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I've done a little bit of housecleaning on this article, moving the evolution section to its own article ( Evolutionary advantages of clinical depression), and merging the info under medications into the article on antidepressants.
The move of the evolution information was a straight copy-paste, so the new article could use a new introduction and some new bells and whistles to better be able to stand on its own.
In both sections I simply left behind the first paragraph - a freshly written brief description of each topic would have been better, but I simply don't have the expertise to give one. So if someone else could do that, it would help out a lot.
The article also needs to be cleaned up some more. Many of the sections should be moved to their own pages, with more brief descriptions on this page. As it stands even with my cleanup, it is still far too long. As another wikipedian has stated though, this information is very important so it should not be deleted, just moved. - Uniqueuponhim 00:24, 10 September 2007 (UTC)
My wife was diagnosed with a brain tumor - and has consequently become clinically depressed - would adding in situational depression make sense?
(No. According to the DSM, Major Depressive Disorder can not be caused by a medical condition.)
It's odd that this article never mentions refractory depression, which is major depression that is resistant to the usual treatment methods. I'm not sure where it would be best to mention it, but it should be noted if not a small section of its own.-- Gloriamarie 18:16, 11 September 2007 (UTC)
Clinical depression is a severe illness that won't necessarily go away if you remove the original cause. It can take antidepressants to get rid of the illness even if the cause has been removed. There are also depressions that aren't caused by circumstances, but come from within.
Sardaka 10:13, 12 October 2007 (UTC)
The idea that depression is always caused by external forces and that medication allows people to "quit feeling sorry for themselves" is absurd. If this were so, antidepressant medications would not work. SSRIs are a common effective treatment medication. SSRI stands for Selective Seretonin Reuptake Inhibitor. By nature, it does not introduce new chemicals into the body, it prevents the seretonin that is naturally produced by the body from being re-absorbed by the parent neuron - a process that can be thought of as a "glitch" in the body -- the seretonin should not be subject to re-uptake, and the medications allow the body to make use of the neurotransmitters already in the body.
Assuming a subject with clinical depression is taking SSRIs, once they "feel better" (i.e. overcome the depression) complete cessation of the medication may result in a relapse into depression -- because the body is still malfunctioning.
On a side note -- it is attitudes like the one mentioned above that cause the negative stigma that is attached to mental healthcare and lead to so many undiagnosed and untreated mental disorders. Riley812 00:07, 13 October 2007 (UTC)Riley812
Given the current size of the article (61k), perhaps it some of it should be split away into a sub-article? Maybe the treatment section? -- Ronz 16:09, 3 October 2007 (UTC)
No offense, but someone "liking" the image is not a reason to keep it. What does it contribute to the article? Does it "illustrate" depression, no. Does it add anything to the article at all? No. It should be removed. See Wikipedia:Images#Image_choice_and_placement. AnmaFinotera 03:50, 15 October 2007 (UTC)
I am removing PMDD from the list of other depressive disorders. It does not belong there, for example, see http://pmdd.factsforhealth.org/what/faq.asp: "
How does depression relate to PMDD?
Depression is one of the more common symptoms of PMDD. Women often feel sad, blue, unhappy, down in the dumps, and/or hopeless as part of the PMDD symptom complex. But remember, the depressive symptoms of PMDD are linked to the menstrual cycle and must be absent at least during the week following menses. Also, depression is not necessary for the diagnosis of PMDD. Some women find anxiety and tension or anger and irritability to be the most disturbing symptoms and do not consider themselves depressed.
Women with PMDD also may have a coexisting depressive illness such as Major Depressive Disorder or Bipolar (manic depressive) Disorder. These conditions sometimes begin before the onset of PMDD and sometimes follow it. They differ from PMDD in not being linked to the menstrual cycle. While symptoms of these illnesses may worsen premenstrually, they persist throughout the entire cycle." Paul gene 02:48, 21 October 2007 (UTC)
The sentence in question:"Clinical depression is diagnosed by a psychiatrist or psychologist after any potential physical causes have been ruled out.[1]"
I understand that it is based on the following paragraph from ref1 (NIMH pub): "The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done, by the physician or by referral to a psychiatrist or psychologist."
But the same NIMHpub states on p5: "In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period."
The re-phrasing of the NIMHPub used in the lead paragraph appears to change the meaning of the NIMH quotation. What NIMH mean is that the physician should rule out certain medical conditions, not all physical causes. (NIMH still contradict itself, though.) Secondly, according to NIMH, clinical depression diagnosis does need to be carried out by psychiatrist or psychologist, and the physician himself can do that. (This actually happens quite often.) On the contrary, the lead paragraph of the article implies that only psychiatrist or psychologist can diagnose depression. Thirdly, the discussion of details, such as comorbid depression, does not probably belong to the lead paragraph, and should be done in the text of the article.
So, I propose to remove the sentence in question rather than correcting or expanding it. Paul gene 10:56, 27 October 2007 (UTC)
Although not forbidden expressly, the use of the references in the lead part is generally discouraged. The lead part is a summary of the main article and all the necessary references should already be there. For example, Ref 1 is used multiple times in the Diagnosis section and so is not needed in the lead. Suicide should be addressed in more details later in the article, and ref 2 could be moved there. Paul gene 15:24, 27 October 2007 (UTC)
I think there is a lot of potential for biasedness and POV in how certain treatments are categorized and ordered on this page. I am moving light therapy out of the "other methods" section as many recent studies have found it to be equally effective with many of the more mainstream forms of medication, and the studies are beginning to show a consensus. I also think that one could argue for putting psychotherapy above medication because it is common to have psychotherapy in the absence of medication, but not vice-versa.
The "other methods" mixes too many different things: things like exercise which seem to be more of a supplemental treatment, and things like the "archaic methods" which aren't really treatments so much as they are historical background of what we did wrong in the past! I may move "archaic methods" into the history section where I think it is more appropriate. Cazort 12:38, 2 November 2007 (UTC)
Does anyone have objections to adding yoga, bibliotherapy and computer-assisted psychotherapy under "Other methods of treatment". Proposed text and references are under title "More methods of treatment" in (now in Archives, 26 September). Natural123 19:38, 25 October 2007 (UTC)
Yoga - Pilkington K, Kirkwood G, Rampes H, Richardson J. - Yoga for depression: the research evidence - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16185770&dopt=Citation
Bibliotherapy - Cuijpers P - Bibliotherapy in unipolar depression: a meta-analysis - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9194011&dopt=Abstract
Computer-assisted psychotherapy - http://www.finddepressiontreatment.com/depression-software.html - This page is an overview of computer-assisted psychotherapy and it ranks number 1 on Google for "computer-assisted psychotherapy depression". It also contains links confirming efficiency of this therapy for clinical depression. Natural123 16:12, 27 October 2007 (UTC)
Why isn't Bupropion mentioned here? It's completely different from SSRIs and should mentioned along with MAOIs. I edited earlier today adding a mention of dopamine reuptake inhibitors and it got taken out. I have no idea why. Why can't this be included?
There's a massive lack of references in the psychotherapy section of this page. I am adding a tag and recommend that people who know more about this stuff add appropriate references and delete material which you cannot find adequate references for. Cazort 12:41, 2 November 2007 (UTC)
I've just pulled this out: <ref>{{cite journal | url = http://www.cpa-apc.org/Publications/Archives/PDF/1997/May/BLAND.pdf | last = Bland | first = R.C. |date=1997 | title = Epidemiology of Affective Disorders: A Review | journal = Can J Psychiatry | volume = 42 | pages = 367?377 }}</ref> "The requested URL /Publications/Archives/PDF/1997/May/BLAND.pdf was not found on this server." Would be good to have a replacement... Regards, Ben Aveling 10:59, 27 November 2007 (UTC)
Statements of probability based on personal judgment do not hold up to scientific scrutiny, and thus should be omitted from any article that attempts to be 'objective'. Also, I edited the 'neurological' section to depict what experts believe; views that have not been scientifically proven should not be stated ad nauseum. It is far more accurate to state that most experts accept a certain view.
ShadowCreatorII ( talk) 09:36, 26 November 2007 (UTC)
I've added a cranial electrotherapy stimulation section under Treatment, because this is an FDA-approved method for the treatment of depression. This is stated in the CES article, and confirmed by some simple Googling (e.g.' "cranial electrotherapy stimulation" depression FDA ').
