Talk:Major depressive disorder/Archive 9

Albert Ellis should be in article
Apparently Albert Ellis is commented out in the article, and consequently  he is not mentioned in the article. He is one of the pioneers of Cognitive behavior therapy. His Rational Emotive Behavior Therapy, still in use today, has had a huge impact on the field of psychotherapy. He is a psychologist and a psychotherapist. His omission from this article is glaring. &mdash; Mattisse (Talk) 15:08, 14 November 2008 (UTC)

Resolving inline queries
More there still, I did a few: Sandy Georgia (Talk) 18:45, 14 November 2008 (UTC)
 * When citing opinion (which is OK in some circumstances), attribute the opinion to the "owner" of that opinion: don't state opinion as fact.
 * Laysource summaries can be added to the journal source by using the laysource parameter on cite journal. That allows readers to access the peer-reviewed literature along with the laysource.
 * See CITE; the issues is not Harvnbs (that has been fixed, and Harvnbs can be made to work with cite xxx templates now). The issue is mixing citation formatting: this article does not mix cite xxx with citation, and the format is consistent.  It's easy to discern when there's a problem: citation separates items with commas, and the cite xxx family of templates separates them with periods.
 * Please see the differences in WP:ITALICS, WP:LEAD and WP:MOSBOLD regarding "words as words" and bolding of synonyms in the lead.


 * I am confused. Feature article criteria state: "2(c) consistent citations—where required by Criterion 1c, consistently formatted inline citations using either footnotes or Harvard referencing (Smith 2007, p. 1) (see citing sources for suggestions on formatting references; for articles with footnotes, the meta:cite format is recommended)."
 * This article uses both and  in the body of the article. When  are mixed into the article body, the publications are also listed in the Cited text, but the full information is again given in the footnote itself. Therefore, some of the footnotes in the article body, those using, "hop" to the Cited text while those using  do not "hop" there, although the info is repeated there. Therefore, some listings in the Cited text never get "hopped" to, while others do. It seems to me less than optimal and inconsistent for an FAC.
 * Also, I'm not sure if the s are showing up without a "Footnotes section" and . &mdash; Mattisse (Talk) 19:43, 14 November 2008 (UTC)
 * This article does not use citation (only cite xxx, one of the cite xxx templates now trancludes something from citation/core) and it doesn't use Harvard inline citation method either (see Battle of Red Cliffs for an example of Harvard inlines). The "hopping" issue is not what is referred to at WP:CITE, it's a commonly used hybrid method on Wiki.  The confusion comes from similar terminology used in two different ways to refer to different things on different pages.  Crit 2c refers to the difference between the Harvard inline citation style and cite.php footnote method.  WP:CITE refers to not mixing citation with cite xxx because they are two different styles (periods vs. commas for example).  Harvnb is a method to an end.  Confusing, yes.  Sandy Georgia  (Talk) 19:57, 14 November 2008 (UTC)
 * Actually, I see they do. So "Cited texts" only refers to the s? &mdash; Mattisse  (Talk) 19:50, 14 November 2008 (UTC)
 * A ref has introduced some from of glitch, so all the harvard pages references of teh APA are diverting to ref 159 (??). Cheers, Casliber (talk · contribs) 20:10, 14 November 2008 (UTC)
 * I'm trying to track it down. It could be related to the spaces in the APA citation.  We're supposed to use quotes around ref names with spaces for that purpose: someone has a bot that fixes those. It could be related to that; trying to figure it out still.  Sandy Georgia  (Talk) 20:16, 14 November 2008 (UTC)
 * Still testing: when was the last time they were working? Sandy Georgia  (Talk) 20:27, 14 November 2008 (UTC)
 * I put the article in use to try to fix it, but got edit conflicts, so I'll stop now. It is definitely coming from the spaces in American Psychiatric Association;  knows how to fix this, please call him in, because I can't track it down with the edit conflicts, and this is one of the reasons I Hate Harvnb. Jbmurray will know how to fix it. Sandy Georgia  (Talk) 20:36, 14 November 2008 (UTC)
 * occurs twice in the "Causes" section. Possible cause. --GraemeL (talk) 20:49, 14 November 2008 (UTC)
 * Sorry! I didn't see the in use template, as I was only editing sections, and it doesn't show up. I have stopped editing, if you want to try again. &mdash; Mattisse  (Talk) 20:51, 14 November 2008 (UTC)
 * GraemeL, that won't cause that error (although it should be fixed). When I added underscores, the error went away, so it's certainly the spaces.  Now it needs a workaround, because we don't want underscores in the refs.  Mattisse, I'm done because it will be more efffective to just ask Jbmurray what the best fix is: I got far enough to know it's coming from the spaces.  Sandy Georgia  (Talk) 20:55, 14 November 2008 (UTC)


 * I don't know if this is part of the problem, but if you click one of those harvnb type footnotes and hop down to the "Cited text", there is no way to get back into the article except by clicking the browser back button, which takes you back to the harvnb footnote. From there, by clicking on that little ^ you can make your way back into the article. &mdash; Mattisse  (Talk) 21:10, 14 November 2008 (UTC)
 * PS, the reason you can tell it's the spaces is that this ref works; the problem is, we can't have underscores in the refs. Notice that it works now, while the others don't. The way you get back with Harvnbs is counterintuitive; you have to hit the back button. Another reason I hate Harvnbs (most of our readers probably don't realize that). That's the way they work.  Sandy Georgia  (Talk) 21:13, 14 November 2008 (UTC)


 * Perhaps this is a problem with "cite xxx." With citation, there's no problem with spaces.  See, for instance, the "de la Luz Montes" references in María Ruiz de Burton.  There shouldn't be any need for a work-around of using underscores or whatever.  --jbmurray (talk • contribs) 21:19, 14 November 2008 (UTC)
 * I was afraid you were going to say that ... it's implementation with cite xxx involves that citeref parameter, which apparently isn't recognizing the spaces (see my example that works). I think the workaround involves using a single-word parameter (like APA) somewhere.  Sandy Georgia  (Talk) 21:23, 14 November 2008 (UTC)
 * I think that is it! I remember a conversation on an FAC page regarding this. If you use Harvnb you have to use citation, as cite xxx screws them up. &mdash; Mattisse  (Talk) 21:26, 14 November 2008 (UTC)
 * No, that changed. Now you can use Harvnb with citeref, but there seems to an issue with spaces.  (Notice that all of the rest of them work, and the one I added underscores to work ... only the APAs with spaces aren't working).  Jb is looking at it now.  Sandy Georgia  (Talk) 21:29, 14 November 2008 (UTC)

(outdent:) OK, here's a problem: in fact there are two citations to the APA in 2000. Understandably, the harvnb template doesn't know to which it should refer. It goes for the first it can find. You can fix this by adding dates "2000a" and "2000b." I also note that the problematic reference in the footnote used the "author=" field rather than the "last=" field. (A perennial weakness of "cite xxx" if I may be permitted to get on my hobbyhorse again!) --jbmurray (talk • contribs) 21:29, 14 November 2008 (UTC)
 * You're a gem :-) Are they all set now, or do a and b have to be sorted?  I'll go back and fix that Caspi situation above.  Sandy Georgia  (Talk) 21:33, 14 November 2008 (UTC)
 * I think I've fixed the APA ones. (Heh, and of course this is another advantage of using harvnb... it keeps you honest when you're using different sources with the same author and year.)  --jbmurray (talk • contribs) 21:39, 14 November 2008 (UTC)


 * (copied from my talk archives re Featured article candidates/Albert Speer, a recent FAC ) In this Featured article candidates/Albert Speer, if you read down far enough, there is this discussion:
 * Comments: I believe there's something wrong with the Harvard referencing; the links in the citations do not seem to lead anywhere, when in fact they are supposed to link to the works under "Bibliography", yes? Also, per WP:DASH, dashes for page ranges in the citations need to be changed to en dashes. María ( habla  con migo ) 14:52, 20 October 2008 (UTC)
 * I just copied what was already in the article. Can someone point me in the right direction in fixing the refs?  I'll fix the dashes after I fix the refs, just in case I totally have to redo the refs.--Wehwalt (talk) 17:46, 20 October 2008 (UTC)
 * Swapping the various cite web and cite book templates to citation seems to have solved the issue. - auburn pilot  AuburnPilot


 * &mdash; Mattisse (Talk) 21:33, 14 November 2008 (UTC)
 * Unnecessary, because they didn't know how to use the citeref paramter: they made that change before I saw it or I would have explained. Once they made the change, I didn't want to explain so they wouldn't have to undo it all. Either way works. Sandy Georgia (Talk) 21:39, 14 November 2008 (UTC)

Gender bias?
How come the article only lists famous men with depression in the "Sociocultural aspects" section, especially considering the disease statistically affects more women? If you are looking for a depressed female artist, try Mary Wollstonecraft or Mary Shelley. There are more. Those I happen to know I could get sources for. :) Awadewit (talk) 18:23, 2 November 2008 (UTC)


 * Good point! I also note that neither of those are listed in List of people with depression. /skagedal ... 18:39, 2 November 2008 (UTC)


 * Also, the mention of hormone replacement for men is mentioned but nothing about all the research being done in the field for hormone replacement for for women, now that giving estrogen  for depression and other symptoms is no longer considered safe. The editor dismissed the mention of this by a commenter, saying he had not encountered it.  But there are all sorts of substitutions for estrogen being researched, including nasal sprays that affect dopamine receptors in the brain.   &mdash; Mattisse  (Talk) 18:42, 2 November 2008 (UTC)


 * Regarding adding more British literary figures, although I would agree with that females should be included, there is already a huge British bias to the article, including a section on British literary figures, while literary figures from other countries are ignored, for the most part. &mdash; Mattisse  (Talk) 18:50, 2 November 2008 (UTC)


 * Virginia Woolf would probably be a good example, since she suffered very severely from it. Looie496 (talk) 19:02, 2 November 2008 (UTC)


 * And as a non-British figure, William Styron is probably worth mentioning, since he actually wrote about depression in "Darkness Visible". Looie496 (talk) 19:04, 2 November 2008 (UTC)


 * What about Emily Dickinson? Kate Chopin? Awadewit (talk) 19:14, 2 November 2008 (UTC)
 * Sylvia Plath? Fainites barley 19:51, 2 November 2008 (UTC)


 * MEDMOS: "One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition."  Sandy Georgia  (Talk) 19:53, 2 November 2008 (UTC)


 * I would favor including substitutions for estrogen being researched for women rather than just mentioning men and testosterone, for example (as mentioned above) studies on estrogen research, including nasal sprays that affect dopamine receptors This is an example of bias in the article that another commenter brought up on the FAC page.  &mdash; Mattisse  (Talk) 20:12, 2 November 2008 (UTC)


 * One issue I have with historical people, or in reported media etc. with a psychiatric condition is that I get a sense that some reported mood disorders (whether depression or bipolar) actually sound like other conditions (eg personality disorder) when symptoms are listed, but it is hard to diagnose when the person has been dead for hundreds of years. I would be more than happy to include some women (and should have noticed this before), but it goes without saying that the source needs to be peer-reviewed/academic etc. A psychiatric historian would be great. Woolf and Plath come to mind as highly notable for their connection with psychiatric conditions, and there are likely to be others. If someone can find a scholarly source that would be great. I'd love the help :)


 * WRT hormone therapy, some form of review paper would be good. I will ask and look around. Cheers, Casliber (talk · contribs) 13:25, 3 November 2008 (UTC)


 * PS: I had not been aware of Mary Shelley or Wollestonecraft being linked with depression (but then again, I have not read much about either), Awadewit, if there is a detailed analysis that may be interesting. Cheers, Casliber (talk · contribs) 13:28, 3 November 2008 (UTC)


 * First, let me say that the MEDMOS guideline is terrible! Put that on my list to change. The "popular perception" of a disease is often horribly misinformed. Moreover, the list of people who have "lastingly" affected any historical narrative of a disease is a result of the way historians tell that narrative. Considering that until the 1970s, historians were loathe to consider women important in history, women are often not a part of that narrative. Should we therefore be perpetuating that here? I really hope not. (Now that's off my chest....) Second, the information I have on Wollstonecraft and Shelley does not come from psychiatric historians, I'm afraid, nor have I read any in-depth analyses of their states of mind. As you say, it is difficult to diagnose someone two hundred years after their death, particularly of a psychiatric disorder. However, Wollstonecraft did attempt suicide. Twice. Her letters are horrifying to read. Anyway, the sources I have are modern biographies written by historians and literary scholars. If you don't want to use those, I would understand. Awadewit (talk) 20:27, 4 November 2008 (UTC)


 * Well, given the depth of it, and the fact that there is a 3rd party commentary and discussion on the topic, go for it. The points you raise are valid.:) or should that be :( (depressed emoticon) Cheers, Casliber (talk · contribs) 20:50, 4 November 2008 (UTC)

Linking to here - Elizabeth Wurtzel's Prozac Nation "describes the author's experiences with major depression." .... Judith Guest's Ordinary People "I wanted to explore the anatomy of depression" incl. suicidality EverSince (talk) 04:04, 7 November 2008 (UTC)


 * Eeks, now bringing modern portrayals into it; I have three books on psychiatric condition depictions in cinema - Girl, Interrupted is listed in two, both detailing how she doesn't actually have borderline personality disorder as the film says but is having a depressive episode, Ordinary People, House of Sand and Fog. I hadn't looked at this in detail before as lots of editors are pretty neutral to modern cultural depictions. Ordinary People stands out for me but it is (yet again) a male...I am thinking of gender balance now. Cheers, Casliber (talk · contribs) 12:23, 7 November 2008 (UTC)
 * It was written by a woman about a family. Wurtzel is also female. Yes there's also various online articles about psych conditions in films. EverSince (talk) 17:06, 7 November 2008 (UTC)


 * Wollstonecraft
 * On Wollstonecraft, here is an article that might be useful: G. J. Barker-Benfield, "Mary Wollstonecraft: Depression and Diagnosis" Psychohistory Review 13 (1985). Barker-Benfield is a literary critic, though. Awadewit (talk) 15:40, 7 November 2008 (UTC)
 * In the major biography of Wollstonecraft written recently by Wollstonecraft scholar Janet Todd, she writes in a footnote "I have used the words 'depressed' and 'depression' anachronistically to refer to Wollstonecraft. 'Depression' in fact became a current term only in the mid-nineteenth century when nit came to be used for the lowness of spirits felt by the sick. By 1900 it had achieved its modern meaning of a general sinking of the spirits. I have used 'melancholy' and 'melancholia' also, especially when Wollstonecraft seemed in part to be celebrating her condition." (Todd, Mary Wollstonecraft: A Revolutionary Life, 464) Awadewit (talk) 15:40, 7 November 2008 (UTC)
 * Todd also connects Wollstonecraft's depressive personality with her family and her culture: "Clearly a depressive, even manic depressive, tendency existed in the Wollstonecraft family, there already in passive mother and volatile father, whose moods could swing violently from hatred to fondness. Henry Woodstock is unknown but the siblings Eliza, Everina and James revealed it as surely as Mary, and the bent continued in the few children in the next generation, Mary's and Ned's [for example, Fanny Imlay and Mary Shelley ] . But there was also cultural component in their malady: the high esteem in which the middle classes held melancholy in the eighteenth century, an esteem that must sometimes have prevented the sufferer entirely from giving in to despair. In the seventeenth century melancholy seemed part of the human condition, the proper response of a thoughtful, pious man to life's inevitable sadness. In the eighteenth century religious melancholy fell out of fashion while secular melancholy achieved more of an elite status. Male melancholy in particular was much prized; in mid-century Thomas Warton's The Pleasures of Melancholy delivered it not as insanity or disease but as a kind of moody introspection, a sensitivity to oneself in nature and the world...Women followed the line and their commonplace books of favourite passages overwhelming concerned 'grief, disappointment, the fallen leaf, the faded flower, the broken heart and the early grave'. Mary's catalogue of miseries eased her heart and created her in the softened feminine character of the middle-class ideal, in her case still resolutely pious." (Todd, Mary Wollstonecraft: A Revolutionary Life, 75) - Teasing out what was a "disease" and what was cultural about Wollstonecraft's "depression" is impossible. I don't know if you want to raise this issue in the article or not, but it is frequently raised when discussing Wollstonecraft or other figures at this time because of what Todd outlines - the culture itself promoted "depressive" ideas. :) Awadewit (talk) 15:40, 7 November 2008 (UTC)

Here are some general statements about Mary Shelley. She had many depressive episodes in her life; if you want the list, I can try to assemble it. It is worth noting that Seymour uses the words "melancholia" and "low spirits" in addition to "depression" to describe Shelley's condition - just like Todd:
 * Mary Shelley


 * Mary wrote one great work when she had only begun to taste the bitterness of rejection [Frankenstein]. The most harrowing aspect of her life is to see how, through no fault of her own, it began to mirror her novel. Mary, like her creature, became a pariah. When [Percy Bysshe] Shelley died, his friends had already been made aware that his marriage was on the rocks, and that the fault was Mary's. Disgraced by her connection to him, tortured by the sense of her own inadequacy as a wife, publicly disowned by his family, Mary in her widowhood was thrust into the icy regions of solitude to which she had banished the Creature of her imagination. Hounded, persecuted and vilified, she taught herself how to survive. She remained, until the end of her life, generous, forgiving, tolerant and hopeful. The depression which she voiced in her journals was, we always need to remember, hidden from her friends. Her father [William Godwin] was one of the few people who saw, and pitied, the disposition to melancholy which she had inherited from his wife [Mary Wollstonecraft]. One wonders how much more sympathy she might have gained if she had been a little less fiercely reserved.


 * Remorse is at the the heart of Mary's life after Shelley's death and the key to her recreation of him. Her journal tells us that she firmly believed she was condemned by fate to pay for the suffering and death of his first wife, the young woman Shelley abandoned for a greater love. Shelley himself died during a period of estrangement, the worst of emotional situations in which to lose someone you love. The terrible combination of guilt and remorse impelled Mary to dedicate herself to an act of literary atonement. Her recreation of Shelley as a man who was, if not Christian, Christlike, allowed her to repossess him, to give him in death what she felt she had wrongly withheld in life, and absolute and unconditional devotion....


