Talk:Depression (mood)/Archive 2

Archive 1

Archive 2

Archive 3

Links consideration

Do these links deserve to be in the external links section? -- Barrylb 05:48, 29 March 2006 (UTC)

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

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

http://bluepages.anu.edu.au

Not on this page, but quite possibly on the long clinical depression article.

Could I suggest this link as an interesting and informative addition to the external links section as it has a lot of helpful information and help for sufferers of depression? The website is: http://www.depression-helper.com Karlp295 (talk) 13:41, 14 October 2010 (UTC)

Aetiology and another view on subject matter

I noticed a couple of typos and obvious errors in the physiology section (genetics defined as 'an acquired disposition', 'ellicit'). I rewrote the section, as it was again becoming confused with clinical depression. ('Major depression' is a diagnostic category in DSM but not ICD). While I am personally convinced there is a continuum between depression (unhappiness) and depression (diagnosed as mental illness) and little difference of order, unhappiness certainly deserves its own article as other emotions have, and maybe even distinct ones for 'sadness' and 'despondency'. Most mental health professionals and the vast majority of people who I have met with diagnoses of clinical depression see the distinction as important and, although the diagnoses are arguably arbitrary, the definition is at least clear that depressed mood is a frequent symptom of 'depression' the syndrome. According to these diagnostic categories it is even possible to have clinical depression without depression of mood.

The actual content related to a depressed mood needs elaboration, and I will try to do this.

The introduction is still confusing. Depressed mood is necessarily shorter than 2 weeks? Surely it is best to differentiate, and then say that 'depressed mood, if it lasts longer than 2 weeks may be regarded as a symptom of clinical depression (q.v.), dysthymia or some other mental illness'. Cedders 10:17, 7 April 2006 (UTC)

Have made the changes I suggested. May need a slight clean-up. There are now three possible shades of meaning to confuse things, 'depression' as an emotion (which I felt was lacking), 'depression' as a mental illness concept, and 'depressed mood' mentioned in the second paragraph which is how a psychiatrist might view a sub-syndromal reactive depression. In addition to this, there are shades of sadness, grief, etc. that could perhaps be elaborated. Cedders 11:42, 7 April 2006 (UTC)

Also took the liberty of removing the POV, as it seems reasonably objective even if unsourced. If anyone disagrees, please add it back. Cedders 11:51, 7 April 2006 (UTC)

So are sadness and depression the same? —The preceding unsigned comment was added by 24.176.58.25 (talk • contribs) 05:19, 24 September 2006 (UTC).

No, whichever way you look at it. Clinical depression is very different from sadness for all the reasons listed above. Feeling a bit depressed for a few days is also not quite the same as feeling sad about something as was made clear in some deleted text. Sadness has more obvious intentionality than being generally depressed.

Should this article be moved to Sadness after all, in which case much would need to be added? (This is not a formal proposal.) --Cedders^tk 13:10, 28 February 2007 (UTC)

Interesting book

http://www.acestudy.org/docs/TheTruthAboutDepr.pdf

Rename instead of merging

This article ought to be renamed sadness. IMHO, the word "depression" when used in the context of mood refers to clinical depression, not mere sadness; YMMV. 69.140.155.148 03:45, 29 March 2007 (UTC)

I agree. --Galaxiaad 03:48, 29 March 2007 (UTC)

This makes a certain amount of sense to me as well -- Sammermpc 20:42, 21 April 2007 (UTC)

Picture captions

Do they strike anyone else as trite and a bit strange, "grieving Thai females", "a sad boy". I would argue that no pictures are necessary for this topic, or if they are, a more appropriate set of images (and definitely captions!), be selected. -- Sammermpc 20:42, 21 April 2007 (UTC)

• Yeah, I agree. The picture "Grieving Thai females" has absolutely no reference in the text [When I briefly skimmed over it, I may have missed something.] and I also agree that it seems rather odd. Should it be deleted? Scarian 14:56, 13 June 2007 (UTC)

Depressed mood in literature and culture

This section could be greatly expanded. What about talking about "emos" or at least linking to the appropriate page? And how about talking about some fictional characters apparently in a perpetual state of depression, like Vincent Valantine from Final Fantasy VII (there are plenty of them in manga and anime too)? It could be added that these characters have a considerable fanbase, from which one could infer their depression doesn't play against their popularity, and in some cases maybe even heightens it. Just an idea. Of course, it would have to be done citing sources and all. I won't write about this because I'd probably mess up, but if someone feels up to it... Although it should be discussed before. So, opinions? PoisonedQuill 14:55, 20 July 2007 (UTC)

"Cures"

I merged and retitled the two lists of "cures." They are not cures. The division between "natural" and "chemical" is arbitrary and promotes a certain viewpoint over others that may be as good or better. --Ronz 17:23, 23 September 2007 (UTC)

Some of those items have been scientfically proven to be effective in treating depression. It doesn't make sense to group those items in with unproven treatments such as St. John's Wort.75.111.74.39 (talk) 22:50, 28 March 2008 (UTC)

Missing citations

This article needs proper sources and re-formatting of its citations in a consistent suitable format. I added the section heading and code for references. They did not show up until now. Now that they show up, one can see how inconsistently they are formatted. They need clean up. The whole article needs sources. See the template(s). --NYScholar (talk) 10:09, 26 March 2008 (UTC)

Deletions not necessarily helpful

While I cede that "non-clinical depression" is an almost infinitely difficult term to define (because it's at least half-subjective), I'm not sure that deleting all of the (recent, added since the above comment on 3/26/08) unsourced text is the best idea. Can we not, at least for a shortish period of time, just put up some "citation needed" tags to give people the opportunity to work on it? I'm not saying that deletions are bad always -- but since I'm not of the opinion that the deleted stuff is outrageous-sounding, I'd rather see it up on probation than removed altogether. Isn't that what "citation-needed" tags are for, anyway? (Disclaimer: Yes I did contribute some of the removed stuff, but if the consensus is that it shouldn't appear at all, even with temporary tags, I'm fine w/leaving it out. Just for the record. And even though I'm totally suicidal.) Sugarbat (talk) 17:43, 21 May 2008 (UTC)

I believe that my deletions are justified. The article itself really should not exist as all, since of the material belongs either to psychiatry (Clinical depression) or to psychology (sadness). At most, there should be a few short, disambiguation-like paragraphs to provide links to medical and psychological articles. What I deleted clearly was not any kind of legitimate content - it was philosophizing not supported by references. I consider it harmful, since a person coming to that page may conclude that WP has nothing better to offer about depression. Paul Gene (talk) 20:10, 21 May 2008 (UTC)

Well, I disagree about the justification of the article itself (since "depression" isn't a synonym for "sadness," at all -- clinically or non-clinically -- and the best empirical evidence of this is clinical, in that we don't have a pathology called "clinical sadness"), but I do agree that if an article exists at all, it should be as valuable as consensus can make it. I guess what I'm trying to debate here is not so much whether you were right to delete material not supported by source tags (because, as I said, I believe you made a technically correct decision), but whether it's altogether reasonable to cut, without warning, an an already really stubby article. Your saying that the material you removed is "philosophizing" and "illegitmate" is, itself, opining, and that's not the reason we delete unsourced material. We delete it because it's unsourced -- and not because we don't agree with it. (i.e., if the material you removed were sourced, you might still consider it "harmful," but you'd have no grounds for removing it.)

I like to remove unsourced things myself (and often without warning) so please don't think that's my criticism -- it really is a thing where the subject of this article is a nebulous term (as is, for example, sadness) that's difficult and tricky to define, and I propose slightly more tender treatment of the text (as long as it's not outright gibberish, as I don't think was the case) than we'd apply to, say, cigarette lighter or ant, so the consensus dynamic can work most effectively. That's all. Sugarbat (talk) 23:36, 21 May 2008 (UTC)

Version 0.7

Sorry, but there are too many issues of OR and uncited information in this article, which also seems very short for such a major topic. Please renominate once the cleanup has been done. Thanks, Walkerma (talk) 08:13, 10 November 2008 (UTC)

Sources lacking

This edit introduced ref tags named "kim", "Pennington", "Harvard_health" and "Rosenthal" that didn't actually include the full reference. I've asked the editor about this; if we don't get an answer and no one else knows what these are in reference to, we need to revert the edit, which becomes more work as other stuff is added to the article... /skagedal^... 11:15, 27 November 2008 (UTC)

Define "briers"

What is the definition of briers as used here: "Depression cuts across all briers and affects all races, cultures and social classes."?

I've tried google (define:brier) and m-w.com/dictionary/brier, and neither gives a definition that seems applicable.

Choose a different word, or provide a definition, either here or in wiktionary (with a link from here).

Rhkramer (talk) 14:06, 20 February 2010 (UTC)

Opening paragraph phraseology

Loss of a parent is discussed as possibly effecting a "slight depression". Something seems very amiss here. 64.223.101.74 (talk) 01:02, 28 February 2010 (UTC) 64.223.101.74 (talk)

Most depressed persons smoke, and depressed persons find it much harder to quit.