I find it interesting to note that two newer, expensive, and (in the case of TMS) non-FDA-approved procedures (TMS & VNS) involving electrical induction are listed, but the older, cheaper, FDA-approved, at-home CES device was not. Not trying to start a debate here or anything, I just think it's kind of sad that even on Wikipedia there's a dearth of information on this treatment. (Why don't we have information on the "conforming" frequency/power output of FDA-approved CES devices? Why don't we have info on fda-approved devices so that one can differentiate them from the numerous non-approved devices on the market?) -- Lode Runner ( talk) 19:18, 29 November 2007 (UTC)
Just found a relevant tidbit in my source paper:
“ | Over the past three decades, at least eight medical device companies have applied for and received FDA clearance to market CES devices. A bibliography by Kirsch (2002) listed 126 scientific studies of CES involving human subjects and 29 animal studies. Most of the studies were completed in the U.S. over the past 30 years. The majority of the studies were double-blind and conducted at American universities. In total, therewere 6,007 patients treated under varying research conditions, with 4,541 actually receiving CES treatment. | ” |
Unlike the vast majority of the other methods listed under "Other methods of treatment", CES has been the subject of double-blind studies AND it has received FDA approval. There's absolutely no valid reason for its exclusion from this article. -- Lode Runner ( talk) 07:04, 30 November 2007 (UTC)
-- Lode Runner 03:43, 1 December 2007 (UTC)
I am sorry if I'm coming off as hostile, but I really have a hard time understanding the position being taken here. I'm not saying CES has as much research behind it as Zoloft. I'm saying it has more research and approval behind it than fucking hypnotherapy, and therefore merits mention in the article.
If you really can't stand my paper as a source, just Google ' "cranial electrotherapy stimulation" depression ' There are tons of articles out there. Here are some example hits:
http://findarticles.com/p/articles/mi_m0FDL/is_3_7/ai_n18610638 It indicates that double-blind research has been done. Mentions one specific doctor that has studied over 1,500 patients in always single-blind (and usually double-blind) studies.
http://www.depressiontreatmentnow.com/bioelectric_medicine.pdf Many detailed lists of specific studies, many of which are double-blind. Overall, has positive conclusions regarding CES.
http://www.ingentaconnect.com/content/haworth/jneu/2005/00000009/00000002/art00002 Abstract:
“ | The use of Cranial Electrotherapy Stimulation (CES) to treat depression and anxiety is reviewed. The data submitted to the Federal Drug Administration (FDA) for approval of medication in the treatment of depression are compared with CES data. Proposed method of action, side-effects, safety factors, and treatment efficacy are discussed. The results suggest there is sufficient data to show that CES technology has equal or greater efficacy for the treatment of depression compared to antidepressant medications, with fewer side effects. A prospective research study should be undertaken to directly compare CES with antidepressant medications and to compare the different CES technologies with each other. | ” |
http://www.clinph-journal.com/article/PIIS1388245701006575/abstract Shows the mechanism at work--i.e., it shows the CES can alter EEG readings.
http://www.maxilife.co.za/download/healthguides/HG27-CES%20in%20the%20Treatment%20of%20Depression.pdf Includes charts of specific studies similar to one of the other papers, but is written by different researchers. Select quote:
“ | Based on this data it might be concluded that antidepressant medications may be adequate when treating mild to moderate depression if one can tolerate the negative side effects, but that CES should be considered a first line of treatment or at least an add-on to medication for the treatment of more difficult cases. | ” |
K, done for now. If you still insist CES should be deleted, please provide sources exceeding the level of what I've provided for every other therapy under "Other methods of treatment". Alternately, you must provide a source that indicates all the significant CES research I've cited is flawed. Sorry, anonymous opinions don't count.
(And yes, some brief fiddling reveals Alpha-stim is behind one or two of these as well. I don't care. I'm sure the company that makes Prozac was responsible for 95% of the studies supporting Prozac, too. And there are at least a couple links there that don't appear to have a connection to any CES company.)
-- Lode Runner 04:27, 1 December 2007 (UTC)
PS:
Your link
http://findarticles.com/p/articles/mi_m0FDL/is_3_7/ai_n18610638 is to the article from a magazine Original Internist published by the chiropractor Kessinger, not a peer reviewed publication, and thus is not a reliable source. You really want to read the sources you are recommending -- your link
http://www.depressiontreatmentnow.com/bioelectric_medicine.pdf comes up with essentially the same article as
http://www.maxilife.co.za/download/healthguides/HG27-CES%20in%20the%20Treatment%20of%20Depression.pdf. The latter is discussed below. Your link
http://www.ingentaconnect.com/content/haworth/jneu/2005/00000009/00000002/art00002 refers to The Journal of Neurotherapy, which is a scientific analog of a supermarket circular (see earlier discussion). Your link
http://www.clinph-journal.com/article/PIIS1388245701006575/abstract is about the effect of CES on normal people’s EEG, not about depression treatment. Your link
http://www.maxilife.co.za/download/healthguides/HG27-CES%20in%20the%20Treatment%20of%20Depression.pdf is a link to a promotional brochure, and not a peer reviewed publication so it is not very reliable. But anyway, look at the list of purported “depression studies” in Table 2, p 13. The double blind studies were conducted for Alcoholism, Alcoholics, Psychiatric Inpatients, Closed Head Injured, Psychiatric Inpatients, Fibromyalgia , Psychiatric Inpatients, Psychiatric Outpatients, Insomnia/Anxiety. If you read the text of the review, all the groups of psychiatric patients are mixed and so there is not a single study for clinical depression.
Paul gene
06:00, 1 December 2007 (UTC)
1. I thought you had already conceded that CESes have received class III FDA approval? Well, this link should settle that:
http://www.fda.gov/cdrh/pdf6/K062284.pdf . This PDF deals with a specific device (not CESes in general), but it clearly shows that the FDA has indeed approved the use of CESes (in general) for "treatment of insomnia, depression or anxiety." The identifier for CES hardware equivalence is (apparently) K895175.
2. The double-blind trials:
There are tons. I don't think you looked at the charts properly. Some examples:
Moore JA, Mellor CS, Standage KF, Strong H. A double-blind study of electrosleep for anxiety and insomnia . Biol Psychiatry 1975; 10(1):59-63. [Despite the lack of "Depression" in the title, it did record depression. It showed a 59% "clin rating" improvement, 17% self-rated improvement, 5% Beck DI improvement--whatever that is.]
Passini FG, Watson, CG, Herder, J. The effects of cerebral electric therapy (electrosleep) on anxiety, depression, and hostility in psychiatric patients. Journal of Nervous and Mental Disease 1976; 163(4):263-266. [Double-blind. 24% improvement]
Rosenthal did a double-blind trial with 88 subjects that showed a 64% "clin rating" improvement, 21% "Zung SRDS" improvement. He did two other (non-blind) trials, and am not sure which one is which in the bibliography. However, you can find the details for this and the other studies in the papers I've already linked.
THESE PERCENTAGE IMPROVEMENTS ARE SHOWN UNDER THE "DEPRESSION" SECTION. THEY REFER TO IMPROVEMENT OF CLINICAL DEPRESSION ONLY. THERE ARE SEPARATE SECTIONS SHOWING DIFFERING PERCENTAGE IMPROVEMENTS FOR ANXIETY AND INSOMNIA.
Also, from the original paper I cited:
A bibliography by Kirsch (2002) listed 126 scientific studies of CES in-volving human subjects and 29 animal studies.
3. I must stress that I asked for sources, not unsourced opinions from an anonymous Wikipedia editor. The CES has been around for what, 40 years? More? If its efficacy is questionable, you should have no trouble finding a source that says so. The onus is on you to prove that these sources are not reputable. Simply calling them not reputable doesn't cut it, I'm sorry. I'm not denying that they probably aren't on par with the most widely-read and respected medical journals--but this isn't a popularity contest. If a whole crapload of people are saying a piece of information is true, and saying it in a most reasonable, orderly, and ostensibly-scientific fashion, and you cannot produce a single bit of criticism that says otherwise (over the many, MANY decades that they've had the chance to offer it), then I don't think it makes sense to demand the removal of said information.
