Talk:Major depressive disorder/Archive 4

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Normal Course

I think it's worth a bit of discussion on what the course of "untreated" depression normally is in the prognosis section. Meaning does depression typically subside on its own after a specific amount of time? What happens if the depressed person does nothing?98.210.205.24 (talk) 09:04, 25 February 2008 (UTC)

If the person does nothing, the problem falls steadily worse unless the user has sought help or have been willing to accept help. Prowikipedians (talk) 02:20, 15 March 2008 (UTC)

reference? i imagine some percentage experiences remission of symptoms, even if they are predisposed to another bout of major depressive disorder later in life. Xwordz (talk) 06:28, 5 May 2008 (UTC)

Dietary Causes

I'm doubtful about the statement that excess sugar consumption alters mood. I believe this was recently disproven in children, and since the section doesn't have a reference (the footnote at the end of the paragraph refers only to the claims about alcohol's effect on depression), I propose that it be edited out. Minerva9 (talk) 05:19, 29 April 2008 (UTC)

Causes: Neurological

These 2 sentences are misleading:

Evidence has shown the involvement of neurogenesis in depression, though the role is not exactly known.[25] Recent research has suggested that there may be a link between depression and neurogenesis of the hippocampus.[26]

This sounds as though depression is caused by neurogenesis (growth of new neural cells). This is the opposite of what has been found in several studies, a few of which were referenced in the opinion article of reference #25.

The wording needs to be changed to reflect what the cited article says: neurogenesis in the hippocampus has been seen in rats after SSRI treatment. A different source (a review by Davidson et al. 2002) mentions that neurogenesis was observed in adult human hippocampus---but I do not know the context of the study, which is published by Eriksson et al. 1998. It may not have had anything to do with depression or pharmaceuticals. (Feel free to check, though...!)

It's okay with me to keep reference 25, since the article can't cite every study ever conducted on brain tissue volume and cell density.

But reference #26 is not verifiable. I have access to Scientific Amer (not a peer-reviewed journal, btw) through my university: "Vol 17" is questionable, because even Dec 1985 was Volume 250; and a search of all issues/all text for "Helen Mayberg" gave zero results. —Preceding unsigned comment added by Xwordz (talk • contribs) 04:33, 5 May 2008 (UTC)

sorry, forgot to sign this earlier :) Xwordz (talk) 06:24, 5 May 2008 (UTC)

cortisol levels & depression: chicken or egg?

Under "Causes - Sleep Quality"

Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.

It's actually not quite so straight-forward as this (uncited) sentence implies.

It's not known if the higher levels of plasma cortisol often (but not always) found co-occuring with depression are caused by depression --- or if depression is caused by raised cortisol. In fact, a considerable amount of correlative evidence points towards stress-incuded depressive symptoms, although there are working hypotheses for the reverse. And cortisol is actually just the parameter chosen for measuring hypothalamic-pituitary-adrenal [HPA] axis activity, and upstream hormones are of interest as well as other glucocorticoids.

When I have time I'll come back and post a few citations here for community review/feedback. :) Xwordz (talk) 18:27, 5 May 2008 (UTC)

St John's wort

Is the part about potentially active molecules under dispute? I pulled those from St John's wort just to give it a little context. For stylistic reasons, the bullet should start with the proposed treatment. Including the molecules sidesteps the "whole herb" question. At least based on the Cochrane Review, the evidence base cannot address that question, as different manufacturers use different preparations without a standard reference for what is contained in different pills bearing the same label.

The reverting edit summary indicated that the conclusions of the Cochrane Review (link) may be interpreted differently from my reading. My interpretation of the abstract and plain language summary is that the evidence is weak, inconsistent, and confusing. Given the well-known problems of publication bias, this probably means "no", but WP:V says we should wait for a reliable source to say so. To quote the abstract, "[Extracts of St John's wort] seem more effective than placebo and similarly effective as standard antidepressants for treating mild to moderate depressive symptoms. Beneficial effects for treating major depression appear minimal." The sentence previously cited to this review read: "A meta-analysis by the independent Cochrane Review found that current evidence suggests that St John's Wort preparations may be similarly efficacious to standard antidepressants for mild to moderate depression, but only minimally efficacious in cases of major depression." The review can (and probably should) be qualified with language about the strength of this conclusion based on the poor quality and heterogeneity of results of included studies, but I would appreciate clarification of exactly how the conclusions presented differ from those of the source. - Eldereft ~(s)talk~ 07:45, 7 May 2008 (UTC)

http://www.nimh.nih.gov/health/publications/depression/treatment.shtml http://www.ncbi.nlm.nih.gov/pubmed/11939866 http://www.mayoclinic.com/health/st-johns-wort/NS_patient-stjohnswort Here are links to a good secondary sources that take both sides of the issue and which should be treated as majority opinion. This is a scientific question and the Cochrane review at best should be considered minority, possibly fringe opinion. Try a rewrite here. Lets see if we can't do a better job then what is on the page now.--scuro (talk) 11:42, 7 May 2008 (UTC)

Doctors among us, would you comment please on the Scuro's conclusion that "Cochrane review at best should be considered minority, possibly fringe opinion". Paul Gene (talk) 14:53, 7 May 2008 (UTC)

What I offered was a citation from the Journal of the American Medical Association and two citations from National health institutions...all with excellent creditability and secondary verifability. A simple informal personal judgement from ANY contributor really has little currency within wikipedia...although the any well thought out and reasoned response is always appreciated.--scuro (talk) 16:49, 7 May 2008 (UTC)

And those are good sources. The fact that the NCCAM trial has been cited by NIMH &c. certainly gives it more WP:WEIGHT than some of their trials. Those good sources also agree with my interpretation that the evidence is weak but positive compared with placebo for mild to moderate depression and negative for major depression. Next time instead of reacting with hostility and taking an at best dubious stance on reliability, just point out that this is the Clinical depression article, and mild to moderate depression is beyond its scope. I just edited the article to reflect this, please feel free to improve. - Eldereft ~(s)talk~ 18:31, 7 May 2008 (UTC)

Minimal effects for major depression does not mean no effect. The Cochrane meta-analysis states: "In trials restricted to patients with major depression, the combined response rate ratio (RR) for hypericum extracts compared with placebo from six larger trials was 1.15 (95% confidence interval (CI), 1.02-1.29) and from six smaller trials was 2.06 (95% CI, 1.65 to 2.59)." So even in the most reliable and least favorable large trials SJW was statistically significantly better than placebo. As for the effect size, it is known that some meta-analysis of established antidepressants also indicated only weak to moderate effect size. This is also consistent with the second conclusion of the Cochrane review, that SJW was equivalent to antidepresants in trials for major depression: "Compared with selective serotonin reuptake inhibitors (SSRIs) and tri- or tetracyclic antidepressants, respectively, RRs were 0.98 (95% CI, 0.85-1.12; six trials) and 1.03 (95% CI, 0.93-1.14; seven trials)." Paul Gene (talk) 02:29, 8 May 2008 (UTC)

I am no expert on Depression. Yet I do know of SJW and it's possible benefits, the NIMH speaks to this treatment. In my eyes it deserves more weight. From my eyes, quoting studies is useless for a lead on a subsection. If you need to quote anything, quote what a major national health institute has to say on an issue. That is majority opinion and should receive the majority of the space on the issue. In this particular instance I believe the issue should be flushed out some more because it is notable and readers generally will have heard about this herb. Once that is taken care of, a sentence or two can be used for minority viewpoints or new studies.--scuro (talk) 02:55, 8 May 2008 (UTC)

That sounds fine, but probably we should keep it short with more in depth discussion reserved for St John's wort. On a related question, should we link to the relevant subsection over there, or is the article link preferred? - Eldereft ~(s)talk~ 03:39, 8 May 2008 (UTC)

Sure you could link back here. Actually I don't particularly like the theraputic section of that article. It relies to heavily on studies and data and there is no reason why generalizations can't be made supported either by direct quotations or citations. I'll tweak this section a little right now.--scuro (talk) 16:30, 8 May 2008 (UTC)

Meta-analysis is an approach which was invented for the cases exactly like SJW - when both negative and positive studies exist. Meta-analysis combines the results of all studies into one super-study with much higher validity and lower error. That is why the meta-analysis by Cochrane Foundation is not just a study, but exactly what you are asking for - the systematic scientific summation of the knowledge on SJW for depression. On the contrary, the NCCAM trial is just a study; moreover, its results were included in the Cochrane meta-analysis and their summation. The NCCAM study is just one out of 37 analyzed by Cochrane foundation, so it cannot carry more weight than Cochrane meta-analysis. The Cochrane foundation carries enormous authority in medical community, and certainly, the authority of a website (even government-affiliated) with popularized information is much much lower. Paul Gene (talk) 22:34, 8 May 2008 (UTC)

A meta-analysis is not necessarily the best source for Wikipedia. I would argue that a webpage from the NIMH or the Mayo clinic would be the better source. First an MA is stuck in a moment of time. Webpages are fluid and updated. Secondly, a meta-analysis is only as good as the people doing the analysis. Third, the best in the field would be at the national institutes and would be aware of the best sources including the meta-analysis. They would be even more accountable then the researchers because their information would be consumed by the general public.--scuro (talk) 11:43, 9 May 2008 (UTC)

I'd go with Cochrane. It is pretty gold-standard. Webpages of clinics etc. are often distilled and may also degrade over time and/or not be updated, or reflect views not more widely held. This is a controversial area, but I'd trust Cochrane's rigour more. Cheers, Casliber (talk · contribs) 14:33, 10 May 2008 (UTC)

Major depression vs clinical depression

Erm, any idea why this is not listed under its official DSM IV TR name? Has this discussion been had before? Cheers, Casliber (talk · contribs) 14:29, 10 May 2008 (UTC)

The official DSM-IV name would be major depressive disorder, and ICD-10 - depressive episode. I suggest renaming the article Major depressive disorder. Clinical depression term is not really used by anyone, and I am at a loss as to how this article got named so. Paul Gene (talk) 10:51, 13 May 2008 (UTC)

I agree. Unless there's reasonable opposition, let's move it to Major depressive disorder. Aleta ^Sing 17:52, 13 May 2008 (UTC)

From what I can make out, the original page placement was way back in 2003 or earlier as per here. Funnily enough The Anome, and Delirium are still around. Hopefully some more folks will drop by. I'll drop a note on the medicine and psychology wikiproject talk pages. Cheers, Casliber (talk · contribs) 19:09, 13 May 2008 (UTC)