Depressed Adults are Nearly Twice as Likely to Smoke as Those Not Depressed

Pratt LA, Brody DJ. Depression and smoking in the U.S. household population aged 20 and over, 2005-2008. NCHS data brief, no 34. Hyattsville, MD: National Center for Health Statistics. 2010. http://www.cdc.gov/nchs/data/databriefs/db34.htm#ref5

Depressed People Smoke More, Quit Less As Depression Deepens, Cigarette Smoking Increases By Daniel J. DeNoon WebMD Health News Reviewed by Laura J. Martin, MD http://www.webmd.com/depression/news/20100414/depressed-people-smoke-more-quit-less

Survey shows how depression and smoking intertwine http://www.reuters.com/article/idUSTRE63D48O20100414

Many Smokers Suffer from Depression By Psych Central News Editor Reviewed by John M. Grohol, Psy.D. on April 14, 2010 http://psychcentral.com/news/2010/04/14/many-smokers-suffer-from-depression/12846.html

Many smokers are depressed April 14, 2010 | 8:54 am "Among men ages 40 to 54, a whopping 55% of those who smoke have depression. Among women ages 20 to 39 who smoke, 50% have depression." http://latimesblogs.latimes.com/booster_shots/2010/04/smoking-depression.html

Looks like treatment for depression is also being used to help smokers.

At least a couple of antidepressants are already marketed as smoking-cessation aids, with demonstrable benefits.

Could be a really interesting treatment study. Perhaps also successfully treating smoking at the same time helps reduce relapse. —Preceding unsigned comment added by 68.165.11.102 (talk) 15:15, 15 April 2010 (UTC)

Treatment section needs work

The treatment section should be a summary of the 'treatments for depression' article, but currently it is a little bizarre and needs rewritten. Also we should probably feature exercise a little more prominently in the treatments page (currently it is relegated to a paragraph in the alternative therapies section). --sciencewatcher (talk) 03:48, 29 April 2010 (UTC)

It never was a summary. It's just some information that was added here with some slight changes since.

If you want to try to summarize, it would be better to work from Major_depressive_disorder#Management. It's a huge task to summarize it, given the complexity of it all. --Ronz (talk) 03:58, 29 April 2010 (UTC)

I've reduced it to just the link, given how horribly unbalanced it was. --Ronz (talk) 15:40, 1 May 2010 (UTC)

Trim and direct readers to Mood disorders

Hi. I came across this article the other day and did a minor edit. But the article is poorly cited and I doubt its scholarship. I think it should simply define psychological depression and direct readers to Mood disorders. It gets 1500 hits a day and the last person to edit left this. I would prefer that user, and the other 1499, were directed to a better page and I would like to replace the present Depression (mood) with Depression (mood). Any thoughts? Anthony (talk) 01:14, 20 May 2010 (UTC)

Done. Anthony (talk) 12:02, 22 May 2010 (UTC)

Yeah, looking at an old version, a lot of it is rather ill defined and nebulous. I thought you were putting in a redirect to Mood disorder somewhere (?). What I would add is a short sentence or three on mood disorders explaining that they are disorders where a disturbance of mood is a key feature and list other psychiatric disorders known to have depressed mood as a feature.

The other query is the section As a defense mechanism on the old pre-chopped page as some material that may be somehow worth keeping, but I am not sure how to integrate it. Will think on it. Casliber (talk · contribs) 03:01, 25 May 2010 (UTC)

Hi Casliber

• I don't see the value in singling out major depressive disorder.
• Depression is sometimes comorbid with Borderline personality disorder and is not a cardinal symptom of adjustment disorder, though common. Depression is often comorbid with very many physical and mental disorders. Listing them here would be endless.
• You overwrote my direction to mood disorders.
• I would oppose a discussion here about depression as a defense mechanism. Though I believe the theory has merit, it is presently highly speculative and lacking empirical support. It deserves an article in its own right, with a link from here and other depression articles.
• A lot of people come here looking for useful information about depression and I would like to see them directed promptly to a page that actually might help them.

Sorry if this sounds blunt but I believe it is important this page does not waylay people away from pages that offer clear concise empirically-based useful information. Anthony (talk) 04:47, 25 May 2010 (UTC)

Yes, there are many conditions where a depressed mood can be a feature, but it is a pretty key part of Adjustment disorder with depressed mood, which is not a mood disorder nor as it stands linked from the mood disorder page, so like you I am trying to think about parthways. I do believe major depressive disorder is worth singling out as that is the disorder most conflated with what lay people call depression or clinical depression. Some mood disorders such as cyclothymia and bipolar may not have much in the way of depression happening at all. WRT borderline personality disorder, it is not just comorbidity, but dythymia is actually one of the criteria used for diagnosis (unlike many other conditions where people may be depressed.). Casliber (talk · contribs) 05:07, 25 May 2010 (UTC)

OK. How about

For a discussion of mental illnesses featuring depression see adjustment disorder, borderline personality disorder and mood disorder.

with a few well-chosen words describing each? Anthony (talk) 06:06, 25 May 2010 (UTC)

Yes, looks good. Do you wanna do the honours or should I? Casliber (talk · contribs) 03:41, 26 May 2010 (UTC)

I suspect you know more about it than me. But I have the time if you'd rather not. Anthony (talk) 07:34, 26 May 2010 (UTC)

(I'd also appreciate your opinion on this merge/delete suggestion if you have the time. Anthony (talk) 06:15, 25 May 2010 (UTC) I just saw your comment at mood disorder. Anthony (talk) 06:22, 25 May 2010 (UTC))

External Review Comments

Hello, Depression(mood) article writers and editors. This article currently a priority article for the Wikipedia talk:WikiProject Medicine/Google Project. The goal of this project to is provide a useful list of suggested revisions to help promote the expansion and improvement of this article.

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

General comments

There is extensive discussion about merging this article with clinical depression which redirects to major depressive disorder. It is a valid point, that many readers seeking information on depression-related mood disorders will find this page. However, I think this article was meant to be either about non-clinical moods of depression OR a more general overview of depressed mood states resulting from any cause, including mood disorders, which would encompass:

• non-clinical feelings of depression
• Dysthymia
• Major Depressive Disorder
• Bipolar Disorder
• Depressive Disorder Not Otherwise Specified
• Seasonal-affective Disorder

Thus, in order to make it the most useful more readers of Wikipedia, I would suggest placing see a also link to mood disorders at the top of the page, making it clear in the introduction what the (mood) qualifier means, and adding a section on differential diagnoses that includes mention of all causes, including depression-related mood disorders. It is important to note that because this article falls within the scope of Wikiproject medicine, it would do well to be outlined as a medical sign or symptom.

The Wikiproject medicine styleguide recommended outline is:

• Definition (current)
• Differential diagnoses or Associated medical conditions
• Pathophysiology or Mechanism
• Diagnostic approach or Evaluation
• Treatment or Management (for the symptom itself, if any: e.g., analgesics for pain)
• Epidemiology (incidence, prevalence, risk factors)
• History (of the science, not of the patient: e.g., "The oldest surviving description is in a medical text written by Avicenna.")
• Society and culture (e.g., cachexia was a literary symbol for tuberculosis in the 19th century and for AIDS in the 1980s.)
• Research (Is anything important being done?)
• In other animals

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

Introduction

The current list of signs of depression would be better suited for a Definition section. Instead, an overview of what depression is would be better here. The Merck manual entry for Depression is a good model:

“After anxiety, depression is the most common mental health disorder. About 30% of people who visit a primary care practitioner have symptoms of depression. However, only some of these people have major depression. People who become depressed typically do so in their mid teens, 20s, or 30s, although depression can begin at almost any age, including during childhood”

• Depression in online Merck Manual (http://www.merck.com/mmhe/sec07/ch101/ch101b.html#sec07-ch101-ch101b-216)

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

I was one of the major contributors to the major depressive disorder article, and am a psychiatrist. One of the frustrating issues was finding sources which are ambiguous. I would hazard a guess that the above source is talking about MDD, often abbreviated to 'depression', which it then mentions. Casliber (talk · contribs) 21:07, 12 August 2010 (UTC)

Definition

The list of signs from the Introduction could go here. The Merck manual also mentioned four different categories of depression, though a second reference for these categories would be useful: “Catatonic depression: People are very withdrawn. Thinking, speech, and general activity may slow down so much that all voluntary activities stop. They may not take care of their children or pets or even feed themselves. Some people mimic others' speech (echolalia) or movements (echopraxia). Melancholic depression: People do not receive pleasure from activities they usually enjoy. They appear sluggish, sad, and withdrawn. They speak little, stop eating, and lose weight. Their face may show no emotions. They may feel excessively or inappropriately guilty. Psychotic depression: People have false beliefs (delusions), often of having committed unpardonable sins or crimes, of having incurable or shameful disorders, or of being watched or persecuted. People may have hallucinations, usually of voices accusing them of various misdeeds or condemning them to death. A few imagine that they see coffins or deceased relatives. Atypical depression: People with this type appear anxious and fearful (especially in the evening). They have an increased appetite, resulting in weight gain, and although initially unable to sleep, they sleep for increasingly longer periods. They tend to cheer up in response to positive events but are excessively sensitive to perceived criticism or rejection. Some people become agitated. They are very restless—wringing their hands and talking continuously.” References:

