is very little motivation to suggest B 12....SAD to say....

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 14:24, 19 August 2008 (UTC)


 * An intriguing thought. Anyway, if you can find a double-blind, placebo-controlled study linking B-12 to effective treatment of MDD, then I'm sure we'll be happy to have it in there. Cosmic Latte (talk) 14:30, 19 August 2008 (UTC)


 * That site is based on a McGraw-Hill publication, and McGraw-Hill is certainly a well-known publisher, so I went ahead and added a very brief summary of that article to the alternative treatments subsection. The evidence does not look astounding, but a Columbia University psychiatrist, presumably cited in a McGraw-Hill publication, is certainly a reliable source of speculation. Cosmic Latte (talk) 14:52, 19 August 2008 (UTC)


 * Hmmm...this is interesting, but I'd like to see what others think of it before being too WP:BOLD and adding anything myself. Cosmic Latte (talk) 14:58, 19 August 2008 (UTC)

Prose size
PS: Prose size = 44 kB (6834 words), so we are ok sizewise still..Cheers, Casliber (talk · contribs) 12:38, 18 August 2008 (UTC)


 * Yep, I agree. And although I appreciate Ronz's vast improvement of Treatment of depression, I'm still inclined to leave the treatment section as-is in here (unless the article ends up getting so long as to pose a genuine WP:FAC problem, in which case I'd indeed opt for trimming the treatment). The article is relatively long, yes, but not unwieldy IMO. Cosmic Latte (talk) 13:51, 19 August 2008 (UTC)


 * Agree. Cheers, Casliber (talk · contribs) 14:10, 19 August 2008 (UTC)

SAD
Sniff, sniff. Oh, right--I agree with the placement of SAD in Subtypes, given that it's basically seasonal MDD, at least as far as I'm aware. I just wonder why it's regarded as a distinct "affective disorder" rather than, say, "Seasonal depression," which would be nominally consistent with the other specifiers. Cosmic Latte (talk) 03:17, 19 August 2008 (UTC)


 * possible solution to depression from SAD....vitamin d ?


 * Here is the link...Web Doctor and vitmain D for depression

--Caesar J. B. Squitti :  Son of Maryann Rosso and Arthur Natale Squitti 03:38, 19 August 2008 (UTC)


 * Hmm..not sure where I should place it now. was just a free-thinking moment. I was showing someone WP and they mentioned it so I stuck it in....Cheers, Casliber (talk · contribs) 03:50, 19 August 2008 (UTC)

Treatment of depression
We could use some help merging the treatment section from here with Depression and natural therapies into what is now Treatment of depression. I think it would be helpful for someone to go over the references in Treatment_of_depression and the one in Talk:Treatment_of_depression, and comment on their appropriateness. --Ronz (talk) 14:30, 19 August 2008 (UTC)

taxobox image
I guess we whould have a picture of Robert Spitzer (psychiatrist) in hte taxobox as he led the taskforce which gave the disorder its name :))) Cheers, Casliber (talk · contribs) 15:22, 19 August 2008 (UTC)

Intro
What's up with the second paragraph ("Both psychological and biological causes...significant risk of suicide or self-neglect")? It's well-written, but it makes the intro rather long, and it almost-too-conveniently sums up some controversial stuff (e.g., causes and classification) that's covered in the necessary depth later in the article. It also sums up treatments, but they're already summarized in the last paragraph of the intro ("Specific treatments include psychotherapy, antidepressants, or ECT in severe cases"). So perhaps the second paragraph should be moved, tightened, etc.? Cosmic Latte (talk) 13:50, 20 August 2008 (UTC)


 * I know, I did it last thing before sleeping. Generally articles this long have a fairly lengthy lead - have a look at schizophrenia - the idea is that a lead is a potted summary for those who are not going to read the article. Feel free to reorganize and reduce repetition, or remove or add material. It serves as a 'heads up' really. :) Cheers, Casliber (talk · contribs) 14:08, 20 August 2008 (UTC)


 * I just tweaked it a bit here and there--but I'm just about to sleep, too, so feel free to undo any mess I might have made. =) Cosmic Latte (talk) 14:41, 20 August 2008 (UTC)


 * That's cool, it'll work out with a bit of juggling and I am sure we'll play with it a bit more :) Cheers, Casliber (talk · contribs) 23:07, 20 August 2008 (UTC)