• Support for major depressive disorder. The present form is outdated. The only argument against I could imagine is that the lay readership does not recognise the term, but neither would they be familiar with the concept "clinical depression" vis a vis other forms of depression. JFW | T@lk 05:53, 14 May 2008 (UTC)
• What about depression (mental disorder). Depression seems to be used more than major depression or clinical depression (e.g. [1]) — fnielsen (talk) 09:25, 14 May 2008 (UTC)
• Why not simply move to depression? Probably the most common search term. --Steven Fruitsmaak (Reply) 23:30, 14 May 2008 (UTC)

  This is where it gets tricky. Major Depressive Disorder is part of a group of mood disorders in DSM IV-TR (the psychiatric bible). Now the article is just starting to be polished up and hte issue is that much of the research that quotes incidence of problem/effectiveness of medication etc, uses MDD as the goalposts/yardsticks etc. Techincally there are some other conditions which would colloquially be called depression, including Adjustment Disorder with Depressed Mood (related to what was previously Reactive Depression (sort of)), Dysthymia and Minor Depression (this was a research diangosis in DSM IV for further study), which would feasibly be considered under 'depression' but not 'major depression'. Thus having the article simply as 'depression' would introduce ambiguity, even though I agree it is a much simpler title. I am thinking a brief disambig and discussion on the depression disambig page with links to all the diagnoses I have mentioned is the best bet. Cheers, Casliber (talk · contribs) 03:15, 15 May 2008 (UTC)

• Oppose We already have a web of redirects and dab pages for all the variations on naming for this topic. Clinical depression seems fine in that is a common term for the topic and falls nicely midway between slang like Blues and jargon like Major Depressive Disorder. The essential feature of the topic is that it is about depression considered as an illness rather than just a mood. Clinical says this better than Major. Colonel Warden (talk) 12:00, 15 May 2008 (UTC)

  Erm, CW, do you actually know anyone who calls it clinical depression, 'cos I don't. In which case it could be construed as OR. Most folks who aren't calling it MDD or major depression would just call it depression. Cheers, Casliber (talk · contribs) 21:51, 15 May 2008 (UTC)

• Yes, I know many people who use the term. For example, see scholarly sources for many thousands of examples. Since you are not familiar with such a widely-used term and have not even made such a simple search, your suggestion seems frivolously grounded in ignorance. Colonel Warden (talk) 11:56, 16 May 2008 (UTC)

Please refrain from insults - that diminishes your argument. Besides the Google search for "clinical depression" as you suggest gives 28,700 hits, while the search for "major depressive disorder" gives 56,900 hits and for "major depression" 370,000 hits. Paul Gene (talk) 15:51, 16 May 2008 (UTC)

Google Scholar naturally returns hits which use scholarly language. A more general search gives the following numbers:

• Depression = 90 million
• Major Depression = 2.5 million
• Clinical Depression = 1.2 million
• Depressive illness = 1.0 million
• Major depressive disorder = 0.5 million

I performed searches of this sort before venturing any opinion on the matter. Major depression has a numerical lead but we must allow that there will be many non-medical usages in there - economics, especially. Note that both NIMH and NHS use the phrase depressive illness which we should include in our considerations. This phrase was not previously familiar to me but now I am less ignorant than before. Colonel Warden (talk) 17:04, 16 May 2008 (UTC)

• Support for major depressive disorder. Clinical depression is too wide and too ambiguous to be used in clinical practice. Major depressive disorder is not jargon, but the commonly used term and standard terminology. Depression as a layterm and cultural phenomenon also deserves to be discussed, but separately as proposed by Casliber. All the types of "clinical depression" can be briefly explained there with links provided to their respective articles. --Eleassar ^{my talk} 10:35, 16 May 2008 (UTC)

• ''Major depressive disorder is certainly technical jargon and is likely to get a big "huh?" from most lay people. As such, it is not appropriate for the main title of an article in a general encyclopaedia. Per WP:NAME: "The names of Wikipedia articles should be optimized for readers over editors, and for a general audience over specialists.". Colonel Warden (talk) 12:05, 16 May 2008 (UTC)

What about e.g. erectile dysfunction, hypertension or myocardial infarction etc. etc.? I don't know what do the lay people understand under these terms if anything at all. Per Wikipedia:Manual of Style (medicine-related articles). The article title should be the scientific or recognised medical name rather than the lay term. As for the jargon, please read Technical terminology before arguing that major depressive disorder is jargon; jargon is informal. --Eleassar ^{my talk} 14:58, 16 May 2008 (UTC)

We absolutely should use the correct medical term. Colonel Warden, "Clinical depression" can and should be a redirect to "Major depressive disorder", thereby allowing anyone who searches under that term to go directly to the article. Aleta ^Sing 15:48, 16 May 2008 (UTC)

Right, Aleta - that is exactly what WP:MEDMOS recommends! Use the systematic name, for example, from ICD10 and create redirects from other terms. Quote: "Create redirects to the article to help those searching with alternative names. For example, heart attack redirects to myocardial infarction." Another example of WP using systematic name vs the easier version is the article named Attention-Deficit Hyperactivity Disorder not Attention-Deficit Disorder Paul Gene (talk) 16:04, 16 May 2008 (UTC)

Heart attack/Myocardial infarction is a similar case and so it's no surprise to find that that article name is also disputed. It is a good example because the medical name is absurdly pompous and obscure. It's like arguing that we should have articles called Equus caballus rather than Horse. Colonel Warden (talk) 16:24, 16 May 2008 (UTC)

Some definitions from the OED so that our usage is clear:

• Jargon - ...the terminology of a science or art, or the cant of a class, sect, trade, or profession.
• Clinical - ...treating a subject-matter as if it were a case of disease

Colonel Warden (talk) 16:32, 16 May 2008 (UTC)

It is a difficult issue. Elsewhere where there is a difference, two articles exist, eg. Raven and Common Raven. Thus here I'd recommend embellishing discussion of general psychological Depression into a fairly concise paragraph on the depression page, with a link to MDD for all the scientific material on this page. Cheers, Casliber (talk · contribs) 21:51, 17 May 2008 (UTC)

An example of the term being used by the Canadian Mental Health Association: "Depression becomes an illness, or clinical depression, when the feelings described above are severe, last for several weeks, and begin to interfere with one's work and social life. Depressive illness can change the way a person thinks and behaves, and how his/her body functions." (Emphasis added)OnBeyondZebrax (talk) 18:03, 27 May 2008 (UTC)

• Don't care. I think the content of the article is much more important than the name at the top. All of the terms are used. Any of the terms could be appropriate. The lead should include all the names and explain their differences in how they are used: Clinical depression as a catchall for all the things that are, or might be considered by a lay person, to be "depression serious enough to warrant attention in a physician's or therapist's office," and Major depressive disorder and Depressive episode to describe the more carefully delimited concepts in the DSM or in research papers. WhatamIdoing (talk) 16:12, 17 May 2008 (UTC)

Update

OK, I have moved it. Main thing is to check redirects, and convert points into a nice prose pragraph on ]]depression]] page...Cheers, Casliber (talk · contribs) 07:05, 24 May 2008 (UTC)

Also check out depression (mood) page, which is full of crap but nevertheless manages to misinform ~50,000 Wikipedia visitors per month. Paul Gene (talk) 10:01, 24 May 2008 (UTC)

Acupuncture

Eldereft removed the positive meta-analysis results from the acupuncture sub-chapter because the evidence was "sub-par", I am returning it back. The evidence is sub par for most of the non-mainstream methods. That does not prevent Cochrane and APA from supporting, for example, light therapy. As much as I may disagree with it, the meta-analysis shows that acupuncture (or light therapy) appear to be efficacious, reflecting the fact that most of the studies in the literature were positive. Noting that is a duty of encyclopedia, the same as qualifying these findings. Paul Gene (talk) 10:32, 15 May 2008 (UTC)

I do not mean to imply that weak evidence should be excluded (properly characterized and weighted, yes, but not excluded when that is all that we have). I have not checked the full paper, but according to the abstract and plain language summary (doi:10.1002/14651858.CD004046.pub2), that meta-analysis made one and only one conclusion - that the evidence base provides no evidence. Without larger methodologically sound studies, no conclusion as to the efficacy of acupuncture vs. sham, medication, or nothing may be drawn. - Eldereft ~(s)talk~ 11:27, 15 May 2008 (UTC)

Here is what the summary states: "There was no evidence that medication was better than acupuncture in reducing the severity of depression (WMD 0.53, 95%CI -1.42 to 2.47), or in improving depression, defined as remission versus no remission (RR1.2, 95%CI 0.94 to 1.51)." Paul Gene (talk) 23:17, 15 May 2008 (UTC)

Which does not lead to a conclusion that "acupuncture improved depression to a degree similar to conventional medication", which our article stated. It especially does not justify wording that seems to imply that the authors conclusions were wrong or otherwise not supported by the data. "No evidence" is absolutely in accord with my interpretation, as well as with "There is insufficient evidence to determine the efficacy of acupuncture compared to medication, or to wait list control or sham acupuncture, in the management of depression.", "There is insufficient evidence that acupuncture may be helpful with the management of depression", and "Based on the findings from seven trials of low quality, there is insufficient evidence to determine whether acupuncture is effective in the management of depression." The evidence base simply does not support any conclusions. If your accusation of POV-warring were correct, I would interpret failure to discard the null as negative evidence. Instead, I have restored the section to match what the source says without interpretation or editorializing. - Eldereft ~(s)talk~ 21:45, 16 May 2008 (UTC)

It does lead to the conclusion that acupuncture improved depression to a degree similar to conventional medication. If you do not believe me, here is how the professional journal "Journal of affective disorders" interprets the Cochrane evidence in their review on complemetary and alternative therapies for depression (I bolded the critical part):

"A Cochrane systematic review and meta-analysis of 7 RCTs on Acupuncture (Smith and Hay, 2004) produced equivocal results. The results from 5 trials (409 participants) included in the meta-analysis showed no difference in the reduction in the severity of depression (HAM-D) compared to medication (WMD 0.53, 95% CI −1.42 to 2.47). 4 trials (375 participants) reported on improvement in depression as an outcome (RR 1.20, 95% CI 0.94–1.51), again showing no differences between groups. However, the evidence was insufficient to determine the efficacy of acupuncture vs. medication due to the poor methodological quality and reporting of these trials. There was insufficient data to demonstrate whether acupuncture is more effective than a wait-list control, non-specific or sham acupuncture control, or whether acupuncture plus medication is more effective than acupuncture plus placebo." Paul Gene (talk) 00:30, 17 May 2008 (UTC)

Bullets or prose?