• Depression in online Merck Manual (http://www.merck.com/mmhe/sec07/ch101/ch101b.html#sec07-ch101-ch101b-216)
• Bostwick JM. A generalist's guide to treating patients with depression with an emphasis on using side effects to tailor antidepressant therapy. Mayo Clin Proc. 2010 Jun;85(6):538-50. Epub 2010 Apr 29. PMID 20431115

How about this for the definition:

Depression is a state of low mood and aversion to activity. A depressed person may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable or restless. They may experience problems concentrating, remembering details and making decisions, and may contemplate or attempt suicide. Fatigue, loss of energy, persistent aches, pains or digestive problems that are resistant to treatment may be found in depression as well as insomnia, waking early, or excessive sleeping. Loss of interest in activities that once were pleasurable, loss of appetite, or overeating may occur.

I've grouped the emotions, followed by the cognitive, somatic and behavioral features. Anthony (talk) 06:45, 2 August 2010 (UTC)

Sounds good to me. I vote for add. BSW-RMH (talk) 03:01, 12 August 2010 (UTC)

Me too...oh, its already there :) Casliber (talk · contribs) 22:03, 14 August 2010 (UTC)

Differential diagnoses and Associated medical conditions

This section can mention that the in the absence of other indicators/causes, the severity and duration of depression symptoms determines whether the depression is classified as non-clinical, Dysthymia, or Major depressive disorder. Depression can also be aging-related, substance-induced, indicative of other mood disorders, associated with adjustment disorders/ stress responses (see Maercker 2007 and Biegler 2008), associated with other medical conditions, and/or responses to difficult life changes/situations. Depression can be a symptom of:

• emotionally distressing life changes/events
• responses to serious medical conditions
• difficulty adjusting to aging
• Postpartum Depression
• Thyroid and hormone disorders
• Nutritional imbalance (Vitamin B6 or Vitamin B12 deficiency) (Buhr 2010)
• Bereavement
• Seasonal adjustive disorder (Howland 2009)
• Dysthymia
• Major Depressive Disorder
• Bipolar Disorder
• Depressive Disorder Not Otherwise Specified
• Seasonal affective disorder
• Substance abuse
• Side effects of certain prescription medications

References:

• Depression in online Merck Manual (http://www.merck.com/mmhe/sec07/ch101/ch101b.html#sec07-ch101-ch101b-216)
• Bostwick JM. A generalist's guide to treating patients with depression with an emphasis on using side effects to tailor antidepressant therapy. Mayo Clin Proc. 2010 Jun;85(6):538-50. Epub 2010 Apr 29. PMID 20431115
• Maercker A, Einsle F, Kollner V. Adjustment disorders as stress response syndromes: a new diagnostic concept and its exploration in a medical sample. Psychopathology. 2007;40(3):135-46. PMID 17284941
• Biegler P. Autonomy, stress, and treatment of depression. BMJ. 2008 May 10;336(7652):1046-8. PMID 18467412
• Howland RH. An overview of seasonal affective disorder and its treatment options. Phys Sportsmed. 2009 Dec;37(4):104-15. PMID 20048547 [
• Buhr G, Bales CW. Nutritional supplements for older adults: review and recommendations--Part II. J Nutr Elder. 2010 Jan;29(1):42-71. PMID 20391042
• Reynolds CF 3rd, Kupfer DJ. Depression and aging: a look to the future. Psychiatr Serv. 1999 Sep;50(9):1167-72. PMID 10478902

This section should have a See also link to [[depression{differential diagnoses)]]

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

Last link should be Depression (differential diagnoses). - Hordaland (talk) 03:11, 6 August 2010 (UTC)

I just noticed this -the two pages should be merged, or at the least some truncated list should be here. Given how short this page is, there is nothing to justify splitting on length alone. Casliber (talk · contribs) 21:48, 14 August 2010 (UTC)

Pathophysiology or Mechanism

Depression is thought to arise from changes in substances in the brain that help nerve cells communicate (neurotransmitters). Specifically, the neurotransmitters associated with depression are serotonin, dopamine and norepinephrine. The levels of these neurotransmitters can be influences by genetics, hormonal changes, responses to medications, aging, brain injuries, seasonal/light cycle changes, and other medical conditions. (Lee 2010, Merck manual)

The genetic contribution to depression is estimated to be 40-50%. (Lee 2010) In addition, women are twice as likely as men to experience depression, perhaps because of fluctuations in hormone levels during the menstrual cycle and after childbirth. (Merck manual)

There are several other hypotheses for the pathophysiology of depression (see Lee 2010), however these might better be discussed in a Research section, because they may not all be as widely accepted.

• Lee S, Jeong J, Kwak Y, Park SK. Depression research: where are we now? Mol Brain. 2010 Mar 10;3:8. PMID 20219105

Diagnostic approach

A full patient medical history, physical assessment, and thorough evaluation of symptoms helps determine the cause of the depression. Standardized questionnaires can be helpful such as the Hamilton Depression Rating Scale (Zimmerman 2004) and the Beck Depression Inventorym (McPherson 2010).

• Zimmerman M, Chelminski I, Posternak M. A review of studies of the Hamilton depression rating scale in healthy controls: implications for the definition of remission in treatment studies of depression. J Nerv Ment Dis. 2004 Sep;192(9):595-601. PMID 15348975
• McPherson A, Martin CR. A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population. J Psychiatr Ment Health Nurs. 2010 Feb;17(1):19-30. PMID 20100303

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

Yes. Agree something like this needs to be in. Casliber (talk · contribs) 21:58, 14 August 2010 (UTC)

Treatment

The treatment of depression depends upon the diagnosis of the underlying cause. I recommend directing readers to differential diagnoses. There is extensive information, for example, on the treatment of major depressive disorder.

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

Epidemiology

“Depression affects up to 25% of women and 12% of men . . . Depression is a major cause of disability worldwide and accounted for more than $83 billion in US costs in 2000.”

• Gelenberg AJ. The prevalence and impact of depression. J Clin Psychiatry. 2010 Mar;71(3):e06. PMID: 20331925

“About 30% of people who visit a primary care practitioner have symptoms of depression.”

• Depression in online Merck Manual (http://www.merck.com/mmhe/sec07/ch101/ch101b.html#sec07-ch101-ch101b-216)

“Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a [depression-related] mood disorder.”

• Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27. PMCID 2847357
• U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005. http://www.census.gov/popest/national/asrh/

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

Wondering if these statistics don't belong in Major depressive disorder rather than here. - Hordaland (talk) 02:57, 6 August 2010 (UTC)

I agree - we have to be careful what entity is being referred to, and I'd say all of the above refer to MDD apart from maybe the Merck Manual. Casliber (talk · contribs) 19:38, 9 August 2010 (UTC)

The first refers to any type of depression. The third refers to all depression-related mood disorders. BSW-RMH (talk) 03:12, 12 August 2010 (UTC)

I'd contend the first one is meaning major depressive disorder - I found this alot when I was buffing the major depressive disorder article, that it was called by its other name major depression and then abbreviated to depression -you could tell by the way the figures were used and also the description of it as a discrete entity. Kessler is worth mentioning though. Casliber (talk · contribs) 21:43, 14 August 2010 (UTC)

Depression as adaptation

This is interesting but speculative and I am not sure if this belongs here or should be it’s own article. Perspectives welcomed. However, I would recommend recategorizing it under Society & culture.

BSW-RMH (talk) 21:02, 1 August 2010 (UTC)

I believe this information deserves its own article. Anthony (talk) 06:59, 2 August 2010 (UTC)

I disagree. The view of depression as adaptation is mainstream; has been for years, even if many practicing psychiatrists aren't up-to-date. But leaving that aside: an article like this, on a major disorder, must contain a section about the origin of that disorder, whether or not there is a current consensus. (The etiology of Alzheimer's disease is still debated, but this doesn't keep the Alzheimer's article from including a section on "causes".) So, please leave this section, but expand it if you like to include other proposed explanations.UVA Astronomer (talk) 13:18, 25 August 2010 (UTC)

Including this large section about one of the speculations concerning what's behind depression, gives it undue weight. Remedying that by giving the same amount of coverage to all the other speculations would expand the section to the size of a stand-alone article. Patients and their families and friends who are looking for information about depressed mood shouldn't be hijacked by reams of speculation. Please start another article. I have removed the section again. Please do not restore it; a careful read of this page will show that there is no support for it being in the article. Anthony (talk) 17:16, 25 August 2010 (UTC)

Depression as an adaptation content moved here from article.