4. We are NOT discussing CES in isolation--we are discussing an article on Clinical Depression. Thus, St. John's Wort and hypnotherapy matter because our standards for inclusion in the article should remain the same. I have presented you with evidence far outweighing the evidence cited to support those two's inclusion. Therefore, if CES is removed, so should they. To leave them intact while removing CES would be hypocritical. (Good luck finding consensus in the removal of 95% of the "Other methods of treatment" section.)
I understand your frustration with the new-agey, pseudo-science aspect to the CES crowd. In fact, one of the reasons I came here and added CES was because I was tired of drowning in mystical, unscientific crap. However, now that I've found stuff that certainly appears to be very scientific...
I can postulate that the articles aren't published in mainstream journals because they don't have the financial muscle to do so. There's a lot of money in patentable compounds (drugs)--not a lot of money in public domain and easy-duplicated electrical devices. I can also postulate that if there was real evidence that CESes don't work at all, the FDA would have withdrawn its approval a long time ago.
You can put as many sourced disclaimers as you like (such as the questionable relevance of class 3 FDA approval), but I do not believe you have a case for outright removal. -- Lode Runner 06:43, 1 December 2007 (UTC)
I have re-added the info Paul deleted (again) and better integrated it with the info Paul added. I have done my best to emphasize the untested and experimental nature of CES devices (despite their FDA approval) in the second paragraph; however, that doesn't mean the first paragraph should be removed entirely. The readers deserve a simple explanation as to how CES devices work, especially as contrasted to the other electromagnetic methods (which are expensive, do not offer the ability for at-home treatment, and/or require surgery.) -- Lode Runner 18:54, 1 December 2007 (UTC)
I can point you to evidence that supports people's claims to be able to talk to the dead, and of horses that can do maths. But there is far more evidence that such things don't exist. This page is about Clinical Depression, treatments for it are worth a mention and that is all. This is not the place for a long weighting of arguments on whether CES is a complete fraud or not. That discussion would not be a short one and it doesn't belong here. Regards, Ben Aveling 23:54, 1 December 2007 (UTC)
To clarify my position: I am against your edits, Ben, because by they imply that CES is completely unproven. By mentioning only the doubt (including the doubtfulness of the FDA classification), you are violating WP:UNDUE (undue weight)--you are mentioning only the possibly that CES is ineffective and/or completely unstudied, without mentioning any evidence that supports it. If anti-CES disclaimers are printed (and in fact dominate the CES section), then pro-CES studies must also be mentioned. What you're doing violates one of Wikipedia's core policies (NPOV). -- Lode Runner 02:16, 2 December 2007 (UTC)
I asked Lode Runner repeatedly to provide at least "one double-blind trial for clinical depression specific quotation." His answers were:
Moore JA, Mellor CS, Standage KF, Strong H. A double-blind study of electrosleep for anxiety and insomnia . Biol Psychiatry 1975; 10(1):59-63. [Despite the lack of "Depression" in the title, it did record depression. It showed a 59% "clin rating" improvement, 17% self-rated improvement, 5% Beck DI improvement--whatever that is.]
Passini FG, Watson, CG, Herder, J. The effects of cerebral electric therapy (electrosleep) on anxiety, depression, and hostility in psychiatric patients. Journal of Nervous and Mental Disease 1976; 163(4):263-266. [Double-blind. 24% improvement]
The first article was on patients with anxiety and insomnia not clinical depression. The 5% Beck DI (Beck Depression Inventory) improvement was very small and statistically insignificant according to the paper. The abstract [ PMID 1091305] states: "Despite largely negative findings, several subjects reported a remarkable improvement in their symptoms some two to three weeks after electrosleep (ES) treatment was concluded, so that it remains unclear whether or not ES may be an effective treatment."
The second paper deals with a mixed group of psychiatric patients and so is again methodology impure. So it is really hard to make any positive or negative conclusions from it, but the abstract [ PMID 972328] states: "No difference in the amount of improvement shown by the two groups appeared on any of the five measures employed, although a major placebo effect was evident on all of the criteria. The results argue against the use of electrosleep as a treatment for these symptoms except when it may be employed for its placebo value." Paul gene 15:59, 2 December 2007 (UTC)
Lode Runner is right in that the CES section is getting too long. We should just mention it, say what it is, and quickly summarize the known reliable trials. The weighing of evidence should happen in Cranial electrotherapy stimulation which at the moment blindly endorses CES.
Lode Runner is wrong when he says that the onus on proof is on the doubters. WP:V says:
So we don't need to prove that it doesn't work, only that known published studies to date say that it doesn't work any better than placebos. That doesn't say that there isn't about to be a study that shows that CES works, it doesn't even say that there hasn't already been one that we didn't find, it just says that we've looked, and if there is such a study, we didn't find it.
And lastly, Lode Runner is right when he says that there several other voodoo treatments in the article that should also be cleaned up. This is supposed to be an article about depression, not an article about treatment of depression. Regards, Ben Aveling 19:51, 2 December 2007 (UTC)
Another study: Rosenthal SH. Electrosleep: A double-blind clinical study. Biological Psychiatry 1972; 49(2):179-185. I cannot find details on it without paying subscription fees, but it lists a 21% improvement on the Zung SRDS depression scale. And again, Paul--just because I haven't (yet) told you that study X exists doesn't give you the right to add an unsourced claim that study X does NOT exist. Also, I am not your damned research monkey--every line I've added has been sourced; many of yours have not. Also, given that there have been multiple double-blind trials that measured depression (including the studies you linked), your section title is a lie. This is the third or fourth time you've repeated this lie after I initially corrected you. -- Lode Runner 22:14, 2 December 2007 (UTC)
To all: going to be busy for at least the next few days; after that, I'll be focusing my efforts on fleshing out cranial electrotherapy stimulation. Will worry about this article after we've reached some sort of consensus there. Though I don't expect it, I'd be nice if I came back to some objective, reasonably written articles. The links I've given (especially the 'untrustworthy' AlphaStim-promo papers) are great starting places. 99% of the edit wars and arguments here could have been avoided if people here had read them and followed up on the studies they referred to as necessary, instead of insisting--without sources--that the papers were wrong or biased. -- Lode Runner 23:23, 2 December 2007 (UTC)
I've just read the first part of the "Clinical Depression" item and find it extremely outdated, misleading and innaccurate.
I could just jump in and chnage it to what I think but it's rather a big job and I don't want to waste time writing when it may be edited out. Is there a way to discuss the changes before such are done?
The reason I have come to this article is because someone is quoting the article as an authority on depression and it is not.
I see below so many different types of "treatment" that no one could possibly follow all of them. Many are fad theories and bear little relationship to reality.
There are only 2 basic methods of treatment being talk therapy anmd meds, or a combination of both. Every other "theory" is essentially perupheral, rarely used and rarely succesful.
I have a personal philosophy of "whatever works is good" but to list every fad really does just offer false hope.
I'd much rather see the item state there are more "alternate" theories than you can poke a stick at and maintain focus on those that are know to work consistently.
Being new here I don't know how tro contact anyone etc so I'll give my email here notmeagain@eml.cc
It's a spare email so it doesn't matter as I can just drop it if spammers move in etc.
I've had depression for over 40 years and seen more doctors, had more treatments and tried more drugs than the average bear. I have no medical background but I do know what is a fad and waht isn't.
Hope I haven't offended anyone as much work has been done here but to me it's actually causing problems having ridiculous statements which mislead.
To give you an idea of what I mean here's my first point relating to the diagnosis section :
"Before a diagnosis of depression is made, a physician will perform a complete medical exam to rule out any possible medical or physical cause for the suspected depression."
Doesn't happen. No GP's do this as they don't have time. If you walk in and say you feel depressed they reach for the prescription pad and away you go.
Psychiatrists do take this approach but again the diagnosis is made well before any physical issues are considered.
To have this listed will only confuse people when they sit down with a doctor. In fact it may deter many from trying to get the help they need.