Hi, I changed some bulleted lists in the treatments section to prose, following the Wikipedia:Manual of Style, which states that "Do not use lists if a passage reads easily using plain paragraphs." The Manual says that "Most Wikipedia articles should consist of prose, because prose allows the presentation of detail and clarification of context," while a list does not. "Prose flows, like one person speaking to another, and is best suited to articles, because their purpose is to explain." As well, when you take bulleted points and convert them to prose, you can indicate the importance, usage, or other comparisons for each example. Another editor changed the section back to bullets, on the grounds that they like the bullets better. In this case, though, I argue it should be the widely-accepted Wikipedia style conventions which we should follow, not any single editor's preferences.OnBeyondZebrax (talk) 20:51, 17 May 2008 (UTC)

WP:MOS states only: "Do not use lists if a passage reads easily using plain paragraphs." It does not. Prose in this case obscures the individual items - the list, on the other hand, offers easy navigation among them. There is no need for the prose to flow since the paragraphs are very short, nor the goal is to explain anything or present the details but only to offer the summation of scientific evidence. The reader then can pick the item of interest and read the full article to which the item is linked.

WP:EMBED states: "However, it can be appropriate to use a list style when the items in list are "children" of the paragraphs that precede them. Such "children" logically qualify for indentation beneath their parent description. In this case, indenting the paragraphs in list form may make them easier to read, especially if the paragraphs are very short." Which matches our case precisely. WP:EMBED then goes on to show an example, which is quite close to what we have in this article. Paul Gene (talk) 00:07, 18 May 2008 (UTC)

Depressive episodes with somatic syndrome

I can't seem to find any mention of depressive episodes with somatic syndrome on wikipedia. It's mentioned in the ICD-10 criteria for research (~p97, F32.01, F32.11), and it's something that's in a couple of psychiatry textbooks I've seen. I'm not sure how clinically relevant it is, but should it be mentioned? Ged3000 (talk) 17:52, 18 May 2008 (UTC)

Sociological and cultural aspects section and Cultural references subsection

I have reorganized the bottom of the article like we have done in schizophrenia. I am trying to get a list of the most notable books/media/films etc. on depression to write about in a paragraph or two here. The list of books by psychiatrists seems unwieldy and I think should be trimmed if not cut completely. Input most welcome. I was rather pleased howthe section in schizophrenia turned out. Cheers, Casliber (talk · contribs) 14:05, 24 May 2008 (UTC)

Illustrations

Both illustrations do not fit the article well.

MDD is not one among the 30-some diagnoses the contemporary psychiatrists try to apply to Van Gogh, since his illness was characterized by seizures, changes in the mood and periods of euphoria. The diagnosis of epilepsy he got from his physician is still the most likely one according to the consensus. Nor is the content of the painting is typical for the contemporary presentation of MDD. Most of the MDD sufferers are women. The despair in more often not completely black, and melancholia is a minority of major depression cases.

Melencolia is a heavily symbolic and philosophical painting illustrating the concept of four humors, and is even more out place on the MDD page. Paul Gene (talk) 21:18, 24 May 2008 (UTC)

Yeah, good point. The painting is rather a good one (of a sad person, that is), unfortunately Van Gogh had other mental health symptoms suggesting problems other than depression. OK, let's leave it open for a little bit but removing I think I agree with. Cheers, Casliber (talk · contribs) 21:39, 24 May 2008 (UTC)

....which leads me to ponder what are good illustrations. A nice 3D model of imipramine in the drug bit? Umm....Cheers, Casliber (talk · contribs) 21:43, 24 May 2008 (UTC)

I completely agree the Durer doesn't fit here. I do think the Van Gogh works, but that we need to change the caption not to focus so much on Van Gogh himself or any possible diagnosis of his illness. It does seem to portray someone in emotional anguish, such as from an episode of major depression - even if that episode was actually caused by some other disorder than MDD. Aleta ^Sing 23:02, 24 May 2008 (UTC)

Funnily enough, I pulled out my copy of Kaplan & Sadock...and there was Durer's illustration in the mood disorders section. I wanna be different from a psych textbook too....hehehehe. Cheers, Casliber (talk · contribs) 09:20, 25 May 2008 (UTC)

Because of silly WP copyright policies, we cannot use anything more contemporary than Van Gogh. And in comparison with a shiny imipramine molecule he wins hands down. But we have to change the caption, yes. Paul Gene (talk) 11:01, 25 May 2008 (UTC)

How about.......Cheers, Casliber (talk · contribs) 11:07, 25 May 2008 (UTC)

Ha. I must confess, when the debate on this talk page gets too heated, I sometimes just scroll up, look at this thing for a few seconds, and then all is well. We should patent "Emoticonal Psychotherapy." *Grin* Cosmic Latte (talk) 09:50, 15 June 2008 (UTC)

Booklist moved to here - can we identify most notable for a prose paragraph on them?

OK - I moved this here so we can identify most notable for a prose paragraph on them...and this is onlty the tip of the iceberg...Cheers, Casliber (talk · contribs) 00:09, 25 May 2008 (UTC)

Books by psychologists and psychiatrists

• Beck, A. T., Rush, A. J., Shaw, B. F., Emery, G. (1987). Cognitive therapy of depression. New York: Guilford.
• Bieling, Peter J. & Anthony, Martin M. (2003) Ending The Depression Cycle. New Harbinger Publications. ISBN 1572243333
• Burns, David D. (1999). Feeling Good : The New Mood Therapy. Avon. ISBN 978-0380810338
• Griffin, J., Tyrrell, I. (2004) How to lift Depression – Fast. HG Publishing. ISBN 1-899398-41-4
• Jacobson, Edith: "Depression; Comparative Studies of Normal, Neurotic, and Psychotic Conditions", International Universities Press, 1976, ISBN 0-8236-1195-7
• Klein, D. F., & Wender, P. H. (1993). Understanding depression: A complete guide to its diagnosis and treatment. New York: Oxford University Press.
• Kramer, Peter D. (2005). Against Depression. New York: Viking Adult.
• Manning, Martha. (1995) Undercurrents: A Life Beneath the Surface. ISBN 978-0062511843
• Papolos, Demitri & Papolos, Janice. (1997) Overcoming Depression. ISBN 978-0060927820
• Plesman, J. (1986). Getting off the Hook, Sydney Australia. A self-help book available on the internet.
• Rowe, Dorothy (2003). Depression: The way out of your prison. London: Brunner-Routledge.
• Sarbadhikari, S. N. (ed.) (2005) Depression and Dementia: Progress in Brain Research, Clinical Applications and Future Trends. Hauppauge, Nova Science Publishers. ISBN 1-59454-114-0.

Psychotherapy section

The therapies generally used fall under the broad categories of CBT, IPT and psychodynamic therapy (the last also includes psychoanalysis and should probably discuss some link into Attachment theory somehow too). I have begun restructuring. Cheers, Casliber (talk · contribs) 11:04, 5 June 2008 (UTC)

Oops. actually supportive therapy is a new thing which needs defining as well. This secion really needs some work....Cheers, Casliber (talk · contribs) 11:14, 5 June 2008 (UTC)

"No laboratory test for major depression"?

The introduction states that "there is no laboratory test for major depression", however the article goes on to name several laboratory tests that should be done to determine if there is a physiological basis for depression. It also cites a study that shows high levels of MAO-A are significantly correlated to depression. While I agree there is no single universal laboratory test which can rule in or out major depression, there are certainly laboratory tests used to determine at least some kinds of major depression. As it is, it sounds a bit like a Scientology claim to me. Can we get some clearer wording on this please? -- HiEv 11:47, 9 June 2008 (UTC)

I've added a clause to the sentence to explain this. Does it address your concern? Gimme danger (talk) 11:51, 9 June 2008 (UTC)

It's given that here is no laboratory test for MD. If there was it would be called a disease, hence the term "disorder". Furthermore, why does this need to be inserted into the intro which should be a synopsis of the article?--scuro (talk) 16:25, 9 June 2008 (UTC)

Physical causes being ruled out is part of the article, but I agree that the lead probably doesn't summarize the diagnosis section properly. Gimme danger (talk) 16:37, 9 June 2008 (UTC)

Thanks, it's better, though I'm a bit unsure about the phrasing saying physical conditions cause "similar symptoms". Isn't major depression still major depression even if it has a physical cause? In that case it wouldn't be "similar symptoms" to major depression, it would be "major depression", right? The current wording kind of implies that major depression can't be caused by physical conditions. -- HiEv 21:29, 13 June 2008 (UTC)

"Historical significance of psychoanalysis"

Just pointing out that it's completely appropriate to include psychoanalysis in the main psychotherapy section of this article. It may appear to be of "historical significance" from the perspective of many research-oriented institutions, but just google "psychoanalytic institute" to get a glimpse of how alive and well it is in many areas. Cosmic Latte (talk) 00:28, 13 June 2008 (UTC)

Also be advised that, after adding the foregoing note, I did quite a bit of reorganization in the psychotherapy section, so that cognitive-behavioral approaches are consolidated (and, yes, even first), and so that the difference between "psychoanalysis" and later "psychodynamic psychotherapy" is clearer. Cosmic Latte (talk) 00:50, 13 June 2008 (UTC)

Wikipedia's charter is to reflect the general expert consensus on the topic, and not how often Google mentions the term. WP:Weight recommends that rare or fringe views (in our case treatments) should not be overrepresented in the articles.

The general expert consensus is that psychoanalysis is a fringe treatment, which is rarely used, but of significant historical interest. So I would suggest that it can written about, and in more detail, in the History section.

Quoting from the textbook I have on the shelf (author=Durand, Vincent Mark; Barlow, David |title=Abnormal psychology: an integrative approach |publisher=Brooks/Cole Pub. Co |location=Pacific Grove, CA, USA |year=1999 |pages=20-21 |isbn=0-534-34742-8 |oclc= |doi= |accessdate=), and many other textbooks say the same:

• Rarely used. "Because of the extraordinary expense of psychoanalysis, and the lack of evidence that it is effective in alleviating psychological disorders, this approach is seldom used today."

• Fringe. "A major criticism of psychoanalysis is that it is basically unscientific, relying on reports by the patient of events that happened years ago. ... There has been no careful measurement of any of these psychological phenomena, and there is no obvious way to prove or disprove the basic hypotheses of psychoanalysis. This is important, because measurement and the ability to prove or disprove a theory are the foundations of the scientific approach."

• Of significant historical interest. "Nevertheless, psychoanalytic concepts and observations have been very valuable, not only to the study of psychopathology and psychodynamic psychotherapy but also to the history of ideas in Western civilization." "Careful scientific studies of psychopathology have supported the observation of unconscious mental processes, ... understanding that memories of events can be repressed,... the importance of various coping styles or defense mechanisms."