A number of authors have suggested that depression is an evolutionary adaptation. A low or depressed mood can increase an individual's ability to cope with situations in which the effort to pursue a major goal could result in danger, loss, or wasted effort. In such situations, low motivation may give an advantage by inhibiting certain actions. This theory helps to explain why depression is so prevalent, and why it so often strikes people during their peak reproductive years. These characteristics would be difficult to understand if depression were a dysfunction, as many psychiatrists assume.

Depression is a predictable response to certain types of life occurrences, such as loss of status, divorce, or death of a child or spouse. These are events that signal a loss of reproductive ability or potential, or that did so in humans' ancestral environment. Depression can be seen as an adaptive response, in the sense that it causes an individual to turn away from the earlier (and reproductively unsuccessful) modes of behavior.

A depressed mood is common during illnesses, such as influenza. It has been argued that this is an evolved mechanism that assists the individual in recovering by limiting his/her physical activity. The occurrence of low-level depression during the winter months, or seasonal affective disorder, may have been adaptive in the past, by limiting physical activity at times when food was scarce. It is argued that humans have retained the instinct to experience low mood during the winter months, even if the availability of food is no longer determined by the weather.

Paul Gilbert notes, "Common to most evolutionary theories of depression is the view that loss of control over aversive events and/or major resources/rewards exert downward pressure on positive affect. Social theories, however, suggest that it is loss of control over the social environment that is particularly depressogenic." Some hypotheses compare depression to fatigue, pain, and other biological functions that can impair performance but nonetheless have adaptive value. One postulate is that the depressive state evolved in relation to social competition as an unconscious, involuntary losing strategy, enabling the individual to accept defeat and to accommodate what would otherwise be unacceptably low social rank. The depression may signal "no threat" to rivals and "out of action" to kin or supporters might wish to push the individual back into the arena to fight on their behalf. It is also sometimes hypothesized that depression can serve to draw the attention of others to a person in need of help with a difficult situation.

John Price points out, "It may or may not be desirable to share the yielding hypothesis with the patient; for instance, the therapist might say: 'Your depression is serving an important function in your marriage, it is enabling you to submit to your husband's demands without rebellion, and is therefore saving your relationship from probable rupture.'" The wife might then consider whether other strategies for dealing with the situation might be preferable, or at least benefit from understanding the true cause of the depression. Studies show that males tend to prefer submissive females; this makes submissiveness an adaptive trait, and interpersonal conflict and oppressive or dominating male tactics may generate depression in the submissive female, who uses said depression to cope and to avoid a combative response that may result in harm to her.

It is also hypothesized that pre-menopausal major depression and bipolar disorder are often associated with superior intelligence and creative capacities — attributes likely to increase one's attractiveness as a potential mate — due to a pleiotropic gene, and that the gene survives for that reason.

Is the article fine just as it is?

I've been wondering. Is there anything more to say about depression (mood), if by that we mean the cluster of symptoms and signs listed in the lead? Everything else is, I think, well-covered by the articles linked to under Depression (mood)#Related conditions. We could plump it up with stuff, but would it be better to leave it as a simple signpost to the articles that cover that stuff in context? Anthony (talk) 10:56, 10 August 2010 (UTC)

It seems to me there is a cluster of symptoms, per the lead of this article, which we all recognize as depression. There's a bunch of life experiences that can cause these symptoms, a bunch of medical conditions that can cause them, and a bunch of psychiatric syndromes that consist of these symptoms plus chronicity. I'm thinking this page should stay as it is, just describing this symptom cluster and what's known about its neurological and physiological correlates. And this article then feeds the reader to other pages that deal with the medical illnesses that can cause this cluster of symptoms and the psychiatric syndromes that feature it. Sorry if I'm repeating myself here. Anthony (talk) 21:41, 12 August 2010 (UTC)

• Crap - forgetting the bleading obvious - we really need to write a few sentences on (and link to) bereavement grief - i.e. normal vs pathological grieving yada yada...Casliber (talk · contribs) 22:22, 14 August 2010 (UTC)

• PS: I note the grief article doesn't really have much on it (sigh - more stuff to fix :((), but something like [1] this is needed. Casliber (talk · contribs) 22:26, 14 August 2010 (UTC)

The photo

The photo, Migrant Mother, is iconic for The Great Depression, which is another type of depression altogether. Poverty doesn't necessarily lead to depression (mood). I feel that this isn't the right place to use that photo. --Hordaland (talk) 14:40, 12 August 2010 (UTC)

I can live without it but I like the photo. She looks depressed to me! I've removed the caption, as I don't see the point, since it's the facial expression and attitude that it's there for. However, that said, If you think it should go I won't mind you deleting or replacing it. Anthony (talk) 14:44, 14 August 2010 (UTC)

I'd agree with Hordaland. I think the photo is just too simplistic a choice - she looks glum! - as far as I know, the subject of the photo is not particularly associated with the subject of the article. bobrayner (talk) 15:32, 14 August 2010 (UTC)

I thought "glum" pretty much summed up the subject of the article. Anthony (talk) 15:56, 14 August 2010 (UTC)

How about Albrecht Dürer's "Melancholia I"? Anthony (talk) 10:51, 19 September 2010 (UTC)

Yes. At least as classic and very appropriate. --Hordaland (talk) 13:55, 19 September 2010 (UTC)

Done. Anthony (talk) 15:30, 19 September 2010 (UTC)

Merge discussion

I was surprised to find Depression (differential diagnoses) today. Do I think it is notable and important? Absolutely. And ultimately I feel it would get greater exposure if it were contained on a general page about Depression (mood) rather than segmented of somewhere else. It is unequivocally a subset of this page. Casliber (talk · contribs) 21:53, 14 August 2010 (UTC)

Support

1. Given that the main article itself is so short, and the content of the differential diagnoses article is so relevant, an integration would be wise. The article needs to be clear about which ailments are differential diagnoses and which are causes of depression, as that distinction isn't made clearly enough at the moment. MartinPoulter (talk) 22:13, 14 August 2010 (UTC)
2. Agree - duh, forgot to support me own proposal. Casliber (talk · contribs) 22:20, 14 August 2010 (UTC)
3. I think that having a separate page for differential diagnoses is a little silly. A merge would help provide encyclopedic context for readers. WhatamIdoing (talk) 06:03, 15 August 2010 (UTC)

Just when you thought it was safe to go back in the water....I guess Richard C. Hall M.D. and his colleagues who wrote "Physical illness presenting as psychiatric diasease" is a little silly too. PMID 568461 You're a trouble-maker, your little snide comment was meant to illicit a response from me.

Since our last little tete e tete, I've been trying to contribute positive content, to articles on a wide variety of topics like Wounded Knee Massacre, Brooklyn, Drymarchon couperi and Depression (differential diagnoses), a topic of which wasn't silly to one of the examples I cited, the writer from Newsweek who suffered for years, being misdiagnosed and God knows how many others like her.

I try to improve content not my ego, I can't help but notice a majority of your contributions are still just to Talk pages. Considering you and I have a negative history, your opinion is to say the least circumspect. Playing infantile baby games with you is an annoying waste of time, so please be gone before somebody drops a house on you. Oh and for your edification like with the proper use of i.e. and e.g., I think you meant "provide encyclopedic content", "provide encyclopedic context", sounds a little silly, well actually the whole sentence even with the word "content" does. O.K. bye-bye 7mike5000 (talk) 03:37, 16 August 2010 (UTC)

I don't know the background here, but I was vicariously offended by the "silly". Don't, Whatamidoing. (Is there an emoticon consisting of a waggling index finger?) Anthony (talk) 07:00, 16 August 2010 (UTC)

1. I'm persuaded. The differential diagnosis process (and there are several different work-ups out there, I think) and a list of medical illnesses and psychiatric syndromes involving these symptoms, on this page would serve the reader best. Anthony (talk) 06:29, 15 August 2010 (UTC)

Oppose

1. Nothing personal with a few exceptions I'm sure the people commenting here have good intentions and are trying to do the right thing. My attachment to this article is partially because I wrote it I'm human. But unlike some people my altruism supercedes my ego. I originally thought it might be a good idea but not after some consideration and reading the comments here.

The article is titled Depression (differential diagnoses), it's not about depression, or major depressive disorder, or the prevalence of depression, it's about medical and other psychiatric conditions which may be misdiagnosed as primary depression, cut and dry.