Best, Peter Porter. —Preceding unsigned comment added by Clocodile ( talk • contribs) 15:33, 10 December 2007 (UTC)
I think a lot of people here fail to understand the purpose of Wikipedia articles. We're here to report on reality, not simply a given treatment's medical worth. By all means, we can give evidence supporting or disputing a given treatment's efficacy or proposed mechanism of action, or mention whether a certain treatment has received FDA approval (ahem) or is approved for use in other countries, and we can mention whether guidelines say that a physical exam should be performed--but, ultimately, Wikipedia is here to report on what's happening REALITY. If significant numbers of people are treating depression by shoving pickles in their ears, then we report that. If a physical exam is rarely being performed prior to anti-depressant prescription (and I would say this is almost assuredly the case, though I don't have any non-anecdotal evidence), then that should be mentioned as well, though if source XYZ says an exam SHOULD be performed, that should also be mentioned. If the article becomes too long and cumbersome, we split off the treatment methods into treatment of depression and give only a short summary here.
In summary--if most physicians don't perform a physical exam, then the article should not state otherwise. If certain "alternative" treatments have received significant use/marketing/press coverage, then they should be mentioned (along with any supporting, contraindicating, or lack of evidence.) -- Lode Runner ( talk) 20:09, 16 December 2007 (UTC)
Jesus Christ, have I offended the Union of Delusional Rule Lawyers or something? I have said, done or advocated absolutely NOTHING that violates any of the WPs, verifiability included. In fact, I have used "reality" as a synonym for "verifiability", and repeatedly argued AGAINST inserting any unsourced material. Please stop spamming this talk page with explanations of rules that NO ONE here (...except, at times, yourself) is violating.
"Should" is still a slightly inappropriate word, given that this is specific to the Mayo Clinic only and not a policy set forth by any recognized national or worldwide authority (in the highly standardized field of medicine), but I have no doubt that such a source probably does exist so I'll give it the benefit of the doubt--it's better than "will." -- Lode Runner ( talk) 23:04, 17 December 2007 (UTC)
Hello, in the latest revision (as of this one), there is a problem with the references that I can't figure out. Try looking at "References", #28, and there is a table of contents and numerous lines that look like source citations. I can't find where the source of this problem is. Could someone who is better versed at ref tags please fix this? Thank you. -- Kyok o 21:22, 19 December 2007 (UTC)
I believe we should highlight two works:
Darkness Visible: A Memoir of Madness, William Styron, a classic and extraodinary book, by someone who is a master of words, about the descent into the hell of depression.
The Noonday Demon, Andrew Solomon, National Book Award, 2001, Finalist Pulitzer, extraordinary self-account, history, social analysis, etc. http://www.noondaydemon.com/
Neither of these books are by "psychiatrists or psychologists," but deserve (as do others I presume, but none as important as these, in particular Styron) a citation not buried in "references."
Best, Shlishke ( talk) 22:36, 22 December 2007 (UTC)
Depression and natural therapies is a povfork, and contains little if anything not already in this article (other than unsourced and poorly sourced information with NPOV problems). It should be merged into this article. -- Ronz 16:12, 3 October 2007 (UTC)
We don't have a povfork issue in the first place. The article wasn't created as a fork for pushing a point of view, at the risk of repeating myself. It was created to cover ground that wasn't covered in the first article.
Sardaka 10:09, 12 October 2007 (UTC)
The existence of an article on depression doesn't mean that there couldn't be other articles about depression. For example, if you look up Sydney, you will find many articles about it, on different aspects: general, history, architecture etc. This is a legit way of covering the subject. With depression, there can be more than one article to cover different aspects of the issue. the existence of the first article doesn't preclude others.
Sardaka 09:52, 17 October 2007 (UTC)
I've restored this conversation from the archive to allow more discussion since the merge hasn't happened or been conclusively rejected yet. AnmaFinotera ( talk) 05:41, 1 January 2008 (UTC)
Sardaka took it upon himself to move the POV fork to Depression and Complementary Therapies which I have undone as the "move" was done improperly and with no consensus on the new name. Feel free to join the discussion at Talk:Depression and natural therapies regarding the need to rename the article as there appears to be no consensus for a merge and the AfD of the article also resulted in no consensus. AnmaFinotera ( talk) 15:23, 15 January 2008 (UTC)
Depression and natural therapies is, as others have said, a POV joke. That's not to say we can't mention therapies that aren't scientifically proven--on the contrary, we should document ANY therapy that has been used on a significant scale or somehow achieved prominence or approval somewhere in the world--but it's a joke to separate out the "natural" options. "Natural" medicine is just medicine, like "natural" food is just food. The word is simply meaningless. A molecule from a plant isn't any different than one from a lab.
What we need is a Treatment of Depression article. Yes, I do believe a separate article is needed, because some contentious therapies (such as CES) inevitably turn into a massively detailed (sourced) analysis. I don't think such analyses are a bad thing, but if they all turn out to be like CES, they would clearly render this article unmanageable. Even if you were to restrict yourself to accepted, mainstream, FDA-approved (or pending-approval) methods,there is still a LOT of ground to cover: SSRIs, SNRIs, dopamine reuptake inhibitors, tricyclic, MAOI, electroshock therapy and each of the other electric therapies approved or pending approval, light therapy, psychotherapy...
I would do this myself, except I don't think I can deal with another Paul Gene-type sabotage effort again. (He believes that all negative studies about CES--all 1 or 2 of them--should be explained in detail, yet doesn't allow anyone to mention the positive studies without a mile of disclaimers and forty paragraphs of debate on the talk page. I'm all for plenty of skepticism when it comes to "alternative" medicine, but damn...) I could just do a cut/paste job and walk away, but I wouldn't feel quite right about that. Perhaps someone with a little more stamina than myself is up for it.-- Lode Runner ( talk) 10:07, 6 January 2008 (UTC)
I agree too, a Treatment of Depression article is needed. I am going to make a link on the Depression page to the Treatment of Depression article. -- Luke ( talk) 23:31, 8 January 2008 (UTC)
I'm a research assistant for a study that is working to determine the causes of depression by looking for genes that contribute. Is it appropriate to link to our study on this page, either in the links at the bottom or in the "Genetic predisposition" section? The link in question would be to: http://depressiongenetics.stanford.edu/
Thanks in advance for any input. 171.65.2.53 ( talk) 19:23, 9 January 2008 (UTC)
I understand there are reasons for this, and there's that handy link, but this section, as it stands, conveys almost no information to the reader, what so ever. I think perhaps some example is in order, perhaps the least disputed? Kimbits ( talk) 07:32, 9 February 2008 (UTC)
I propose that we add the following passage written by me:
One etiological theory of depression is the Aaron Beck cognitive theory of depression. His theory is regarded as the most verified psychological theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. According to Beck’s theory of the etiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence. (Children and adolescents who suffer from depression acquire this negative schema earlier.) Depressed people acquire such schemas through a loss of a parent, rejection of peers, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounter a situation that resembles in some way, even remotely, the conditions in which the original schema was learnt learned, the negative schemas of the person are activated.
Beck also included a negative triad in his theory. A negative triad is made up of the negative schemas and cognitive biases of the person. A cognitive bias is a view of the world. Depressed people, according to this theory, have views such as “I never do a good job.” A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. This in the negative triad. Also, Beck proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.
Another cognitive theory of depression is the hopelessness theory of depression. This is the latest theory of the helpless/hopeless theories of depression. According to this theory, hopelessness depression is caused by a state of hopelessness. A state of hopelessness is when the person believes that no good outcomes will happen and that bad ones will happen instead. Also, the person feels that he or she has no ability to change the situation so that good things will happen. Stressors (negative life events) are thought to interact with a diathesis (in this case, a predisposing factor to depression) to create a sense of hopelessness.
Some proposed diathesis’s are attributing negative events to stable and global factors, low self-esteem, and a tendency to believe that negative life events will have severe negative consequences. Theses diathesis increase the chance that a person will have hopelessness depression.
If it's ok with you all, I will add the passage in a few weeks, with complete references. Thanks. -- Luke ( talk) 23:43, 7 January 2008 (UTC)
Should nutritional therapies be included from quality articles and studies (i.e. peer reviewed, double-blind, randomized, controlled-trials)? I think, absolutely. If there is general agreement, will do... Gnif global ( talk) 12:49, 23 February 2008 (UTC)
Please DO NOT make the bullet points any more confusing. One point per line please. See article for more details. Prowikipedians ( talk) 02:22, 15 March 2008 (UTC)
![]() | This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
I've done a little bit of housecleaning on this article, moving the evolution section to its own article ( Evolutionary advantages of clinical depression), and merging the info under medications into the article on antidepressants.