Paul Gene (talk) 11:04, 13 June 2008 (UTC)

Incidentally, I own a copy of, and have read, the very book you're referencing--and I don't deny its value one bit. When it comes to many, many psychological and psychiatric issues, especially to new anxiety disorder treatments, Barlow is the man. But, with all due respect, I think that he and his co-author fall prey to the common tendency among research-oriented scholars (one of which I consider myself to be!) to gloss over psychoanalysis as the proverbial elephant in the room. We can't deny it's there, and we don't know what to say about it, and all we end up uttering is "it's of historical interest"--which, IMHO, has become rather cliché among contemporary psychologists. Yes it's "unscientific," but aside from Freud's antiquated use of the term "science," it was never really supposed to be "scientific" in the sense that it could be dissected with psychometrics or experimentally validated for a large population. As dogmatic as Freud could be, he did not believe that his therapy would work for everyone. I believe his term for those who wouldn't benefit was "worthless"--a demeaning choice of words, to be sure, but a testament to the fact that those who criticize his approach as "unscientific" may be, in large part, preaching to the choir. Because psychoanalysis is more of an interpretive than a curative therapy, why should we be surprised that experimental evidence of curativeness is not exactly forthcoming? As for the "extraordinary expense" and relative rarity of psychoanalysis, well...let's take an analogy. Rolls-Royce cars are also "extraordinarily expensive" and seldom used, but does that relegate them to mere artifacts from the history of automobiles? I think not, given that Rolls-Royces are still in use today. Psychoanalysis, despite falling outside the reign of APA/APS hegemony, is certainly still used today, as I'm sure the American Psychoanalytic Association would be happy to attest. Cosmic Latte (talk) 11:41, 13 June 2008 (UTC)

I take it that, although we disagree in regards of how often psychoanalysis is used, we agree that most research scholars agree that it is a fringe unscientific treatment ("elephant in the room", "preaching to the choir" in regard of it being unscientific), which is rarely used. That all that matters.

It's probably fair to say that (many) psychological/psychiatric research scholars tend to see psychoanalysis as a "fringe treatment," although it would probably be more encyclopedic (and more NPOV, considering that many literary scholars, and a notable minority of practitioners, still find Freud and insight-oriented therapy to be highly relevant) to paraphrase this as something like, "Most scholars would agree that psychoanalysis is generally more effective at providing insight into mental disorders than at alleviating their manifest symptoms." (In fact, I once heard a very scientifically-minded researcher make a concession quite like that.) It may also be appropriate to mention in the article that psychoanalysis is "rarely used," at least relatively speaking. But it hasn't disappeared from the face of the earth, and it's still a viable option for those with the means (i.e., $$) and the motive (i.e., insight), so I think it'd be a tad premature to dismiss it as "historical." Expensive, yes. Eccentric, yes. But non-notable enough to exclude from the main body of the article? Not yet, anyway. Cosmic Latte (talk) 13:12, 13 June 2008 (UTC)

Also bear in mind that, although psychoanalysis might not be widely available today, it wasn't widely available from the outset. Sure, Freud acquired a considerable lay following, and American psychiatry certainly co-opted his ideas enthusiastically for a while. But formally, Freud was always very esoteric. His harsh treatment of "dissenters" like Jung and Adler provides ample illustration of the idea that if psychoanalysis is a "fringe treatment" now, then things haven't really changed a whole lot from what Freud allowed in the beginning. (One might even go so far as to argue that such continuity, or at least such coming-full-circle, betrays the unilinear sense of the "historical," as in "historical significance," in which many people hold the term.) Cosmic Latte (talk) 13:22, 13 June 2008 (UTC)

As an aside, I personally believe, that DSM (and ICD derived from it) is doing a great disservice to psychiatry, and is more harmful than useful for the research. It may even be more harmful than Freudism, since the latter only arrested the development of biological psychiatry in the US, while the DSM-ICD has a worldwide stifling effects. But in Wikipedia we have to work within this framework provided by the current consensus. Paul Gene (talk) 12:52, 13 June 2008 (UTC)

I walked into this late but I need to add that psychodynamic psychotherapy (which is I guess can be seen as a more pragmatic descendant of psychoanalysis), is definitely not fringe and definitely used by a large number of psychiatrists and psychologists today. It has been under-studied in quantitative research and marginalised by many in psychiatry for a number of reasons but remains a lot broader in usage than psychoanalysis. Still, some features of the the latter are still widely seen in psychiatry to this day. I was waiting for some material before really getting stuck into this article on a march to FAC, but can see there may need to be some planning pretty quickly...Cheers, Casliber (talk · contribs) 15:38, 13 June 2008 (UTC)

Oh heck this could be a really big discussion....(groan)... :(

Good point. Even when therapists don't expressly identify as "psychoanalysts" or even as "psychodynamic psychotherapists," they sometimes include elements of psychoanalysis (e.g., dream interpretation) as part of their therapy. And it's still somewhat common to hear in the news about some sort of imaginal evidence (e.g., an ambiguous picture interpreted in a sexual way) admitted in court as evidence of childhood abuse. Now this surely is an abuse of what Freud and others intended, but the point is that psychoanalysis often survives in modified and fragmented form. In fact, I believe there is actually a term for this sort of thing: "psychoanalytic psychotherapy." Cosmic Latte (talk) 23:30, 13 June 2008 (UTC)

Think about what you are saying. That is exactly what historical means. Nobody denies that elements are useful. See the quotations from Barlow. But it is not psychoanalysis. And I myself put in a couple of good refs for psychodynamic psychotherapy, but it is not psychoanalysis. Paul Gene (talk) 10:20, 14 June 2008 (UTC)

Hell yeah..aah well, we can do the psychotherapy article which is where the fun will really start...but I digress. The other thing I thought is that narrative therapy as such isn't used much that I can see, if anything, that is not used as such under that name (in Oz anyway). May be differnt in US..Cheers, Casliber (talk · contribs) 01:25, 14 June 2008 (UTC)

Yeah, I'm not aware of narrative therapy being used a whole lot in the U.S either. I'm rather ambivalent about its inclusion in the MDD article, mainly because the article is so long as it is, and the inclusion of narrative therapy could open the door for the addition of many more therapies of limited prevalence and influence. Cosmic Latte (talk) 01:47, 14 June 2008 (UTC)

So I figured I'd do some research into this narrative therapy. Personally I find it fascinating, although editorially I'm still ambivalent about its presence in the MDD article. Might be best to reserve it for more general articles, like psychotherapy. Anyway, I find it rather ironic that it's not popular in Australia, considering that it was invented by...an Australian! :-) Cosmic Latte (talk) 05:39, 14 June 2008 (UTC)

Yep, my bad. I just talked to someone about it who said it is used mainly in group and family therapy, and is also used by survivors of sexual abuse in reauthoring. Either way, I tend to agree that maybe it is best mentioned in a psychotherapy article and not here. Cheers, Casliber (talk · contribs) 05:57, 14 June 2008 (UTC)

Of course psychoanalysis is historically significant--or, to trim off some syllables and get down to the point, it is historic. No one would deny that. My point, however, was that not everyone who psychoanalyzes would identify as a "psychodynamic psychotherapist." Some therapists might say, for example, that they employ a mixture of humanistic and psychoanalytic techniques. Some simply identify as "eclectic." If you want them to interpret your dreams, they will. If you want them to desensitize you to a phobia, no problem. Others don't go through mainstream research-psychological training--e.g., they instead go through counseling programs, certain psychiatry departments, maybe even Psy.D. programs--and pick up psychoanalytic techniques along the way. The fact that psychoanalysis does not completely dominate their approach does not mean that psychoanalysis is strictly of "historical" interest, especially since all interest in postmodernity is relatively fragmented. I'm aware of what CBT and other experimentally supported (or, should I say, experimentally supportable) treatments can do. But the idea that this approach can be presented as the answer to psychopathology arguably reeks more of "historical significance" than does psychoanalysis, because it is fully in line with the Comtean positivism (see Law of three stages for a quaint but seminal summary) of the early 19th century! The debate among various positivistic and post-positivistic schools of thought still rages on. I'm not trying to take sides in that debate here--and, due to my research-oriented background, you might reasonably suspect that I'm playing devil's advocate--but I think it's fair to say that because the jury is still out, it would be quite WP:POV to deny non-positivistic psychotherapy an equitable place in the article. And what could possibly be a better, more quintessentially interpretive therapy than psychoanalysis to represent the non-positivistic angle? Well, so much for theory. In "practice," it is frankly remarkable that as many "psychoanalytic institutes" (like this one and that one and this one and that one and this one and that one) as there are have withstood a plethora of opposition and a paucity of funding. (As an aside, regardless of just how "rare" these strangely accessible institutes may be, your statement that "Wikipedia's charter is to reflect the general expert consensus on the topic" seems to confuse WP:N with WP:CON, the latter of which pertains to us as editors, the former of which pertains more directly to the material we're editing. As for WP:WEIGHT's caution against "rare or fringe views," I couldn't have reponded better than this.) Cosmic Latte (talk) 09:30, 15 June 2008 (UTC)

Now this bit is going to be tricky - I have Glen Gabbard's book lying around somewhere - there are some more global assessments of the benefits of the insight-based therapies which don't fit neatly into the Evidence-based medicine paradigm. I tend to (slightly) favour Cosmic Latte's view of the current to'ing and fro'ing from my psychiatric perspective but I will try to find some more sources and think about ways of phrasing it in a balanced manner. Cheers, Casliber (talk · contribs) 11:43, 15 June 2008 (UTC)

Cas, could we maybe concentrate on the efficacy of psychoanalysis for depression (see my next post), not just psychoanalysis in general? Hopefully, that could be easier to decide upon. Paul Gene (talk) 14:36, 15 June 2008 (UTC)

Psychoanalysis for major depression

Could it be easier to agree on a more narrow topic, which is more relevant to the article we discussing, that is what is the psychoanalysis role in the treatment of major depression? I tried to find any research on the contemporary use of psychoanalysis for major depression by running a Pubmed search on "psychoanalysis and depression". Some 200+ refs came up. Limiting them to the contemporary research (that is the last 20 years) cuts the number to about 100+. Dutifully, I looked through the abstracts of all of them. However, to my dismay, not a single review or even study of psychoanalysis therapy for major depression among these 100+ was published in a mainstream publication (that is not containing psychoanalytical in its title). In a desperation, I looked for any kind of more or less reasonable study, no matter what the source is. What I found was the psychoanalysis of depression in historical figures, unusable statistics on the % of depressed patients in certain psychoanalytic practices, self-referential studies of what depression means in psychoanalytical terms (Core transference themes in depression)..., and that was about it. I pose that psychoanalysis has no visible place in the contemporary treatment of depression, besides as a source for the psychodynamic psychotherapy. We could as well be giving equal weight to voodoo treatment of depression, and voodoo views on what depression means. I am serious about voodoo, by the way.[PMID: 2607490][PMID: 12520887] Paul Gene (talk) 14:34, 15 June 2008 (UTC)