I started it 5 weeks ago, the fact is that prior to that there was little to no mention of differential diagnoses of depression in the article on Major depressive disorder, or Disthymia or Depression (mood). How Major depressive disorder is a "featured article" without mention of medical differential diagnoses is beyond me. Everything in that article is a moot point if the person reading it has depression due to Lyme disease, neurosyphilis, toxoplasmosis etc. How many people with depression are tested for these conditions, or recieve neuroimaging to detect the presence of tumors? Very few. The fact that a large portion of reported pituitary tumors are incidentalomas and many of those are found at autopsy is amazing. How they can be considered to be generally "benign" is interesting being that there are no retroactive studies to assess the medical and psychological maladies the person with the incidentaloma may have had.

To gut this article and remove just one iota of information does a disservice to those who it might have benefitted. Some people think that Wikipedia is a place to get their ego strokes, like a comment here from the peanut gallery, critical just for the sake of criticism. Its a valuable resource that can potentially provide useful information. And it's being squandered due to a select few who think they own it and put their own egos first, everyone else be damned, thats wrong.

The same person who wanted to put a picture of a starving girl on the Anorexia nervosa page, which I also wrote, has the audacity to pass judgement on this article, with it's "NPOV". I provided sources. The fact that it only gets about 250 hits on average a day is 250 it didn't get 5 weeks ago... because it didn't exist. There should be an indepth article on "differential diagnoses" on most major conditions including "anxiety".

Nobody knows how many people suffering from depression actually have a medical condition causing it. There isn't even a perfunctory diagnostic protocol for making "psychiatric" diagnoses. Most diagnoses are done without benefit of medical testing, and the few that are done are usually limited to the thyroid gland. I've read that 1/3 of all suicides have been in touch with a mental health "professional" in the year prior to their death. That doesn't say much for the mental health profession.

If doing the right thing is the prime consideration, the section on differential diagnoses in Major depressive disorder, Disthymia and Depression (mood) should be expanded and touch upon some differential diagnoses. There should be an article on proper diagnostic procedure for "psychiatric illnesses" in general. How professionals have the balls to diagnose anybody with anything without medical tests is not only incredulous it actually meets the definition of malpractice.

"A plea is made for the careful medical examination of psychiatric patients": Richard Hall M.D. wrote that in 1978, it still holds true today. How many people between 1978 and today had the quality of their life diminished or became suicide statistics because they didn't get a proper evaluation and treatment?

If somebody doesn't like me personally I don't give a shit, but Do the right thing and don't screw somebody out of information that could help them

Can I propose that we drop all talk of deleting Depression (differential diagnoses)? If changes here, and at other pages, genuinely make it redundant, I will support delete, and maybe 7mike5000 will too. For now, can we all think about how this page should look, and what it should do? Anthony (talk) 10:13, 16 August 2010 (UTC)

Erm, Major_depressive_disorder#Clinical_assessment, para 3 mentions what broad physical examinations and investigations should happen in the absence of any specific clues to any other condition. Generally, other conditions will leave clues within this framework to follow up on. I am not sure of the benefit of mentioning conditions that only exceedingly rarely manifest as depression without other symptoms to the degree that they aren't mentioned in secondary sources as differentials. Should we examine people carefully? absolutely and this is what the other article already states. 'nuff said. Casliber (talk · contribs) 12:54, 16 August 2010 (UTC)

Yes, we'll have to adhere strictly to WP:MEDMOS here. A reliable secondary source will have to say the illness can or does produce depression before Wikipedia can say it.

Major_depressive_disorder#Clinical_assessment says "a doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms" but 7mike5000 says "Most diagnoses are done without benefit of medical testing" (above). Can you both provide WP:MEDMOS-compliant citations to support your conflicting propositions? Copied to Talk:Depression (differential diagnoses) Anthony (talk) 16:27, 16 August 2010 (UTC)

Not for nothing it gets pretty tiresome, defending content which is based in common sense., serves a valid purpose, and is referenced. I thought you made the proposal to merge the articles out of altruism, doesnt seem to be the case now, now it seems you just want to impress your opinion. If your going to make an argument make a valid one. "I am not sure of the benefit of mentioning conditions that only exceedingly rarely manifest as depression without other symptoms to the degree that they aren't mentioned in secondary sources as differentials. Besides the point that that is an incredibly verbose comment that comes of like Double speak, it's also the whole point of the article because they aren't mentioned and they should be. That's why i included references. Should we examine people carefully? absolutely and this is what the other article already states. 'nuff said. Casliber Who are you to decide it's 'nuff said? There are lists on Wikipedia for very stupid shit under the sun.

• List of Star Wars characters: Let's delete that, the fact that there are Star Wars characters are in the article Star Wars. 'nuff said.
• List of Digimon: that alone is 'nuff said.
• List of people on the cover of Time magazine (1920s): that's important 'nuff said.
• List of people in Playboy 1980–1989: Reading this has been an epiphany for me 'nuff said.
• List of Playboy Playmates by birthplace: of course the fundamental benefits to human society are self evident, 'nuff said.
• Little is known about the prevalence and characteristics of misdiagnosis among psychiatric patients, although some studies, based on retrospective chart reviews and subjective patient reporting, have reported misdiagnosis of bipolar disorder.

According to the investigators, misdiagnosis of mood disorders has been linked to higher rates of psychiatric hospitalization and medical costs. They sought to investigate the prevalence of misdiagnosis of mood disorders in adult patients admitted to a mood-disorders unit in 2008. "We can say that about 1 in 4 patients didn't have the correct diagnosis, which is quite a big number," study author Akhil Sethi, MD, told Medscape PsychiatryAdults Admitted to a Mood-Disorder Clinic Are Often Misdiagnosed

Discussion

This idea has potential. How do you picture the page in its final form, Casliber? What do you see it containing, what role will it be performing? Anthony (talk) 21:58, 14 August 2010 (UTC)

(groan) editing this is too much like work :(......I think some notes on assessment is good and I have added. Ultimately it is frustrating as much of what is called 'depression' is 'mdd' including much (but not all) of what is discussed in peer reviewed literature. I think the differential diagnoses needs to be here, also so we can add to assessment general prilimiary tests on how these things are excluded (baseline bloods etc.) They are covered in the mdd article and with a little tweaking can be imported here...watch. Casliber (talk · contribs) 22:10, 14 August 2010 (UTC)

Also I do think we can add some epidemiology on the reporting of depressed mood. Casliber (talk · contribs) 22:18, 14 August 2010 (UTC)

I'm having a lot of difficulty sorting out in my own mind how much of Depression (differential diagnoses) belongs here and how much belongs in Major depressive disorder, but I do agree that there's no justification for a stand-alone article, particularly when you see what links to it: Special:WhatLinksHere/Depression_(differential_diagnoses). This article needs expanding (as #External Review Comments above states) to include more of the sections recommended in MOS:MED#Sections and including some of the relevant differential diagnoses would be a good start. --RexxS (talk) 22:36, 14 August 2010 (UTC)

Excuse me. This article is about a mood: depression. Feeling down, feeling blue, feeling all that stuff in the lead, that state we recognize as depression. That can be caused by life (being dumped, losing a job, etc), drugs of various types, many different physical illnesses, or there may be no known cause, in which case it is considered in relation to chronicity, temporal profile, severity, and other symptoms - and the syndrome is allocated a place within the psychiatric classification system.

Please don't assume, at least without engaging in some polite discussion beforehand, that this page must somehow be built around the DSM or the ICD.

It makes sense for differential diagnosis to appear here, because that is what a good physician does when confronted with a patient presenting with depressed mood. But slapping a psychiatric syndrome on the patient is only one of several possible outcomes of that differential diagnosis. Anthony (talk) 23:12, 14 August 2010 (UTC)

As for epidemiology, it doesn't belong here. Depression (mood) is what I felt when my father died, I was inconsolable for weeks. But I got over it. Now it feels good to think of him, I miss him, but I'm over the bereavement. That's not pathological, it's normal mammalian behaviour. It may be appropriate to report here estimates of the number of patients misdiagnosed with a psychiatric syndrome when they in fact have been living for years with an adrenal, thyroid or pituitary problem, but I don't have those stats yet.