The move of the evolution information was a straight copy-paste, so the new article could use a new introduction and some new bells and whistles to better be able to stand on its own.
In both sections I simply left behind the first paragraph - a freshly written brief description of each topic would have been better, but I simply don't have the expertise to give one. So if someone else could do that, it would help out a lot.
The article also needs to be cleaned up some more. Many of the sections should be moved to their own pages, with more brief descriptions on this page. As it stands even with my cleanup, it is still far too long. As another wikipedian has stated though, this information is very important so it should not be deleted, just moved. - Uniqueuponhim 00:24, 10 September 2007 (UTC)
My wife was diagnosed with a brain tumor - and has consequently become clinically depressed - would adding in situational depression make sense?
(No. According to the DSM, Major Depressive Disorder can not be caused by a medical condition.)
It's odd that this article never mentions refractory depression, which is major depression that is resistant to the usual treatment methods. I'm not sure where it would be best to mention it, but it should be noted if not a small section of its own.-- Gloriamarie 18:16, 11 September 2007 (UTC)
Clinical depression is a severe illness that won't necessarily go away if you remove the original cause. It can take antidepressants to get rid of the illness even if the cause has been removed. There are also depressions that aren't caused by circumstances, but come from within.
Sardaka 10:13, 12 October 2007 (UTC)
The idea that depression is always caused by external forces and that medication allows people to "quit feeling sorry for themselves" is absurd. If this were so, antidepressant medications would not work. SSRIs are a common effective treatment medication. SSRI stands for Selective Seretonin Reuptake Inhibitor. By nature, it does not introduce new chemicals into the body, it prevents the seretonin that is naturally produced by the body from being re-absorbed by the parent neuron - a process that can be thought of as a "glitch" in the body -- the seretonin should not be subject to re-uptake, and the medications allow the body to make use of the neurotransmitters already in the body.
Assuming a subject with clinical depression is taking SSRIs, once they "feel better" (i.e. overcome the depression) complete cessation of the medication may result in a relapse into depression -- because the body is still malfunctioning.
On a side note -- it is attitudes like the one mentioned above that cause the negative stigma that is attached to mental healthcare and lead to so many undiagnosed and untreated mental disorders. Riley812 00:07, 13 October 2007 (UTC)Riley812
Given the current size of the article (61k), perhaps it some of it should be split away into a sub-article? Maybe the treatment section? -- Ronz 16:09, 3 October 2007 (UTC)
No offense, but someone "liking" the image is not a reason to keep it. What does it contribute to the article? Does it "illustrate" depression, no. Does it add anything to the article at all? No. It should be removed. See Wikipedia:Images#Image_choice_and_placement. AnmaFinotera 03:50, 15 October 2007 (UTC)
I am removing PMDD from the list of other depressive disorders. It does not belong there, for example, see http://pmdd.factsforhealth.org/what/faq.asp: "
How does depression relate to PMDD?
Depression is one of the more common symptoms of PMDD. Women often feel sad, blue, unhappy, down in the dumps, and/or hopeless as part of the PMDD symptom complex. But remember, the depressive symptoms of PMDD are linked to the menstrual cycle and must be absent at least during the week following menses. Also, depression is not necessary for the diagnosis of PMDD. Some women find anxiety and tension or anger and irritability to be the most disturbing symptoms and do not consider themselves depressed.
Women with PMDD also may have a coexisting depressive illness such as Major Depressive Disorder or Bipolar (manic depressive) Disorder. These conditions sometimes begin before the onset of PMDD and sometimes follow it. They differ from PMDD in not being linked to the menstrual cycle. While symptoms of these illnesses may worsen premenstrually, they persist throughout the entire cycle." Paul gene 02:48, 21 October 2007 (UTC)
The sentence in question:"Clinical depression is diagnosed by a psychiatrist or psychologist after any potential physical causes have been ruled out.[1]"
I understand that it is based on the following paragraph from ref1 (NIMH pub): "The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done, by the physician or by referral to a psychiatrist or psychologist."
But the same NIMHpub states on p5: "In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period."
The re-phrasing of the NIMHPub used in the lead paragraph appears to change the meaning of the NIMH quotation. What NIMH mean is that the physician should rule out certain medical conditions, not all physical causes. (NIMH still contradict itself, though.) Secondly, according to NIMH, clinical depression diagnosis does need to be carried out by psychiatrist or psychologist, and the physician himself can do that. (This actually happens quite often.) On the contrary, the lead paragraph of the article implies that only psychiatrist or psychologist can diagnose depression. Thirdly, the discussion of details, such as comorbid depression, does not probably belong to the lead paragraph, and should be done in the text of the article.
So, I propose to remove the sentence in question rather than correcting or expanding it. Paul gene 10:56, 27 October 2007 (UTC)
Although not forbidden expressly, the use of the references in the lead part is generally discouraged. The lead part is a summary of the main article and all the necessary references should already be there. For example, Ref 1 is used multiple times in the Diagnosis section and so is not needed in the lead. Suicide should be addressed in more details later in the article, and ref 2 could be moved there. Paul gene 15:24, 27 October 2007 (UTC)
I think there is a lot of potential for biasedness and POV in how certain treatments are categorized and ordered on this page. I am moving light therapy out of the "other methods" section as many recent studies have found it to be equally effective with many of the more mainstream forms of medication, and the studies are beginning to show a consensus. I also think that one could argue for putting psychotherapy above medication because it is common to have psychotherapy in the absence of medication, but not vice-versa.
The "other methods" mixes too many different things: things like exercise which seem to be more of a supplemental treatment, and things like the "archaic methods" which aren't really treatments so much as they are historical background of what we did wrong in the past! I may move "archaic methods" into the history section where I think it is more appropriate. Cazort 12:38, 2 November 2007 (UTC)
Does anyone have objections to adding yoga, bibliotherapy and computer-assisted psychotherapy under "Other methods of treatment". Proposed text and references are under title "More methods of treatment" in (now in Archives, 26 September). Natural123 19:38, 25 October 2007 (UTC)
Yoga - Pilkington K, Kirkwood G, Rampes H, Richardson J. - Yoga for depression: the research evidence - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16185770&dopt=Citation
Bibliotherapy - Cuijpers P - Bibliotherapy in unipolar depression: a meta-analysis - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9194011&dopt=Abstract
Computer-assisted psychotherapy - http://www.finddepressiontreatment.com/depression-software.html - This page is an overview of computer-assisted psychotherapy and it ranks number 1 on Google for "computer-assisted psychotherapy depression". It also contains links confirming efficiency of this therapy for clinical depression. Natural123 16:12, 27 October 2007 (UTC)
Why isn't Bupropion mentioned here? It's completely different from SSRIs and should mentioned along with MAOIs. I edited earlier today adding a mention of dopamine reuptake inhibitors and it got taken out. I have no idea why. Why can't this be included?
There's a massive lack of references in the psychotherapy section of this page. I am adding a tag and recommend that people who know more about this stuff add appropriate references and delete material which you cannot find adequate references for. Cazort 12:41, 2 November 2007 (UTC)
I've just pulled this out: <ref>{{cite journal | url = http://www.cpa-apc.org/Publications/Archives/PDF/1997/May/BLAND.pdf | last = Bland | first = R.C. |date=1997 | title = Epidemiology of Affective Disorders: A Review | journal = Can J Psychiatry | volume = 42 | pages = 367?377 }}</ref> "The requested URL /Publications/Archives/PDF/1997/May/BLAND.pdf was not found on this server." Would be good to have a replacement... Regards, Ben Aveling 10:59, 27 November 2007 (UTC)
Statements of probability based on personal judgment do not hold up to scientific scrutiny, and thus should be omitted from any article that attempts to be 'objective'. Also, I edited the 'neurological' section to depict what experts believe; views that have not been scientifically proven should not be stated ad nauseum. It is far more accurate to state that most experts accept a certain view.
ShadowCreatorII ( talk) 09:36, 26 November 2007 (UTC)
I've added a cranial electrotherapy stimulation section under Treatment, because this is an FDA-approved method for the treatment of depression. This is stated in the CES article, and confirmed by some simple Googling (e.g.' "cranial electrotherapy stimulation" depression FDA ').