I'll take the chickens and sacrificial knives to work then today, eh? :) That was very thorough. Actually, upon thinking about it I suppose strictly what we'd be doing with analysis is long term dysthymia and post-traumatic/developmental and other interpersonal issues. OTOH, I'd dispute the fact that it is expensive compared with frequent hospital presentation adn admission of patients, but then again they are mainly personality related diagnoses. Problem is I can see the limitations of the EBM paradigm and also WRT wikipedia and RS, but there are similar issues as with writing pharmaceutical articles. Nevermind, I am thinking much of the more in depth discussion should go to psychotherapy article anyway. Maybe just leave it that analysis was used historically and that psychodynamic psychotherapy has evolved from it and remove all criticisms etc to latter article. Cheers, Casliber (talk · contribs) 21:07, 15 June 2008 (UTC)

My solution would be to remove all after ref 58 until mention of psychodynamic psychotherapy, with one line about its lower rate of use currently (and it had declined before the current emphasis on EBM anyway). The two sentences are overly simplistic and one-sided in their reasoning and there were alot of other factors at foot. Cheers, Casliber (talk · contribs) 21:12, 15 June 2008 (UTC)

That was indeed thorough, and I definitely appreciate the effort. But in a more general EbscoHost search I came across an article by Sidney J. Blatt, a prof. of psychiatry and psychology at Yale, from which I extracted (and included) the following qualification: "When depression is understood explicitly in terms of 'interpersonal relatedness (attachment) and self-definition (separation),' psychoanalysis may be a particularly insightful therapy." Yes, the journal is "Psychoanalytic Inquiry," but lest anyone prepare to accuse the Yale scholar of quackery, allow me to block-quote a couple paragraphs of his article, in order to sample his style and references:

The constructive response of introjective patients to long-term psychodynamic treatment in the MPRP and the R-YP stand in contrast to findings in our analyses (e.g., Blatt, Quinlan et al., 1995; Blatt et al., 1996) of data from the extensive study of brief (16 weeks of once weekly) outpatient treatment for severe depression in the NIMH-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a carefully designed randomized clinical trial that compared three manually directed brief outpatient treatments for depression: Cognitive-Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Imipramine with clinical management (IMI-CM) with a double blind, passive placebo with clinical management (PLA-CM). While IMI-CM resulted in a significantly more rapid reduction of symptoms at midtreatment (after 8 weeks) than the other treatments (Elkin et al. 1995), no differences were found in the level of symptom reduction among the three active treatment conditions at termination(Elkin et al., 1985; Elkin et al., 1989; Elkin, 1994) or at a followup evaluation conducted 18 months after the termination of treatment (Shea et al., 1992; Blatt et al., 2000). (p. 511) [....]

Taken together, these findings from the study of long-term intensive, psychodynamic treatment in the MPRP and the R-YP, as well as the results from analyses of data from the brief outpatient treatment of severe depression in the TDCRP, provide strong confirmation of Cronbach's (e.g., 1953) formulations that pretreatment characteristics of patients are important dimensions that influence therapeutic response (Blatt and Felsen, 1993). (p. 512)

The conclusion that psychoanalysis isn't used to treat such a common, and such a frequently comorbid, condition as depression raises the question: then what on earth are all those psychoanalytic institutes training people to treat? I trust that this question can remain rhetorical for now, and that the Blatt article is sufficient evidence that, when associations between psychoanalysis and depression are made, they're not necessarily made by charlatans. Cosmic Latte (talk) 23:51, 15 June 2008 (UTC)

I am sorry, but the Blatt, being a psychoanalyst publishing in a psychoanalytical journal, does not qualify as an independent source. What about cold fusion professors publishing in Cold Fusion Times (Published quarterly. ISSN# 1072-2874, http://world.std.com/~mica/cft.html)? Are we going to include the views of voodoo guys (http://www.neworleansvoodoocrossroads.com/consultation.html) on the treatment of depression? Remember, Yale also has a Yale University Divinity School.

But for the sake of argument, lets try to understand what Blatt is really saying. He did not say that psychoanalysis brings measurable results in the treatment of depression. He only says that treatment of depression by imipramine, CBT and IPT can be understood in the terms of psychoanalysis: "findings in our analyses (e.g., Blatt, Quinlan et al., 1995; Blatt et al., 1996) of data from the extensive study...clinical trial that compared three manually directed brief outpatient treatments for depression: Cognitive-Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Imipramine with clinical management (IMI-CM)"

Yes, major depression is being treated by psychoanalysts, according to their own accounts. But no results have been published in the past 20 years in peer-reviewed independent journals, or in any kind of usable format even in psychoanalytical journals. Thus, mentioning psychoanalysis as a treatment for depression in the article on depression is giving it inappropriate weight. Paul Gene (talk) 00:40, 16 June 2008 (UTC)

I am going to try Casliber's solution, what do you say. But I also would like to avoid the details and jargon of psychoanalysis, similarly as I would like to avoid mentioning the mechanisms of antidepressant action. The reader can follow a link and read about it. Paul Gene (talk) 00:50, 16 June 2008 (UTC)

The trouble with "independent journals" is that no one is really "independent"; everyone has biases, and the illusion of "independence" in psychology is fostered by the fact that no matter how "independent" of any particular psychological school one may try to be, just about everyone (very often without explicitly realizing it) is biased toward either a positivistic or a hermeneutic (i.e., a more scientifically-minded or more interpretation-minded) school of social theory more generally. So, really I'm not trying to "POV-push" with psychoanalysis in particular; I'd just like to see a reasonable balance of scientifically-oriented and interpretation-oriented therapeutic approaches (the latter of which I think psychoanalysis happens to be exemplary). Although we might cite as many or as few opinions about each approach as we please, it's just important for us, as editors, not to imply that one approach is obviously dismissable because it lacks features of the other approach. Hermeneutic approaches aren't necessarily wrong because they're weak on science, just as scientific approaches aren't necessarily wrong because they're lacking in hermeneutics. So, although I'm fine with the wording of the section immediately following the Blatt addition (and would be interested in what Casliber thinks about this, as well), I don't imagine I'll object if you follow through with what Casliber suggested above--just as long as "psychodynamic psychotherapy" is still mentioned, and just as long as the section does not appear to be editorially biased either in favor of or against the positivistic approach. I'm not interested here in advocating one approach or critiquing the other, but rather in attesting to the distinction between these approaches, and thereby alerting readers to the existence of a very meaningful and very real debate. Cosmic Latte (talk) 01:25, 16 June 2008 (UTC)

Just noticed your recent edit to that section. Perfect. Cosmic Latte (talk) 01:34, 16 June 2008 (UTC)

Yep, me too. I am happy with how it reads now, as far as the wider view on long term therapies and how psychiatry has evolved...a multifactorial can of worms... :( Cheers, Casliber (talk · contribs) 03:08, 16 June 2008 (UTC)

Spirituality

Although I'm fascinated by the associations between depression and belief systems, I'm a bit skeptical of the Barry Kaufman reference (someone else added the reference; I looked it up and added the name) in the "Spiritual" section of the article. I haven't read the book (and perhaps I shouldn't judge a book by...well, its author), but I did a quick search to see what I'd find, and my first impression isn't glowing. Seems like he believes he cured his son of autism (see Son-Rise)--a feat that is, to my knowledge, impossible. I'd like to see this section improved, but I'd think it should reference more obviously credible scholars, all the way from Jung to David Myers. Cosmic Latte (talk) 15:56, 19 June 2008 (UTC)

Presumably a low mood due to spirituality would be either due to some form of bereavement (over loss of belief) or internal conflict, neither of which are unique to spirituality or religious belief as such. It is true there has been little written about depression and spirituality in psychiatry but there is some stuff out there. I tend to think there may be more scope in treatment rather than cause but we'll see what arises. I can see this being a tricky area to navigate. Cheers, Casliber (talk · contribs) 21:20, 19 June 2008 (UTC)

"Other conventional" vs. "alternative" treatments

Just wondering what criteria are being used to distinguish the "Other conventional methods of treatment" subsection from the "Alternative treatment methods" one. Is this a subjective judgment? If so, whose? (If it's any of ours, then it might be treading on WP:OR territory. Otherwise, I'm not criticizing anything in particular about the sections now, but I'm beginning to think that this article now has some potential to succeed as a WP:FAC, so I'm paying special attention to areas that may need a little extra polishing.) Cosmic Latte (talk) 13:48, 21 June 2008 (UTC)

My take would be the former category is for those for which there is some evidence of effectiveness while the latter are those for which there is none as such. Some are prrtty rare...Cheers, Casliber (talk · contribs) 14:16, 21 June 2008 (UTC)

The criterion I used to define these treatments as conventional is approval by the regulatory bodies in Europe or the US for the purpose of treating depression. Paul Gene (talk) 01:17, 22 June 2008 (UTC)

Tricyclics

"Once the mainstay of pharmacological treatment, their use has declined due to their marked sedative and anticholinergic side effects, and their lethality in overdose." This is incorrect. If you do not think about it, this may sound like it is true. However, the problem is that the tricyclic antidepressants are a very heterogeneous group. For example, imipramine is more activating than sedating. The anticholinergic effects of desipramine, if used in moderation, are not greater than anticholinergic effects of the SSRI paroxetine. SNRI venlafaxine is known to be quite toxic in overdose, see for example [PMID 14695048]. I suggest we just stick with the broad statement that there are more side effects with tricyclics, which is true for all of them. Paul Gene (talk) 21:05, 22 June 2008 (UTC) The decline of the use of tricyclics to a significant degree can be explained by the market competition and therapeutic traditions. In some countries the use of tricyclics did not decline that much, for example, in Canada the TCA amitriptyline is a second most prescribed antidepressant, after venlafaxine. And neither looks to me like the best therapeutic choice. Paul Gene (talk) 21:26, 22 June 2008 (UTC)

(edit conflict) OK, I will concede the anticholinergic bit (though in general they are more sedating) because of the heterogeneity. However, they are notorious for their dangerousness in overdose in causing a cardiac arrest which is resistive to cardioversion (I can't recall whether it goes to asystole or VF - have to check) - much more dangerous than other antidepressant drugs, and considering the relationship between low mood and overdose, it is an important consideration. Yes, venlafaxine ODs have caused problems but not in the same ballpark as tricyclics. I feel the overdose note needs to stay, but I will find try and find a robust reference (eg from some sort of consensus statement or authoritative work). Cheers, Casliber (talk · contribs) 21:27, 22 June 2008 (UTC)

True on market promotion (sigh). I was being naive...Cheers, Casliber (talk · contribs) 21:28, 22 June 2008 (UTC)

OK, how about Their adverse side effect profile and toxicity in overdose limit their use? Cheers, Casliber (talk · contribs) 21:30, 22 June 2008 (UTC)

PS: Replaced it anyway and will find a source. Cheers, Casliber (talk · contribs) 21:44, 22 June 2008 (UTC)

Sounds good. But maybe you should add ...not in Canada. ;) Not seriously, Paul Gene (talk) 22:49, 22 June 2008 (UTC)

Whenever thinking of the separateness of canadians, Southpark comes to mind..but I digress...Cheers, Casliber (talk · contribs) 00:52, 23 June 2008 (UTC)

History section

POV in History section

The part of the article that I flagged seems to be entirely inspired by a single essay, the reliability and neutrality of which are questionable. (For example, the essay makes the claim that, "King Saul is described as experiencing depression," without giving any evidence to support this. Our article does a very good job of making that NPOV, "In the Old Testament description of King Saul, has symptoms that resemble some elements in the modern diagnosis of depression.")