 * Mary Shelley is not the active, enthusiastic, optimistic woman described by recent biographers. She is a woman who struggled all her life against the unpredictable volatility of her own nature, who never knew when the black cloud of depression would settle around her, who was tormented by the sense of her own inability to become what she felt the world expected her to be, a second Mary Wollstonecraft, who tortured herself with the thought that every misfortune that came to her was directed by fate, as her punishment for having taken Shelley from his first wife, for having failed him herself." (Miranda Seymour, Mary Shelley, 560-61)

Let me know what else I can do. Awadewit (talk) 16:09, 7 November 2008 (UTC)


 * The first Wollenstonecraft source is but I can't access full text.  The rest of the text on her raises some concern about depression vs. bipolar, and the sources aren't of the peer-reviewed medical quality I'm accustomed to working with (e.g.; Johnson).  If someone can get hold of the full text, it may yield something useful.  I found   on Shelley.  Perhaps the gender bias comes from the sources: that historically famous women aren't as well covered by sources as men are.  Sandy Georgia  (Talk) 02:55, 8 November 2008 (UTC)
 * This is not a reliable source, but it does give a list of women for whom reliable sources might be found.
 * Ditto: Not a reliable source, but includes women for whom sources might be found.
 * Can't access this, don't know if something can be found here:
 * Same:
 * Based on how difficult it is to find info, I suspect that Samuel Johnson gets mentioned because the writing about him left such a detailed record, while we don't have that same quality of medical evidence on hardly any other historical figures, much less women. Sandy Georgia  (Talk) 03:10, 8 November 2008 (UTC)
 * I did mention that these were biographies written by historians and literary scholars. Casliber wanted them anyway. As far as I know there is no detailed medical analysis written by medical professionals of either Wollstonecraft or Shelley in the way there is for Johnson. I don't know about other famous women, such as Plath or Chopin, however. Awadewit (talk) 16:20, 9 November 2008 (UTC)
 * Awadewit, thankyou for the material - I'll give you an example of the difficulties "mood swings" as such have often been likened to bipolar disorder (latter day manic-depression), however what many people outside psychiatry mean by the term is Emotional dysregulation of mood which occurs over minutes to hours, which is more a sign of personality disorder ( (groan) that bluelink just revealed another page which needs fixing :. I don't know how many patients, relatives, and other laypeople I have had to clarify this to at work, it seems to be once a fortnight. The Shelley stuff looks good, especially the internalisation of guilt..I am trying to address all the remaining primary sources and other material and time is limited (argh!) Cheers, Casliber (talk · contribs) 19:08, 9 November 2008 (UTC)
 * Whenever you have the time - clearly this is not the most important part of the article. :) Awadewit (talk) 05:56, 15 November 2008 (UTC)
 * Gah! I have been juggling all sorts of stuff - I had meant to check on psych journals too for famous women...Cheers, Casliber (talk · contribs) 07:18, 15 November 2008 (UTC)


 * Whoa, here is one written by a psychoanalyst Badalamenti...Cheers, Casliber (talk · contribs) 12:41, 16 November 2008 (UTC)
 * Dammit, can't get fulltexts (or abstracts for that matter) of any of these! Hmmm...library time I guess. Cheers, Casliber (talk · contribs) 12:54, 16 November 2008 (UTC)


 * Hormones and women
 * Repeat these two statements as they have  gotten no response:
 * Also, the mention of hormone replacement for men is mentioned but nothing about all the research being done in the field for hormone replacement for for women, now that giving estrogen  for depression and other symptoms is no longer considered safe. The editor dismissed the mention of this by a commenter, saying he had not encountered it.  But there are all sorts of substitutions for estrogen being researched, including nasal sprays that affect dopamine receptors in the brain.
 * I would favor including substitutions for estrogen being researched for women rather than just mentioning men and testosterone, for example (as mentioned above) studies on estrogen research, including nasal sprays that affect dopamine receptors This is an example of bias in the article that another commenter brought up on the FAC page. &mdash; Mattisse (Talk) 17:15, 7 November 2008 (UTC)


 * Addendum - This has been mentioned by others also. I am not the only editor to see this bias regarding hormones and women. Of course, the whole article only peripherally addresses sex differences. &mdash; Mattisse (Talk) 17:18, 7 November 2008 (UTC)


 * This looks like a recent full-text review, available thru the link to CNS spectrums:  .  Go for it !!  Sandy Georgia  (Talk) 05:28, 8 November 2008 (UTC)


 * I was able to read the full-text version of this review article in Current Opinion in Psychiatry. The review ref covers the paragraph, and given the discussion of primary sources I left out those reffing sub-snippets within. Cheers, Casliber (talk · contribs) 12:44, 9 November 2008 (UTC)

Bullying and depression
Finding anything other than primary sources is proving tricky for this as I try and find some review articles --> this cites two studies. There are several studies about the place showing links between bullying and depression, yet no Review article as such, which I am looking to bolster the Social Causes section. Cheers, Casliber (talk · contribs) 04:27, 14 November 2008 (UTC)

And this..Cheers, Casliber (talk · contribs) 04:28, 14 November 2008 (UTC)

Stuff it - no reviews and I have been looking for hours!! These bullying studies are important and I am moving them to 'to do' box for noting in a future causes article. Cheers, Casliber (talk · contribs) 13:04, 14 November 2008 (UTC)


 * How about this one (see p. 5 onward)? Cosmic Latte (talk) 15:06, 14 November 2008 (UTC)


 * Here's another, although I don't have full text. Cosmic Latte (talk) 20:49, 15 November 2008 (UTC)

Circadian rhythm image
Rather than jumping in with another illustration, I figured I'd make the suggestion here first. How about adding this to the Biological causes section? Correct me if I'm wrong, but I believe that the associations between depression and the circadian rhythm are better-documented than those between depression and the hippocampus (a picture of which I removed upon Looie's suggestion).

Image:Biological clock human.PNG Caption: Depression appears to be related to disruptions in the circadian rhythm, or human biological clock.

Cosmic Latte (talk) 19:32, 14 November 2008 (UTC)

No one has objected (yet), so I went ahead and added it. See what you think--although I'd say that this one is quite on-topic. Cosmic Latte (talk) 14:38, 15 November 2008 (UTC)


 * Nice illustration...and pertinent, can't think of a reason not to include it as we have done for a few others...so I am happy if other folks are. Cheers, Casliber (talk · contribs) 11:55, 16 November 2008 (UTC)

Books need ISBNs
There is at least one that still does not have one. I am sick to death of going through this article and still finding so many mistakes. I am tired of putting the inline notes in. Unless I recover from my current prostration, I will not complete the check of the article. &mdash; Mattisse (Talk) 22:10, 14 November 2008 (UTC)


 * hard to look for what's not there...oh wait (lightbulb above head goes on), I can CNTRL-F "book"....Cheers, Casliber (talk · contribs) 22:28, 14 November 2008 (UTC)
 * I would have preferred that you had addressed my comments on the FAC page rather than spend you time writing other articles and collecting DYKs. Instead you did not. I feel like I have put more work into this article since the FAC opened than you have, that I have been doing your work for you. I am done.  Cheers,   &mdash; Mattisse  (Talk) 23:16, 14 November 2008 (UTC)
 * How dare you dictate to me how I spend my time on WP???? I spent hours yesterday looking for review articles of material which I have moved to the talk page. I have pandered and changed or tried to address lots of your points except where you are plainly wrong, and had to listen to your threats of signing off several times over, and not-so-subtle digs at other editors. You complain about acrimony yet you were the one who brought acrimony into this. Your tone has been impossible and you are holding this to ransom and you know it, your behaviour is incredible. i have a life off-wiki and cannot devote 24 hours a day to it at your beck and call. Cheers, Casliber (talk · contribs) 00:01, 15 November 2008 (UTC)
 * I've added isbn's to the couple of things that were missing them. Two books, DSM-II and the Letters of William James, don't seem to have isbns at least according to Google Books. looie496 (talk) 00:35, 15 November 2008 (UTC)
 * DSM II predates isbns, so maybe oclc or something...Cheers, Casliber (talk · contribs) 03:13, 15 November 2008 (UTC)

bare book references

 * The following are the bare text references as of this version.
 * Ref 53: Fromm E (1941). Escape from Freedom. New York: Holt, Rinehart, & Winston. (in removed bit)
 * Ref 54: Heidegger M (1927). Being and time. Halle, Germany: Niemeyer. (in removed bit)
 * Ref 70: Mashman, RC (1997). "An evolutionary view of psychic misery". Journal of Social Behaviour & Personality 12: 979–99. (issn best I could find)
 * Ref 88: Yesavage JA (1988). "Geriatric Depression Scale". Psychopharmacology Bulletin 24 (4): 709–11. (pmid elusive but found)
 * Ref 151: Depression Guideline Panel. Depression in primary care. Vol. 2. Treatment of major depression. Clinical practice guideline. No. 5. Rockville, MD: Agency for Health Care Policy and Research, 1999. (removed for second source, see below)
 * Ref 215: Hirschfeld RMA (2001). "The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care". Primary Care Companion to the Journal of Clinical Psychiatry 3 (6): 244–254. (done)
 * Ref 223: Hippocrates, Aphorisms, Section 6.23
 * Ref 238: Mapother, E (1926). "Discussion of manic-depressive psychosis". British Medical Journal 2: 872–79. [added ISSN—article is not available online /skagedal ... 18:38, 15 November 2008 (UTC)]
 * Ref 244: Schildkraut, JJ (1965). "The catecholamine hypothesis of affective disorders: A review of supporting evidence". American Journal of Psychiatry 122 (5): 509–22. (done)
 * Ref 261: Heffernan CF (1996). The melancholy muse: Chaucer, Shakespeare and early medicine. Pittsburgh, PA, USA: Duquesne University Press. (got that one)
 * Ref 270: James H (Ed.) (1920). Letters of William James (Vols. 1 and 2). Boston, MA, USA: Atlantic Monthly Press, pp. 147–48.
 * Hope this helps. --GraemeL (talk) 22:30, 14 November 2008 (UTC)


 * Thanks. Cheers, Casliber (talk · contribs) 22:41, 14 November 2008 (UTC)
 * Feel free to edit the comment and strike them out as they are dealt with. Makes it easier on you. --GraemeL (talk) 22:44, 14 November 2008 (UTC)
 * There's an ISBN finder in the userbox on my userpage. Sandy Georgia  (Talk) 22:45, 14 November 2008 (UTC)


 * Ref 215 has a here but I can't get a pmid. I have to go out for a while and do chores, so any help on this and any others much appreciated. Cheers, Casliber (talk · contribs) 00:32, 15 November 2008 (UTC)
 * pmid for 215 is 15014592. looie496 (talk) 00:41, 15 November 2008 (UTC)
 * Terrific! thanks for that. Cheers, Casliber (talk · contribs) 02:07, 15 November 2008 (UTC)
 * I've got an ISBN for a paperback reprint of ref 270 if thats OK. Might need to change the page numbers though. Fainites barley 14:08, 15 November 2008 (UTC)
 * No - page numbers the same. New publisher.Fainites barley 14:23, 15 November 2008 (UTC)

re ref 151 - all attempts to clarify this produce the 1993 guideline (for which I have an url, which is still being cited and which states it is no longer current) but nothing for 1999. Can somebody clarify this? Fainites barley 21:42, 15 November 2008 (UTC)
 * Thanks for looking. I was puzzled by this, but it is actually covered more thoroughly in the source for the second part of the sentence, so removed. Cheers, Casliber (talk · contribs) 11:54, 16 November 2008 (UTC)

Removed paragraph
After much cogitating, I have removed the paragraph on existential/humanistic in causes. It makes a nice whole but there are too many page numbers and isbns missing which I cannot address, and as it is more philosophical than directly clinical, it is possibly less central than the paragraphs above it WRT more 'core' material. I am very sorry to those who contributed to the bit. Luckily it would go well, along with the other material in the to-do box, in a causes article. Cheers, Casliber (talk · contribs) 00:14, 15 November 2008 (UTC)


 * As the primary author of that paragraph, I must admit that I'm a bit attached to it--but I sincerely think it would be a mistake to omit Rollo May from a discussion of depression. Please see what you think of my new version of the paragraph. Note that I now cite only psychologists (May and Maslow), and note that page numbers and ISBNs are all included. :-) Cosmic Latte (talk) 10:24, 15 November 2008 (UTC)
 * Also note the more clinical approach that I took to discussing May this time. Cosmic Latte (talk) 10:29, 15 November 2008 (UTC)


 * Certainly is more relevant to depression and having the referencing sorted is good. I am not fond of lots of quotes, and think the 2nd and 3rd can be reworded to avoid this. I will have a go. Cheers, Casliber (talk · contribs) 19:39, 15 November 2008 (UTC)

inline notes
I am using inline notes as a last resort. I have found that talk page comments are largely ignored or answer by irrelevant replies on another subject, or merely with threads that are discursive and chatty, or photos posted meant to dismiss comments. Comments on the FAC page are ignored. After several weeks, I am losing hope. &mdash; Mattisse (Talk) 18:42, 8 November 2008 (UTC)


 * Yes, the tags are very helpful for this article. I think I can change a few primary sources. I am busy so my time is in bits and pieces for a few days but can get there. Cheers, Casliber (talk · contribs) 22:44, 8 November 2008 (UTC)


 * Yeh will try to address in due course; the biopsychosocial reviews I posted above cover some of it. I'm wondering if it would be best to cover within a causes subarticle first (what to call it though), then consider how to address within the word count constraints here. EverSince (talk) 04:45, 9 November 2008 (UTC)


 * I have to say though, I'm unclear how a 2008 peer-reviewed "meta-analytic review" is a "primary source only" and better replaced with a 2002 psychiatric textbook... EverSince (talk)


 * Also not comfortable with some of the other sources (whcih as well as providing new data, summarize the existing) being replaced by nonspecific textbooks that are several years older, which probably cover it less progressively & sourced to even older studies (I recall the psychiatrist in a Simpsons episode telling Bart to stop messing around climbing on the shelves in his office because "most of those books haven't been discredited yet". EverSince (talk) 05:14, 10 November 2008 (UTC)


 * I know it is frustrating - I guess my take on it is the book/review article forms the 'core' of an article, and the studies act as dressing if need be and thus are aligned with their sources (eg. A 1988 multicentre study reported...x), and thus the issue of synthesis is avoided. I have been trying to look for review articles to place here. The book I used is like a big fat review article wirtten by a load of psychiatrists and epidemiologists which was very notable (and cost $200!!) when it came out, and is a fascinating read. Cheers, Casliber (talk · contribs) 03:40, 12 November 2008 (UTC)


 * I don't disagree with that, and no doubt that 2000 book on unmet need in psychiatry is excellent. It's a shame that along the way an important sourced (2008) point has been deleted - that the association found between early adverse events and later major depression can be at least partly due to the fact that an adverse environment has itself persisted from childhood through adolescence. I might try to cover it again. EverSince (talk) 22:07, 12 November 2008 (UTC)


 * Sorry about that, listen, a good idea may be to place material removed into the to-do box at teh top of the page for a future cuases of depression page down the track like what has happened with schizophrenia. That way, it won't get archived and lost on talk pages or in diffs. Cheers, Casliber (talk · contribs) 00:24, 13 November 2008 (UTC)

These seem to be the remaining issues in inline notes (that are not already fully commented out): /skagedal ... 08:52, 19 November 2008 (UTC)
 * Page number needed for Helplessness: On depression, development and death, ISBN 0716707519 – My library has this book, I could take a look next time I'm there. I'm not sure this needs a page number, though, as WP:CITE says: "Page numbers within a book or article are not required when a citation is for a general description of a book or article, or when a book or article, as a whole, is being used to exemplify a particular point of view." Doesn't this apply in this case? Alternatively, the Barlow & Durand textbook, used in other places in this article, p. 230, could be used. I don't know what is best.
 * Page number needed for Comprehensive guide to interpersonal psychotherapy, ISBN 0-465-09566-6
 * Page number needed for The Inner World of Abraham Lincoln, ISBN 0-252-06667-7


 * Seligman's is a pretty notable book, and I do like the idea of diversity of sources, and his book is the best reference for his idea, so I would be extremely grateful for the ref. I will review the IPT issue as maybe there is a paper which will substitute, otherwise I can check hospital. Cheers, Casliber (talk · contribs) 09:43, 19 November 2008 (UTC)
 * Ok, now we have some page numbers – it now points to the specific chapter where he makes the argument of comparing depression to learned helplessness. There is no single page number that would make sense to use, IMHO. /skagedal ... 15:43, 19 November 2008 (UTC)


 * I was thinking the same thing (i.e. a chapter rather than a page was a better reference) as it is/was a broadly discussed point and central theme that may have been difficult to pinpoint to a particular page. Good work and thanks!! Cheers, Casliber (talk · contribs) 23:30, 19 November 2008 (UTC)

Somatization
The symptom and signs section includes a mention of chronic pain, but is does not convey the meaning of somatization. Snowman (talk) 00:08, 20 November 2008 (UTC)
 * I have put a strike through my line above, partly because I should have said "somatic symptoms" rather than "somatization". Snowman (talk) 12:31, 20 November 2008 (UTC)
 * There are a couple of separate issues here - conditions which are associated with chronic pain, and give rise to a chonic pain disorder, are commonly associated with depression, then there is the issue of communicating psychological distress through physical symptoms, actually a very common part of English terminology (eg "my stomach in knots" = "anxiety" etc), and then there are several somtatoform disorders, and then there is the fact that in clinical practice it can be very difficult at times to determine where one ends and another begins (eg how much physical basis there is for a pain, which came first etc.).