I find it interesting to note that two newer, expensive, and (in the case of TMS) non-FDA-approved procedures (TMS & VNS) involving electrical induction are listed, but the older, cheaper, FDA-approved, at-home CES device was not. Not trying to start a debate here or anything, I just think it's kind of sad that even on Wikipedia there's a dearth of information on this treatment. (Why don't we have information on the "conforming" frequency/power output of FDA-approved CES devices? Why don't we have info on fda-approved devices so that one can differentiate them from the numerous non-approved devices on the market?) -- Lode Runner ( talk) 19:18, 29 November 2007 (UTC)
Just found a relevant tidbit in my source paper:
“ | Over the past three decades, at least eight medical device companies have applied for and received FDA clearance to market CES devices. A bibliography by Kirsch (2002) listed 126 scientific studies of CES involving human subjects and 29 animal studies. Most of the studies were completed in the U.S. over the past 30 years. The majority of the studies were double-blind and conducted at American universities. In total, therewere 6,007 patients treated under varying research conditions, with 4,541 actually receiving CES treatment. | ” |
Unlike the vast majority of the other methods listed under "Other methods of treatment", CES has been the subject of double-blind studies AND it has received FDA approval. There's absolutely no valid reason for its exclusion from this article. -- Lode Runner ( talk) 07:04, 30 November 2007 (UTC)
-- Lode Runner 03:43, 1 December 2007 (UTC)
I am sorry if I'm coming off as hostile, but I really have a hard time understanding the position being taken here. I'm not saying CES has as much research behind it as Zoloft. I'm saying it has more research and approval behind it than fucking hypnotherapy, and therefore merits mention in the article.
If you really can't stand my paper as a source, just Google ' "cranial electrotherapy stimulation" depression ' There are tons of articles out there. Here are some example hits:
http://findarticles.com/p/articles/mi_m0FDL/is_3_7/ai_n18610638 It indicates that double-blind research has been done. Mentions one specific doctor that has studied over 1,500 patients in always single-blind (and usually double-blind) studies.
http://www.depressiontreatmentnow.com/bioelectric_medicine.pdf Many detailed lists of specific studies, many of which are double-blind. Overall, has positive conclusions regarding CES.
http://www.ingentaconnect.com/content/haworth/jneu/2005/00000009/00000002/art00002 Abstract:
“ | The use of Cranial Electrotherapy Stimulation (CES) to treat depression and anxiety is reviewed. The data submitted to the Federal Drug Administration (FDA) for approval of medication in the treatment of depression are compared with CES data. Proposed method of action, side-effects, safety factors, and treatment efficacy are discussed. The results suggest there is sufficient data to show that CES technology has equal or greater efficacy for the treatment of depression compared to antidepressant medications, with fewer side effects. A prospective research study should be undertaken to directly compare CES with antidepressant medications and to compare the different CES technologies with each other. | ” |
http://www.clinph-journal.com/article/PIIS1388245701006575/abstract Shows the mechanism at work--i.e., it shows the CES can alter EEG readings.
http://www.maxilife.co.za/download/healthguides/HG27-CES%20in%20the%20Treatment%20of%20Depression.pdf Includes charts of specific studies similar to one of the other papers, but is written by different researchers. Select quote:
“ | Based on this data it might be concluded that antidepressant medications may be adequate when treating mild to moderate depression if one can tolerate the negative side effects, but that CES should be considered a first line of treatment or at least an add-on to medication for the treatment of more difficult cases. | ” |
K, done for now. If you still insist CES should be deleted, please provide sources exceeding the level of what I've provided for every other therapy under "Other methods of treatment". Alternately, you must provide a source that indicates all the significant CES research I've cited is flawed. Sorry, anonymous opinions don't count.
(And yes, some brief fiddling reveals Alpha-stim is behind one or two of these as well. I don't care. I'm sure the company that makes Prozac was responsible for 95% of the studies supporting Prozac, too. And there are at least a couple links there that don't appear to have a connection to any CES company.)
-- Lode Runner 04:27, 1 December 2007 (UTC)
PS:
Your link
http://findarticles.com/p/articles/mi_m0FDL/is_3_7/ai_n18610638 is to the article from a magazine Original Internist published by the chiropractor Kessinger, not a peer reviewed publication, and thus is not a reliable source. You really want to read the sources you are recommending -- your link
http://www.depressiontreatmentnow.com/bioelectric_medicine.pdf comes up with essentially the same article as
http://www.maxilife.co.za/download/healthguides/HG27-CES%20in%20the%20Treatment%20of%20Depression.pdf. The latter is discussed below. Your link
http://www.ingentaconnect.com/content/haworth/jneu/2005/00000009/00000002/art00002 refers to The Journal of Neurotherapy, which is a scientific analog of a supermarket circular (see earlier discussion). Your link
http://www.clinph-journal.com/article/PIIS1388245701006575/abstract is about the effect of CES on normal people’s EEG, not about depression treatment. Your link
http://www.maxilife.co.za/download/healthguides/HG27-CES%20in%20the%20Treatment%20of%20Depression.pdf is a link to a promotional brochure, and not a peer reviewed publication so it is not very reliable. But anyway, look at the list of purported “depression studies” in Table 2, p 13. The double blind studies were conducted for Alcoholism, Alcoholics, Psychiatric Inpatients, Closed Head Injured, Psychiatric Inpatients, Fibromyalgia , Psychiatric Inpatients, Psychiatric Outpatients, Insomnia/Anxiety. If you read the text of the review, all the groups of psychiatric patients are mixed and so there is not a single study for clinical depression.
Paul gene
06:00, 1 December 2007 (UTC)
1. I thought you had already conceded that CESes have received class III FDA approval? Well, this link should settle that:
http://www.fda.gov/cdrh/pdf6/K062284.pdf . This PDF deals with a specific device (not CESes in general), but it clearly shows that the FDA has indeed approved the use of CESes (in general) for "treatment of insomnia, depression or anxiety." The identifier for CES hardware equivalence is (apparently) K895175.
2. The double-blind trials:
There are tons. I don't think you looked at the charts properly. Some examples:
Moore JA, Mellor CS, Standage KF, Strong H. A double-blind study of electrosleep for anxiety and insomnia . Biol Psychiatry 1975; 10(1):59-63. [Despite the lack of "Depression" in the title, it did record depression. It showed a 59% "clin rating" improvement, 17% self-rated improvement, 5% Beck DI improvement--whatever that is.]
Passini FG, Watson, CG, Herder, J. The effects of cerebral electric therapy (electrosleep) on anxiety, depression, and hostility in psychiatric patients. Journal of Nervous and Mental Disease 1976; 163(4):263-266. [Double-blind. 24% improvement]
Rosenthal did a double-blind trial with 88 subjects that showed a 64% "clin rating" improvement, 21% "Zung SRDS" improvement. He did two other (non-blind) trials, and am not sure which one is which in the bibliography. However, you can find the details for this and the other studies in the papers I've already linked.
THESE PERCENTAGE IMPROVEMENTS ARE SHOWN UNDER THE "DEPRESSION" SECTION. THEY REFER TO IMPROVEMENT OF CLINICAL DEPRESSION ONLY. THERE ARE SEPARATE SECTIONS SHOWING DIFFERING PERCENTAGE IMPROVEMENTS FOR ANXIETY AND INSOMNIA.
Also, from the original paper I cited:
A bibliography by Kirsch (2002) listed 126 scientific studies of CES in-volving human subjects and 29 animal studies.
3. I must stress that I asked for sources, not unsourced opinions from an anonymous Wikipedia editor. The CES has been around for what, 40 years? More? If its efficacy is questionable, you should have no trouble finding a source that says so. The onus is on you to prove that these sources are not reputable. Simply calling them not reputable doesn't cut it, I'm sorry. I'm not denying that they probably aren't on par with the most widely-read and respected medical journals--but this isn't a popularity contest. If a whole crapload of people are saying a piece of information is true, and saying it in a most reasonable, orderly, and ostensibly-scientific fashion, and you cannot produce a single bit of criticism that says otherwise (over the many, MANY decades that they've had the chance to offer it), then I don't think it makes sense to demand the removal of said information.