I'm looking into differential diagnosis in psychiatry and am taking notes here. At present, this article describes depression (mood) with no padding at all, and swiftly dispatches the reader to articles that detail some of the illnesses that have it as a symptom. That's pretty good. I believe this article deserves very thoughtful considered discussion. Not a drive-by vote. Anthony (talk) 23:39, 14 August 2010 (UTC)

Mmm. I like what you've just added Casliber. Nice :) But, frankly, I think that's enough. The litany of physical illnesses inducing depression (mood), I think deserves its own article, just as the psychiatric syndromes do. Anthony (talk) 23:58, 14 August 2010 (UTC)

See above re grief - we need at least a sentence or two mentioning bereavement as a natural entity and how to recognise abnormal bereavement. I will find some notes somewhere. Casliber (talk · contribs) 01:24, 15 August 2010 (UTC)

(edit conflict) This is a disorder - it has an epidemiology, and that most certainly belongs here. You give a list of causes, why isn't there a section discussing them? This article is rated top/high importance by two Wikiprojects and it's start class. There's no good reason why an article on a medical condition shouldn't make use of the sections suggested for medical conditions. Is there no history? no prognosis? no societal impact? Finally, what is the point of removing sourced content relating to hereditary causes? --RexxS (talk) 01:33, 15 August 2010 (UTC)

Yes, Casliber. I agree with fleshing out the types of life event or circumstance (low social support ^(?) etc) that cause depression (mood), as well as clarifying and giving more detail to the medical illnesses that cause depressed mood (particularly of course those that are often mistakenly diagnosed as a mood disorder). But the latter is, it seems, quite an extensive list. I was thinking that, to do the differential physical diagnoses justice, it would take an article of its own. But perhaps you're right, and maybe a list with a little detail coupled with Wikilinks would do the job. Anthony (talk) 03:15, 15 August 2010 (UTC)

RexxS, I am very aware of the importance of this article. I have been trying to attract attention to it for a while now. Nothing is more important than that it should form a sensible element of an efficient, swift pathway to knowledge. This is not an article on a medical condition. It is a cluster of symptoms common to certain non-medical conditions, various psychiatric syndromes, and an array of medical illnesses. If you want to include here information about the epidemiology of the various circumstances and disorders that produce it, or are associated with it, I believe there is no good served by that. All it would do is bulk up the article with unnecessary noise. If you want to provide a sentence or two about the prevalence of depression (mood), sure. Anthony (talk) 03:15, 15 August 2010 (UTC)

RexxS, I see you have reverted my removal of "The genetic contribution to depression is estimated to be 40-50%". I did that, as I explained in the edit summary, because those stats refer to mood disorders. Presently, this article is about depression, the mood. If you think it should be about the psychiatric syndromes, the mood disorders, but not adjustment disorder or borderline personality disorder, or the physical illnesses that cause depression or the normal life events that cause non-pathological depression, please argue that here. But applying that stat to this article, as it stands now, is wrong. Please consider reverting yourself. Anthony (talk) 03:50, 15 August 2010 (UTC)

I think the segment in discussion is better off out of the article as it is a case of depression abbreviated mdd. It wouldn't be 40% otherwise. Casliber (talk · contribs) 05:31, 15 August 2010 (UTC)

Prevalence

Hordaland, I've reverted your addition of UK statistics because it's not clear the source is talking about depressive symptoms in general (as in the US data above). As best as I can work out, it is discussing major depressive disorder, but it's not clear. Anthony (talk) 16:58, 1 October 2010 (UTC)

OK, was just trying to get something not USA in there. --Hordaland (talk) 17:07, 1 October 2010 (UTC)

I'd like to see that too. I didn't think this kind of detail on the prevalence of depressive symptoms would be available for anywhere. (See the bottom of the thread immediately above.) Anthony (talk) 17:24, 1 October 2010 (UTC)

Youtube external link

This YouTube video was added by 85.65.243.51 (talk), and has been repeatedly deleted. From what I've seen (it is freezing on me after a couple of minutes) it seems to be addressing the mood disorders. If that's the case it probably belongs there rather than at depression (mood). And I vaguely recall there's some guideline against linking to Youtube, but I don't know where to find that. I see the IP has now added it to Major depressive disorder. Anthony (talk) 16:33, 18 October 2010 (UTC)

And now it's been removed from there, described as "redundant". Without having seen it through I can't comment on that. Anthony (talk) 16:40, 18 October 2010 (UTC)

The Israeli one? I saw it all the way through. (About 10 minutes?) 3 doctors talk about medications and therapies for depression of various severity. All very professional and believable. (Electroshock is not mentioned.) I don't see why it shouldn't be linked. Hordaland (talk) 18:53, 18 October 2010 (UTC)

There is a policy on external links which I'm not very familiar with. User Ronz removed it from MDD because what's covered in the video is covered in the article so, according to WP:EL, it doesn't belong on the article. In this conversation the inserting editor has been referred to Wikipedia:External links/Noticeboard. Anthony (talk) 19:35, 18 October 2010 (UTC)

I've removed it after it was restored. The video is primarily about depressive mood disorders, and the content is a redundant subset of the information in Major depressive disorder. --Ronz (talk) 20:51, 18 October 2010 (UTC)

Would it be ok then to attach it to the Mood Disorder article? Furthermore, I think the video puts additional emphasis on the CBT (from 5:10 min) subject, and therefore fits the Major depressive disorder page as well. And to Anthony, I think they have a non-youtube version. 85.65.243.51 (talk) 21:10, 18 October 2010 (UTC)

The video is not about all mood disorders, so doesn't belong in Mood Disorder. I agree that the best fit is in the MDD article, where it is redundant. --Ronz (talk) 21:33, 18 October 2010 (UTC)

<--I really have no opinion on the content, though my impression, having watched a few minutes, is that it does not add much, given its more or less educational nature. But I could be wrong there. The injunction against YouTube, the way I read it, is really an injunction against using primary sources. In this case, that the video is available on YouTube does not take away from its authority and should be no reason in itself for removal. Thanks, Drmies (talk) 22:45, 18 October 2010 (UTC)

I don't think the redundant argument should hold. Some people learn and understand best through reading, others may get much more out of the lecture mode. Such a good video only adds to the worth of the article IMO. Hordaland (talk) 22:52, 18 October 2010 (UTC)

I've just read the YouTube section of the external links guidelines. Provided it is clear the copyright owners approve of it being up there, there is no problem with us linking to it. Though things would be clearer if (a) it was hosted on their site (b) it was released on a Creative Commons lisence.

I've just watched the video and thought it was truly excellent. It covers the fundamentals of clinical depression (major depressive disorder) and dysthymia well.

Putting it on those articles would appear to go against item 1. in the section Wikipedia:External links#Links_normally_to_be_avoided: "Any site that does not provide a unique resource beyond what the article would contain if it became a featured article."

But I'm persuaded by Hordaland's point about the spoken word being a better medium for some. (I've seen spoken word files of the article text on some Wikipedia articles, but not recently.) Given that the most important audience for these articles will be having concentration problems, and a clear and simple clip will be much more effective for them than a wall of text, I favor placing a link to this video at the top of the EL section of Major depressive disorder and Dysthymia. It does provide a unique resource beyond what the article text could ever provide, accessibility for those too distressed to read. Anthony (talk) 04:29, 19 October 2010 (UTC)

I've advised Talk:Dysthymia and Talk:Major depressive disorder of this conversation, and emailed the person who posted the film on YouTube, asking for clarification on the copyright status. Anthony (talk) 06:27, 19 October 2010 (UTC)

Youtube videos raise copyright concerns, per WP:EL-- how do we know this content isn't copyrighted or was rightfully uploaded to Youtube? SandyGeorgia (Talk) 13:34, 19 October 2010 (UTC)

I sent an email to the producer/director and he has forwarded it to Prof. Benny Leshem, who is in charge of the project and is the copyright holder of the film. I'll get something from him that will satisfy OTRS before linking to anything. The position at the moment is, according to the producer/director, equivalent to (CC BY ND NC) and if that can be verified, there's no problem linking to it. The question of whether it should be linked to is still very much open, though. Anthony (talk) 13:53, 19 October 2010 (UTC)

For the record, I emailed Prof. Leshem, at his Ministry of Health email address, and he has confirmed he understands the implications of (CC-BY-SA) and the film is, indeed (CC-BY-SA). Anthony (talk) 08:50, 20 October 2010 (UTC)

Thanks-- that should cleat that part up (eventually). SandyGeorgia (Talk) 14:36, 19 October 2010 (UTC)

Anthony, I thought you just gave a pretty good argument for linking it, no? Drmies (talk) 15:26, 19 October 2010 (UTC)

I'm pleased to hear that. I actually asked if the owners would release it under CC BY SA, so we could host it. But it's a big ask. Anthony (talk) 15:51, 19 October 2010 (UTC)

Hello everybody. I work with Dr. Leshem as the IT manager and have the license in question. Who do I send it to? 85.65.243.51 (talk) 16:43, 19 October 2010 (UTC)

Hi 85.65.243.51. I've just asked at this Wikipedia noticeboard, how we establish the copyright status. Perhaps you could deal directly with them. They've got the experience in copyright matters. By the way, that's not a (CC BY SA) license you're holding there, is it? Anthony (talk) 16:54, 19 October 2010 (UTC)

CC it is my friend 85.65.243.51 (talk) 16:58, 19 October 2010 (UTC) That CC joke went right over my head, amigo. Anthony (talk) 19:37, 19 October 2010 (UTC)

You know, if it's (CC BY SA) we'd be able to host it here on Wikimedia Commons, and, provided other editors approve, give it some prominence in the articles. Major depressive disorder and Dysthymia attract 8,000 hits a day from interested readers. [2] [3] Anthony (talk) 17:22, 19 October 2010 (UTC)

This latest change in the discussion (disclosure of COI, hit stats) has me very concerned about adding a link that offers nothing beyond presentation. Please take this to WP:ELN as has been repeatedly advised. --Ronz (talk) 17:25, 19 October 2010 (UTC)

WP:ELN is definitely the next port of call. But we're not finished here, yet. The copyright bona fides have not been established. When that is done, if there is consensus here to add the link to a page, and I see nothing like that yet, then it must go to WP:ELN to test the very point you have been raising all along: the appropriateness of linking to a source that offers the same content as the text, via a different medium, video.