 * I take it what you mean is this bit "The person may report persistent physical symptoms..." and teh fact that it needs some form of elaboration that (a) the symoptoms lack a clear cut pathology and (b) they are consciously or (more usually) unconsciously communicating a psychological distress. It is tricky to know how much detail to go into here, as I thought it was fairly self explanatory, but I do see your point (I think). I am trying to think if tehre are any simple adjectives which may help. Cheers, Casliber (talk · contribs) 00:47, 20 November 2008 (UTC)


 * Actually, I have been thinking on it. again this is a pplace where symptoms are discussed rather than investigations/causes, and as such it is purely descriptive. Like so many other terms, somatisation has now a pejorative connotation and a woolly boundary. Thus strictly speaking, somatisation does include the communication of these symptoms here, yet the term is often reserved for somatisation disorder which has a much different level of severity, thus another headache...Stigma is bad enough without using another label which has a negiatve connotation. Cheers, Casliber (talk · contribs) 01:51, 20 November 2008 (UTC)
 * How about something like this "Depressed people may suffer from a range of persistent and often vague physical symptoms, especially in cultures where emotional problems are stigmatised". (refs needed) To me this helps include more cultures, as well as being more descriptive. Snowman (talk) 02:03, 20 November 2008 (UTC)
 * Strike out line in section above as it has been superseded by my DIY edit to the article. Snowman (talk) 18:01, 20 November 2008 (UTC)
 * Hmmmm...not bad if'n I say so myself, though in reality they are pretty well stigmatised in all cultures, though some even more than others. However, the big stickler is ensuring the connection/inferenced is referenced in the source (i.e the source is not just making the observation but the infrerence as well. I know DSM is purely descriptive, as is the standard textbook. I will have a look at the ref again a bit later, if not it might be something worth hunting up in a Review article...Cheers, Casliber (talk · contribs) 02:39, 20 November 2008 (UTC)
 * I have checked the ref at the end of the line and I made a DIY edit to modify to odd line to say more closely what the ref says. The phrase "chronic pain" does not occur in the ref, so I am wondering if the use of "chronic pain" and the wikilink is appropriate here. Snowman (talk) 11:40, 20 November 2008 (UTC)

Yeah, good point - the issue is this - somatic symptoms is a pretty broad term which includes miscellaneous aches, pains, fatigue and all sorts of physical complaints. Upon thinking about it, this may include pain which is chronic, but the term chronic pain has taken on a different meaning and is generally a more overt/pervasive symptom. Therefore, though chronic pain in a broad sence could be a symptom, the stricter definition of the term is not so good here and there is more accuracy to be gained by leaving it out rather than keeping it in. Cheers, Casliber (talk · contribs) 12:27, 20 November 2008 (UTC)

Religious alienation
It's pretty clear to me that Matisse is right here. The statement relies on a single primary source reporting a relatively small study, with little backing from other sources as far as I can tell. Why is this worth fighting about? looie496 (talk) 21:29, 20 November 2008 (UTC)
 * Thank you for using the talk page, rather than the bloated FAC. The bit about religious alienation was originally attributed to an opinion piece by noted psychiatrist Nancy Coover Andreasen, which was replaced with the primary source only after Mattisse removed the original source as "too old"; my intention in citing the new ref was primarily to show (in a supplement to common sense) that Andreasen's perspective has not been lost in the sands of time. In a nutshell, though, I still feel that Andreasen (who is undoubtedly notable) is worth mentioning&mdash;even if in an "According to Nancy Coover Andreasen" form; I cited the primary source only as backup. Cosmic Latte (talk) 21:41, 20 November 2008 (UTC)
 * This has been discussed over and over. Common sense has nothing to do with it. WP:MEDRS has everything to do with it. Why are you clinging to this primary source? Without the beginning clause, there was still a statement about religion referenced to a review article in the lead of this sentence after I rewrote the sentence Why weren't you happy with that and had to revert it? Tony1, Delldot and I objected to any specific possible related factors being mentioned in the lead. Why not mention alcoholism, childhood trauma and other possible related factors that have lots of supporting references to back them up, instead of singling out religion, sourced only by a poor primary source? You are being unreasonable. However, I have not found talk page discussions with you useful. You just argue. You do not compromise. These types of "discussions" are why I am so frustrated.  &mdash; Mattisse  (Talk) 21:58, 20 November 2008 (UTC)
 * Speaking of alienation, you might want to WP:COOL down a notch or two, so as not to alienate your fellow editors. "Why not mention alcoholism, childhood trauma and other possible related factors that have lots of supporting references to back them up"? I don't know. Why not? No one is objecting to mentioning anything like that, if it's properly sourced and doesn't create article length issues, etc. Religiosity is mentioned because it is so common. Strong feelings about it are even more common. So, it is likely to be of interest to the average editor. Alcoholism and childhood trauma are considerably less common than religiosity, but again, no one is objecting to mentioning them as well. Cosmic Latte (talk) 22:09, 20 November 2008 (UTC)
 * "Why are you clinging to this primary source?" I'm not. I'd much rather cite Andreasen, although you've yet to show me which part of WP:MEDRS even the primary source conflicts with. Cosmic Latte (talk) 22:18, 20 November 2008 (UTC)
 * (ec)Please provide some reliable sources that "religiosity" is "so common" that it is more important than other possible related causes of depression. The objections of Tony, Delldot and I were based on singling out any purported cause in the lead. Rather, the suggestion was to have a section on common purported causes that have research support where religiousity could be included along with others. I'm unclear what you mean when you say about religion, "Strong feelings about it are even more common.", do you mean as a cause of depression? If so, then please provide a reference for that.  &mdash; Mattisse  (Talk) 22:23, 20 November 2008 (UTC)
 * If you remove purported causes from the lead, then you've removed nearly the entire lead. "Various aspects of personality and its development are integral in the occurrence and persistence of depression.[37] Although episodes are strongly correlated with adverse events, how a person copes with stress also plays a role.[37] Low self-esteem and self-defeating or distorted thinking are related to depression." "Purported causes" are in bold. Remove them, and you have virtually nothing. Cosmic Latte (talk) 22:29, 20 November 2008 (UTC)
 * What does that have to do with anything other than the lead to "Psychological" is poorly written and needs rewriting. My view is that whole section is poorly written and inaccurate. &mdash; Mattisse  (Talk) 22:36, 20 November 2008 (UTC)
 * If you want to add a new lead, go for it. However I maintain that it is as appropriate to cite Nancy Coover Andreasen, who published in 1972, as it is to cite Martin Seligman, who published in 1975, somewhere in the section. Both individuals are sufficiently notable, and I would much prefer the Andreasen source over the primary study about religiosity. Cosmic Latte (talk) 22:51, 20 November 2008 (UTC)

Here are some rules of thumb for keeping an article up-to-date while maintaining the more-important goal of reliability. These guidelines are appropriate for actively-researched areas with many primary sources and several reviews, and may need to be relaxed in areas where little progress is being made and few reviews are being published. &mdash; Mattisse (Talk) 23:53, 20 November 2008 (UTC)
 * (ec)Per WP:MEDRS on up to date sources: Why it is not appropriate to cite Nancy Coover Andreasen's opinion piece, published in 1972 (besides the fact it was an opinion piece):
 * Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews examined should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies.
 * Within this range, things can be tricky. Although the most-recent reviews include later research results, do not automatically give more weight to the review that happens to have been published most recently, as this is recentism.
 * Prefer recent reviews to older primary sources on the same topic. If recent reviews don't mention an older primary source, the older source is dubious. Conversely, an older primary source that is seminal, replicated, and often-cited in reviews is notable in its own right and can be mentioned in the main text in a context established by reviews. For example, Genetics might mention Darwin's 1859 book On the Origin of Species as part of a discussion supported by recent reviews.
 * "Rules of thumb" are probably the best kinds of rules to apply WP:IAR to. Your absolutistic fixation with WP:MEDRS continues to baffle and frustrate me. But I'm happy with the review Casliber found, so I won't push the Andreasen issue further. Cosmic Latte (talk) 00:02, 21 November 2008 (UTC)


 * hold the fort!!! OK, we have a review article, let's get this sorted! Cheers, Casliber (talk · contribs) 22:58, 20 November 2008 (UTC)
 * Looks good to me! Cosmic Latte (talk) 23:46, 20 November 2008 (UTC)

TFT
"These include blood tests measuring TSH to exclude hypo- or hyperthyroidism;" Of course at TSH and T4 and/or T3 will exclude hyperthyroidism, but I doubt if hyperthyroidism needs to be excluded in depression. Davidsons's Principles and practice of Medicine 17th edition 1993. page 623. provides a long list the features of hyperthyroidism and depression is not one of them. On pages 946 to 949, it does not list hyperthyroidism as a cause of depression, and it does list hyperthyroidism as a cause of anxiety. I can only see the abstract of the ref online which does not clarify this point, but I would be grateful if this line was double checked. The Oxford Textbook of Psychiatry 3rd edition, page 405, lists hypothyroidism as a cause of depression but not hyperthyroidism. I am wondering if there might be some confusion with hyperparathyroidism (not diagnosed with TFT) which can cause "low spirits" for years before diagnosis. Snowman (talk) 19:01, 20 November 2008 (UTC)
 * I have boldly removed the mention of hyperthyroidism. Not an expert on this, but logically hyperthyroidism could cause something that looks like mania, so might well be mentioned in the context of mood disorders in general -- no obvious reason why it would cause anything like depression, though.  Even if this is wrong, the statement in the article is still correct, since it doesn't say the list is exhaustive. looie496 (talk) 20:16, 20 November 2008 (UTC)
 * It is standard to test for TSH and T4 together, unless the patient is taking T4 therapy. I have made a further amendment. Snowman (talk) 11:58, 21 November 2008 (UTC)

Depression and dementia
"Conducted in older depressed people, screening tests such as the mini-mental state examination, or a more complete neuropsychological evaluation, can rule out cognitive impairment.[83]" The statement in the article is to dogmatic.

The summary of this reference says that cognitive tests, used in combination with the clinical history and imaging, can help to make a diagnosis between depression and dementia. Snowman (talk) 21:42, 20 November 2008 (UTC)


 * Hang on, I am not sure that I follow - the MMSE and neurospych mentioned are cognitive testing, and cognitive impairemnt is another term for demnetia, but now I think of it a little ambiguous, so I will put in dementing process. The sentence lies within a section on clinical assessment, so assumes that the tests take place within a framework of clincial assessment - do you think this needs to be spelt out more clearly within the sentence? Cheers, Casliber (talk · contribs) 23:24, 20 November 2008 (UTC)


 * nevermind, I gotcha now I think. Is this what you meant? Cheers, Casliber (talk · contribs) 23:28, 20 November 2008 (UTC)


 * I see that you have amended the article, and I see that you have got the gist of it. The full ref is available on-line to all. The ref comments on the diagnosis of pseudo-dementia (an old term used where the slowing of depression in elderly people has the outward appearance of dementia) and dementia, and co-morbidity of the two. The term "complete neuropsychological assessment" is used, why not describe this a little more instead of using this term and include the phrase "with brain imaging". I am going back to the ref to see if mini-mental state questioning by itself is useful in the diagnosis. Snowman (talk) 10:08, 21 November 2008 (UTC)


 * I am not sure if you can say it is a "screening test". A complete neuropsychological evaluation is not a screening test. I think it is a "diagnostic procedure". Snowman (talk) 10:47, 21 November 2008 (UTC)
 * I do not think that "mini mental state" will help to differentiate it by itself, it needs to be a more complete cognitive assessment to include motivational factors and assessment of retention of long or short term memory, (and possibly with a behavioural assessment). Snowman (talk) 10:52, 21 November 2008 (UTC)
 * Update: I have made DIY amendments to remove "screening test" and "mini mental state". Snowman (talk) 11:04, 21 November 2008 (UTC)


 * The minimental state exam is a quick and easy-to-administer test which is a good heads up when interviewing on cognitive changes. It is pretty crude but if it someone scores, say 22 or less (and is not delirious, and English is their first language) one gets a pretty strong suspicion of dementia. Normal=27 or 28-30. However, even though one may highly suspect a dementing process with a low score, given the seriousness of the diagnosis, one generally follows it up with some more testing. So, yes it can be diagnostic but one would really want to confirm it with more testing. I was a bit sloppy with leaving hyperthyroidism. There is some discussion these days that a T4 is actually redundant if one is doing a TSH, but it is not universal. Cheers, Casliber (talk · contribs) 12:14, 21 November 2008 (UTC)
 * OK, the mini mental state; its use is to help the diagnosis of dementia. The ref is about identifying dementia and depression, or co-morbidity. I think that the mini-mental state should go in relevant to the initial diagnosis of dementia (which is not within the scope of this page). I think that we are in agreement here. Snowman (talk) 12:24, 21 November 2008 (UTC)
 * TFT: What about picking up sub-clinical forms of hypothyroidism? (Davidson's Principals and Practice of Medicine, 17th edition. page. 634. ISBN 0443040923). I think that in the UK you would only request TSH as an isolated test for monitoring hyperthyroidism on therapy. For diagnostic tests do both in the UK, and after that possibly thyroid antibodies and sometimes T3 and thyroglobulins Snowman (talk) 12:32, 21 November 2008 (UTC)


 * additional tests such as cognitive testing, or a more complete neuropsychological evaluation with brain imaging: Right now the sentence is not correct: brain imaging is NOT a neuropsychological evaluation and cognitive testing and neuropsychological evaluation are synonyms: If you want to simplify eliminating the MMSE the correct sentence would be to say the following: additional tests such as cognitive testing or brain imaging....Nevertheless the ref only talks about cognitive testing and not neuroimaging so one more ref should be searched. Best regards.--Garrondo (talk) 12:34, 21 November 2008 (UTC)
 * Thank you for bringing this up, because I am sure the sentence can be improved. I think I was working with the original line and wikilinks, when I should have rewritten the line. Brain imaging is mentioned in the ref. The wikilink to neuropsychological evaluation (I did not put the link there) says that it includes brain imaging. Snowman (talk) 12:38, 21 November 2008 (UTC)
 * Update: I have amended it leaving in brain imagine because it is mentioned in the ref. Perhaps the line could be better. I have removed "neuropsychological evaluation" with its wikilink, because it includes a bit of a long word, and can be superseded with a few words. Snowman (talk) 12:46, 21 November 2008 (UTC)
 * Whatever the wikilink says I had never seen that neuropsychology included neuroimaging (at least in its clinical use as opposed to research). They are more like related-complementary fields. The sentence right now sounds OK, although I might still give the wikilink to neuropsychological evaluation. Anyway I'll take a look at the wikilink for more mistakes. Best regards. --Garrondo (talk) 13:55, 21 November 2008 (UTC)
 * Just a minor point: I have been reading the neuropsychology evaluation article and it does not say it includes neuroimaging; what it says is that formerly; when there was no neuroimaging methods, neuropsychological evaluation was used to hipothezise about the location of brain damage from its behavioral consequences.I am going to readd the wikiling inside cognitive testing. Best regards. --Garrondo (talk) 14:00, 21 November 2008 (UTC)
 * Whoops, I made a mistake in reading the "neuropsychology evaluation" page. Trying to get too many things done. I think I was "off guard" as I was not quoting a ref. I should have been more vigilant and thorough. I thought that the "neuro-" bit meant brain and hence imaging - a preconceived incorrect idea. I think it is time for a break. In a different context "brain imaging" is mentioned in the ref, is it not? Snowman (talk) 14:21, 21 November 2008 (UTC)
 * I am not very sure; I will take a look. Nevertheless it won't be difficult to find a ref on the use of neuroimaging in the diagnosis of dementia. (Maybe there is one in the Alzheimer's article). Best regards.--Garrondo (talk) 14:28, 21 November 2008 (UTC)
 * It does talk about neuroimaging.--Garrondo (talk) 14:31, 21 November 2008 (UTC)

Note
I'm seeing statements on the FAC suggestive that comments are based on reading PubMed abstracts only, without accessing the full text of the journal articles. PMID links/abstracts are for convenience only, so that readers can locate and access the full text of articles. Presumably, a source is only used when the full journal article has been accessed and read: basing edits or FAC commetary on a read of only a convenience link to a PMID abstract is incorrect. Sandy Georgia (Talk) 23:04, 20 November 2008 (UTC)
 * Certainly that applies to edits, but regarding comments you should bear in mind that many people can't get access to the full articles without either having access to a first-class academic library or paying an outrageous sum of money. looie496 (talk) 23:25, 20 November 2008 (UTC)
 * Correct, but likewise, someone can't state that text isn't backed by a citation if they're only reading the abstract, not the full article. (What they can do in those cases is request a quote from the full journal article.)  Sandy Georgia  (Talk) 00:24, 21 November 2008 (UTC)
 * Someone can flag up a likely problem after reading the abstract, when it is the only text readily available to them, for others to check. Someone can also flag up a possible problem with a line if the content is not in line with standard text books, even if the abstract is not available. Snowman (talk) 09:52, 21 November 2008 (UTC)
 * Someone can also flag a problem when the reference is being used to cite a general statement, and the abstract for the reference states it is a primary study involving the comparison of 200 college students and 54 outpatients. Or when the reference is used to source current data, and the abstract is a primary study several years old and out of date, or a review article five, ten or more years out of date. Also, if the abstract shows the reference is a commentary or essay and the reference is being used to cite current date. &mdash; Mattisse  (Talk) 14:53, 21 November 2008 (UTC)
 * But, of course, there's nothing wrong with citing a primary study or a commentary/essay and identifying it as such with an "According to..." introduction. Cosmic Latte (talk) 15:08, 21 November 2008 (UTC)

Subheaders of "Causes"
Tony1 said on FAC, 22 October 2008: ''BTW, can you insert "causes" after the solely adjectival subtitles in the "Causes" section? They look strange, and I think MoS says titles should usually be nominal groups.'' I agree with this—I think it would look much better with "Psychological causes" and not just "Psychological". I guess it's a matter of taste, but I also think this is in agreement with WP:HEAD: "Titles are generally nouns or noun phrases". It will still be succinct enough. /skagedal ... 14:36, 21 November 2008 (UTC)


 * Another problem in the "Causes" section is the lack of symmetry in the subsections. "Biological" cites no "famous people" names, does not go into history from the 1970's and back into the 19th century, but states only current biological research. The "Psychological" section rambles, repeating statements from the "History" section, eg Freud, talks about old "famous figures" and give no recent data on psychological causes. The "social" section is much shorter than the "Psychological", even though bio-social models are the most popular now, along with bio-social-psychological. Like the "Biological" section, it does not bog down naming "famous people" at all and tries to focus on the current and not 1970s and prior. Why is the "Psychological" section so out of whack? Much in the "Psychological" section is actually "social" anyway and  "psychological". The "Psychological" section needs to be rewritten to be in line with the other two "Causes" section. The "Psychological" describes theories and not data-based causes.  &mdash; Mattisse  (Talk) 15:07, 21 November 2008 (UTC)
 * Ever consider that some psychological theories might be based on something other than "data" of the variety that change from time to time and from place to place? For example, genes and archetypes are, according to those who study them, pretty darned durable. Anyway, what "famous people" ought we to cite in the Biological subsection? A name that comes to mind is Joseph J. Schildkraut, a major proponent of the monoamine hypothesis. But the Joseph Schildkraut article appears to be about some androgynous-looking Austrian actor. Cosmic Latte (talk) 15:25, 21 November 2008 (UTC)
 * Wow, this really took an off-topic turn exceptionally fast. Replied to Mattisse here. /skagedal ... 15:35, 21 November 2008 (UTC)
 * Response to Skagedal here &mdash; Mattisse (Talk) 15:59, 21 November 2008 (UTC)
 * I first started complaining about this on November 4 or so, but was ignored. &mdash; Mattisse  (Talk) 15:56, 21 November 2008 (UTC)
 * We discussed this stuff months ago, and reached consensus. For your reading pleasure: and . Cosmic Latte (talk) 16:07, 21 November 2008 (UTC)
 * In a nutshell: Science-based (positivistic) approaches are very important, as are more literary-based (hermeneutic) approaches. The impact of Freud in particular is demonstrably outstanding, and is certainly more than "historical," a term that has an oddly perjorative aura to it among mental health professionals. This was the basic WP:CONSENSUS that was reached. Thanks. Cosmic Latte (talk) 18:12, 21 November 2008 (UTC)
 * That would be fine if you changed the title of this article. As it is, it reflects a specific diagnostic disorder as defined by the American Psychiatric Association's diagnostic manual. Therefore, this is not the place to dispute science-based (positivistic) approaches. Rename the article and you can say what you like. Otherwise, the subject is off-topic if you want to attack science here. Also, it is not the place to discuss more literary-based (hermeneutic) approaches to the "Psychological" causes of Major depressive disorder. In addition, no scientific-based "Psychological" causes are described, unlike the other sections on "Causes".  One of the FA criteria is to remain focused and on topic. The topic of this article is Major depressive disorder, specifically.  &mdash; Mattisse  (Talk) 18:29, 21 November 2008 (UTC)
 * Learned helplessness and locus of control are mentioned, and they are based on considerable science. Bandura, Beck, Seligman: all scientists. Risk factors: science. That's four paragraphs. Two, at the bottom, are devoted to more hermeneutic approaches. And DSM criteria are decided by committee. There is nothing "scientific" about the two-week cut-off period. Even Paul Gene, who is very much the positivist, would probably agree with me on this (see his "aside" here). Cosmic Latte (talk) 18:45, 21 November 2008 (UTC)
 * Bandura was a social psychologist and did not deal with "psychological" causes. Bandura, Beck, Seligman are not recent and any science-based studies of theirs are old. Please read the quotations I gave from WP:MEDRS regarding using recent data. I did a search for Learned helplessness and one of the complaints in articles is that the concept is based on the behavior of laboratory rats. Did you read the articles that you link to: Learned helplessness and locus of control? Since those articles give little if no information, you need to provide it in this article with appropriate references. &mdash; Mattisse  (Talk) 19:00, 21 November 2008 (UTC)
 * WP:MEDRS is of limited relevance when we're not necessarily dealing with medical information. Don't forget that this article falls under the scope of WP:PSY as well as WP:MED, and not all psychology is science-based. Surely you know this, as you're the one who tried to introduce Rogerian phenomenology. Cosmic Latte (talk) 19:20, 21 November 2008 (UTC)
 * The field of psychology is science-based. There are many topics that call themselves "psychology" but are not within the field of professional psychology. It is a core teaching that psychology is science-based. If you want to be a Licensed Psychologist in the USA, you better have a firm grip on this fact. &mdash; Mattisse  (Talk) 20:11, 21 November 2008 (UTC)
 * What if I want to get licenced by any of the bajillion psychoanalytic institutes that I note in those infamous talk archives? Of course much of psychology is science-based; much of it is not. I'm not arguing for one side or the other; I'm arguing for WP:NPOV. Cosmic Latte (talk) 20:19, 21 November 2008 (UTC)
 * That would probably be fine for Canada or the UK, I don't know. But the DSM is an American manual, and in the USA it is strictly controlled who can, and who cannot sling diagnoses around. &mdash; Mattisse  (Talk) 20:43, 21 November 2008 (UTC)
 * By the way, Beck and Seligman are still major forces in psychology today. Many cognitive-behavioural therapists practically idolize Beck, and Seligman was a recent APA president. Cosmic Latte (talk) 19:28, 21 November 2008 (UTC)
 * "Practically idolize" is very unprofessional terminology, not used by psychologists, and sounds more in the realm of religion than science. Do you have references for "practically idolize"? &mdash; Mattisse  (Talk) 20:15, 21 November 2008 (UTC)
 * Uh. It's called speaking colloquially. Cosmic Latte (talk) 20:23, 21 November 2008 (UTC)
 * Beck is a psychiatrist, I believe, and is almost 90 and has not been active in the field for years. He is a historical figure primarily, at this point, for coming up with the first depression scale in the 1960s. I don't know much about Martin Seligman, but his article says he is the father of Positive psychology. That article says: Positive psychologists seek "to find and nurture genius and talent," and "to make normal life more fulfilling," not to cure mental illness. So it doesn't sound like it has much to do with depression. &mdash; Mattisse  (Talk) 20:38, 21 November 2008 (UTC)