Even beyond the source, this section has been made more POV with weasel words. I flagged each statement that I think ought to be reliably justified.

Just trying to help, hope this doesn't cause a stir. --π! 09:10, 9 June 2008 (UTC)

No, that's a good start. We should start verifying it. I was the one who place the expand tag in the first place and can see obiovus stuff like galen etc. The rest I have not checked, so the tags were the best thing to do. If you have any scholarly sources it would be great but we'll get there... Cheers, Casliber (talk · contribs) 11:06, 9 June 2008 (UTC)

Paul Gene was somewhat more unequivocal than I was, but I placed it in a 'to-do' box for verifying. I find these boxes useful now as a place to store information on large articles which cannot be left in as is. Cheers, Casliber (talk · contribs) 11:53, 9 June 2008 (UTC)

Hi, I put all the sole-sourced content in from the Priory article, because at the time that I did this, the History section was very slender. Several concerns have been raised about the reliability of the article. Just to contribute to the discussion, here is more info about the Priory website. Priory's Online Medical Journals are the world's first web based medical journals. The website claims that articles are peer-reviewed. So at the very least, you shouldn't look at the article like some self-published Blog posting. I agree we should look into the Priory company more, to determine how well they do their peer reviewing, and to find out what sort of reputation they have. But I was just trying to "kick start" the History section.OnBeyondZebrax (talk) 02:38, 23 June 2008 (UTC)

That's fine. We do appreciate it, often building these articles up is a long road...Cheers, Casliber (talk · contribs) 03:15, 23 June 2008 (UTC)

Hi, Several editors are displeased with the History section. I want to remind you all that it is just a start. This rough version, with all its flaws (reliance on 2 sources, one of which is hard to evaluate ...Priory.com) can act as the "framework" which can be fleshed out with a variety of sources in the coming weeks. As well, I wish to point out that Wikipedia articles and sections are expected to evolve and develop over time.OnBeyondZebrax (talk) 13:53, 26 June 2008 (UTC)

History section is based on an unreliable source

Most of the History section is based on priory.com, which is not a reliable source. The single source for the most of the History section is an article [2] in Psychiatry On-Line by one Mead Matthews. This author apparently has no academic credentials, and I was not able to find any additional information about him, or any other articles written by him. Psychiatry On-Line [3] is a strictly online publication put forward by Priory Lodge Education Ltd. Google search turned out no further information on this publisher. Psychiatry On-Line is not indexed by PubMed or by the recognized authority for evaluating journals, Journal Citation Reports. Psychiatry On-Line claims to be peer-reviewed but anyone can be a reviewer via their Peer Review Form [4]. The Chief Editor of Psychiatry On-Line is Dr. Ben Green [5], who is an MB and not even an MD. According to his CV [6] he has published only one original research article since 2002, which would disqualify him from being an editor of any real scientific journal. Paul Gene (talk) 02:42, 22 June 2008 (UTC)

I know, this section reappeared again after I moved it to the to-do box above. Cheers, Casliber (talk · contribs) 03:43, 22 June 2008 (UTC)

No, actually several other sections from History are also based on that article. Paul Gene (talk) 04:08, 22 June 2008 (UTC)

It's certainly good to use a variety of sources, but...just a note on the degrees. The MB is the British equivalent of the MD awarded elsewhere, and the British MD is more like a medical PhD, awarded to research-oriented physicians. Cosmic Latte (talk) 09:40, 22 June 2008 (UTC)

I'm not having much luck finding anything out about this Mead Matthews. But as far as I can tell, his work on priory.com looks like a decent, coherent piece of secondary research, with enough sources of its own. And nothing about it strikes me as glaringly inaccurate. As for the "peer review" issue, perhaps a Wikipedian or two is a specialist in the history of psychology and would be willing to take a look at it. In any case, it certainly can't hurt to beef that section up a bit with a variety of sources. Cosmic Latte (talk) 09:52, 22 June 2008 (UTC)

I know about MD and MB; nevertheless, I would expect a chief editor of a real medical journal, even in the UK, to have MD and publish original research. I agree that the piece looks reasonable, but so are a lot of self-published websites. I am not deleting it right away; however, I do not think it is fit to have an undergrad-type essay as a source in a WP article with more than 100,000 people per month readership. Paul Gene (talk) 10:19, 22 June 2008 (UTC)

There is reasonable peer-reviewed material out there. I do recall seeing it but will have to fgiure out hwere it was...Cheers, Casliber (talk · contribs) 10:58, 22 June 2008 (UTC)

Anyway most of the current history section is very general about mental illness, instead of the topic of (clinical) depression. EverSince (talk) 16:15, 23 June 2008 (UTC)

Hi, Regarding the history section, please note that editor Paul Gene has pointed out that (edited version of his text) "The historical context is very complicated. There is not much left from the historical concept of insanity in the contemporary concept of major depression. That renders the discussion of the views of the ancients almost irrelevant."( 12 June 2008). Since what we now call depression was called by different names over the centuries, I have been having a hard time find historical information on depression. Thus I have been relying on a controversial source (Priory.com) which does provide a handy overview of the history of depression. OnBeyondZebrax (talk) 13:57, 26 June 2008 (UTC)

It's true it's vague and complicated, and hard to find professional open-access overviews like that one (btw the private Priory Clinics are quite well known in the UK, often deal with celebs). Melancholia is mentioned - there are various books and peer-reviewed articles to source this as a rough equivalent in many cases and perhaps the section could be centred around (but often need to depart from) the psychiatric usage of that term to denote a disorder from Hippocratic times through the centuries (becoming more like modern usage in the asylum era, contrasted with categories of mania and dementia) until Kraepelin's system merged it with mania into one concept manic-depressive illness, later to be split again into manic-depression/bipolar and unipolar depression (reactive and endogenous), and on into the current DSM terminology (which of course retains a subtype of melancholic). 20:24, 26 June 2008 (UTC)

Placement of history section

I'd like to suggest that the "history" section of this article be moved from (nearly) rock bottom to at least somewhere higher up in the article. My personal inclination is to move it to the very top, but I'd settle for somewhere in the middle. To describe the "nature" of depression so long before describing the historical context, in which our understanding of that nature has emerged and evolved, is to impose upon the reader a very clunky hermeneutic circle, through which one really has to read the entire article before getting any sense of how the contemporary parts and the historical whole synergistically create a more-or-less NPOV (or at least a thorough) picture of depression. Becausee the current revision emphasizes the ahistorical, it implicitly reifies depression, treating it in an essentialist manner, as if it were as objectively "real" an entity as gold, silver, or even a bona fide mental disease such as neurosyphilis. But, you'll notice that the "history" sections even in the articles for hydrogen, oxygen, and gold--things that can be treated in an essentialist manner--are in the middle of their pages. The historical context for something far less elemental, such as MDD, should feature at least as prominently, if not more so. Cosmic Latte (talk) 11:24, 12 June 2008 (UTC)

A fair point. However, here is an order of medicine related articles as per Wikipedia:Manual of Style (medicine-related articles). I think we can get around it by a summary of (a) current classification and (b) ensuring a succinct summary an distinction between what is known and what is hypothesised. Agree reification is an issue in DSM but wikipedia is not a place for OR. Cheers, Casliber (talk · contribs) 11:46, 12 June 2008 (UTC)

The histortical context is very complicated. There is not much left from the historical concept of insanity in the contermporary concept of major depression. That renders the discussion of the views of the ancients almost irrelevant. Even since 1970s, the concept of major depression changed significantly. Because of that, I do not feel that history is more important than symptoms, causes and treatment. I would only be confusing, if the article starts with history, which will have to include the historical split of the diagnosis of manic depression into bipolar disorder and MDD before explaining what MDD is. Paul Gene (talk) 16:36, 12 June 2008 (UTC)

Thank you for alerting me to WP:MEDMOS, Casliber. I had not been aware of that page before (although it appears that I'm not the only one who has had issues with the placement of "history" sections in MEDMOS-related articles). For now I just tweaked the second paragraph of the intro, in order to counteract reification a bit, and in the process I removed some editorializing language in accordance with WP:WTA. Cosmic Latte (talk) 07:42, 13 June 2008 (UTC)

I would just like to note that MEDMOS is only a guideline, and conditions such as this are also the domain of non-medical fields such as clinical psychology (but they don't have a style guide). I assume NPOV takes precedence ultimately. EverSince (talk) 14:05, 13 June 2008 (UTC)

History

This text was just added to the [[Clinical depression#History|]] section, but it looks like it was intended here. - Eldereft ~(s)talk~ 04:08, 19 March 2008 (UTC)

This section can be built up with citations from histroical records. The following two examples make it clear to me that the idea of depression is not a modern or recent one but has been with humans for, at least, hundreds of years..

Hector Berlioz, the composer, complained in 1826, in a letter to a friend, that he was 'depressed'.

Strong's EXHAUSTIVE CONCORDANCE of the King James Bible, published in 1890, elaborates the definition of 'poor' as being 'depressed in mind or circumstances'.

Last bits to satisfy comprehensiveness

OK, some final thoughts to satisfy comprehensiveness:

• discussion on treatment-resistant depression, which is acknowledged as a phenomenon but is poorly defined. I do haev a paper on this somewhere...

• DSM sub classifies MDD into mild, moderate and severe. There has also been controversy in Australia which Professor Gordon Parker who feels the divisions are incorrect and that redefining the subcat of melancholia is needed as it delineates predicted response to antidepressants better - he developed CORE criteria. Not sure whether this concept was circulated outside Australia though.