4. We are NOT discussing CES in isolation--we are discussing an article on Clinical Depression. Thus, St. John's Wort and hypnotherapy matter because our standards for inclusion in the article should remain the same. I have presented you with evidence far outweighing the evidence cited to support those two's inclusion. Therefore, if CES is removed, so should they. To leave them intact while removing CES would be hypocritical. (Good luck finding consensus in the removal of 95% of the "Other methods of treatment" section.)
I understand your frustration with the new-agey, pseudo-science aspect to the CES crowd. In fact, one of the reasons I came here and added CES was because I was tired of drowning in mystical, unscientific crap. However, now that I've found stuff that certainly appears to be very scientific...
I can postulate that the articles aren't published in mainstream journals because they don't have the financial muscle to do so. There's a lot of money in patentable compounds (drugs)--not a lot of money in public domain and easy-duplicated electrical devices. I can also postulate that if there was real evidence that CESes don't work at all, the FDA would have withdrawn its approval a long time ago.
You can put as many sourced disclaimers as you like (such as the questionable relevance of class 3 FDA approval), but I do not believe you have a case for outright removal. -- Lode Runner 06:43, 1 December 2007 (UTC)
I have re-added the info Paul deleted (again) and better integrated it with the info Paul added. I have done my best to emphasize the untested and experimental nature of CES devices (despite their FDA approval) in the second paragraph; however, that doesn't mean the first paragraph should be removed entirely. The readers deserve a simple explanation as to how CES devices work, especially as contrasted to the other electromagnetic methods (which are expensive, do not offer the ability for at-home treatment, and/or require surgery.) -- Lode Runner 18:54, 1 December 2007 (UTC)
I can point you to evidence that supports people's claims to be able to talk to the dead, and of horses that can do maths. But there is far more evidence that such things don't exist. This page is about Clinical Depression, treatments for it are worth a mention and that is all. This is not the place for a long weighting of arguments on whether CES is a complete fraud or not. That discussion would not be a short one and it doesn't belong here. Regards, Ben Aveling 23:54, 1 December 2007 (UTC)
To clarify my position: I am against your edits, Ben, because by they imply that CES is completely unproven. By mentioning only the doubt (including the doubtfulness of the FDA classification), you are violating WP:UNDUE (undue weight)--you are mentioning only the possibly that CES is ineffective and/or completely unstudied, without mentioning any evidence that supports it. If anti-CES disclaimers are printed (and in fact dominate the CES section), then pro-CES studies must also be mentioned. What you're doing violates one of Wikipedia's core policies (NPOV). -- Lode Runner 02:16, 2 December 2007 (UTC)
I asked Lode Runner repeatedly to provide at least "one double-blind trial for clinical depression specific quotation." His answers were:
Moore JA, Mellor CS, Standage KF, Strong H. A double-blind study of electrosleep for anxiety and insomnia . Biol Psychiatry 1975; 10(1):59-63. [Despite the lack of "Depression" in the title, it did record depression. It showed a 59% "clin rating" improvement, 17% self-rated improvement, 5% Beck DI improvement--whatever that is.]
Passini FG, Watson, CG, Herder, J. The effects of cerebral electric therapy (electrosleep) on anxiety, depression, and hostility in psychiatric patients. Journal of Nervous and Mental Disease 1976; 163(4):263-266. [Double-blind. 24% improvement]
The first article was on patients with anxiety and insomnia not clinical depression. The 5% Beck DI (Beck Depression Inventory) improvement was very small and statistically insignificant according to the paper. The abstract [ PMID 1091305] states: "Despite largely negative findings, several subjects reported a remarkable improvement in their symptoms some two to three weeks after electrosleep (ES) treatment was concluded, so that it remains unclear whether or not ES may be an effective treatment."
The second paper deals with a mixed group of psychiatric patients and so is again methodology impure. So it is really hard to make any positive or negative conclusions from it, but the abstract [ PMID 972328] states: "No difference in the amount of improvement shown by the two groups appeared on any of the five measures employed, although a major placebo effect was evident on all of the criteria. The results argue against the use of electrosleep as a treatment for these symptoms except when it may be employed for its placebo value." Paul gene 15:59, 2 December 2007 (UTC)
Lode Runner is right in that the CES section is getting too long. We should just mention it, say what it is, and quickly summarize the known reliable trials. The weighing of evidence should happen in Cranial electrotherapy stimulation which at the moment blindly endorses CES.
Lode Runner is wrong when he says that the onus on proof is on the doubters. WP:V says:
So we don't need to prove that it doesn't work, only that known published studies to date say that it doesn't work any better than placebos. That doesn't say that there isn't about to be a study that shows that CES works, it doesn't even say that there hasn't already been one that we didn't find, it just says that we've looked, and if there is such a study, we didn't find it.
And lastly, Lode Runner is right when he says that there several other voodoo treatments in the article that should also be cleaned up. This is supposed to be an article about depression, not an article about treatment of depression. Regards, Ben Aveling 19:51, 2 December 2007 (UTC)
Another study: Rosenthal SH. Electrosleep: A double-blind clinical study. Biological Psychiatry 1972; 49(2):179-185. I cannot find details on it without paying subscription fees, but it lists a 21% improvement on the Zung SRDS depression scale. And again, Paul--just because I haven't (yet) told you that study X exists doesn't give you the right to add an unsourced claim that study X does NOT exist. Also, I am not your damned research monkey--every line I've added has been sourced; many of yours have not. Also, given that there have been multiple double-blind trials that measured depression (including the studies you linked), your section title is a lie. This is the third or fourth time you've repeated this lie after I initially corrected you. -- Lode Runner 22:14, 2 December 2007 (UTC)
To all: going to be busy for at least the next few days; after that, I'll be focusing my efforts on fleshing out cranial electrotherapy stimulation. Will worry about this article after we've reached some sort of consensus there. Though I don't expect it, I'd be nice if I came back to some objective, reasonably written articles. The links I've given (especially the 'untrustworthy' AlphaStim-promo papers) are great starting places. 99% of the edit wars and arguments here could have been avoided if people here had read them and followed up on the studies they referred to as necessary, instead of insisting--without sources--that the papers were wrong or biased. -- Lode Runner 23:23, 2 December 2007 (UTC)
I've just read the first part of the "Clinical Depression" item and find it extremely outdated, misleading and innaccurate.
I could just jump in and chnage it to what I think but it's rather a big job and I don't want to waste time writing when it may be edited out. Is there a way to discuss the changes before such are done?
The reason I have come to this article is because someone is quoting the article as an authority on depression and it is not.
I see below so many different types of "treatment" that no one could possibly follow all of them. Many are fad theories and bear little relationship to reality.
There are only 2 basic methods of treatment being talk therapy anmd meds, or a combination of both. Every other "theory" is essentially perupheral, rarely used and rarely succesful.
I have a personal philosophy of "whatever works is good" but to list every fad really does just offer false hope.
I'd much rather see the item state there are more "alternate" theories than you can poke a stick at and maintain focus on those that are know to work consistently.
Being new here I don't know how tro contact anyone etc so I'll give my email here notmeagain@eml.cc
It's a spare email so it doesn't matter as I can just drop it if spammers move in etc.
I've had depression for over 40 years and seen more doctors, had more treatments and tried more drugs than the average bear. I have no medical background but I do know what is a fad and waht isn't.
Hope I haven't offended anyone as much work has been done here but to me it's actually causing problems having ridiculous statements which mislead.
To give you an idea of what I mean here's my first point relating to the diagnosis section :
"Before a diagnosis of depression is made, a physician will perform a complete medical exam to rule out any possible medical or physical cause for the suspected depression."
Doesn't happen. No GP's do this as they don't have time. If you walk in and say you feel depressed they reach for the prescription pad and away you go.
Psychiatrists do take this approach but again the diagnosis is made well before any physical issues are considered.
To have this listed will only confuse people when they sit down with a doctor. In fact it may deter many from trying to get the help they need.