Adding "causes" making "Biological causes", "Psychological causes" etc. is incorrect per MoS
For the reason this is incorrect, see: MoS:Section headings. "Section names should not explicitly refer to the subject of the article, or to higher-level headings, unless doing so is shorter or clearer. For example, Early life is preferable to His early life when His means the subject of the article; headings can be assumed to be about the subject unless otherwise indicated." &mdash; Mattisse (Talk) 20:03, 21 November 2008 (UTC)


 * I certainly preferred not repeating the 'causes' for the subsections, it was Tony who suggested otherwise. I have no strong opinions either way. Cheers, Casliber (talk · contribs) 23:13, 21 November 2008 (UTC)


 * Well, I agree that it looks clumsy as it is, and is unclear. But MoS:Section headings is clear and usually enforced. In reality, in the literature, there is not such a distinction between "social" and "psychological", as the two are virtually combined. It is a very artificial distinction that allows for all that irrelevant stuff about historical figures that are important only to a group of Westerners. "Existential" sounds quaint now, a luxury for third-world countries, as is all that stuff about self-fulfillment etc. American naval-gazing. &mdash; Mattisse  (Talk) 23:25, 21 November 2008 (UTC)


 * (ec) As I wrote above under "Subheaders of Causes" (which you, Mattisse replied to with "Another problem"...), there's also the MOS guideline that headings should be nouns or noun phrases. I'd say this takes precedence. A heading that just says "Biological" looks weird to me. But I guess it's a matter of taste, and I'll let you native English speakers decide... but it does feel good to have User:Tony1 on my side! :-) /skagedal ... 23:26, 21 November 2008 (UTC)


 * I agree that it is less than ideal and not a distinction made in the field the way it is made in this article. But I guess this is not a professional article, but a layperson's article, as Cosmic Latte has pointed out many times by the WP:IAR and the disregard for WP:MEDRS. So we will let this article be the typical Wikipedia mess. I do admire those science folk though on Wikipedia who get to write professional articles! &mdash; Mattisse  (Talk) 23:34, 21 November 2008 (UTC)


 * Also, I did not notice Tony making that suggestion. He has weighed in again after his original support based on reading the intro? &mdash; Mattisse  (Talk) 23:36, 21 November 2008 (UTC)


 * It has been brought to my attention that Tony made this suggestion a month ago!!!! &mdash; Mattisse (Talk) 00:15, 22 November 2008 (UTC)


 * And it was added after he suggested it, then subtracted again. Cheers, Casliber (talk · contribs) 00:42, 22 November 2008 (UTC)

Second suggestion for change in article title - article unfocused with current title
I continue to suggest a renaming of the article, as the talk page reflects a desire by one of the two major contributors to counteract science-based (positivistic) approaches with more literary-based (hermeneutic) approaches. This is his reason for maintaining the content of "Causes", "Psychological" as a discursive discussion on older non science-based theories, rather than including current science-based evidence. A title change from the specific diagnosis of Major depressive disorder to a more general title might allow this type of unbalanced exclusion of current evidence on "Psychological" causes. With the current title, the article remains unfocused as it wanders to the general subject of depression periodically, as it does in "Causes", "Psychological" rather than providing science-based information in that section. &mdash; Mattisse (Talk) 19:06, 21 November 2008 (UTC)
 * Once again, the DSM criteria are decided by committee, not in a laboratory. Disorders are added and removed with each edition. There is no scientific reason why, say, homosexuality was classified as a disorder in one edition but not in the next. There are, of course, statistical determinants of abnormality, but the reclassification of abnormality as pathology is a subjective decision. There is good reason why the "S" in "DSM" does not stand for "scientific." Cosmic Latte (talk) 19:25, 21 November 2008 (UTC)
 * No. But the "S" in DSM does stand for "Statistical". Science is based on statistics. &mdash; Mattisse  (Talk) 19:58, 21 November 2008 (UTC)
 * But the inclusion criteria for MDD are not. We've already decided that "MDD" and "depression" and "melancholia" will be treated rather interchangeably in the article, but with WP:WEIGHT given where it seems due. None of us appear to take the absolutistic sort of stand about this that you appear to take. And we already decided that psychodynamic approaches are of more than "historical" relevance. See the talk archives. Anyway, check this out: almost 9/10 counselors are eclectic, and "The most frequently reported single 'pure-form' broad-band orientations were psychodynamic (9.4%), humanistic/existential (4.5%) and behavioural (4%)." Goodness gracious, more than twice as many psychodynamic as behavioural, and still fewer behavioural than humanistic/existential. WP:NPOV requires this eclecticism and diversity to be fairly represented. Cosmic Latte (talk) 20:12, 21 November 2008 (UTC)
 * I would like to stress that "counselors" are not psychologists. That is a common layman misperception that the American Psychological Association seeks to dispell. In the USA it is against the law to call yourself a "psychologist" unless you are a Licensed Psychologist.   A "counselor" can be anybody and needn't have any professional training at all so what they practice is irrelevant. &mdash; Mattisse  (Talk) 20:23, 21 November 2008 (UTC)
 * In the USA a "counselor" does not diagnose and does not use the DSM. &mdash; Mattisse  (Talk) 20:25, 21 November 2008 (UTC)
 * What are the qualifications to be a "counselor" in Great Britain? Do they independently diagnose, using the DSM? Are they independently reimbursed by insurance? Do they testify in court as experts in diagnosis? &mdash; Mattisse  (Talk) 20:28, 21 November 2008 (UTC)
 * [edit conflict] I don't know, I'm not British. But counselors treat depression. Let's not lose the forest for the trees. This is fundamentally an article about depression, not about the DSM, not about psychologists. Yes, the DSM is used to diagnose, but those who are diagnosed can be referred to counselors. Anyway, the ref comments about "the prevalence of eclectic and/or integrative views in counsellors and clinical psychologists in Britain." Perhaps these authors included clinical psychologists in their study; someone with full text would have to confirm that. Here is another one: "The results showed that while New Zealand psychologists use cognitive approaches more often than both British and North American psychologists, they use behavioral and psychodynamic approaches less often. Overall, it was found that the eclectic approach is the most popular theoretical orientation obtained in surveys of Australian, New Zealand, and North American psychologists, in that no group subscribed exclusively to a single theoretical orientation." I repeat: WP:NPOV requires that eclecticism be represented. The WP:CONSENSUS in the talk archives jives with this. Let's not unnecessarily rehash old debates. Muchas gracias, Cosmic Latte (talk) 20:40, 21 November 2008 (UTC)
 * Then change the name of the article to reflect this. This article is not about counselors treating depression. It is about the diagnosis Major depressive disorder. If you want the article to be about counselors treating depression, then change the article name. &mdash; Mattisse  (Talk) 21:57, 21 November 2008 (UTC)
 * Correct me if I'm blind, but I'm pretty sure my statement above mentions psychologists. See also and  and, p. 744, for more on eclecticism and variety. The article is on depression. There is such a thing as being in-the-ballpark. And as the article mentions, there has been argument for a return to a diagnosis of melancholia, which is what Freud explicitly addressed. Methinks you are, once again, making mountains out of molehills. Cosmic Latte (talk) 22:36, 21 November 2008 (UTC)
 * Copy-pasting the Freud resolution from FAC, just for the record. Cosmic Latte (talk) 14:28, 22 November 2008 (UTC)
 * Re Freud, had a long, hard look at the bit on mourning/melancholia and have placed it into history after much deliberation, mainly because (I concede) the vast majority of psychotherapists wouldn't talk about it in these terms anymore; it is still influential thinking but has evolved. Cheers, Casliber (talk · contribs) 04:12, 22 November 2008 (UTC)
 * My own preference would still be to keep it in the causes section, but psychoanalytic/psychodynamic thinking has certainly had a rich post-Freudian history--so, I can appreciate this rationale. Still, I should note that even Paul, who isn't the least bit fond of Freud as far as I can tell, eventually conceded that "psychoanalysis...is [still] used by its practitioners to treat clients presenting with major depression" (he's the one who added that to the article). Cosmic Latte (talk) 09:59, 22 November 2008 (UTC)

Ref #70
It is equivocal. You do not give that flavor in the way you report it. &mdash; Mattisse (Talk) 00:42, 22 November 2008 (UTC)


 * (sigh) you are right. I read through again a few times - I did think "There is mixed evidence..." conveyed the equivocalness, but upon reading the abstract even, it is more vague even than that. Thus, it doesn't really come to much of a conclsuion at all, and hence really adds nothing to this section. I have placed it above as it would be good only on an article with sufficient detail for pro's and cons to be argued, on a causes of ... page or soemthing. Cheers, Casliber (talk · contribs) 02:12, 22 November 2008 (UTC)
 * Can I ask that when referring to a ref, the name of at least the first author be given in addition to a number? Otherwise as soon as a new ref is interpolated, the whole discussion will become incomprehensible.  In this case, I take it the Carey article is being referred to. looie496 (talk) 17:32, 22 November 2008 (UTC)
 * I think this is about the info removed here. Cosmic Latte (talk) 17:57, 22 November 2008 (UTC)

Anatomy of Melancholy
Blast, this one is proving hard to get a more scholarly source. There is a reference from a peer-reviewed journal which looks good, The History of Psychiatry here, but the fulltext of this journal is not accessible to me. I will have to look for it at work but if someone can find it it would be great. Cheers, Casliber (talk · contribs) 12:58, 23 November 2008 (UTC)

here. Cheers, Casliber (talk · contribs) 13:01, 23 November 2008 (UTC)
 * Jennifer Radden is a published author who has reviewed the book online


 * This is the sort of thing that drives me nuts -- finding sources for the importance of a book that has been beloved for hundreds of years is sort of like finding sources for the fact that the sky is blue, i.e., really hard and basically a waste of time that could better be spent on more important things. looie496 (talk) 17:11, 23 November 2008 (UTC)


 * (shrugs) I know, I do agree a better source would be idea, luckily it looks like a good one, and a good journal too. Cheers, Casliber (talk · contribs) 23:31, 23 November 2008 (UTC)

FAC restarted
Just so everyone is aware, the FAC for this article has been restarted at Featured_article_candidates/Major_depressive_disorder. Let's try to keep the drama to a minimum this time? Cosmic Latte (talk) 02:20, 24 November 2008 (UTC)

Redirects
There are quite a lot of redirects on the page. Do these need to be fixed? Snowman (talk) 01:50, 24 November 2008 (UTC)


 * Not an overt deal-breaker per se but highly desirable. I culled alot of bluelinks before it came ot FAC. It makes good practice to link to an appropriate page with the use of the item in correct context, which I did with copper and magnesium on the page. Cheers, Casliber (talk · contribs) 02:16, 24 November 2008 (UTC)


 * PS: Danny had a parser which automatically checked all the links. i not he has not bee so active lately but I will give him a ping and see. Cheers, Casliber (talk · contribs) 05:51, 24 November 2008 (UTC)

caveat - prose vs sources
For all, we need to be extremely careful with any smoothing of prose that it still reflects the original source. Place any questions here.Cheers, Casliber (talk · contribs) 12:54, 24 November 2008 (UTC)

Albert Ellis

 * Casliber, please do not rely on talking to "folks" as a main source in deciding what is important for this article.
 * Albert Ellis has been a huge force in the field of CBT, as the developer of Rational Emotive Behavior Therapy. He was first to popularize its widespread use in the 1960s. and is  perhaps the single most important force in bring it  popularity. His model has been the one most widely researched.
 * From his Wikipedia article (which is generally correct and one of the few wikipedia psych articles that you could wikilink to that is adequately sourced):
 * He is generally considered to be one of the originators of the cognitive revolutionary paradigm shift in psychotherapy and the founder of cognitive-behavioral therapies.


 * His omission from the historical section is glaring. He died only one year ago, and remained active in the academic field, publishing and teaching until his death.
 * You mention people such as Viktor Frankl, who is a historical figure and Gordon Parker (whose wiki article is a disgrace and should not be linked to in an FAC article) and others, who have little if any solid impact on the field today, unlike Ellis.
 * Also, please note that most of the wikilinks you give in this article go to bad, unsourced, OR wiki articles. I discourage the wikilinking to bad, misleading articles for the general reader in an FAC article. On other FAC pages, I have often seen criticism of this practice and a request for a removal of these offending wikilinks.
 * If you respond to this note of mine, please do so at the bottom, so as not to fragment my remarks and make them look foolish. &mdash; Mattisse  (Talk) 16:05, 24 November 2008 (UTC)
 * Agree that Ellis, and even more importantly IMHO, Beck, deserve a mention in the article as founders of the most succesful psychological treatments for depression, probably best in the history section.
 * Disagree re: the wikilinks, per Sandy & Casliber below. (Also, I note that the Albert Ellis article is mostly sourced with the "Albert Ellis institute", REBT websites and the New York Times... but that is entirely off-topic) /skagedal ... 22:59, 24 November 2008 (UTC)
 * Ellis was enormously important in the US. When I was in grad school Beck was already a historical figure, noted for his invention of the depression scale, and I have read some of his books on cognitive approaches to therapy, but Ellis  revolutionized the field with Rational Emotive Behavioral Therapy, that in the US has had an enormous impact. I cannot speak for the UK/Australia. His article may be badly referenced but at least it has enough to be notable, unlike the Gordon Parker article. Gordon Parker's  one journal article is referenced three times in the MDD article, and is practically the only reference for an entire paragraph. Oh well. This article does not represent psychology in the US. So what. The fact that the MBCT stuff gets so much play, shows you there is something fundamentally wrong with the therapy section. And the concepts behind the therapy are never explained, and they are not exactly complicated.   &mdash; Mattisse  (Talk) 23:45, 24 November 2008 (UTC)
 * Actually, according to this article, not a reliable source (just found it on Google), Ellis was the grandfather and Beck was the father of cognitive behavioral therapy! and an obituary from the NYTimes. &mdash; Mattisse  (Talk) 23:51, 24 November 2008 (UTC)

Comments on wikilinks

 * Please note that most of the wikilinks you give in this article go to bad, unsourced, OR wiki articles. I discourage the wikilinking to bad, misleading articles for the general reader in an FAC article. On other FAC pages, I have often seen criticism of this practice and a request for a removal of these offending wikilinks.
 * If you respond to this note of mine, please do so at the bottom, so as not to fragment my remarks and make them look foolish. &mdash; Mattisse  (Talk) 16:05, 24 November 2008 (UTC)


 * I am not going to enter the Ellis debate, since I do not have the knowledge to do it. Only a minor comment on wikilinks: Is there any guideline or policy for your opinion on not giving wikilinks to anything but perfect articles? I had never read anything about it. My personal opinion is that 1-some information is better than nothing; 2-wikilinks to far from perfect articles are a great way to improve the encyclopedia (which is our final aim); since a person may follow them, see that they are not as good as he expected and decide that can help and improve it. That is at least how I have got involved in several articles. I heavily oppose your view that they are "offending" by any means. To believe that they are misleading is to believe that the reader is not capable of judging the quality of an article. Best regards.--Garrondo (talk) 16:14, 24 November 2008 (UTC)
 * Complaints about the quality of linked articles are not actionable at FAC, and not relevant to the FAC. Any article that meets or can meet notability and isn't WP:OVERLINKing should be linked: see WP:RED.  At FAC, we aren't evaluating the quality of linked articles: we are evaluating the article at FAC.  Sandy Georgia  (Talk) 16:26, 24 November 2008 (UTC)
 * Does Gordon Parker meet notability, for example? &mdash; Mattisse (Talk) 18:55, 24 November 2008 (UTC)
 * Please respect WP:TALK; whether Gordon Parker meets notability is not a concern for this article's FAC; you can raise that at AfD. Sandy Georgia  (Talk) 19:01, 24 November 2008 (UTC)
 * O.K. I know when I edited for Dinesh's FACs, I always made sure that the wikilinked articles were of high enough quality that they did their job to inform the reader. I guess the desire not to send the reader to a worthless wikilink is not important to FAC. Just asking. &mdash; Mattisse  (Talk) 19:09, 24 November 2008 (UTC)
 * The thing is, the number/proportion of stubs and poorly written articles is so high that I would hazard a guess and say that every one of the 2000 odd featured articles has at least one if not several bluelinks to one or more. Part of FAs role is to get an article to a de facto 'flagged revision' point, upon which efforts can be made on those around it. Cheers, Casliber (talk · contribs) 22:24, 24 November 2008 (UTC)

Please clarify the role of WP:MEDRS and its specific qualifications regarding primary, secondary, tertiary sources