• Need proper epidemiology improving, but needs some tweaking

• History cleanup looks much better

• I wouldn't mind suggestions as to other clearly notable and unequivocal famous people who had depression (I can think of Nick Drake) or film/book/depiction to buff up last section. Also most notable self-help books/commentaries/personal jounreys etc. Suggestions folks? Little Miss Sunshine comes to mind too but would need some scholarly ref.

You are not talking about FAC, I hope. I am not sure I would not support it even after the issues you noted above are addressed. On the other hand, it is quite close to GA, in my opinion. Paul Gene (talk) 11:08, 23 June 2008 (UTC)

Generally I think of moulding a Featured Article as broad things (i.e those above), then finer details, then copyediting. These are some of the big holes still missing that you are welcome to add to. I am not hugely fussed about GA along the way though it is alot more worthwhile than it used to be and the last few I have put through GAN before FA I have gotten a good grilling and some very thorough and helpful feedback, so..any more big holes to add? Cheers, Casliber (talk · contribs) 11:17, 23 June 2008 (UTC)

It might be good to say something about the associations between depression and the arts. You might argue that the link is a bit more salient for bipolar than for unipolar, but plenty of evidence suggests that there's far more than just a "kernel of truth" in the stereotype of the "depressed poet." I've got enough sources for a decent, succinct summary of this, and will add the summary when I get a chance, but if anyone else knows anything about depression-as-inspiration, then it could certainly help to counterbalance the idea of depression-as-...well, depressing. Cosmic Latte (talk) 16:12, 23 June 2008 (UTC)

I'd tend to agree that the article has a way to go in terms of providing some more context to all the excellent content on the current core medical definition and viewpoint. I agree about mentioning the scientific debate over subclassifying depression, which actually also encompasses debate over the overall validity of the classification, the suitability of the DSM exclusion criteria, the relationship to minor depression and subsyndromal depression/prolonged low mood, and to bipolarity/mood spectrum.[7][8][9][10][11][12] (this all of coures relates to the essentialist vs nominalist point made a while back re history section). I guess an outline could go in the diagnosis section. But that's just the thin scientific end of a wedge of massive social and cultural contextual variation in the views towards, and appropriateness of, this diagnosis, including the question of "structural determinants of powerlessness that need to be addressed, rather than individual psyches."[13][14][15]; currently the article doesn't contain the word "culture" and the section headed "sociocultural" is very brief and not yet addressing these issues. Prognosis is also very brief and assumes treatment, and then only antidepressants. I'd also like to see the article address views about the potential for value and truth in the experience, whether regarding artistic achievements or depressive realism or moral concern.[16] EverSince (talk) 13:40, 24 June 2008 (UTC)

I do like the idea of a depression/poet/art interface discussion under the sociocultural section, either notable people and discussion of them, or a discrete subsection. (I thought I put the evolutionary bit here before...didn't I? If not, that's where I meant to put it...have to check now).

The real thing about various diagnostic debates is that there are loads of them and we have to cherrypick the most salient ones. Minor depression ain't a diagnosis yet, though research criteria have floated around (oh heck I forgot, the whole of DSM is research only...). One of the things I meant to do was find a succinct summary of the transition of reactive depression to adjustment disorder with depressed mood and place it as well. In the history section we will also need to note the now old term endogenous depression..Cheers, Casliber (talk · contribs) 13:57, 24 June 2008 (UTC)

The informal category of "minor depression" is already mentioned in the article, I was just tying it in to the overall debate. The traditional reactive vs endogenous distinction is also related yes. EverSince (talk) 14:47, 24 June 2008 (UTC)

Incidentally this central diagnostic debate involve critiques by some of the very architects of the modern DSM like Spitzer & First, and is at play in the planning of the DSM-V. EverSince (talk) 14:54, 24 June 2008 (UTC)

Placement and phrasing of evolution section

Paul, regarding A) the movement of evolutionary explanations from "biological" to "psychological" and B) calling the evolutionary approach "controversial":

A) Carey states, among other things, that "it is the psychological activation of this suite of emotions that causes changes in brain biochemistry, such as altered levels of neurotransmitters – changes that are an intrinsic part of these emotions and are not due to some biological illness" (p. 220). Carey is not making the nonsensical claim that evolution is not biological (although if he were talking about memetics, which he is not, you could argue that he's saying that the brain plays the role of a more or less passive "host"). He is simply stating that if neurochemical changes coincide with the depressive "suite of emotional programmes," then the latter probably causes the former, and not vice versa. While he objects to the notion of depression as a neurochemical "disease" (as do a number of psychopharmacologists, I should note), he believes that this suite of emotions can be physiologically activated, if not precisely isolated. "If depression is a 'programme' that can be switched on with electrodes," he says, "then it can probably be switched off in a similar way" (p. 218). A fairly analogous thing is going on with antidepressant drugs: The activation of imprecisely understood physiological mechanisms leads to psychological changes, which may, in turn, lead to further physiological alterations. Whatever is being activated when depression occurs, Carey's whole point is that it is rooted in the human genome. In a sense, everything in this article is "psychological." But to deny that the evolutionary understanding of depression is significantly more "biological" than other approaches (e.g., humanism) strikes me as a bit bizarre. Furthermore, he is critiquing the medical model, not renouncing pharmacotherapy. His approach "would admit a role for anti-depressants, but only in most cases as temporary 'water-wings' to suppress the pain and other symptoms of depression until the individual has been enabled to regain his or her sense of usefulness. It allows severe depression to be viewed as usually due to the inappropriate activation of an inherited emotional condition" (p. 219, emphasis added). Since heritability is mentioned (quite rightly) in the "biological" subsection, it is perfectly reasonable to account for that heritability in the same subsection. Again, Carey is arguing not that depression is "psychological" to the exclusion of biological factors--indeed, as an evolutionary psychologist, Carey's whole argument is that biological factors are predominant--but rather that the conception of depression as a biological disease is improper.

B) As for "controversial," I read and re-read Carey's paper. And, for good measure, I did a word search for "controversy" and "controversial." In all cases, I failed to find any assertion or implication on his part that the theory is marred by any controversy. Even if I had succeeded, that would be far beside the point. For one thing, what issues in academia aren't controversial? If it's still being studied and debated, then it's controversial. The whole point of study and debate is to resolve controversy. You could find a critique of every single viewpoint in this article, and rightly--but completely unhelpfully--call each viewpoint "controversial." (If you're looking for controversy, check out "The Emperor's New Drugs" by Irving Kirsch, an author already cited in the "biological" section.) To insert this adjective into a sentence begs for elaboration, but such elaboration is probably inappropriate for an overview article like MDD. That's what Wikilinks are for: If people want to learn about the "controversial" aspects or any other details about a topic, then they can click on the links. In any case, this phrasing smacks of editoralizing per WP:WTA and "weaseling" per WP:AWW. And, perhaps most to the point, here is a line from WP:WTA: "It's often a good idea to avoid terms that appear biased or may be perceived so by some notable group, even if technically they aren't" (emphasis in original). The word "controversial" in regard to evolutionary approaches, and not in regard to other approaches, does not say to the reader, "Hey, there's an interesting debate about this theory--so check it out!"; rather it says, "Take this theory with a grain of salt." As for "some notable group," I'd love to see what E. O. Wilson, Steven Pinker, and their colleagues think about your implication that the fusion of evolutionary and social sciences should be taken with a grain of salt. Cosmic Latte (talk) 14:10, 24 June 2008 (UTC)

OK, it has been a long time since I have looked at papers on evolution and depression, but I didn't think that these were in general controversial, and that maybe the best fit is sociocultural, though as it doesn't bear directly on clinical practice but alot on a larger-cultural bigger picutre type thing. (I think I need to read the paper...) Cheers, Casliber (talk · contribs) 14:32, 24 June 2008 (UTC)

I'd agree it's not generally that controversial, although it has been and continues to be for some (which could be indicated in a milder way perhaps). It clearly crosses the arbitrary boundaries of biology and psychology, so perhaps the section headings need changing to accommodate; it does have both theoretical and direct clinical relevance.[17]

No, (sigh) this is going to get tricky as I work in this field. I think something has been lost in the translation there, but ok, let's presume we take it as is and accept the article, then it is a social phenomenon. i.e. species adaptation, and directly applicable to the last section. Cheers, Casliber (talk · contribs) 22:02, 24 June 2008 (UTC)

Point taken. Certainly, relative to the other factors listed in the "causes" section, evolutionary factors would be more distal causes of depression in the individual--so I don't think I would object if you moved it back to the "Sociocultural aspects" section. But, as it is still causally significant, what would you say about adding a short sentence, maybe at the end of the heritability paragraph in "causes," to the effect of "Evolutionary psychologists have theorized that depression may have originated in our foraging past (see Sociocultural aspects)"--or, for the sake of tidiness, perhaps "Evolutionary psychologists have theorized that depression may have originated in our foraging past" (i.e., with the wikilink to Sociocultural aspects embedded in the sentence itself)? (Also, if you think I've misconstrued the article, then I'd certainly welcome any thoughts you have on that matter, as well as any revisions of the evolution paragraph.) Cosmic Latte (talk) 02:08, 25 June 2008 (UTC)

I apologize for the error. It is not Carey but Nesse, who in his review article stated that the evolutionary theory of depression is controversial. That reference somehow got lost from the sources ().

• Evolutionary hypothesis of depression is controversial as even its proponents admit."Is depression an adaptation, an adaptation gone awry, or a pathological state unrelated to any function? Opinions range from dismissal of the possibility that depression or low mood could be useful to the conviction that even severe depression is an adaptation with a specific function." (Nesse, 2000) (Emphasize mine. PG). What is this but not a definition of controversial?

• Evolutionary hypothesis of depresssion is a hypothesis, that is has no solid evidence to back it, even according to its proponents. "Is depression an adaptation? At present, we do not have the evidence needed to say for sure." (Nesse, 2000)

• Evolutionary hypothesis of depression is a psychological hypothesis, according to its proponents: "In this model depression is seen as not normally a biochemical illness or disorder, but instead as usually due to the person becoming trapped within a psychologically activated but unwanted and inappropriate suite of natural emotions." (Carey, 2005)(Emphasis mine. PG) Of course all psychological changes have neurochemical substrate, but we are not talking about that. Or would you prefer to merge psychological causes of depression into biological causes?

Paul Gene (talk) 10:55, 25 June 2008 (UTC)

Well put Paul. As I said, both problems are solved by moving to the sociocultural section. Cheers, Casliber (talk · contribs) 11:02, 25 June 2008 (UTC)

I'm not sure that requires it to be described as controversial, but perhaps as being at the hypothetical stage in many cases (as noted there is also some empirical support and clinical application).