If you believe there is a Wikipedia:Conflict of interest problem, probably the best place to address that is WP:COIN Anthony (talk) 17:45, 19 October 2010 (UTC)

As a regular participant at WP:ELN, I can predict with a high degree of certainty what the response will be:

A video that provides no new information ("unique resources beyond what the article should contain") will not be supported. It's a direct violation of WP:ELNO#EL1, and videos are gently discouraged (largely because of the digital divide between our relatively wealthy editors, and our substantial developing-world reader base).

So I'd say that if your proposed process is to have another long, time-consuming discussion here, and then go to ELN for some sort of 'permission', then you can just stop and save yourselves the time, because the folks who frequent ELN are highly unlikely to support a link to a redundant video. WhatamIdoing (talk) 19:41, 19 October 2010 (UTC)

Thanks for the tip. I would like to know if there's consensus here for linking to the video, though. Now that copyright has been sorted out, does anybody reading this think it would be a good thing, harmful, or neutral for MDD and Dysthymia to link to this video? Anthony (talk) 20:25, 19 October 2010 (UTC)

Support including the link. Hordaland (talk) 21:21, 19 October 2010 (UTC)

This isn't a WP:VOTE. Why do you support including it? --Ronz (talk) 00:03, 20 October 2010 (UTC)

I've "defended" inclusion of the video twice already in this thread. Once to say that it is excellent. Once to say that some people get more out of 'lecture mode' than just reading. Those are (still) the reasons I support including it. Hordaland (talk) 03:35, 20 October 2010 (UTC)

I was fairly sure of your position Hordaland, but not so sure of Drmies, who has removed the link but who also said I'd made a pretty good argument for linking it. Was the argument good enough, Drmies? Anthony (talk) 04:17, 20 October 2010 (UTC)

Well, I'm usually on the strict side of reading EL, but we're not dealing with some spam link here, I am not bothered by the COI (it's above board now), and I find Anthony's defense of the video's quality and Hordaland's case for its usefulness persuasive. Ron, is that good enough for you? (Yes, I know it's not a vote...) Happy editing to all, Drmies (talk) 16:53, 24 October 2010 (UTC)

If a link adds something to an article over what we will be able create here and it is reliable, the place where it is hosted should not be a reason to eliminate it. I believe this one does adds to this article and it seems to be reliable, so it would be a pity to loose it.--Garrondo (talk) 09:47, 7 February 2011 (UTC)

The Lead's Weird Picture

Its a really weird picture! Im not sure what its supposed to be getting across. Though the pattern itself is unmistakable. It just doesnt seem an appropriate lead if theres this one giant, confusing spot to distract from the rest, as in the image above.

Chardansearavitriol (talk) 04:21, 14 February 2011 (UTC)

There's an article on it: Melencolia I. --Anthonyhcole (talk) 04:31, 14 February 2011 (UTC)

Body clock

I've removed this from the article because it discusses one possible etiology or contributing factor, and I don't think this article can do justice to etiology for such a broad range of conditions and syndromes, or selectively report a few. It should be thoroughly covered at articles discussing etiology of the listed psychiatric syndromes, though if it is implicated in those.

A 2010 review suggests that the genes which control the body clock may contribute to depression. (Footnote: Kennaway, David J. (2010). "Review: Clock genes at the heart of depression". Journal of Psychopharmacology (SagePub) 24 (5): 5–14. doi:10.1177/1359786810372980. PMC 2951587. PMID 20663803. http://jop.sagepub.com/content/24/2_suppl/5. Retrieved 2010-10-20. "In humans, single nucleotide polymorphisms in Clock and other clock genes have been associated with depression.")

--Anthonyhcole (talk) 08:23, 17 April 2011 (UTC)

Rationale for revert

I've just reverted a recent edit by User:Tesseract2. [4] The rationale for the revert is that this article covers the mood, depression, which can be caused by normal life events (not pathological) and many physical illnesses, while also being a feature of several psychiatric syndromes. The information you added was specific to the psychiatric syndromes. Wikipedia articles that might be appropriate for this information include

• Mood disorder
• Major depressive disorder
• Dysthymic disorder
• Psychotic depression
• Postpartum depression
• Seasonal affective disorder
• Borderline personality disorder
• Adjustment disorder

Only content verifiably directly related to depressed mood caused by Addison's disease, hypothyroidism, hypoparathyroidism, hyperthyroidism, Graves' disease, Hashimoto's thyroiditis, pituitary tumors, post-concussion syndrome and many, many other non-psychiatric disorders that produce depressed mood as a symptom, non-pathological depression resulting from bereavement and loss, as well as psychiatric syndromes featuring depressed mood should be included in this article. Information related to some of these diseases and the depressed mood associated with them belongs on the articles for those diseases. --Anthonyhcole (talk) 16:24, 17 April 2011 (UTC)

I am not clear on your logic. You seem to be saying that this page should focus on the mood itself - rather than any syndromes which cause it (although you are allowing for physiological diseases that cause it?)

My point is that the source I added was discussing a depressive disorder, but it was a valid source for a claim about an effect of the mood itself (I provided the citation which is about feeling depressed, whatever the cause). Furthermore, I do not think it is regarded as a contentious claim that a depressed mood can cause an unfortunately self-fulfilling prophecy. Please put the information back.-Tesseract²(talk) 16:57, 17 April 2011 (UTC)

Yes, this article is about the mood, depression, so it describes some of the physical conditions that produce depressed mood, and mental illnesses that feature it. It briefly mentions normal (non-pathological) life can produce depressed mood.

Your contribution was "Depression can cause pervasive problems in an individual's life through its (often unconscious) changes to behaviour in a self fulfilling prophecy (e.g. obsessing over past mistakes can cause individuals to miss real solutions)" and was supported by Blogs - Science and Sensibility - A psychological potpourri by Dr. Bill Knaus EdD This is not a reliable source for health claims - appropriate sources for such content are outlined in WP:MEDRS. --Anthonyhcole (talk) 18:13, 17 April 2011 (UTC).

Clinical psychologist and former professor Bill Knauss is more than adequate for the benign claim I was making. Are you saying this is a contentious claim? Because otherwise you are being unproductively demanding about sourcing. -Tesseract²(talk) 02:28, 18 April 2011 (UTC)

Yes, I am saying it is an inadequate source for health information. (Not reflecting in any way on this author) professors make all kinds of claims outside the scrutiny of peer-review. I, and others, take this article very, very seriously; actually as a life and death matter. So yes, I'm being demanding about sourcing. If by "unproductively demanding" you mean the standard advocated by WP:MEDRS will limit the amount of irrelevant content in the article, mea culpa.

The article could use some concise well-sourced information about strategies for ameliorating/coping with this mood (regardless of the source of the mood), but if you intend adding such content please be certain it is concise, well-sourced and explicitly universally applicable to the mood, not just to the mood associated with bereavement and/or psychiatric syndromes. That is, the source you use must be of the highest standard, ideally a systematic review in an authoritative peer-reviewed journal, and be explicitly addressing the mood regardless of its cause. Strategies and theories built around depression associated with psychiatric syndromes and/or life events cannot simply be assumed to apply to depressed mood caused by hypoparathyroidism. --Anthonyhcole (talk) 02:58, 18 April 2011 (UTC)

Rationale for revert II

I have reverted this recent edit to the section, Depression (mood)#Psychiatric syndromes:

Depression can also result from high levels of Post Traumatic Stress which impacts individuals of all age groups. “Persons of both sexes aged over 60 years had higher scores for Post Traumatic Stress Disorder and depression compared to persons in other age groups.” (Telles, Singh, Joshi, 2009). Groups like single women, children and men with negative coping behavior are the most vulnerable and are in need of a lot more social support (Telles, 2009). Social support helps give people the emotional and practical resources that they need. People who receive less social and emotional support from others are more likely to experience less well-being, more depression, and suffer from social exclusion. Persons who suffer from social isolation are at higher chances of living in poverty. The stresses of living in poverty are particularly harmful to children and elderly people (Wilkinson, Marmot).

The information on the association between depression and PTSD after disaster is important but too detailed for this broad overview of the mood. If it is not covered already in those articles, it might be appropriate for Major depressive disorder or Post traumatic stress disorder but, as the cited source (Telles, Singh, Joshi, 2009) does not support the claim with a reference, you will need to find a systematic review or literature review to support the claimed association. (A search of the PubMed database will probably turn something up.)