 * WP:MEDRS gives specific qualifications regarding the use of primary, secondary and tertiary sources. These qualifications were originally ignored in the prior version of this FAC. Any suggestions to follow  WP:MEDRS were answered with the comment that WP:IAR was just as important and should be balanced with  WP:MEDRS. Is this true?
 * Are old textbooks and popular science books adequate sole sources for statements in the article? Is it acceptable to use primary source journal articles, either review articles or primary studies, that date to 1988, for example?
 * I notice that a great deal of personal discretion was used in removing statements from the FAC page to talk. For example, and important statement about the suicide map was dismissed and moved to the talk page. I urge improved discretion in removal of these comments, and less idiosyncratic judgment. Maybe someone who knows more about the subject matter should make these decision about the content of the comment being dismissed.
 * I request that if anyone response to my comments, that they do so below. Please do not interrupt my comments as that ultimately renders them unintelligible. &mdash; Mattisse  (Talk) 15:21, 24 November 2008 (UTC)
 * A diff please for suicide text that was moved to talk? I'm not aware of any, and a search on the talk page reveals none.  The MEDRS question was already answered in the restart notes.  Sandy Georgia  (Talk) 16:27, 24 November 2008 (UTC)


 * In general I agree in the use of secondary sources over primary sources. By far the most effective way of addressing this is by placing an inlined comment in the text. I have addressed every one you have placed (except the last batch). As far as age of articles, it clearly depends on the context within the article, much of the core of CBT was established by Beck in the 60s and 70s, so when referencing, a reference to a definitive text is better than some tertiary commentary, unless there has been some substansive change. One minute you are pushing for more recent referencing, next you are pushing for Ellis whose REBT slightly predates Beck.(?) Cheers, Casliber (talk · contribs) 23:42, 24 November 2008 (UTC)
 * I know this is not a reliable source, also a link to his obituary in the NYTimes but you totally underestimate the influence of Ellis in the US. I realize you have no obligation to recognize anything about the US, as this article is about UK/Australia primarily, but it would be nice if you would at least look into it. Cheers, &mdash; Mattisse (Talk) 00:21, 25 November 2008 (UTC)
 * I promise to look into it, as online material is often a beacon and guide where to source Reliable material. PS: there is plenty of US sourcing in this article, if not most. Cheers, Casliber (talk · contribs) 01:35, 25 November 2008 (UTC)

Psychotherapies
Regarding psychotherapeutic techniques. The general thrust of the literature talks in terms of three modalities being CBT, IPT, and psychodynamic psychotherapy. Strict behavioural therapy I have not seen talked about in overview or review articles. I was asking a couple of psychologists who did note that mindfulness was popular and widespread, and I am wondering whether as an offshoot of CBT, maybe we should replace the para on MBCT with a one line note "Several variants developed from CBT (for use in depression), most notably rational emotive behaviour therapy (mentioned in Beck's CBT/depression book) and more recently MBCT" to be placed on the end of CBT section. Cheers, Casliber (talk · contribs) 12:27, 24 November 2008 (UTC)


 * I did it. Again, nothing is being lost, but getting the depth of material right is tricky. he treatment section on this page has to be an equally balanced overview. Cheers, Casliber (talk · contribs) 12:50, 24 November 2008 (UTC)


 * (Posted after edit conflict and lengthy freeze of my browser due to wikEd, I'm so unchecking that gadget – haven't looked at your edit, gotta run now) I agree CBT (more specifically, Beck's Cognitive therapy), IPT and psychodynamic are the three big ones that the main focus should be on. Among the lesser researched modalities, I think BT is important both because of its historical relevance and recent developments. Both early behavioral attempts and the Jacobson findings are briefly discussed in Barlow & Durand, p. 240. I will look for further reviews. REBT might be relevant to mention, but I think some people will object to it as being "developed from CBT" since Ellis' model (although not called REBT then) predated Beck's (but Beck's model got more attention and much more research, so its appropriate to focus on this). I might be colored by the zeitgeist in my environment, where CBT versus CBT is a lively debate and it's a lot of mindfulness-this-and-that, but no one would mention the Ellis approach except in a historical discussion./skagedal ... 13:13, 24 November 2008 (UTC)


 * Yes, actually folks I talked to today described Ellis as strictly historical. I will be asleep and offline for 12 hours or more, and be my guest with tweaking ref to REBT and maybe mentioning BT somewhere v. briefly in section. I did try to cahnge "from CBT" - damn tricky to word that bit as I realised it antedated it late on...Cheers, Casliber (talk · contribs) 13:34, 24 November 2008 (UTC)
 * Please note that Albert Ellis is the founder of Rational Emotive Behavior Therapy. I think you should clarify the connections and timelines here, as there seems to be a great deal of confusion. Yes, Beck was important, but Ellis was equally important, certainly in the US which I realize is not Australian/UK and not the focus of this article. However, that does not excuse the neglect of Ellis, a major figure. &mdash; Mattisse (Talk) 16:05, 24 November 2008 (UTC)


 * It's not easy to figure out what therapies are most worthy of mention. Here is one example, though: In the comprehensive NICE guidelines, they discuss behavioral treatments as historically important and a current trend, but evidence is lacking. Neither REBT or MBCT are mentioned. is a recent review of empirically validated therapies for depression that says: "Although behavioral techniques are typically combined with a cognitive approach, recent studies of behavioral activation, a dismantling of CBT that employed only its behavioral component, have shown that it can have greater efficacy than cognitive therapy alone.", but I can't really speak for the quality of that journal. /skagedal ... 09:55, 25 November 2008 (UTC)

New material placed here (apologies to new IP)
I reverted the addition of the material as the article is in a delicate stage and new stuff will need sourcing from some Review Article or secondary source before being reinserted.

I just wanted to use one of those nice boxes really, but if anyone finds anything we can discuss here. I will be going to bed soon. Cheers, Casliber (talk · contribs) 12:43, 25 November 2008 (UTC)


 * Hmmm...we have this (small) review, and this 2002 trial, note that this discusses the previous trial. If this is it, I'd be inclined to leave it out, though put it in the treatment subarticle. We certainly don't use it here in Oz, but we often lag a few yeasr behind :) So if anyone finds anything else, place it here and we can discuss later after I have a snooze... Cheers, Casliber (talk · contribs) 12:52, 25 November 2008 (UTC)

How common is this?
"develops increased frequency of passing urine, a common side-effect of selective serotonin reuptake inhibitor antidepressants.[86]" The ref says that it is a common hospital cause of hyponatraemia. It does not say that it is a common side effect of SSRI's. The BNF 56, ISBN 978-0-85369-778-7 gives this side effect very much towards the bottom of the list, so I would have said that it is an uncommon side effect of SSRI. Snowman (talk) 13:01, 21 November 2008 (UTC)


 * Fair enough. Best neutral word is 'possible'. I was pondering on uncommon but could mean quite differnt things to different people (and doctors). Good pickup. Cheers, Casliber (talk · contribs) 23:11, 21 November 2008 (UTC)


 * It is commoner in the elderly, according to a CSM (Committee on Safety of Medicines) warning. "Possible" is a vague word. Perhaps the reader could be provided with an adjective to indicate how rear this is. I know it is not in the ref provided at the end of the line. Snowman (talk) 23:58, 21 November 2008 (UTC)


 * OK, how about 'recognised' (as it is in the literature, but is a fairly generic adjective which means little) or just leave out an adjective altogether (may be best of all really)? I am not fussed either way. Cheers, Casliber (talk · contribs) 02:24, 22 November 2008 (UTC)


 * PS: I did some thinking - unfortunately leaving out an adjective altogether may give the impression the side-effect happens all the time (which is untrue obviously). Tricky...Cheers, Casliber (talk · contribs) 05:55, 24 November 2008 (UTC)


 * I have made some modifications and added another ref, and it now gives a better summary of low sodium with antidepressants, but it is still extremely brief. I have also moved it in another section more relevant to drug side effects. Snowman (talk) 18:29, 27 November 2008 (UTC)

Review article for effectiveness of CBT for depression elusive (to replace what we have)
OK I have found this but I can't see full-text and this journal is not one I have full-text for. Can someone see all of it? Cheers, Casliber (talk · contribs) 18:20, 26 November 2008 (UTC)
 * Yep. I'll mail the PDF to you if you drop me a mail at skagedal@these guys. /skagedal ... 18:39, 26 November 2008 (UTC)
 * Cool, gimme a sec.Cheers, Casliber (talk · contribs) 18:42, 26 November 2008 (UTC)
 * Actually, this seems to be a short review of, which is available full text for everyone at PubMed Central. (Right? At least I get the full text, if you don't send me another e-mail.) /skagedal ... 19:07, 26 November 2008 (UTC)
 * So, is it that you want replaced, i.e. the support for CBT treatment for adolescents? Or Roth & Fonagy, for the general efficacy of CBT?  could be useful. It seems to me that the evidence CBT for adolescent depression isn't that solid, hasn't been researched as much as with adults. /skagedal ... 19:42, 26 November 2008 (UTC)


 * Yes, Mattisse commented on the primary source. I went looking online for a review and found it surprisingly elusive. I do not have the latest edition of Roth and Fonagy (a highly regarded specialist work and hence 2ndary source on effectiveness of various psychotherapies in various disorders), but the 1996 edition is very cautious and actually echoes this 2008 review (i.e. better studies --> effect size not so big. also milder and 'simpler' cases do better) I now have it (thanks skagedal, much appreciated!). Weird, seems to be a one page review and commentary of a 2007 metaanalysis by Klein etc. So as a secondary source, trumps Klein which is a primary one albeit a metaanalysis (?) Cheers, Casliber (talk · contribs) 01:22, 27 November 2008 (UTC)
 * Yes, I don't see how a one-page summary of a meta-analysis is a better source than the meta-analysis itself, especially considering it's by the same author. The meta-analysis is by Klein et al, the "review" is by Klein (seems to be essentially the abstract of the meta-analysis?), then there's also commentary by Weersing and Walker. I can understand how the commentary is a secondary source but not really the review.
 * Actually, quoting WP:MEDRS: In medicine, primary sources include clinical trials, which test new treatments; secondary sources include meta-analyses that bring together the results from many clinical trials and attempt to arrive at an overall view of how well a treatment works. So, what's wrong with using the meta-analysis?
 * I have the second edition of Roth and Fonagy right here, if I find the time (rather, if I take the time) I'll take a look to see how the article reflects the book. /skagedal ... 10:20, 27 November 2008 (UTC)
 * (sigh) the good thing is they seem to all concur more or less. I feel like tossing a coin really; in any case, 3 options is better than none :) Cheers, Casliber (talk · contribs) 10:33, 27 November 2008 (UTC)
 * If it's really a coin toss, I'd say that from the reader perspective, it's more useful to get a direct reference to the actual article (Klein et al). I would love to get a comment on whether meta-analyses are in fact to be considered secondary sources, or if I'm somehow misreading WP:MEDRS. This also applies to our discussion above on behavior therapy... /skagedal ... 11:30, 27 November 2008 (UTC)
 * I know, ironic ain't it? For some reason the 2007 Klein metaanalysis was not coming up for me. I guess the deal of metaanalysis vs Review is that we are supposed to be reflecting the sources accurately; hence if a metaanalysis is unassuming and says that an effect was shown but stops short of positively generalising a find, this is where the problem comes in (I guess). Cheers, Casliber (talk · contribs) 12:49, 27 November 2008 (UTC)
 * Why don't you post a query over at MEDRS? There was some discussion in the archived talk pages. My guess is meta-analyses are part primary part secondary. They do review previously published literature, but apparently can also have access to the raw data, log books, etc. -- stuff that wasn't previously published. The statistical analysis results are themselves newly published data but the paper may contain commentary on the studies under review. One could perform a flawed meta-analysis (e.g. by restricting the set of papers to study in an arbitrary way that skews the results) so an independent review can add weight to the conclusions. Even if you do regard them as primary, they are among the best primary sources you could choose. My amateur 2p. Colin°Talk 15:50, 27 November 2008 (UTC)

depressive realism note
I am removing the sentence on depressive realism as it is explicitly not about major depressive disorder but "milder depression" (pretty obvious really...) and will put it in depression (mood)Cheers, Casliber (talk · contribs) 02:15, 27 November 2008 (UTC)

Removed sentence
I removed this one:

as I realized there is a problem - learned helplessness =/= ext locus of control. Share some common attributes but different ideas really, so the linking bit is a headache and I am too tired to reformulate now. Need to sleep on it. Cheers, Casliber (talk · contribs) 14:05, 27 November 2008 (UTC)


 * I agree this is problematic, mostly due to "may be related to" – that's a bit vague; how are they related? I briefly looked at the second source, Benassi and Dufour (1988). An interesting read. It discusses learned helplessness in what is called a "depressive paradox" (Abramson, L. Y., & Sackeim, H. A. (1977). A paradox in depression: Uncontrollability and self-blame. Psychological Bulletin, 84, 838–851.) between two common models of depression, Beck's and Seligman's, both which have some apparent evidence.
 * In Seligman's learned helplessness theory, depression is related to events seen as uncontrollable. Beck's model describes depression in terms of self-blame and self-deprecation; the paradox then is basically "why blame yourself for things seen as uncontrollable?". It seems that evidence for the "uncontrollability" model (i.e. learned helplessness) is often presented in terms of locus of control: "A common test of the uncontrollability model comes from studies that have assessed the relation between locus of control orientation and depression". The writers then conduct a meta-analysis and finds a positive correlation between external locus of control and depression, therefore concluding that there is indeed a "depressive paradox" to be resolved. But they also present criticism that this correlation may be due to measuring biases.
 * My conclusion is that the source does actually support the removed sentence, but it is to vaguely phrased. One way to "save" it would be to only mention the found relationship between external LOC and depression, but really something must have happened in this area since 1988? /skagedal ... 15:03, 27 November 2008 (UTC)


 * Looie, sorry I pulled it (I was really tired), how does the book link them - we may be able to get it back in. I can see the themes, funny as external locus of control I associate more without the mood component, and also more with personality function. Cheers, Casliber (talk · contribs) 20:17, 27 November 2008 (UTC)
 * I don't have any stake here -- I only put a cite there because Matisse asked for one, I wouldn't have seen the need otherwise. looie496 (talk) 23:41, 27 November 2008 (UTC)

challenge
OK, neuroplasticity - I have to get off for a few hours, anyone like to think of how/if this can be made into plainer words without losing meaning...Cheers, Casliber (talk · contribs) 20:19, 27 November 2008 (UTC)
 * The brain's malleability? Its ability to form new neural connections,  to change neural patterns?  &mdash; Mattisse  (Talk) 20:29, 27 November 2008 (UTC)


 * Oooh, when I think of "malleability" I think of squishing plasticene and moulding, however it isn't a bad comparison, though funnily enough it is sort of in reverse, the idea of the nerve cells growing and making new branches. Personally, there are some cases that I think we just need to bluelink and hope (or write) a really good succinct definition on the linked page. I need to think some more on this one...tricky...Cheers, Casliber (talk · contribs) 23:20, 27 November 2008 (UTC)


 * This being my area of expertise, I would vote for simply dropping the mention of neuroplasticity. I know this is an appealing idea to some people, but it's really just a correlation, and likely to be a spurious one:  the hippocampus (where the alterations occur) is more vulnerable to HPA disruptions than any other part of the brain, and of course HPA disruptions are very common in MDD.  The source here is not great either:  Germans pretty much only write in German if they are only writing for other Germans -- they all speak English.  ("Neuroplasticity" in this case means the birth of new neurons, of a type that are thought to be involved in episodic memory, by the way.) looie496 (talk) 00:27, 28 November 2008 (UTC)


 * The source should be dropped then.  &mdash; Mattisse  (Talk) 00:32, 28 November 2008 (UTC)


 * OK dropped it, as too speculative to really add to the article. Cheers, Casliber (talk · contribs) 02:25, 28 November 2008 (UTC)

Some notes

 * (old and possibly oversimplified)- Recent research emphasizes the importance of alterations in responses to stress in the etiology of depression.


 * (closer to source) Most evidence supports a contribution of genetic factors in a susceptibility for depression, although recent research emphasizes the importance of alterations in responses to stress and disrupted neuroplasticity in the etiology of depression.


 * ref=

Ideas below -

i.e. "Not only genetic and psychosocial factors but the impact of stress on brain development" (?)

National Depressive and Manic Depressive Association
There is an external link to this. It has got a new name now, so this can be changed. Its own wikipage has already been changed. Snowman (talk) 21:51, 27 November 2008 (UTC)
 * I have changed it to its new name "Depression and Bipolar Support Alliance". Snowman (talk) 22:36, 27 November 2008 (UTC)

What does 'blunted' mean?
I'm happy to see circadian rhythms mentioned in this article. 50% of people with circadian rhythm disorders (CRD) are, or have been, diagnosed depressive as well. (Including yours truly.) A few years ago, papers carefully explained that it was unknown which was cause and which was effect. They seem now to be coming 'round, agreeing with me that severe (particularly undiagnosed and misunderstood) CRDs are a social cause of depression.

You refer to "a blunted circadian rhythm". Never heard of it; what does this mean? Can this please be explained in the article, or another, understandable, adjective be chosen? Thank you. - Hordaland (talk) 06:43, 24 November 2008 (UTC)


 * The term is used in the literature to mean a reduced amplitude of circadian modulation, but it's MD-speak and perhaps "diminished circadian rhythm" or something of the sort could be used instead. looie496 (talk) 17:11, 24 November 2008 (UTC)
 * Thanks for answering. The term is not only still in the text, it's also been added to an image caption.  Would "a weakened circadian rhythm" mean the same?  That would mean to me that the period of the rhythm isn't altered, but the effects are less noticeable. --Hordaland (talk) 23:25, 28 November 2008 (UTC)

False statements in the other treatments section
As I noted in a recent edit, there were blatant errors in the "other" treatments section, especially in regards to tryptophan and 5-HTP. I looked through the history and found that these articles were originally cited correctly, but when OrangeMarlin cleaned up that section, he switched the correct wording for rather incorrect wording. He also removed the the deep brain stimulation review, which I would argue merits inclusion, in addition to removing the acupuncture review, which probably doesn't merit inclusion. Anyway, everyone makes mistakes, it's not a huge deal, but it's something to be careful of. Edits which have a fair-sized kilobyte impact need to be analyzed. UPDATE: Loo496 corrected OrangeMarlin's mistake, but OrangeMarlin went back and inserted the incorrect language again. I try to assume good faith, but it seems that OrangeMarlin is deliberately misrepresenting sources. That's more than a bit disappointing. I'll admit I don't try hard enough at AGF sometimes. It's more reasonable to think that OrangeMarlin skimmed the papers and didn't notice the correct language, otherwise he wouldn't have repeated his language. For those curious as to the tryptophan/5-HTP conclusion: Available evidence does suggest these substances are better than placebo at alleviating depression. II | (t - c) 05:16, 27 November 2008 (UTC)


 * provides a free, full-text review that discusses deep brain stimulation in clinical depression:


 * Sandy Georgia (Talk) 05:24, 27 November 2008 (UTC)


 * I think it deserves a mention of that fact, because it's received a fair bit of attention in the news. I don't know if it is actively used much for depression -- the article doesn't say. If it is used much, then I'd say it deserves to be mentioned. Maybe I'm wrong, but this is a decision for a group to decide. II  | (t - c) 05:33, 27 November 2008 (UTC)
 * For the record, although I wasn't keen on the way OM handled this, I see no need for accusations of bad faith and really hope we can stay away from that kind of thing. I don't believe for a second that OM was "deliberately misrepresenting" things.  I believe that he interpreted the papers in question as being too timid to explicitly state what the data really implied, or something like that.  I didn't agree with that interpretation, but I never thought, and don't now think, that there was any dishonesty in it. looie496 (talk) 05:53, 27 November 2008 (UTC)


 * I'm easily shocked by the misrepresentation of sources, which I consider to be much more important than civility or AGF. I don't see if often, fortunately. I'll admit that I'm no saint when it comes to these things, though. OrangeMarlin helped catch me in a somewhat less extreme misrepresentation over at alternative medicine, where the National Research Council cited a position, and I cited the National Research Council as if they had that position. II  | (t - c) 06:12, 27 November 2008 (UTC)


 * hang on, I will be off-wiki for several hours. Given the volume of material, I was restricting to treatemtns with efficacy in meta-analysis or systemic review, however, things heavily in the public consciousness proably warrant a mention. I will have a look in a wee while. Cheers, Casliber (talk · contribs) 05:58, 27 November 2008 (UTC)
 * How about The limited available evidence does suggest these substances are better than placebo at alleviating depression though further studies to evaluate efficacy and safety were recommended. On tryptophan and 5-HTP. Fainites barley 08:53, 27 November 2008 (UTC)


 * (ec) I have added a qualifier to the tryptophan sentence. It is frustrating as they cannot recommend it but I guess this is because of the risk. I hate summarising these things on a summary article.Cheers, Casliber (talk · contribs) 09:02, 27 November 2008 (UTC)


 * Too many medical articles on this project have utter crap when discussing medications. Tryptophan or 5-HTP cannot treat depression under any condition, and picking one dumb-ass paper out of the millions published is an embarrassment.  Do you really want to treat your spouse, your mother or yourself with tryptophan if you have MDD?  I wouldn't.  I think there's a CAM-wikipedia somewhere.  Take this stuff there.  Not here.  I intend to remove any CAM crap from this article, and if Casliber blocks me for doing so, I'll respect that.  However, if I'm mistaken and some of these useless therapies have shown to work as described in a fair number of real peer-reviewed journals, then I'm willing to eat humble pie.  I don't see it however.   Orange Marlin  Talk• Contributions 17:44, 27 November 2008 (UTC)


 * OM, I don't particularly like to do this, but I have to remind you that you are operating under Arbcom sanctions, and this is precisely the sort of behavior that got you sanctioned. I'm happy to carry on a discussion based on the literature, but this sort of belligerent intimidation is not going to fly. looie496 (talk) 18:40, 27 November 2008 (UTC)


 * What in holy fuck are you talking about??? You'd like to show me that, because I am under no fucking sort of sanctions. You better take your fucking lie off of here now.   Orange Marlin  Talk• Contributions 21:10, 28 November 2008 (UTC)

OK WRT the DBS above, the evidence is inconclusive; I would think of including it if it had been high profile in the media, but it hasn't really been the case here, nothing like St Johns wort. I'd be inclined to leave it in a treatment sub-article really. Cheers, Casliber (talk · contribs) 10:52, 27 November 2008 (UTC)


 * DBS has received far more attention for Tourette syndrome than for depression (including full focus of a one-hour media special, can't remember if it was the Discovery Health Channel or something else) and a lot of mainstream media attention, so it may be instructive to see how I handled it. Weight is given in the main article relative to the most recent, secondary reviews.  No TS reviews give DBS more than a few sentences and a passing mention as an experimental new treatment.  I added a clause at Tourette syndrome, and included a paragraph in the Treatment sub-article at Treatment of Tourette syndrome.  Using Summary style and sub-articles can be very effective (see History of Tourette syndrome, Treatment of Tourette syndrome, Sociological and cultural aspects of Tourette syndrome and Causes and origins of Tourette syndrome); aggressive use of summary style allowed me to hold down the size and the amount of speculative and undue weight material that drivebys and IPs tend to want to add to the main TS article, while setting the stage for me to be able to write full featured articles on each sub-article if I ever find the time.  Food for thought on the structure of this article.   Sandy Georgia  (Talk) 15:34, 27 November 2008 (UTC)


 * I guess I see this as largely a moot point. Having a lot of personal experience putting electrodes into the brains of rats and monkeys, I'm too well aware of what a radical intervention this is to think that it will ever be used on a major scale for people with depression.  The morbidity rate would be horrifying. looie496 (talk) 18:43, 27 November 2008 (UTC)


 * Good points sandy, it has been harder on this article than any other figurin what has 'priority' to go into the article, which could have been double or triple the size...Cheers, Casliber (talk · contribs) 20:07, 27 November 2008 (UTC)

Rational Emotive Behavior Therapy
I am not sure if this is capitalised or not. Its own wikipage shows capitalised form in the title, and a few webpages that I look at were also showed it capitalised, but they could be wrong. Could the wikipage and its use in the article be made consistent? Snowman (talk) 21:48, 27 November 2008 (UTC)


 * Hang on, I know a place to look. It does look odd having it capitalised and other therapies are all in lowercase. I hope the reference I will look at has it in lower case (fingers crossed). Cheers, Casliber (talk · contribs) 23:24, 27 November 2008 (UTC)

Bother, the Beck book on Cognitive therapy and depression has caps, but then again, cognitive therapy is capitalised through the book as well. Cheers, Casliber (talk · contribs) 23:54, 27 November 2008 (UTC)
 * I do not see why they should be capitalised; radiotherapy, physiotherapy, and other therapies are not capitalised. Perhaps it was a book that used different capitalisation rules. Snowman (talk) 01:20, 28 November 2008 (UTC)
 * I just checked in Abnormal psychology, not capitalised tehre so I agree that lowercase is best. Cheers, Casliber (talk · contribs) 02:20, 28 November 2008 (UTC)
 * I recently raised this issue at Wikipedia talk:WikiProject Psychology. I'd love to get some further input on this, possibly in relation to the rest of MOS:, so we can promote consistency throughout the project. I'm documenting it at WikiProject Psychology/Psychotherapy. /<span style="font-family: monospace, monospace; color: #003300">skagedal <sup style="color: #003300">talk 07:27, 28 November 2008 (UTC)


 * I understand that several sources have been examined (see links to discussion above) and that this phrase is usually not capitalised, so the text in the article appears to be correct in using lower case. At the present time the linked page uses upper case, and this may be confusing. Snowman (talk) 14:01, 28 November 2008 (UTC)
 * Update: discussion has started about a page move to change the capitalisation of the linked page referred to. Snowman (talk) 21:42, 28 November 2008 (UTC)

Suggestion for new image
An transmission electron micrograph of a synapse would be interesting and relevant. Snowman (talk) 19:51, 28 November 2008 (UTC)
 * I'm experiencing problems with load time because of the current images (see http://www.websiteoptimization.com/services/analyze/); people on dialup may be unable to access the article. Sandy Georgia  (Talk) 19:58, 28 November 2008 (UTC)
 * A black and white photo of a TEM might seem a bit plane. Snowman (talk) 20:41, 28 November 2008 (UTC)
 * Regardless of this article, if you can find a good TEM of a synapse that is usable on Wikipedia, I'd love to have it for other articles such as chemical synapse. I spent some time searching and wasn't able to find a decent one. Looie496 (talk) 20:49, 28 November 2008 (UTC)
 * Maybe or maybe not. Snowman (talk) 00:47, 29 November 2008 (UTC)

Skagedal's comments
I started a reread of the article to give a review for the restarted FAC, but I realize I don't really have time for this at the moment, so I'll just give you my raw notes so far "as-is". <span style="font-family: monospace, monospace;">skagedal ... 08:57, 24 November 2008 (UTC)
 * I decided that real life can wait and continued reading the rest.:) Here's my continued notes. I'll try to write a summary on the FAC page on what I think is most important. Sorry for repeating a few things I've already mentioned on this talk page, wanted to have my "objections" collected so I can strike them as they are addressed (or alternatively, I'm convinced that they don't have to be!) /<span style="font-family: monospace, monospace;">skagedal ... 10:48, 24 November 2008 (UTC)


 * Summary section: Just "depression" should be among the list of bolded terms in the first sentence, since this disorder is often (I would almost say, typically) referred to as just that.
 * (OK, I agree with you on the bold here. I think Sandy de-bolded it but upon thinking about it, bold should be used for synonyms, which it 75% is (and more). I will discuss with Sandy and Tony whnen they note it)Cheers, Casliber (talk · contribs) 11:44, 24 November 2008 (UTC)
 * "based on the patient's self-reported experiences, behavior reported by relatives or friends, and mental state." – since "mental state" can't be observed directly, it is redundant to the rest of the sentence, no? Hmm, I see mental state points to a specific meaning of this, that includes things like appearance... was not clear to me.
 * Clarify: Without the wikilink, the sentence does not make sense. It would be better to say what the diagnosis is directly based on: self-report, behavior reported by relatives and friends, behavior noted by clinician...
 * "under a short-acting general anaesthetic." – details on the procedure of ECT is irrelevant to the introductory summary section
 * (Snowman added it as he felt it was important, I think, due to fears that it was still performed without anaesthesia)Cheers, Casliber (talk · contribs) 10:09, 24 November 2008 (UTC)
 * Well, I'm hoping practitioners don't turn to Wikipedia for guidance... ;) /<span style="font-family: monospace, monospace;">skagedal ... 10:48, 24 November 2008 (UTC)
 * (I think it is unnecessary detail myself; the idea is that ECT is mentioned and detail is on the daughter page/link. Snowman will probably pop up soon and we can discuss it with him and/or others then)Cheers, Casliber (talk · contribs) 11:33, 24 November 2008 (UTC)
 * There's suddenly a reference after "medical conditions such as heart disease" – inconsistent with rest of summary
 * (There has been much debate on inline refs in lead. I generally avoid them, but some insist on keeping them for controversial-sounding statements and those likely to be challenged. I agree it looks odd and is certainly does not stand out as too unusual. I will remove it.)Cheers, Casliber (talk · contribs) 11:52, 24 November 2008 (UTC)


 * Unnecessary detail on monoamine chemicals for summary section, IMHO
 * Clarify: Referring to the sentence "The monoamine chemicals serotonin, norepinephrine, and dopamine are naturally present in the brain and assist communication between nerve cells." – don't think this is called for in the lead section
 * Symptoms and signs: "reduced libido (sex drive)" – no reason for parenthetical explanation; either expect readers to know what libido is, or just write sex drive – choose one term.
 * (good point, the terms are synonymous so let's use the simpler one) Cheers, Casliber (talk · contribs) 10:09, 24 November 2008 (UTC)
 * Thanks! /<span style="font-family: monospace, monospace;">skagedal ... 10:48, 24 November 2008 (UTC)
 * Causes: "The etiology of mental disorders is best appreciated through a multidimensional integrative approach that disfavors reductionism and encourages models that consider a wide array of biological, psychological, and social forces" – such normative language should be avoided. Does not have a NPOV feel. Other than that, this section has been much improved lately, nice!
 * Still feel that the adjective headings "Biological", "Psychological" look bad.
 * This is because a) I think that the recommendation in WP:HEAD that titles and section headers should be nouns or noun phrases is more important than the recommendation to not refer back to higher-level headings. b) It keeps the reader (and contributor) on track, remembering that it's causes we're talking about here, not generally the "biology of depression", "psychology of depression" etc.
 * Biological: "The proponents of this theory recommend..." – who are they? Is it not compatible to accept the monoamine theory, but still recommend other treatments?
 * I don't know how to address this, but observing structural differences in the brain (correlation) does not mean it's a "cause" of depression.
 * "Although the precise relationship between sleep and depression is mysterious" – odd choice of word? (changed to unclear)Cheers, Casliber (talk · contribs) 11:59, 24 November 2008 (UTC)
 * Psychological: "However, depression is less likely to occur among those who are religious" – it's a bit odd that this is the only protective factor mentioned, especially in the first "summary" paragraph. I suggest this is moved a bit down in the section, somewhere among interpersonal factors and existential/humanistic approaches.
 * "Recent research emphasizes the importance of alterations in responses to stress in the etiology of depression" – this is a bit difficult to understand...? What kind of alterations?
 * ditched now) Cheers, Casliber (talk · contribs) 13:19, 30 November 2008 (UTC)


 * Last time I reviewed, I noticed an underrepresentation of Beck's important cognitive theory, this is now much improved. Great!
 * Social: – Question: There's an emphasis on risk factors, with only a brief mention of a protective factor. Do you think this reflects literature? /<span style="font-family: monospace, monospace;">skagedal ... 12:11, 24 November 2008 (UTC)
 * Evolutionary hypothesis: "Some evolutionary explanations for the apparent contradiction between biopsychosocial, psychological and psychosocial hypotheses" – what about "biosocial" hypotheses? :-) This mixture looks a bit odd... "psychosocial hypotheses" have not been mentioned previously in the article. I'm not sure I even understand this sentence... what's the contradiction? The heritability is reported as "approximately 40% for women and 30% for men", how does that contradict psychosocial hypotheses? How is "high prevalence" of depression contradictory to any explanation?
 * Clinical assessment: "A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms" – hmm, how often would a CT scan be administered in reality...? (quite often. It is generally done for a first presentation of a psych illness resulting in an inpatient stay, asa one-off excluder of someting organic going on)Cheers, Casliber (talk · contribs) 12:04, 24 November 2008 (UTC)
 * Casliber – I take your word on that... I think it would be a improvement if it would somehow briefly suggest that it not only can be used, but is often used (in the inpatient setting), if a good source can be found.
 * Rating scales: The first sentence kind of gives the impression that this whole section will be about screening. Maybe start off with a sentence like: "Rating scales are used in screening, research, and general followup during treatment."
 * "The Hamilton Depression Rating Scale[84] and the Montgomery-Åsberg Depression Rating Scale.[85] are the two most commonly used among those completed by researchers assessing the effects of drug therapy" – bit awkward sentence
 * Major depressive episode: "Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning)." – I'm a bit allergic to excessive use of parentheses. Actually, I take that back! It's fine. :) /<span style="font-family: monospace, monospace;">skagedal ... 10:58, 24 November 2008 (UTC)
 * Subtypes: "Atypical depression is characterized by mood reactivity (paradoxical anhedonia) and positivity" – "positivity" in relation to MDD in general, then..
 * "social impairment as a consequence of hypersensitivity to perceived interpersonal rejection" – sounds a bit psychobabbly :-) can language be made more accessible?
 * Catatonic depression – is stuporose a common English word? yes it is, get a dictionary :) /<span style="font-family: monospace, monospace;">skagedal ... 10:11, 25 November 2008 (UTC)
 * Psychotherapy: "is often considered by some to be a combination of medication" – weasel wording
 * I still find the mention of MBCT to be a bit undue, because of the low amount of available research. I'm aware that mindfulness is the new hotness in psychotherapy, maybe this general trend could be noted somehow? There's also ACT and all that (which in itself hasn't received that great empirical support either, as of yet). – much better with the brief mention
 * Behavioral treatments for depression have been researched since at least the 1970s (e.g. Ferster, Lewinsohn), but fell out of style with the cognitive revolution. There has a been a renewed interest in these treatments since component analyses have shown that administering only the behavioral components of cognitive therapy was as successful as the whole cognitive therapy package; this puts the whole hypothesis of cognitive mediation to question. Jacobson et al 1996 has been a widely discussed study. I think this deserves being addressed in this paragraph, if only in one sentence. For a meta-analysis of behavioral activation treatments, see.
 * (see below. I appreciate it is a meta-analysis but is not a secondary source, and I've not seen behavioural therapy come up as listed on treatment overview-type articles. I made a proposal below)Cheers, Casliber (talk · contribs) 12:27, 24 November 2008 (UTC)
 * Medication: "SSRI" abbreviation is being used before its definition
 * "People with chronic depression usually need to take medication for the rest of their lives" – well, they don't need to, but they are probably recommended...
 * (reworded to "People with chronic depression may need to take medication indefinitely to avoid relapse") Cheers, Casliber (talk · contribs) 13:00, 24 November 2008 (UTC)
 * Electroconvulsive therapy: "..anterograde memory has mostly returned to baseline..." – make less jargony?
 * (yes; changed to "memory disturbance after ECT" with link to anterograde amnesia)Cheers, Casliber (talk · contribs) 12:16, 24 November 2008 (UTC)
 * Thanks! I'm also thinking that "returned to baseline" might be a bit research-jargony. "returned to pre-ECT level" or something...? /<span style="font-family: monospace, monospace;">skagedal ... 12:26, 24 November 2008 (UTC)
 * returned to baseline --> resolved (meaning the same I think). Cheers, Casliber (talk · contribs) 22:44, 29 November 2008 (UTC)


 * Sociocultural aspects: The discussion of medicalization of sadness and over-diagnosis could possibly be completed with the view of those who don't neccessarily think there's an overdiagnostication, but a treatment bias favoring pills instead of psychological treatments. I'm pretty sure I read Aaron Beck making such an argument recently, can't find it right now but will look further if anyone wants me to.

Greetings! /<span style="font-family: monospace, monospace;">skagedal ... 10:48, 24 November 2008 (UTC)

Prose check
This version:
 * Redundancy (see exercises at User:Tony1): Under 18 years of age = under 18.
 * In people under 18 years of age, medication should be ...


 * Typographical errors: Additionally, low lself-esteem and self-defeating or distorted thinking are related to depression. Some eveidence shows that epression may be negatively correlated with  with the presence of religious beliefs.
 * lself-esteem
 * eveidence
 * epression
 * with with


 * Something completely off in the lead:
 * The understanding of the nature and causes of depression has evolved over the centuries; nevertheless, many aspects of depression are still not fully understood, and are the subject of debate and research Psychological, psycho-social and biological causes have been proposed. Psychological theories and treatments are based on ideas about the personality, interpersonal communication, and unduly negative thoughts.