Best, Peter Porter. —Preceding unsigned comment added by Clocodile ( talk • contribs) 15:33, 10 December 2007 (UTC)
I think a lot of people here fail to understand the purpose of Wikipedia articles. We're here to report on reality, not simply a given treatment's medical worth. By all means, we can give evidence supporting or disputing a given treatment's efficacy or proposed mechanism of action, or mention whether a certain treatment has received FDA approval (ahem) or is approved for use in other countries, and we can mention whether guidelines say that a physical exam should be performed--but, ultimately, Wikipedia is here to report on what's happening REALITY. If significant numbers of people are treating depression by shoving pickles in their ears, then we report that. If a physical exam is rarely being performed prior to anti-depressant prescription (and I would say this is almost assuredly the case, though I don't have any non-anecdotal evidence), then that should be mentioned as well, though if source XYZ says an exam SHOULD be performed, that should also be mentioned. If the article becomes too long and cumbersome, we split off the treatment methods into treatment of depression and give only a short summary here.
In summary--if most physicians don't perform a physical exam, then the article should not state otherwise. If certain "alternative" treatments have received significant use/marketing/press coverage, then they should be mentioned (along with any supporting, contraindicating, or lack of evidence.) -- Lode Runner ( talk) 20:09, 16 December 2007 (UTC)
Jesus Christ, have I offended the Union of Delusional Rule Lawyers or something? I have said, done or advocated absolutely NOTHING that violates any of the WPs, verifiability included. In fact, I have used "reality" as a synonym for "verifiability", and repeatedly argued AGAINST inserting any unsourced material. Please stop spamming this talk page with explanations of rules that NO ONE here (...except, at times, yourself) is violating.
"Should" is still a slightly inappropriate word, given that this is specific to the Mayo Clinic only and not a policy set forth by any recognized national or worldwide authority (in the highly standardized field of medicine), but I have no doubt that such a source probably does exist so I'll give it the benefit of the doubt--it's better than "will." -- Lode Runner ( talk) 23:04, 17 December 2007 (UTC)
Hello, in the latest revision (as of this one), there is a problem with the references that I can't figure out. Try looking at "References", #28, and there is a table of contents and numerous lines that look like source citations. I can't find where the source of this problem is. Could someone who is better versed at ref tags please fix this? Thank you. -- Kyok o 21:22, 19 December 2007 (UTC)
I believe we should highlight two works:
Darkness Visible: A Memoir of Madness, William Styron, a classic and extraodinary book, by someone who is a master of words, about the descent into the hell of depression.
The Noonday Demon, Andrew Solomon, National Book Award, 2001, Finalist Pulitzer, extraordinary self-account, history, social analysis, etc. http://www.noondaydemon.com/
Neither of these books are by "psychiatrists or psychologists," but deserve (as do others I presume, but none as important as these, in particular Styron) a citation not buried in "references."
Best, Shlishke ( talk) 22:36, 22 December 2007 (UTC)
Depression and natural therapies is a povfork, and contains little if anything not already in this article (other than unsourced and poorly sourced information with NPOV problems). It should be merged into this article. -- Ronz 16:12, 3 October 2007 (UTC)
We don't have a povfork issue in the first place. The article wasn't created as a fork for pushing a point of view, at the risk of repeating myself. It was created to cover ground that wasn't covered in the first article.
Sardaka 10:09, 12 October 2007 (UTC)
The existence of an article on depression doesn't mean that there couldn't be other articles about depression. For example, if you look up Sydney, you will find many articles about it, on different aspects: general, history, architecture etc. This is a legit way of covering the subject. With depression, there can be more than one article to cover different aspects of the issue. the existence of the first article doesn't preclude others.
Sardaka 09:52, 17 October 2007 (UTC)
I've restored this conversation from the archive to allow more discussion since the merge hasn't happened or been conclusively rejected yet. AnmaFinotera ( talk) 05:41, 1 January 2008 (UTC)
Sardaka took it upon himself to move the POV fork to Depression and Complementary Therapies which I have undone as the "move" was done improperly and with no consensus on the new name. Feel free to join the discussion at Talk:Depression and natural therapies regarding the need to rename the article as there appears to be no consensus for a merge and the AfD of the article also resulted in no consensus. AnmaFinotera ( talk) 15:23, 15 January 2008 (UTC)
Depression and natural therapies is, as others have said, a POV joke. That's not to say we can't mention therapies that aren't scientifically proven--on the contrary, we should document ANY therapy that has been used on a significant scale or somehow achieved prominence or approval somewhere in the world--but it's a joke to separate out the "natural" options. "Natural" medicine is just medicine, like "natural" food is just food. The word is simply meaningless. A molecule from a plant isn't any different than one from a lab.
What we need is a Treatment of Depression article. Yes, I do believe a separate article is needed, because some contentious therapies (such as CES) inevitably turn into a massively detailed (sourced) analysis. I don't think such analyses are a bad thing, but if they all turn out to be like CES, they would clearly render this article unmanageable. Even if you were to restrict yourself to accepted, mainstream, FDA-approved (or pending-approval) methods,there is still a LOT of ground to cover: SSRIs, SNRIs, dopamine reuptake inhibitors, tricyclic, MAOI, electroshock therapy and each of the other electric therapies approved or pending approval, light therapy, psychotherapy...
I would do this myself, except I don't think I can deal with another Paul Gene-type sabotage effort again. (He believes that all negative studies about CES--all 1 or 2 of them--should be explained in detail, yet doesn't allow anyone to mention the positive studies without a mile of disclaimers and forty paragraphs of debate on the talk page. I'm all for plenty of skepticism when it comes to "alternative" medicine, but damn...) I could just do a cut/paste job and walk away, but I wouldn't feel quite right about that. Perhaps someone with a little more stamina than myself is up for it.-- Lode Runner ( talk) 10:07, 6 January 2008 (UTC)
I agree too, a Treatment of Depression article is needed. I am going to make a link on the Depression page to the Treatment of Depression article. -- Luke ( talk) 23:31, 8 January 2008 (UTC)
I'm a research assistant for a study that is working to determine the causes of depression by looking for genes that contribute. Is it appropriate to link to our study on this page, either in the links at the bottom or in the "Genetic predisposition" section? The link in question would be to: http://depressiongenetics.stanford.edu/
Thanks in advance for any input. 171.65.2.53 ( talk) 19:23, 9 January 2008 (UTC)
I understand there are reasons for this, and there's that handy link, but this section, as it stands, conveys almost no information to the reader, what so ever. I think perhaps some example is in order, perhaps the least disputed? Kimbits ( talk) 07:32, 9 February 2008 (UTC)
I propose that we add the following passage written by me:
One etiological theory of depression is the Aaron Beck cognitive theory of depression. His theory is regarded as the most verified psychological theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. According to Beck’s theory of the etiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence. (Children and adolescents who suffer from depression acquire this negative schema earlier.) Depressed people acquire such schemas through a loss of a parent, rejection of peers, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounter a situation that resembles in some way, even remotely, the conditions in which the original schema was learnt learned, the negative schemas of the person are activated.
Beck also included a negative triad in his theory. A negative triad is made up of the negative schemas and cognitive biases of the person. A cognitive bias is a view of the world. Depressed people, according to this theory, have views such as “I never do a good job.” A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. This in the negative triad. Also, Beck proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.
Another cognitive theory of depression is the hopelessness theory of depression. This is the latest theory of the helpless/hopeless theories of depression. According to this theory, hopelessness depression is caused by a state of hopelessness. A state of hopelessness is when the person believes that no good outcomes will happen and that bad ones will happen instead. Also, the person feels that he or she has no ability to change the situation so that good things will happen. Stressors (negative life events) are thought to interact with a diathesis (in this case, a predisposing factor to depression) to create a sense of hopelessness.
Some proposed diathesis’s are attributing negative events to stable and global factors, low self-esteem, and a tendency to believe that negative life events will have severe negative consequences. Theses diathesis increase the chance that a person will have hopelessness depression.
If it's ok with you all, I will add the passage in a few weeks, with complete references. Thanks. -- Luke ( talk) 23:43, 7 January 2008 (UTC)
Should nutritional therapies be included from quality articles and studies (i.e. peer reviewed, double-blind, randomized, controlled-trials)? I think, absolutely. If there is general agreement, will do... Gnif global ( talk) 12:49, 23 February 2008 (UTC)
Please DO NOT make the bullet points any more confusing. One point per line please. See article for more details. Prowikipedians ( talk) 02:22, 15 March 2008 (UTC)