The claim that "single women, children and men with negative coping behavior are the most vulnerable" will need to be sourced to a review addressing vulnerability to depression and PTSD. I haven't read the source you cite, (Telles, 2009), but it probably cites a review for the claim. Read that review and, if it supports the claim, that is the appropriate paper to cite. However, again, this epidemiological data is too detailed for this overview of the mood but, if it is not covered in them already, may be appropriate for Major depressive disorder and/or PTSD.

The information about social support would be very appropriate for this article if appropriate sources could be found to support the claim that social support relieves depressed mood in all it's manifestations: symptom of physical illness, feature of psychiatric syndrome, consequence of loss, failure, bereavement, etc. It seems very obvious to me that social support would reduce the intensity of depressed mood regardless of its cause, and I would like to see that point made here, but it can't be done without appropriate sourcing. Sourcing this claim for depression associated with mood disorders and life events should be no problem, but I've just done a PubMed and Google Scholar search and can't find a review of the effect of social support on depressed mood caused by medical illness. If anyone reading this knows of such a source, it would be a very valuable addition to this article. If it's not covered in Mental illness, Mood disorder, Major depressive disorder, Bereavement, Defeat, Failure, etc., and appropriate sources for the effect of social support on depressed mood in those conditions can be found, it should certainly be mentioned in such articles.

Thank you very much for the effort you went to with this contribution and please don't be disheartened by my reversion. Editing health-related articles here is fairly constrained by the sourcing guideline, WP:MEDRS, and finding the appropriate Wikipedia article for a contribution can take a few attempts. --Anthonyhcole (talk) 03:37, 20 May 2011 (UTC)

Removal of music therapy paragraphs

Several paragraphs on music therapy (could be worked into the article Music therapy) were out of place in this article and I have removed them. None of the many, many other treatments is described here. --Hordaland (talk) 07:31, 12 August 2011 (UTC)

I removed the section on Physiology or mechanism

...because this article is about depression due to life events or physical illness, or as a symptom of a psychiatric illness. The sources in this section are Wikipedia pages or primary studies, or refer only to the psychiatric symptom. That is, they are not reliable sources for medical content per WP:MEDRS, or do not address depressed mood in all its forms. I fully support this article containing a section on the current notable speculations about the physiology or mechanism underlying depressed mood, but an appropriate source is necessary, and that source should address the mood, rather than just depression in psychiatric disorders. --Anthonyhcole (talk) 08:16, 22 September 2011 (UTC)

SciAm resource

From Talk:Epigenetics ...

Epigenetics Offers New Clues to Mental Illness "Experience may contribute to mental illness in a surprising way: by causing "epigenetic" changes—ones that turn genes on or off without altering the genes themselves" Scientific American November 30, 2011 by Eric J. Nestler; excerpt ...

Studies in mice demonstrate a role for long-lasting epigenetic modifications in such disorders as addiction and depression. Epigenetic changes can also affect maternal behaviors in ways that reproduce the same behaviors in their offspring, even though the changes are not passed down through the germline.

99.181.134.134 (talk) 04:36, 29 November 2011 (UTC)

See Regulation of gene expression. 99.35.12.139 (talk) 06:07, 30 November 2011 (UTC)

Rationale for revert III

I've just reverted much of a sizable contribution from new user Fatimaaxo (talk · contribs). I hated doing it because it clearly represented a lot of thoughtful work. The reasons for my revert are mainly:

• some content addressing the mood appeared to address MDD rather than the mood in general
• some content was word-for-word copy of someone else's text.
• the text was not supported by sources that conform to WP:MEDRS

Here is a detailed explanation:

Depression is a serious mental health concern that will touch most people's lives at some point in their lifetime (either directly or through someone close they know). The suffering endured by people with depression and the lives lost to suicide attest to the great burden of this disorder on individuals, families, and society. (Hunter, James. "Research on Depression". PsychCentral.com.)	A copy/paste from the cited source, which has a copyright © notice at the bottom of the page. Per wp:copyvio we can't do that. We can report what they say, but have to use our own words. The source doesn't conform to WP:MEDRS.
Some people describe depression as “living in a black hole” or having a feeling of impending doom. (Smith, Melinda. "HelpGuide".)	The source doesn't conform to WP:MEDRS.
About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families. ("The Depressed Child". The American Academy of Child and Adolescent Psychiatry).	I think this belongs in the article. The source is good enough. But it's a copy/paste. If no one else does, I'll paraphrase it later.
(e.g., Addison's disease, hypothyroidism, menopause, Diabetes Mellitus, Lyme Disease, Multiple Sclerosis, Sleep Apnea, Sinusitis and much more), a side-effect of various medical treatments (e.g., hepatitis C drug therapy, using drugs related to isotretinoin, treating bird flu, Varenicline or Chantix used to stop smoking, birth control pills), (Vann, Madeline. "Prescription Drugs That Cause Depression". Everyday Health, Inc.)	The source is too weak, per WP:MEDRS. I removed the examples because the evidence for depression as a side effect is after-market reports, often very few. (The only one I didn't investigate was birth control pills). I left hepatitis C drug therapy because it's well attested that about a third of users experience depressed mood. I would love to see a separate article detailing all the treatments that do/may cause depression or increased suicidality, with the strength of evidence made clear.
Depression mood is also a feature of certain psychiatric syndromes such as Asperger syndrome, Wernicke's encephalopathy, Folie à deux, and others.("Syndromes in Psychiatry".)	The source is not strong, it doesn't support the assertion, and I couldn't find reliable support for these examples.
This mood must represent a change from the person's normal mood. Social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one which is caused by a general medical condition. Major depressive disorder generally cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder.	This is copy/paste from the DSM IV TR. Also, it's too much detail for this article, and is covered well in Major depressive disorder.
depressed mood most of the time for at least two years, along with at least two of the following symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness. ("Dysthymia".)	This is a copy/paste from the source (which may in turn be a copy of DSM IV TR).
Bipolar Disorder causes serious shifts in mood, energy, thinking, and behavior–from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with a person's ability to function. ("Bipolar Disorder (Mania)".)	I can't find this text in the cited source but it exists on various sites including here so it's a copyright violation. And I'm pretty sure BD doesn't have to include depressive episodes.
Thyroid conditions are extremely common in the adult population in the United States and they can often lead to depression, both an overactive thyroid and an underactive thyroid can lead to depression. And a simple blood test can diagnosis hypothyroidism or hyperthyroidism and lead to appropriate treatment that may be very helpful for relieving the depression (Brendel, David. "Are There Medical Conditions That Cause Depression?". ABC News Network.)	It's a copy/paste from the source, the source doesn't conform to WP:MEDRS, and I couldn't find reliable support for the association of hyperthyroidism and depression.

--Anthonyhcole (talk) 11:01, 15 March 2012 (UTC)

Rationale for revert IV

I have reverted a sizable edit to this article by Maryellenhdf (talk · contribs) All but one of the sources failed to conform to the sourcing guideline for medical content (WP:MEDRS), and the new content exclusively addressed psychiatric syndromes featuring depression, rather than the symptom, depressed mood. The distribution, causes and responses to psychiatric syndromes may differ from that of depressed mood due to hypothyroidsm or heartbreak. Much of this content would, properly sourced, be appropriate for Mood disorder or possibly Major depressive disorder, Dysthymia, Postpartum depression or Adolescent depression. --Anthonyhcole (talk) 08:33, 20 March 2012 (UTC)

Treatments

I'm concerned about the section #Treatments. WP:MEDRS is essential for all medical content. Since most of the treatments included in that section are unsourced, and as a precaution against inadvertently misleading the reader, I've removed the section for now. Let's work on the wording on this talk page, and post it into the article when we've got something that is coherent, useful and reliably sourced. I can't attend to that immediately, but will get to it soon. Feel free to start without me. My main concern is not having unsourced and possibly useless/erroneous assertions about treatment in the article.

If we are to have such a section, it needs to be made clear which types of situation (somatic illness-induced depressed mood, life event-induced, treatment-induced, or psychiatric syndrome) the treatment is effective for. An intervention that has produced clinically significant improvement in MDD can't just be assumed to be an effective treatment for depressed mood due to bereavement, hypothyroidism or hepatitis C therapy; and interventions that have evidence for improving mood in non-clinical populations can't be assumed to affect mood in clinical depression. --Anthonyhcole (talk) 10:10, 3 April 2012 (UTC)

I liked Pine's clarification very much. I removed the entire "treatment" section, and the more I think about it the more I think it should stay out. I think it's too specific to the psychiatric syndromes, and belongs in the articles on the different syndromes, not in this overview on the mood. The treatment regime for depression in BD is very different to that in BPD, and they both differ from that in MD. Anyway, that's what I think at the moment.

I have to take an indefinite Wikibreak, so won't be watching for a while. Regards. --Anthonyhcole (talk) 05:14, 10 April 2012 (UTC)