Sandy Georgia (Talk) 03:09, 29 November 2008 (UTC)


 * Because of the subject matter I suppose it is clear it does not refer to 18 months, but I would prefer to keep in 18 years of age. Snowman (talk) 09:54, 29 November 2008 (UTC)


 * PS:I think I got all the typos. Cheers, Casliber (talk · contribs) 22:38, 29 November 2008 (UTC)

Image facing
The Lincoln image is only very slightly facing left, is this really an issue? If I place it on the right then the images are not alternating, or should we just remove it? Cheers, Casliber (talk · contribs) 22:38, 29 November 2008 (UTC)
 * It's not noticeably facing off the page, so doesn't bother me. The load time on the article due to the number of images is, however, making it very hard to view the article and check diffs.  Sandy Georgia  (Talk) 22:40, 29 November 2008 (UTC)

Jargon
Hi all, I need to sleep now. Any further jargon people think need to be changed list here. I will see you in a while. Cheers, Casliber (talk · contribs) 14:01, 24 November 2008 (UTC)


 * I think the only jargon-complaint that is left in my notes now is the one with "significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection"... Can this be simplified without losing precision? /<span style="font-family: monospace, monospace; color: #003300">skagedal <sup style="color: #003300">talk 09:11, 2 December 2008 (UTC)

Is the page too long?
Is the page too long for a GA or FA? The article is long and currently has nine images, and viewing the page may be difficult for some. The history section has four images and about 20 references, and almost all of this could be removed to a wikilinked offshoot page specifically about the history of depression. A much shorter version of the history could be created for this page with perhaps only one image. Medicine and the history of medicine are essentially different topics and I doubt if many viewers would be interested in both. I think radical steps may be needed to reduce load times. The problematic length of the article, number of images, and load times are important issues and needs to be discussed, in my opinion. Snowman (talk) 18:54, 30 November 2008 (UTC)


 * I would rather remove images than divide up the text myself. My first preference would be to lose the Lincoln, then the circadian and/or isoniazid before slicing up the history section. The history section has already been whittled down alot from a larger version. Cheers, Casliber (talk · contribs) 13:03, 1 December 2008 (UTC)


 * PS: The images should surely take up more load time than text (?) Cheers, Casliber (talk · contribs) 13:04, 1 December 2008 (UTC)


 * Generally, I would agree that images take more time to download, but I am not sure if references need a little extra time for processing and formatting on the wiki servers than plain text. It was partly because the history section has four images, and because it is a different topic to the science, that I thought that it would be ideal to cut out most of the history and move it to a separate article. Having a separate "history of depression" article would permit a fuller version of the history sections there, rather than the cut down version as is found currently on the page here. Snowman (talk) 13:56, 1 December 2008 (UTC)


 * The isonizid image is only 4 KB and so removing it will only be expected to reduce the load time by a minute amount. I think that the Lincoln image should be kept, because it adds a human dimension to see a picture of a famous patient. The schizophrenia article has an image of a famous patient, and so keeping the Lincoln image also tends to be consistent across articles. I would vote for the removal of the Freud image rather than the Lincoln image: however, I think that the best result will be to drastically cut the history section down to one (or zero) image and short text, and make a separate history of depression page. Snowman (talk) 13:56, 1 December 2008 (UTC)


 * (sigh) what would you see as the most salient points then, if you could write a paragraph? This is where it gets very tricky...my issue is I feel these sections are important in getting a flavour of how a concept or idea evolved over time to the present day. I am thinking about it though. Cheers, Casliber (talk · contribs) 14:08, 1 December 2008 (UTC)


 * I am vexed, I'd almost prefer to ditch alot of the rating scales section really (now there's a missing article as WP doesn't have one on rating scales as a group in medicine at all) than the history. Cheers, Casliber (talk · contribs) 14:12, 1 December 2008 (UTC)


 * Perhaps the emphasis could be on history in the 20th and 21st centuries. Anyway, considering history takes up so much space in the article, the introduction has minimal history of depression information perhaps tending to indicate that the history is a secondary consideration to the basic and medical science. I would keep rating scales in as part of the science, and because it is a short section with no images. Snowman (talk) 14:22, 1 December 2008 (UTC)


 * (ec) Ultimately, I would be really unhappy to slice up the section. I do acknowledge your point, and I will see in a few hours what others think. I am popping off to sleep now - if the consensus is to slice it up, then ok, but I find these days WP slows up at certain times of day and all articles, almost regardless of size are slow. Furthermore, a lead summarises salient points of a long article, so someone can really stop there if need be. We have been given a 60kb prose/10k word limit. I would rather trim bits and pieces off than hack off a section. Cheers, Casliber (talk · contribs) 14:25, 1 December 2008 (UTC)

Hang on, I think you may have a point and I will try to trim some older more general material. Cheers, Casliber (talk · contribs) 14:30, 1 December 2008 (UTC)


 * If this is about reducing load times, removing text is really a misdirected optimization, IMHO. With the web site analyzer that Sandy posted, you can see that the (compressed) HTML is 116,645 bytes, and the "biological clock" image (the #2 largest object) is 51,915 bytes alone – so you'd need to cut half the text (probably a lot more since a lot of the HTML is the general Wikipedia stuff) to save as much bandwidth as you could by removing one image. "Suicide rates" comes as #3 with 48031 bytes. The analyzer also recommends reducing the number of images, as each object is its own HTTP request (I think).
 * But sure, there might be other reasons to cut down on the text length. I don't think it's "too long for FA" though; see discussion on FAC. /<span style="font-family: monospace, monospace; color: #003300">skagedal <sup style="color: #003300">talk 14:55, 1 December 2008 (UTC)


 * I find the page too long for convenient editing as there is too much material to contemplate easily at one time. Also, I feel the structure of the article should be considered in conjunction with other related articles such as the main article on Depression, the articles on treatment, evolutionary hypotheses, SSRIs and whatever else.  Anyway, I have removed the image of the map of suicide rates per my comment on the FA review.  Apart from its size, I consider it quite misleading in that it seems to conflate suicide and depression when these are not the same thing.  For example, the recent outrage in India was a suicide mission but not, I suppose, especially related to depression. Colonel Warden (talk) 15:17, 1 December 2008 (UTC)


 * That is a good idea to think of it as one of a set of wiki articles. I was thinking of the load times rather than the prose limit, as well as information organisation, which is a factor independent of page size. What is the current prose size? The kb size will be different in different word processors, because the formatting marks vary. How many words are permitted? I do not know why the "prose check" (above) does not include a prose word count. I fear that more damage may be done to the text by trimming here and there, except if it is by unlinking images. Perhaps, only a few images need to be removed as Casliber suggest. Does the number of references influence the ideal size of the text or the number of images by putting extra load on servers? What size or download-time specification should the page have? I think I would like to know more clearly what exactly are the constraints on the page size, images, and download time in order to continue discussing the page size. Snowman (talk) 15:23, 1 December 2008 (UTC)
 * This issue was discussed a bit in the talk archives. I think the "official" FAC prose limit is 50 kb, but because this article is so thoroughly researched and of such great public interest, it might be okay to WP:IAR a little bit. In any event, 50 kb or so should not take long to load on most computers, even with dialup. The idea of removing images is mainly a courtesy to those with slower connections, although such connections are becoming increasingly rare. I, for one, have never had any trouble loading the article, and I have done so on multiple computers at multiple locations. Cosmic Latte (talk) 17:19, 1 December 2008 (UTC)


 * I can see Colonel Warden's POV WRT removing the suicide map. Snowman, do you have Dr PDAs tool in your monobook? It is very useful for this sort of thing. As far as navigability, this is what the lead and section headings do - one can navigate and read what one wants. I don't feel there is a need to digest the page "all in one hit" so to speak. I agree about developing other related articles on mood disorder and depression (mood), as well as all the subarticles. I am contemplating what can go elsewhere. Problem is, much of (for instance) the history deals with melancholia which when descirbed is alt more like major depressive disorder than a rather nebulous/inclusive depression (mood), and most psychiatry and history texts treat historicla discussion that way. I think possibly the creativity and depression is better placed on depression (mood), but hard to identify what else. Cheers, Casliber (talk · contribs) 22:57, 1 December 2008 (UTC)


 * The prose size in currently 8333 words (or 54 kB) and this does not include the bullet points, which are an additional 424 words. The images, html markup code, and references appear to be collectivity sizeable. The word count is high but may not be a problem in itself, but the total file size is 493 kB (the collective size of all the separate parts of the page) which might be problematic with some browsers with plug-ins, apparently . I have been reading Article size for information and guidance, which indicates a maximum file size of 400 KB. Snowman (talk) 01:09, 2 December 2008 (UTC)

* File size: 495 kB   * Prose size (including all HTML code): 94 kB    * References (including all HTML code): 324 kB    * Wiki text: 143 kB    * Prose size (text only): 54 kB (8333 words) "readable prose size" * References (text only): 50 kB
 * I believe there is no "official" page limit for FAC. According to Dr. Pda, the size of this article is the following:
 * I agree the page takes forever to load, even on a fast connection, especially if I purge the browser cache. Dr. Pda shows, if I am reading this correctly, the References (text only) are almost as weighty as the prose size (text only), and the references add even more with all html the code. Dr. Pda doesn't consider images separately apparently.
 * However, watching the page load, I believe you are correct that each images requires a separate request to the server, as the images arrive unevenly, one at a time.  &mdash; Mattisse  (Talk) 01:59, 2 December 2008 (UTC)


 * As listed above, this website Website Optimization gives an analysis of all the separate parts of the page including the size of each image. It appears to confirm that each image is a automated separate download request. Snowman (talk) 10:44, 2 December 2008 (UTC)


 * Copied from Website Optimization.com

Object Size Totals

&mdash; Mattisse (Talk) 19:28, 2 December 2008 (UTC)

<ul><li> TOTAL_HTML - Congratulations, the total number of HTML files on this page (including the main HTML file) is 1 which most browsers can multithread. Minimizing HTTP requests is key for web site optimization. Y </li><li> TOTAL_IMAGES - Warning! The total number of images on this page is 26; consider reducing this to a more reasonable number. Recommend combining, replacing, and optimizing your graphics to speed display and minimize HTTP requests and to help consolidate decorative images. Use CSS techniques such as colored backgrounds, borders, or spacing instead of graphic techniques to reduce HTTP requests. </li><li> TOTAL_SIZE - Warning! The total size of this page is 459710 bytes, which will load in  100.22  seconds on a 56Kbps modem. Consider reducing total page size to less than 100K to achieve sub 20 second response times on 56K connections. Pages over 100K exceed most attention thresholds at 56Kbps, even with feedback. </li><li> HTML_SIZE - Warning! The total size of this HTML page is 115903 bytes, which is over 100K! Consider optimizing your HTML and eliminating unnecessary content and features, and eliminate as many comments and whitespace as possible. </li><li> IMAGES_SIZE - Warning! The total size of your images is 201797 bytes, which is over 100K. Consider switch graphic formats to achieve smaller file sizes (from JPEG to PNG for example). Finally, substitute CSS techniques for graphics techniques to create colored borders, backgrounds, and spacing. </li></ul> &mdash; Mattisse (Talk) 19:58, 2 December 2008 (UTC)
 * Analysis and Recommendations from Web Obtimization.com (edited)
 * I've made this argument in vain on several FACs (and I have a relatively new computer, Christmas present 2007, has nothing on it except Wiki stuff, so I know my computer isn't the issue). And, Gimmetrow and I have tested removing the citation templates in favor of hard-wired refs, no difference. It's the images.  Summarizing History to one paragraph and a sub-article would solve it. Sandy Georgia  (Talk) 20:02, 2 December 2008 (UTC)
 * I agree with your suggestion. Summarizing History would allow the article to be more focused, rather than all over the place as it is now. It would allow some improvement of the more relevant sections, such as Causes and Treatment, rather than the sketchy, incomplete information now given. For example, there are well known diurnal variations in depression, depending on the type of depression, and that is not explored in this article, despite all the talk of the "Human Clock". Plus, the sub-article on history would allow editors to expand on the topic and fully explore its cultural ramifications, etc., which it seems many would like to do. History, in the sense of most of the information presented in the sections in this article, is not really relevant to the diagnosis and treatment of Major depressive disorder. &mdash; Mattisse  (Talk) 20:23, 2 December 2008 (UTC)
 * I think that this is probably the best way to downsize the page and, at the same time, to focus it on the science. I have a lot of sympathy for anyone using a dial-up connection (or slow mobile device and so on) partly because I was late in getting a faster connection. If this excessively bulky article got past the goalkeepers, then the floodgates could be open to huge pages that many people would find difficult to access. Snowman (talk) 23:28, 2 December 2008 (UTC)

Working on a summary then
OK, if we are going to summarise history, can we list the absolute essential bits to go below and we can develop a consensus on what should be there? Cheers, Casliber (talk · contribs) 21:58, 2 December 2008 (UTC)


 * I don't have strong feelings about this. How about a quick walk through Aristotle (or some ancient mention) to document that depression is an ancient experience, on through the Middle Ages and melancholia to Freud and psychoanalysis (as a turning point); then some mention of  how the focus has shifted from a preoccupation with psychodynamics (since Freud) to current emphasis on  biological causes and with associated medical, behavioural and cognitive-behavioural treatments. Personally, I don't see the need to mention a bunch of names.  &mdash; Mattisse  (Talk) 01:12, 3 December 2008 (UTC)
 * I think DSM and coining of the term MDD needs to be included. Perhaps ICD-10 also, but this depends on the balance of what is retained in the section to what is already in the article in classifications section. Generally, I think, the further back the history, the briefer the text can be. Mention of Aristotle could be included. Most of the people mentioned in the the middle paragraph could be removed. Please note that the two images illustrating the books are each individually larger (in terms of downloaded bytes) than the Freud image. Images are probably not essential, however the artwork can be reassessed after the section has been downsized. What would be the best name for the new page on the history of depression? ... Is it "History of depression and melancholia"? Snowman (talk) 10:27, 3 December 2008 (UTC)


 * For succinctness I would say just History of depression, as melancholia for all intents and purposes is subsumed within it. Cheers, Casliber (talk · contribs) 12:58, 3 December 2008 (UTC)


 * Agree History of depression is fine. Agree that DSM, the selection of the term MDD and relationship to ICD-10 needs to be included in the Major depressive disorder article.
 * I also think much of what is included in "Causes" - "Psychological" could go into the History of depression article. Many of those people and theories mentioned (especially those of the last century) such as humanistic and existential etc. etc. have no relevance today and are of historical interest only. There is no need to give a history of theories of psychological treatment under "Causes", in my opinion, as they are mostly philosophical positions and current research cannot address the effectiveness of philosophical theories.
 * In my mind, Freud was a pivotal figure (as he introduced the "talking" cure and the emphasis on the treatment relationship) until the current focus on biological causes and cognitive schemas. What followed Freud are all variations of the psychodynamic approach introduced by Freud, until the behavioural and cognitive-behavioural strategies shifted treatment paradigms.  Even current behavioural and cognitive-behavioural treatments can be posited as addressing  underlying biological bases in changing behaviour  by theoretically building  new neuronal connections  etc.  &mdash; Mattisse  (Talk) 17:59, 3 December 2008 (UTC)
 * I think others know much more about the history than I do. I wonder if anyone has time to add a few things to the introduction of the "history of depression" article. The introduction there, being a greatly reduced summary of the "history of depression", could become a basis or pointer for a much shorter history section (or part of it) needed on this page. The two would have similarities, but the two are not equivalent. Snowman (talk) 18:25, 3 December 2008 (UTC)

Update - article now snipped

 * OK, I have hived off article and removed most of pre-kraepelin, as material after this point becomes much more relevant. Although now it skips a large chunk of time, but there is a prominent link to the daughter article. I need to sleep now, so people are welcome to decide if some other points need to be relegated to the daughter article out of what is left. I really hated doing this but I do understand about article length and there are at least 3 people who are in favour of this split (and only me and cosmic (I think) against). Anyway, please discuss below and I will be back tomorrow. Cheers, Casliber (talk · contribs) 14:00, 3 December 2008 (UTC)


 * That snipping is a start and has reduced the file size by a small amount. I have counted at least four people who have indicated that the history section should be shorter, and one of these also reported that the "Sociocultural aspects" section should be shorter too. Now the article has a file size of 476 kB (according to Dr pda that I just ran), so I think some axing is needed to get the file size below 400 kB (as in Article size). After some radical axing am sure that the article will have a little more breathing space for elaboration of the science, and nothing is lost because the history is all on a dedicated page which also can be elaborated. I am sure that these organisational changes will lead to much better data organisation, shorter download times, and wider accessibility. The science and history might be in the same psychiatry book, but perhaps not in the same chapter. At least 76 kB more to be axed with the data reorganisation, I wonder if the axing might extend into the "Sociocultural aspects" section and other images. Snowman (talk) 17:12, 3 December 2008 (UTC)


 * I keep getting edit-conflicted - the para Mattisse just moved on existential is the next thing I would moved to a history or causes daughter page. Cheers, Casliber (talk · contribs) 19:25, 3 December 2008 (UTC)
 * I would agree with moving that to history, as it is mostly philosophical and not able to be tested or be databased. Further, I think the "Psychological" causes should primarily be those that are addressed in the "Treatment" section, so that the article has some continuity. Biological causes > biological treatments; psychological causes > psychological treatments. &mdash; Mattisse (Talk) 21:29, 3 December 2008 (UTC)

Snowman, try and think of the next specific bits that are of lowest importance remaining and we can go from there. We now have daughter articles for much of it bar causes, for which I am keeping removed material in the to-do box at the top of the page. Cheers, Casliber (talk · contribs) 19:35, 3 December 2008 (UTC)
 * You could consider moving the "Rating scales" section to its own article, since it really isn't necessary to "Diagnosis", under which it is. I think Casliber suggested that before. Then he could include all the info he wanted on rating scales. I think for the general reader who does not know anything about rating scales, it does not explain anything. For anyone who does, it probably doesn't give them any more than they already know. This article could have one sentence on rating scales with a wikilink to the rating scales article.  &mdash; Mattisse  (Talk) 21:38, 3 December 2008 (UTC)
 * As far as I recall, in the UK it is a recommendation that patients with a chronic medical conditions are screening with PHQ-9 or equivalent, if anything has been picked up on a short 3 question depression test. PHQ-9 has been topical here, so I was interested to see it included. Snowman (talk) 12:40, 4 December 2008 (UTC)


 * May I assume that there is work-in-progress on shortening the history section. To me it now appears as a very large block of amorphous text without subheadings, which I presume is a temporary intermediate stage. I guess that it is about 3 or 4 times too long at the present time. Snowman (talk) 12:30, 4 December 2008 (UTC)

I was thinking para 5 starting Both William James and John Stuart Mill found relief from their depression... in the Sociocultural aspects could be taken to history as well as it possibly isn't as essential as the other material covered (feel free to move over if you agree). The rest of the section is diverse and important. We absolutely need mention of stigma and also cross cultural material. Cheers, Casliber (talk · contribs) 13:49, 4 December 2008 (UTC)

To snowman, what would you see as the most easily cut bit of history section? I really need to sleep. Cheers, Casliber (talk · contribs) 13:49, 4 December 2008 (UTC)

Unnecessary
To answer the question that started this entire thread, "Is the page too long for a GA or FA?"--obviously not, otherwise there probably wouldn't be the considerable conensus to promote the article in this FAC, just as there was in the previous one. This feels like the latest in a long line of laboured, post-FAC critiques that are making the article different, to be sure, but not necessarily any better. And I have always thought that the history section is one of the strongest sections in the article and one of the worst to trim. History puts things into context and is the best antidote to reification. As Neil Postman puts is, "It is hardly necessary for me to argue here that, as Cicero put it, 'To remain ignorant of things that happened before you were born is to remain a child'...To teach, for example, what we know about biology today without also teaching what we once knew, or thought we knew, is to reduce knowledge to a mere consumer product" (Technopoly, p. 189). History is not some incidental tangent that is best tucked away into a "daughter article" that relatively few are going to read; it is, to the contrary, the force that renders current perspectives more than trivial and incidental. Anyway, I finally agreed to moving the psychoanalytic causes to the history section, on the basis that there have been significant post-Freudian developments in this area; I cannot make a similar agreement about moving the existential causes. May and Frankl are still, even posthumously, major figures in the field, and are hardly outdated: The source I gave for Frankl's logotherapy is merely four years old! In short, I'd say that the existential section absolutely needs to be moved back to the psychological causes section of this article (and I'd be happy to be as WP:BOLD in moving it back, myself, as Mattisse was in moving it out), and I'd say that it'd also be a swell idea to keep the full "history" section in this article, as well. Cosmic Latte (talk) 20:52, 3 December 2008 (UTC)