I do agree with including this in the causes section, because the whole point of it is that it uses the distal context to identify and explain current proximate causes, e.g. the relationship between current circumstances and mental adaptations. I do also agree it could be mentioned as an explanation of the general social context, though I think it could seem odd to find the whole issue of depression stemming from our fundamental evolved human nature being classed as a sociocultural aspect. EverSince (talk) 11:45, 25 June 2008 (UTC)

OK, put it this way - the subject of the evolutionary development of depression within Homo sapiens never arises in a Drs consultation room, or psych clinic. When we talk of causes, it refers to the development of individual cases rather than traits among a species, that is left to the biological and pyschological antecedents. Evolution ideas more look at how and why the antecedents exist on a larger scale, is my feeling. Interesting yes and notable yes but also in speculative teerritory and moreso than other causes outlined. Cheers, Casliber (talk · contribs) 12:55, 25 June 2008 (UTC)

Going to respond to both Paul and Casliber here:

Paul: Well...let's take these quotations one-by-one:

1. "Opninions range from dismissal...to the conviction..." (Nesse). What theory doesn't this statement apply to? Every single theory in academia has its proponents and opponents. You name the thesis, I'll name an antithesis. This hearkens back to Hegel. Nothing new here.

2. "Is depression an adaptation? At present, we do not have the evidence needed to say for sure" (Nesse). Well, is depression the result of hippocampal atrophy? "At present," to recall a familiar line, "we do not have the evidence needed to say for sure." That's a pretty new theory, too, but it's still in the article. Is depression the result of X? We don't know. Of Y? Ditto. Is science ever going to give us "the evidence needed to say for sure" about anything? Not according to the principle of falsifiability. This hearkens back to Popper. Again, nothing new here. Moreover, we're probably never going to be able to say, with the kind of deductive "certainty" we can gain from experimental studies, whether just about anything is or isn't an adaptation. You can't have life evolve in one way for a million years on Table A, and then manipulate some variable on Table B and see if things turn out differently. Evolutionary evidence is considerably more inductive than experimental evidence. This hearkens back to Gould and Lewontin ("The Spandrels of San Marco and the Panglossian Paradigm: A Critique of the Adaptationist Programme"). Nothing new, nothing new.

3. "Not normally a biochemical illness or disorder, but instead as usually due to the person becoming trapped within a psychologically activated but unwanted and inappropriate suite of natural emotions" (Carey). Here we have a classic case (if there is such a thing) of "You say tomAHto, I say tomAYto": You emphasize "not normally a biochemical illness or disorder" and "trapped within a psychologically activated"; I emphasize "natural emotions." But let's not lose the forest for the trees. He is an evolutionary psychologist, discussing an evolutionary theory of depression. He is more interested in nature than in nurture, but he rejects the idea that mind is merely an epiphenomenon of body/brain. You could argue that he takes more of an interactionist view on the mind-brain problem. What he rejects is the idea of depression as a biologically constituted pathology; what he supports is the idea of depression as a biologically derived predisposition. Indeed, he states "that the differences between individuals in their susceptibility to depression are mainly due to differences in their psychological make up, arising from the interplay of nature and nurture on personal development" (p. 220, emphasis in original). Diathesis-stress model, anyone?

So (1 & 2), why is Nesse stating common epistemological knowledge? Probably because, in addition to being an accomplished and provocative theorist, he is a humble human being. I'd be willing to venture that there's a positive correlation between a researcher's modesty and the length of the "future research" sections in his articles. He's just saying that more work needs to be done. And (3), yes, I know that Carey uses the word "psychological" a lot. Perhaps he is not as explicitly clear as he could have been, in every case, about how he means to delineate "psychological" from "biological." But implicitly, and overall, it's obvious that he's primarily interested in "nature," even if he doesn't let the reader forget about "nurture."

Casliber: I absolutely agree that, with regard to MDD, "causes" are generally assumed to refer more to proximal than to distal factors--that is, from a clinical, applied-research perspective. But from a more basic-research angle, distal causation can be just as fascinating, if not more so. I see no reason to assume that people who read this article will do so (only) in order to understand the nature of Person X's depression; they may want to understand depression as depression, in all its facets. Then again, it can certainly be helpful to distinguish between psyche and society. But if that distinction is going to be magnified in the article, then, as I mentioned above, I think there should at least be a cross-reference to the evolution paragraph in the list of psychological/proximal causes. Cosmic Latte (talk) 14:55, 25 June 2008 (UTC)

Well, we talk about controversy when the passions get involved. Thus "dissmissal" vs. "conviction" denotes a controversy, while "likely" vs. "not likely" - normal range of scientific opinions. Paul Gene (talk) 16:01, 25 June 2008 (UTC)

Yes, I'll grant you that. (Although in a thought experiment, I imagine surveying a bunch of scholars with questions like, "Are you convinced by theory X?" and "Do you dismiss theory Y?" No matter what you plug in for theories X and Y, it seems almost certain that a fair number of folks will say yes to questions like these.) Denotatively, "controversy" certainly refers to disputes at an order of magnitude above the usual disagreement. But I refer back to the WP:WTA statement, "It's often a good idea to avoid terms that appear biased or may be perceived so by some notable group, even if technically they aren't" (emphasis in original). As denotatively accurate as "controversial" may be in that context, it's connotatively troubling for at least two reasons:

1) My guess is that any disputes over the evolutionary theory of depression are most representative not of objections to that theory in particular, but rather of a larger tension between evolutionary social scientists in general and non-evolutionary social scientists in general--the former of whom undoubtedly constitute a notable minority. So, whatever that minority proposes, it may be controversial by default, simply because it came from a minority. But to stamp the minority view as, among all other potential adjectives, "controversial" in a summary paragraph--that's probably a good way to offend the minority.

2) You mentioned that this article gets 100,000 readers per month? I'd be willing to bet that at least a few of them are not very biologically...inclined, shall we say? Some may see "evolutionary" and "controversial" in the same sentence and think, "Well, of course it's controversial--those silly scientists just won't accept that evolution never happened!" If we reserve the word "controversial" for sections of articles that are devoted to controversy, then we can make sure readers understand that both the controversial ideas and the controversy surrounding them have been taken with due seriousness. Cosmic Latte (talk) 17:53, 26 June 2008 (UTC)

Since even proximal causes of major depression are not clear (lets pretend for a moment that it is clear what major depression is!), trying to find distal causes would bring us into a territory of unfounded speculations. Indeed, that is where the "evolutionary psychology" currently is, as Casliber correctly noted. Again, it is not mainstream by any stretch of imagination, and devoting equal space to it and, for example, CBT is incorrect.Paul Gene (talk) 16:01, 25 June 2008 (UTC)

The evolutionary psychology is discussed quite distally in there at the moment, but although it has that extra dimension it is nevertheless a particular view on current proximal clinical causation (as are other general frameworks included in the section such as existential & humanistic psychology). It is precisely proximate causes that it seeks to identify when examining loss of social rank or disrupted attachment or cognitive biases or resource investment etc. These are matters of individual difference as well as species typicality, for example variance in the "calibration" or sensitivity of a module is often addressed, and how that interacts with differences in development/environment to produce particular patterns of dysfunction. It is sometimes directly discussed in therapy to help clients, there's actually a popular CBT self-help guide[18] in the UK by clinical psychologist Paul Gilbert (who's also cited in the source I gave above) which is authorized for general physicians to refer patients to and is also worked through within clinical psychology sessions, that does just that. Having said that, I do agree that it is generally at the hypothetical stage, so due weight is an issue. EverSince (talk) 16:44, 25 June 2008 (UTC)

Well-said. As for due weight, well...the evolution paragraph isn't much longer than other parts of the "causes" section (and the original version, which Paul objected to and which I, accordingly, rewrote, was even shorter), but perhaps it could still be tightened, maybe by removing the direct quotation? Due to the nature of adaptationist theories, it would obviously be quite a challenge to conduct prospective, deduction-focused experiments. But I think the inductive evidence (e.g., depression is noticeably heritable and cross-cultural; and heritability, especially when species-wide, is likely to be accounted for by natural selection) is strong enough to warrant both inclusion and--for those of us who still hope that further, experimental evidence will come along--an eventualistic attitude. Cosmic Latte (talk) 10:10, 26 June 2008 (UTC)

In response to the due-weight concerns, I went ahead and removed the direct quotation from that paragraph. I figure, if readers want to know the specifics of either the theory or whatever "controversy" may surround it, then they can check out the Wikilinks and sources. Sound like a reasonable compromise? Cosmic Latte (talk) 19:43, 26 June 2008 (UTC)

I came across an interesting writing by the creator of Wikipedia. Although he is talking about physics-related writing, he does have a point in that NPOV can only go so far. Perhaps, after all, I have overstated my opposition to the relatively mild qualifier, "controversial." Yet my opposition still remains, primarily for a reason I have brought up all along: What in psychology isn't controversial? The social sciences are unique among disciplines in their inextricable entwinement with philosophy. Psychology requires so many ethical constraints; it hinges on so much metaphysical discussion (e.g., mind vs. brain); and it empirically beefs up so much epistemology that if you enjoy arousing "the passions," then psychology will probably be right up your ally (or they'll be your cup of tea, or...whatever idiomatic expression works wherever you all are). The evolutionary theory relies largely on inductive evidence, but...so do NT-deficiency theories. Indeed, given that increased serotonin levels lead to increased moods, it does not (deductively) follow that serotonin deficiency causes depression, any more than it follows that aspirin deficiencies cause headaches, given that increased levels of aspirin correspond to decreased pain. Wales makes a good point in that reflection, although I think he was right to make it explicitly in relation to physics (rather than to, say, psychology). Cosmic Latte (talk) 11:32, 28 June 2008 (UTC)

Having said that, the cognitive-behavioral approach is certainly popular enough to warrant some extra weight. This angle, however, is conspicuously absent from the "causes" section! It's odd, for example, that Aaron Beck's "depressive triad" theory receives no mention whatsoever. Cosmic Latte (talk) 11:55, 28 June 2008 (UTC)

Just to note that there's actually a whole Wikipedia article Evolutionary approaches to depression. It doesn't cite it but I think PMID 12706512 is a good review that's clinically focused on major depression... "...it can add to a psychodynamic model...integrates well both with the cognitive therapy model and with biological models...can show people how various behaviors...and certain negative ways of thinking...may be understandable and very ‘human’, but at the same time very destructive, when allowed to become too extreme or too prolonged". EverSince (talk) 11:19, 30 June 2008 (UTC)