Referencing
I think the referencing needs some work. For example journal titles should probably not be abbreviated (they aren't in schizophrenia) e.g. Am J Psych should be American Journal of Psychiatry. And there should be retrieval dates. And web references should be tidied up, perhaps using. How exciting! I don't suppose there is a bot that does this. Anonymaus (talk) 20:43, 20 August 2008 (UTC)
 * This is also useful:

Anonymaus (talk) 20:56, 20 August 2008 (UTC)


 * Absolutely - I did a whole swathe the other night but got sidetracked and very square-eyed and needed a break...back to it soon...and not the bots aren't too good at that, too fiddly methinks. Cheers, Casliber (talk · contribs) 22:57, 20 August 2008 (UTC)

Seligman vs. Rotter
Maybe I'm just so tired that I'm hallucinating, but in the well-revised Causes section I think I'm seeing a contradiction where one may or may not supposed to be. Seligman's "pessimistic explanatory style" (called "depressive attributional style" in another ref), through which blame is assigned internally, corresponds with depression--but so does Rotter's "external locus of control," through which attributions are made externally. What's more, external loci of control are consistent with Seligman's idea of learned helplessness, the maintenance of which has been linked to the pessimistic explanatory style aka depressive attributional style. Anyone see a way to work out this snag? Or am I really just hallucinating after all? Cosmic Latte (talk) 14:59, 17 August 2008 (UTC)

Note that I made an attempt to resolve this in a quick revision, but I don't really think I succeeded. Cosmic Latte (talk) 15:03, 17 August 2008 (UTC)


 * Not bad, though the issue is which causes what - i.e. a feature of depressive thinking is to ruminate and be pessimistic, or is it a cause. need to be careful there. The main thing to do first up is to reword so a 'translation' sentence at the end is not needed. Cheers, Casliber (talk · contribs) 05:34, 18 August 2008 (UTC)


 * Good idea. I just gave the reword a try here (and in subsequent edits). Cosmic Latte (talk) 08:56, 18 August 2008 (UTC)


 * Talking of rumination, its disambiguation page lists "Negative cyclic thinking, persistent and recurrent worrying or brooding; see Rumination on Sadness" That article gives an idiosyncratic definition and probably needs to be retitled and rewritten, and/or just covered here. EverSince (talk) 12:08, 18 August 2008 (UTC)


 * Well spotted. Now to ruminate on what to do...Cheers, Casliber (talk · contribs) 12:33, 18 August 2008 (UTC)


 * See what you folks think of this diff, through which I've provided two slightly different ways of saying essentially the same thing. Basically I'm aiming for ease of reading, especially for the general public. (Then again, perhaps neither version is optimal, and you might want to suggest something of your own, instead.) Cosmic Latte (talk) 06:02, 22 August 2008 (UTC)

Pathways - GA or PR or...not bother
OK folks, mainly referencing fixes and copyedits I think from now on. Shall we stick it up at WP:GAN and see what happens? Or PR? Or do we want to keep going and polishing for FAC? Cheers, Casliber (talk · contribs) 14:11, 19 August 2008 (UTC)


 * I'd go straight for FAC. This seems like a fairly thorough article, with a lot of expert/educated contribution, and very few issues with format, MoS, citations, etc. A few areas of educated contention, but nothing that would strike the average reader as unacceptable or outrageous. I've seen a lot worse get by FAC. I'd say, let's polish a little more and then give it a go. Cosmic Latte (talk) 14:39, 19 August 2008 (UTC)


 * OK, I am trying to model the lead on the nicely structured one for schizophrenia...but needs buffing and I am going to sleep soon. Cheers, Casliber (talk · contribs) 15:20, 19 August 2008 (UTC)


 * Here is a shining example of the sorts of omissions that can get past FAC. I love how high we've set the standards for this article, but I'd be amazed if we still had any difficulty getting it promoted. :-) Cosmic Latte (talk) 02:01, 25 August 2008 (UTC)


 * Gosh, it's nailbiting. Prose size =46 kB (7092 words) "readable prose size"....still under 50 kb..Cheers, Casliber (talk · contribs) 12:44, 25 August 2008 (UTC)


 * PS: Still, it is good to fix no-brainers, like ref formatting etc. Still some more to do. Cheers, Casliber (talk · contribs) 12:45, 25 August 2008 (UTC)