 * That source is not good as it is from a popular business journal, not a scientific journal,  and contains no data. It appears to be a write up of someone's personal experience as a "therapist" whose professional credentials are unclear.   However, more importantly,  it makes no sense to include a bunch of "Psychological" causes in the causes section  that are really untestable theories, when under "Treatment", none of these "psychological" causes are addressed with a treatment approach. The "Treatment" section of the article should match the "Causes" section, in my opinion, for the article to have a decent structure and be credible as a science-based article.  &mdash; Mattisse  (Talk) 21:18, 3 December 2008 (UTC)


 * Also, please see the discussion on the talk page above. This article is too long, contains too many images and references, thus making its download time too long. There are suggestions given as to how to cut down the size of the article to reduce its downloading time. Look at the figures given above and give your opinion as to what should be eliminated or moved to a sub article. &mdash; Mattisse (Talk) 21:23, 3 December 2008 (UTC)


 * That source is from the Journal of Mental Health Counseling; it just seems to be made publicly available though some business-related website. As for "science-based," "reliable sources" do not have to reflect laboratory findings; they can reflect theories that are "tested" by their internal coherence and external relevance. This science criterion keeps being asserted without any sort of justification, other than pointing to the DSM, which is (again) rooted not in science but in committee consensus--there is no "scientific" boundary between depression (mood) and major depressive disorder. Like the theories underlying existential and psychoanalytic approaches, the theoretical backbone of the DSM is "tested" by its internal coherence and external relevance, not any empirical hypothesis that X constitutes a disorder whereas Y does not. As for article size, I don't see any complaints on the FAC page that it's too long or too big; the consensus is that the article ought to be promoted. There are longer articles on Wikipedia and longer pages on the Internet, but I'm not aware of any widespread complaints that pages on either Wikipedia or the Internet in general are too large. Here's a good time to be think like a scientist, for it would appear that the complaints about article size showing up here are not representative of a very large population--not even the population of FAC voters, who are voicing very few concerns with the piece! Anyway, if the page takes a while to load, it's not going to take much less time if we cut out a paragraph or two of history; it would be reduced by removing images instead, so I would opt to remove images rather than text, although I think that this whole criticism, like many criticisms that have been appearing lately, is vastly overstated and does not reflect the FAC consensus, which seems to be that the article is more or less fine and dandy as-is. Cosmic Latte (talk) 22:33, 3 December 2008 (UTC)
 * Primate is a fine example of a long article, an image-rich article...and an article that has just passed FAC. Seems a tad odd and random that these sorts of complaints are popping up only with regard to MDD. Cosmic Latte (talk) 22:49, 3 December 2008 (UTC)


 * The total size of all the separate parts of the page is currently about 470 kB. As far as I am aware, the article is too large for a wiki page and this is not open to dispute. I understand that some images were late additions, and one is still under scrutiny. I think that the history section deserves its own article page, where it can form an excellent article its own right, as part of a organised data. Also, it seems that a lot of facts in the article needed checking and amending, and checking continues. Snowman (talk) 22:54, 3 December 2008 (UTC)


 * Cosmic Latte, SandyGeorgia complained that the article had too many images that were affecting the download time. The discussion about article size is at Talk:Major_depressive_disorder &mdash; Mattisse  (Talk) 23:03, 3 December 2008 (UTC)


 * The changes made here are on the grounds of download times and data organisation. Nevertheless, I am surprised that the Primate article is so large, but on quick inspection the Primate pages seems well organised. Snowman (talk) 23:23, 3 December 2008 (UTC)

Primate vs Major depressive disorder
 * However, Primate is much shorter than this one: 88 kilobyes versus 137 kilobyes which this one is currently. And its stats are much smaller: (compare with this article):
 * File size: 320 kB vs File size: 472 kB
 * Prose size (including all HTML code): 70 kB vs Prose size (including all HTML code): 87 kB
 * References (including all HTML code): 169 kB vs References (including all HTML code): 312 kB
 * Wiki text: 87 kB vs Wiki text: 134 kB
 * Prose size (text only): 35 kB (5499 words) "readable prose size" vs 51 kB (7761 words) "readable prose size"
 * References (text only): 25 kB vs References (text only): 48 kB

&mdash; Mattisse (Talk) 23:46, 3 December 2008 (UTC)


 * Thank you for prompting me to use the wiki size tool to check the page sizes. I get 318 kB vs 470 kB; the small difference of 2 kB to your results is a bit of a mystery. I am using Firefox 3.04 on Ubuntu, and perhaps you are using a different set up. The tool seems to get the stats from the downloaded page. Snowman (talk) 00:02, 4 December 2008 (UTC)
 * I'm using Dr. Pda's script, which is what SandyGeorgia uses, for the file size etc. You can just stick in your monobook.js. I just ran it again on MDD and the File size was: 468 kB. (I commented out some outdated references and a letter to the editor - maybe that made the difference - it does seem from the stats that formatted references take a lot of bandwidth.) Primate remains the same at 320 kB. Must just be a different algorithm between the two tools.  I don't know about the wiki size tool. What is it? (I am using Firefox 3.04 also, but what is Ubuntu?) &mdash; Mattisse  (Talk) 01:09, 4 December 2008 (UTC)
 * I was talking about Dr. Pda's script when I refered to the wiki size tool. I have been using it since Casliber told me about it a few days ago. It is useful. The Primate page is 319 kB this morning. Ubuntu has its own wikipage. Snowman (talk) 10:58, 4 December 2008 (UTC)

S-Adenosyl methionine
"S-Adenosyl methionine" own page says it is a nutritional supplement. Why is it called a herbal supplement in the article? Snowman (talk) 16:27, 3 December 2008 (UTC)


 * No idea. Didn't add it in the first place. If you are sure of change, change it. I will be back later. Gotta run. Cheers, Casliber (talk · contribs) 19:33, 3 December 2008 (UTC)


 * I could not find anything on the internet that says it is a herbal supplement after 45 mins of searching. A ref says it is was licensed as a dietary supplement in 1999 in the USA. . It also suggests that it is various salts of S-Adenosyl methionine in the medication and not actually S-Adenosyl methionine itself as indicated in the article. If this is a reliable ref, then perhaps it can be used. S-Adenosyl methionine is not used in the UK, as far as I am aware, so my information is a bit limited. It is not in the BNF. S-Adenosyl methionine is mentioned in two paragraphs in the article. This may take sometime to repair and decide what to say about it if anything. Snowman (talk) 22:17, 3 December 2008 (UTC)

The dietary supplement information contained on this site has been compiled from published sources thought to be reliable, but it cannot be guaranteed. Efforts have been made to assure this information is accurate and current. However, some of this information may be purported or outdated due to ongoing research or discoveries. The authors, editors and publishers cannot accept responsibility for errors or omissions or for any consequences from applications of the information in this site and make no warranty, expressed or implied, with respect to the contents herein. Not a reliable source! &mdash; Mattisse (Talk) 22:30, 3 December 2008 (UTC)
 * Is S-Adenosyl methionine important enough to include at all? A "dietary supplement" in the USA just means that it probably won't kill you if you take it, but it says nothing about its effectiveness. That source Vitamin and Herb University says at the bottom:


 * Thanks for letting me know sooner rather than later. I was also thinking that S-Adenosyl methionine might be removed from the article, but some of the web pages I found kept on mentioning use in depression. Snowman (talk) 22:58, 3 December 2008 (UTC)


 * Well, if it really is used in some European countries as a prescription for depression, that is different than a "dietary supplement" or "herbal remedy" which, in the USA at least, is meaningless as to effectiveness. It just means some companies can make money selling it with some vague claims regarding its use without breaking the law.  Also, this article has so many equivocations about S-Adenosyl methionine's effectiveness, plus suggestions that it could be dangerous, that it does not seem like a good idea to discuss it in a summary article without good reason. And we are trying to cut down size.  &mdash; Mattisse  (Talk) 23:11, 3 December 2008 (UTC)


 * S-Adenosyl methionine probably should be mentioned only with a lot of evidence for and against to put it in perspective and do it justice, and this is not within the scope of this article. It has caught me by surprise, because it is not in the standard (UK) textbooks that I have got with by my computer desk. I guess it is heading for removal. I might be able to find out more after a few days.

Incidentally, is there a better heading than "Other"? Are there subsections within "Other"? Snowman (talk) 23:42, 3 December 2008 (UTC)


 * You are right. "Other" is poor. The "Other" section is rather a grab bag. Why is light therapy in there if it is effective for Seasonal affective disorder which is not included Major depressive disorder? I think it should go, as evidence is inconsistent for other depressions (according to the article). In fact, according to the article, evidence is inconsistent on all of these: St John's wort, Repetitive transcranial magnetic stimulation (which I don't know anything about but article says "it was inferior to ECT in a side-by-side randomized trial on a small sample."), and Vagus nerve stimulation for treatment resistant depression (which I know nothing about but article says " it failed to show short-term benefit in the only large double-blind trial when used as an adjunct on treatment-resistant patient."). Why is this stuff in here? Maybe the section should be called "Questionable treatments" or or "Experimental" or something to indicate the uncertain status of these treatments. &mdash; Mattisse  (Talk) 00:13, 4 December 2008 (UTC)
 * I think St John's wort is prescribable in some parts of Europe, so it might or might not be moved to the section above, with suitable explanations of side effects and drug interactions. I think repetitive transcranial magnetic stimulation in mentioned in NICE of the UK, as is exercise. You are right it does need a rethink, but it is too late for me in the UK time zone to work on it now. What about a heading of "Controversial therapies". "Questionable therapies" seems to be to negative to be used collectively for all of them. Snowman (talk) 00:26, 4 December 2008 (UTC)

- Managing this page WRT alternative treatments has been a real challenge. Given the issues with S-Adenosyl methionine, I would agree with relegating it to a treatments of page. Ditto light therapy. St Johns wart is highly notable, widely used and much talked about. There is also some biochemical basis for its effect, so I would advocate leaving that in. Similarly Repetitive transcranial magnetic stimulation has been heavily investigated and much talked about in psychiatry circles for about the past 12 years. Presentations on its use are frequent at out journal clubs etc. Cheers, Casliber (talk · contribs) 00:32, 4 December 2008 (UTC)


 * Just give some recent (within 3 to 5 years old from 2008) review articles for references. &mdash; Mattisse (Talk) 01:32, 4 December 2008 (UTC)

(unindent) Are we reading the same article? SAMe is cited to two reviews, both positive (the second one from 1994 could be dropped). has the full-text freely available. The reviewers are fairly positive on it, and there were no indications that it could be dangerous. There's no need for a lot of equivocation, although perhaps a little couldn't hurt. If there's a more critical review that Snowmanradio is looking at, he should add it. Mischouloun et al 2002 conclude: Fairly strong evidence exists that oral and parenteral SAMe are effective for the treatment of major depression. Some studies have suggested a faster onset of action for SAMe than for conventional antidepressants. SAMe may be used alone or in combination with other agents and may even accelerate the effect of conventional antidepressants. SAMe appears to be well tolerated and has relatively benign side effects. Thus, SAMe may be especially useful in patients who experience side effects from conventional antidepressants. The use of SAMe has not been shown to have toxic side effects; however, as mentioned earlier, there have been reports that SAMe may cause increased anxiety and mania in patients with bipolar depression. Recommended doses range from 400 to 1600 mg/d, although some persons may require doses > 3000 mg/d to alleviate depression.

In summary, on the basis of previously published evidence, the best candidates for SAMe or other natural antidepressants may be mildly symptomatic patients for whom a delay in adequate treatment would not be devastating. At the other end of the spectrum, patients who have failed multiple trials with conventional remedies or who are highly intolerant of side effects may also be good candidates. The use of SAMe in conjunction with conventional antidepressants also appears to be a viable application in patients who achieve only a partial response to conventional antidepressants alone. However, clinicians must be careful about recommending the use of SAMe to patients who take other medications, because its interactions with other drugs are not well elucidated. More research is needed to determine optimal doses, and head-to-head comparisons with newer antidepressants should help to clarify SAMe’s place in the psychopharmacologic armamentarium.

There's a lot better case for removing the 5-HTP and tryptophan review, although I personally would prefer that it stay, given their prominence within the AltMed community. There aren't major safety concerns there either except for 1989 poisonings linked to a contaminated batch of tryptophan (no incidents since). II | (t - c) 00:35, 4 December 2008 (UTC)


 * As long as you use review articles that are up-to-date (within 3 to 5 years old from 2008 per WP:MEDRS review articles for references), that is fine with me, although the phrases "fairly strong evidence" and "fairly positive" are not particularly persuasive.  In the USA,   SAMe is an  over the counter "dietary supplement" so it is not taken seriously as a drug. (I forgot what you said "WRT" meant.) &mdash; Mattisse  (Talk) 01:25, 4 December 2008 (UTC)


 * Re St Johns wort. I would agree with moving it to the "medication" section, given there are places that prescribe it. In the USA, it is over the counter. But it is agreed that it should be used with caution in combination with prescribed medications, so that is some recognition that it has some impact.  &mdash; Mattisse  (Talk) 01:29, 4 December 2008 (UTC)


 * You're misinterpreting MEDRS if you think that it requires reviews which are 3-5 years old. It's a guideline, highly subject to editorial judgment of the situation and the editors at hand. Some editors, such as myself and Paul gene were worried that it would be misinterpreted and gamed as a rulebook. Indeed, MEDRS does state that "although the most-recent reviews include later research results, do not automatically give more weight to the review that happens to have been published most recently, as this is recentism." There are attempts along the way to help careful readers. I certainly agree that recent is generally better, although not always better. is from 2005, has the same basic results, and isn't freely accessible. So my vote is to keep the American Journal of Nutrition 2002 reference. In fact, I note on the talk page that Mattisse voiced some support for preferring freely accessible articles as well. II  | (t - c) 01:43, 4 December 2008 (UTC)


 * This topic came up at WT:MEDRS so I came over here for a look-see. Generally speaking, newer reviews are better, particularly when the difference in age is this great. As it happens, the newer review  is freely available. Here's a citation:
 * I briefly looked at this review and I don't think it supports the following claim in Major depressive disorder : "S-adenosylmethionine is available as a dietary supplement and clinical trials have shown that, for most types of depression, it is equivalent to tricyclic antidepressants in effectiveness. The safety and efficacy of over-the-counter versions for MDD is unknown." The review merely states that there is a favorable and significant effect; it doesn't compare it to the effectiveness of tricyclic antidepressants, nor does it talk about over-the-counter. It focuses on "major depression in adults" rather than "most types of depression", a distinction that's probably worth making. I suggest citing it and rewriting the text to reflect what it says. Eubulides (talk) 21:36, 4 December 2008 (UTC)
 * I briefly looked at this review and I don't think it supports the following claim in Major depressive disorder : "S-adenosylmethionine is available as a dietary supplement and clinical trials have shown that, for most types of depression, it is equivalent to tricyclic antidepressants in effectiveness. The safety and efficacy of over-the-counter versions for MDD is unknown." The review merely states that there is a favorable and significant effect; it doesn't compare it to the effectiveness of tricyclic antidepressants, nor does it talk about over-the-counter. It focuses on "major depression in adults" rather than "most types of depression", a distinction that's probably worth making. I suggest citing it and rewriting the text to reflect what it says. Eubulides (talk) 21:36, 4 December 2008 (UTC)


 * Update - I have organised the "Medication" section with subheadings, and some small post-organisational changes may be needed. I have moved St John's wart up to this section to see what it looks like.  Awaiting feedback, and ideas about how to deal with the dietary supplements, and the rest of the features of the "Other" section. Snowman (talk) 12:24, 4 December 2008 (UTC)


 * The subdivisions create more headaches than they solve or help. venlafaxine is an SNRI and not classed as an SSRI as such. Mirtazepine is also mentioned in that subsection and doesn't belong either. I'd leave the headings as antidepressants and pharmacological augmentation only. Cheers, Casliber (talk · contribs) 12:39, 4 December 2008 (UTC)
 * Thank you. That is correct, I was going to put in mixed receptor types, but I did the changes too quickly. Snowman (talk) 12:47, 4 December 2008 (UTC)


 * PS: On thinking about it, I would leave the tryptophan in as Cochrane thought it important enough to review. Cheers, Casliber (talk · contribs) 12:41, 4 December 2008 (UTC)


 * PS: although other is not great, all alternatives I can think of are worse, prudent to avoide negative POV (Controversail/Questionable), and experimental is only partly correct and vague. I am stil thinking....Cheers, Casliber (talk · contribs) 12:59, 4 December 2008 (UTC)
 * Tryptophan, 5-hydroxytryptophan, and SAM are medications, so perhaps they could go in the medication section. I am trying to find out if they are all "dietary supplements", which would make a sub-heading, or how they are classified. Snowman (talk) 13:17, 4 December 2008 (UTC)
 * I guess you could just call them treatments (too general maybe). It seems odd to call them just medications. I need to sleep on this. Just supplements? Cheers, Casliber (talk · contribs) 13:42, 4 December 2008 (UTC)


 * PS: I was musing on removing Bright light therapy, but it does get a bit of pres in the media and people certainly talk about it, so am in two minds really...Cheers, Casliber (talk · contribs) 13:44, 4 December 2008 (UTC)


 * I am beginning to think that "Other" is a good heading, or perhaps "Other treatments". Snowman (talk) 15:04, 4 December 2008 (UTC)

I agree with Snowman that tryptophan, 5-HTP, and SAMe should be discussed under the medications section. A medication is simply a substance which has a druglike effect on the body. These substances are used as medications because they stimulate serotonin, either through inhibiting reuptake as with St John's wort, or through conversion as with 5-HTP. Thus they function similarly to the prescription medications. Serotonin syndrome, which should be mentioned in the medications section, is why taking any of these medications (prescription or not) together with other medications is potentially fatal. Even if the 3 AltMed treatments haven't been proven effective, that doesn't change the fact that they are proposed to work as medications. Putting these substances in the medications section allows the discussion of side effects, comparisons, and possible interactions to proceed more smoothly.

As far as inconsistent evidence, it's worth pointing out the second sentence of the current medications section: "[a] large 2008 meta-analysis of past studies reported that the response to antidepressant treatment in moderate depression were not shown to exceed that of placebo". That article notes that "[o]n average, the SSRIs improved the HRSD score of patients by 1.8 points more than the placebo, whereas NICE has defined a significant clinical benefit for antidepressants as a drug–placebo difference in the improvement of the HRSD score of 3 points". In other words, the evidence is not all that great with any medications, including prescription ones. Somewhat ironically, of the alternative medications 5-HTP is probably the most potent, but the trials have been so bad that it should be cited as having only very preliminary, weak support. I think all sources should be cited as consistently as possible to their sources and editors' own interpretations of the sources should be minimal if possible. II | (t - c) 21:04, 4 December 2008 (UTC)


 * Somehow the "medications" section got changed to an "antidepressants" section with some section re-organisation and then re-organisation. I think that the headings need a great deal of thought. I would like to see what it looks like with the "medications" section restored and all the medications put in this section and not some here and some in the "Other" section. The main bulk of prescribed antidepressants could form a subheading "Antidepressants" in the "Medications" section. Snowman (talk) 22:38, 4 December 2008 (UTC)