User:SingingPsych/sandbox

1) Lead Section
Major depressive disorder (MDD), also known simply as depression, is a mental disorder characterized by at least two weeks of pervasive low mood. Low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause are common symptoms. Those affected may also occasionally have delusions or hallucinations. Some people have periods of depression separated by years, while others nearly always have symptoms present. Major depression is more severe and lasts longer than sadness, which is a normal part of life.
 * Quotation of source article lead from which to edit:

The diagnosis of major depressive disorder is based on the person's reported experiences and a mental status examination [NEEDS A CITATION]. There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms. Those with major depressive disorder are typically treated with counseling and antidepressant medication. Medication appears to be effective, but the effect may only be significant in the most severely depressed. Types of counseling used include cognitive behavioral therapy (CBT) and interpersonal therapy, and electroconvulsive therapy (ECT) may be considered if other measures are not effective. Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes.

The most common time of onset is in a person's 20s and 30s, with females affected about twice as often as males. Major depressive disorder affected approximately 163 million people (2% of the world's population) in 2017. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. Lifetime rates are higher in the developed world (15%) compared to the developing world (11%). The disorder causes the second-most years lived with disability, after lower back pain.

The term major depressive disorder was introduced by a group of US clinicians in the mid-1970s. The cause of major depressive disorder is believed to be a combination of genetic, environmental, and psychological factors, with about 40% of the risk related to genetics. Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. It can negatively affect a person's personal life, work life, or education as well as sleeping, eating habits, and general health. Those currently or previously affected with the disorder may be stigmatized.

Suggested edit of first two paragraphs (paragraphs 3 & 4 are reasonably well done; may revisit on future edits):
Major depressive disorder (MDD), also known simply as depression, is a mental disorder characterized by pervasive low, or depressed, mood and/or anhedonia, a lack of interest in normally enjoyable activities. In order to meet the diagnostic criteria for MDD diagnosis, one must experience two or more weeks of depressed mood or anhedonia, along with 4 or more of the following symptoms (for a total of 5 symptoms): unintentional changes in weight, dysruption to regular sleep patterns (sleeping more or less), becoming physically slowed or fidgeting uncontrollably, having low or no energy, experiencing an increase in feelings of guilt or worthlessness, disruption in concentration or volition, and thoughts of suicide. Those affected may also occasionally have delusions or hallucinations. Some people have periods of depression separated by years, while others nearly always have symptoms present. Major depression is more severe, significantly affects, daily function, and lasts longer than sadness, which is understood to be a normal part of life.

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

2) Symptoms & Signs Section

 * Quotation of source article from which to edit

Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health (SOURCE 15 - NEEDS REPLACED). Its impact on functioning and well-being has been compared to that of other chronic medical conditions, such as diabetes (SOURCE 16 - From 1995; also just a whack claim. Verify with uptodate research).

A person having a major depressive episode usually exhibits a low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities (NEEDS CITATION). Depressed people may be preoccupied with—or ruminate over—thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness or hopelessness (Source 17 needs to be replaced with dsm5). In severe cases, depressed people may have symptoms of psychosis (Source 18 also needs to be updated to DSM5). These symptoms include delusions or, less commonly, hallucinations, usually unpleasant (again, replace source 18 with dsm5). [Other symptoms of depression include poor concentration and memory (especially in those with melancholic or psychotic features - this doesn't appear to be correct, per DSM-V; it's merely a feature of major depression at large), withdrawal from social situations and activities, reduced sex drive, irritability, and thoughts of death or suicide. Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia, or oversleeping, can also happen.] - this could be more succinct; just sig-e-caps it/DSM-5 [Some antidepressants may also cause insomnia due to their stimulating effect.] - this is outside of the scope of signs/symptoms; should be in medication side-effects on an SSRI page.

[A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the World Health Organization's criteria for depression.] - this isn't a review article and is specific to zimbabwe--and it's from 2000. [Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.] '''- Redundant with previous paragraph. Should name all key diagnostic criteria in a single paragraph. Family and friends may notice that the person's behavior is either agitated or lethargic - citation is DSM-IV; verify this is true in in DSM-V (psychomotor retardation, perhaps?)'''. Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements '''I'm surprised this didn't get flagged for plagiarism, as it is very close to source article. However, it leaves out the superimposed vascular dementia component, which seems like a key component of what they're trying to tell us'''.

Depressed children may often display an irritable mood rather than a depressed one, and show varying symptoms depending on age and situation (Source out of date -DSM-IV. I believe to be true, though. Will verify). Most (most? appropriate?) lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness."

Emerging Questions/Research based on above article:

 * The effect of depression on the loved ones of depressed patients.
 * Current NIH resource doesn't seem to speak on the effects of depression on the patient's social sphere. This is also a revised publication from 2008. So, needs replaced.
 * Per this review, there does not seem to be a correlation with depression symptoms and social supports. However, there is evidence that family is protective.
 * Per this review, even after remission of mood symptoms, patients remain impaired; and social dysfunction appears to be predictive of relapse/comorbid psychopathology.
 * Depressed patients' functional status is the same or significantly worse than diabetic and other chronic medical illness patients.
 * Health related quality of life takes a pretty big hit in older adults with untreated MDD/currently dysphoric pts, but there a significant recovery to near the average of never diagnosed patient. There seems to be a relationship with refractory symptoms and the following additional patient demos. Suggests biopsychosocial factors, structural barriers may affect; perhaps not completely organic?
 * Racial/ethnic minority
 * Receiving disability income support
 * Living in urban areas
 * Psychiatric or substance use disorders,
 * ≥3 chronic conditions
 * Lifetime suicide attempt
 * The pervasive nature of the disease (paragraph 2, sentence 1): No citation; it's just an anhedonia definition, so DSM5 should do.
 * How does major depression present in other countries? Somatic predominance in symptoms?
 * Compelling review article that supports this assertion. However, from 2003.
 * Symptom onset in children and adolescents
 * Symptom onset in children and adolescents

Depression affects many aspects of an individual's life, and, in turn, is affected by many aspects, such as race, ethnicity, disability status, and comorbid medical conditions. For example, there is a relationship between symptoms of depression and difficulty maintaining family and personal relationships; however, research has also shown the presence of social bonds to be protective.
 * Suggested edit of 'Symptoms and Signs' section (in progress):

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

There is also a strong relationship between depression and patient-reported pain. A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems. Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person's physical movements to be either agitated or slowed, termed psychomotor agitation and retardation, respectively. Older depressed people may also have more notable cognitive symptoms of recent onset, such as forgetfulness, as a result of comorbid neurological decline associated with aging. Children with affective disorders often display an irritable mood rather than a depressed one, necessitating consideration of the diagnosis disruptive mood dysregulation disorder. Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness."