Talk:Major depressive disorder/Archive 3

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Article cleanup

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)

Situational Depression

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.)

I disagree. I think there ought to be a section that addresses the fact that probably most depression IS situational and that the vast majority of medication for the problem is an inappropriate medical solution for various societal and technical failures. Using the typical weasel language that is necessary the § should probably be titled Controversy something. Lycurgus 21:01, 15 September 2007 (UTC)

Although actually it probably should be somewhere else maybe in a overmedication article as this one is already pretty big. And now that there's a TOC it can be seen that the current § 5.2 addresses appropriate for this article. I have to say though when did DSM become a holy bible? Lycurgus 21:13, 15 September 2007 (UTC)

Refractory depression never mentioned?

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)

Not really

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

Length of article

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)

Van Gogh Image

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)

The portrayal of depression in art is quite relevant and beneficial to the article in my view. 58.151.182.166 11:29, 15 October 2007 (UTC)

How does this particular image provide any benefits to the article, or add relevance? Do any other medical articles include paintings depicting someone suffering from mental illnesses (or any other disease)? I didn't find any. An image is good, but certainly there can be a more academic image used rather than a painting. AnmaFinotera 18:53, 15 October 2007 (UTC)

The use of the image here does conform with Wikipedia:Images#Image_choice_and_placement in my view. The painting does illustrate depression. Its being a painting should not constitute a reason for its removal. Even serious magazines like New Scientist often use quite arty images to illustrate their articles. I am in favour of keeping it. --John 19:25, 15 October 2007 (UTC)

I guess I'm curious as to how it illustrates depression. There are different kinds of depression and it certainly doesn't illustrate them all. It doesn't really illustrate any, IMHO, except perhaps the artist's own instance as depression manifests itself differently in different people depending on a variety of circumstances. However, if others feel this actually somehow illustrates a mental illness, cool, let it stay. The article has much bigger issues to worry about and much more major work needed than to worry too much about the image ;-) I did, however, move it down a little because it was covering some text in the intro in IE 6. AnmaFinotera 19:58, 15 October 2007 (UTC)

I agree with everything you say. I don't feel that strongly about the image either. Let's make the article better. What would you say are its main failings? --John 20:00, 15 October 2007 (UTC)

Probably the top three right now are the need to merge in that natural remedies article, lack of sufficient sources, and the strong need to redo the article to be more inline with the med article style guides. The latter two seem to be primary reasons it got its rating dropped and it was not considered for featured article status. A major undertaking, to be sure. I keep trying to think of smaller pieces to break it into so it doesn't seem to overwhelming, because it is such a huge topic. Any ideas? AnmaFinotera 20:40, 15 October 2007 (UTC)

PMDD is not a depressive disorder

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)

Makes sense and agreed. Thanks for catching that (and some other stuff). AnmaFinotera 04:28, 21 October 2007 (UTC)

Physical causes of depression

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)

Hmmm...I do see your point. Should it perhaps be expanded and moved to the diagnosis section, then, or do you think the diagnosis section covers it well enough already? AnmaFinotera 14:24, 27 October 2007 (UTC)

I deleted it from the lead part, as we seem to agree on that. I think the diagnosis may need a different phrasing, but it is for the later. Paul gene 15:06, 27 October 2007 (UTC)

The use of references in the lead

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)

Can you point me to where you've seen that? I've never seen anything about that in any of the style guides and stuff that I have looked at. Considering the amount of info often included in the intro that is not included in the article, that seems odd to me. AnmaFinotera 18:33, 27 October 2007 (UTC)

Somebody pointed that out to me previously. But now I am looking at the MED FAs, and all of them have references in the lead. Sorry for the confusion Paul gene 19:42, 27 October 2007 (UTC)

Other methods of Treatment

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)

There is potential bias, true, and the entire treatment section needs overhauling. However, you're deciding to move light therapy out of the other methods section on the basis that you feel it is equally effective with other meds also reflects NPOV. Such a major change should be discussed here first, and has been undone. Light Therapy, even by your own additions and sources, is only effective in some forms of depression and is still under study. It is not a primary method of treatment, hence it being in the other methods section. The main section is for the mainstream forms, while the other section is for those that are less used, experimental, and still under study. For now, please leave archaic where it is. Why they are archaic, at least one is still used, even if rarely. AnmaFinotera 14:18, 2 November 2007 (UTC)

Currently, there is only one reference in the medication section, and it is basically an educational brochure, not a primary source that can attest to the effectiveness of treatment by medication. There are plenty of studies and articles out there that do this--far more studies than there are for light therapy (or any of the other alternative treatments mentioned). But the actual results of these studies are not that different from the studies I added. I think that this article would be greatly improved by citing and summarizing such primary sources. Maybe doing that would help resolve this issue. From my reading of the primary literature, there is at least as much uncertainty about antidepressant medication as about light therapy; the main difference I see is that there have been vastly more studies done on medication, which, taking the uncertainty into light, paints a very different picture. Cazort 20:13, 2 November 2007 (UTC)

There is no way to review primary literature on depression as it comprises tens of thousands of references, even secondary literature probably goes to more than a thousand titles. So for most purposes the NIMH brochures or consensus guidelines are just fine. If you are interested in working with primary sources you can contribute to the antidepressants article, or on articles on separate antidepressants or on light therapy for that matter. Paul gene 01:19, 3 November 2007 (UTC)

More methods of treatment

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)

Any additional treatment information must be referenced with a reliable source. OhNoitsJamie ^Talk 19:48, 25 October 2007 (UTC)

Given that exercise, socialization, and relaxation are all treatments that have been shown effective, they should be covered first. Any mention of a treatment that is hard to distinguish from another should be presented in proper context. Eg what's commonly referred to as "yoga" is hard to distinguish from a combination of relaxation and mild exercise. --Ronz 20:13, 25 October 2007 (UTC)

Although yoga has something in common with both relaxation and exercise it is usually not classified under any of these. Wikipedia (http://en.wikipedia.org/wiki/Yoga_%28alternative_medicine%29)- "Yoga is a healing system of theory and practice, its a combination of breathing exercises, physical postures, and meditation, practiced for over 5,000 years." For differences between yoga and excercize you may see http://www.mandalayoga.net/index-newsletter-en-exephysi.html. Research I refer to is specifically about how yoga affects depression. Natural123 14:33, 27 October 2007 (UTC)

I have no objections so long as they are properly cited, as Ohnoitsjamie noted, and the information is placed in a proper context. I.e. the information is specifically for people diagnosed with clinical depression, not simply depressive mood and that you note the severity of the depression tested. For example, the Yoga study mentioned seems to have been for patients with depressive mood, not actually diagnosed as having clinical depression, so it would not be appropriate here. AnmaFinotera 20:17, 25 October 2007 (UTC)

Agreed; similarily, chocolate helps depressive mood but not clinical depression. Anarchist42 21:12, 25 October 2007 (UTC)

That is a good distinction. These sources are about clinical (unipolar, major) depression

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)

Please review the WP:VERIFY policy and the reliable source guidelines to help you in determining what is or is not a good source. While the two links from NIH are good, the one you give for Computer-assisted psychotherapy does not meet the requirements for use, nor does the one you gave earlier for the differences between yoga and exercise. AnmaFinotera —Preceding comment was added at 18:38, 27 October 2007 (UTC)

Computer-assisted psychotherapy link may not meet the requirements, but it is a good compilation of reliable sources. Natural123 21:35, 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?

Because MAOIs are already mentioned. No need to repeat. AnmaFinotera (talk) 06:54, 17 November 2007 (UTC)

Bupropion is not an MAOI or an SSRI. It isn't mentioned at all. —Preceding unsigned comment added by 147.9.33.241 (talk) 07:52, 26 November 2007 (UTC)

I stand corrected, and have added it :) AnmaFinotera (talk) 09:01, 26 November 2007 (UTC)

Massive Lack of References

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)

Yes, we are aware of it. The entire article is in need of clean up, which is being worked on by myself and at least one other editor, including rewrites and sourcing. It is a huge article, however, so it is taking some time. AnmaFinotera 14:08, 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)

Removed phrase 'probably influenced by a combination of genetic and biological factors'.

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)

Cranial electrotherapy stimulation

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)

Paul gene (and possibly others) have deleted the section I've added. Paul's rationale: "not a single double-blind study for clinical depression has been conducted." This is quite possibly the single most ridiculous edit I've ever seen. So, Paul, you're saying that "Hypnotherapy" has been shown effective in double-blind trials? And "Acupuncture"? And "Self-Medication"? And "Herbal and dietary supplements"? And "Transcranial magnetic stimulation"?--Lode Runner (talk) 06:40, 30 November 2007 (UTC)

Also, an FYI--I am not affiliated with AlphaStim (used a PDF hosted on their site 'cause it was a first relevant hit I came across. The article is from the Journal of Neurotherapy), nor any other CES company, nor have I even had a opportunity (yet) to use one myself. I am simply somewhat annoyed that there seems a concerted effort to ignore (and now actively censor) one of the few non-drug FDA-approved depression treatments. --Lode Runner (talk) 06:48, 30 November 2007 (UTC)

Your view that there is a concerted effort to ignore or censor non-drug treatments is not accurate. If that were true, the entire alternate treatment section would not exist. Proven, well sourced additions are welcomed. Unproven, sketchy additions with only one questionable advertising oriented source are not.AnmaFinotera 01:40, 1 December 2007 (UTC)

Ok, then why don't you delete hypnotherapy? (It only has a "sketchy" looking pop-sci book as a "source" for the backing studies. The other source is only cited as saying that hypnotherapy is an "alternative") My CES paper, on the other hand, looks professional, is detailed and has references to other studies and papers you could check out if you so desired. And I'm adding more links that confirm pretty much everything the first source says (see below.) --Lode Runner 03:50, 1 December 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)

The current supporting source for this chapter is a promotional material and is not acceptable. You have to find the direct reference to the corresponding FDA document. The most recent (2007) review written by one of the promoters of CES lists all the studies conducted previously. Most of them are for neurological disorders (plus addictions) and depression comorbid with those disorders. Not a single double-blind study for clinical depression has been conducted. The double-blind study is a must for depression treatments because of the high rate of placebo response. Paul gene 00:32, 1 December 2007 (UTC)

Sorry, but you are not the end-all arbiter of what is and is not acceptable. Your statements contradict the paper--while (perhaps) biased, I see no reason to think that the paper is spreading outright lies. The paper provides the name of a meta-study that listed 126 CES studies, "most of which were double blind." If it comes down to your word vs. the word of a doctor quoting a specific paper by name (even a possibly biased doctor), I will take the doctor's word, thank you very much. Also, I have plenty of links that confirm what the first paper says (see below); where's your source that contradicts it?--Lode Runner 03:43, 1 December 2007 (UTC)

You are wrong. Please see the WP policy on reliable sources: "Articles should rely on reliable, third-party published sources with a reputation for fact-checking and accuracy. Sources should be appropriate to the claims made. The material has been thoroughly vetted by the scholarly community." Websites, advertisements, catalogs are not reliable sources, even if they are written by a doctor. Paul gene 05:48, 1 December 2007 (UTC)

Websites aren't reliable sources? Well, then, why don't go you try to delete 75%+ of Wikipedia then, because that's the most commonly used source out there. I'm sorry I don't have subscriptions to prestigous medical journals--I'm serious, it'd be nice to have access to journals for situations such as this. But I don't, and the websites I've found are all excellent preliminary sources. --Lode Runner 05:57, 1 December 2007 (UTC)

Although the Journal of neurotherapy to which LodeRunner's reference points claims to be a peer-reviewed journal, I have some doubts as for this journal being a reliable source as it is not listed in PubMed. Journal of neurotherapy also is not indexed in the , which provides citation indexes for 7500 scientific journals. Citation indexes serve as a proxy for the journal's influence and could be used to establish as to how influential and reliable the publication is. Unfortunately, Journal of neurotherapy is not there, which suggests that is not a very reliable publication. Paul gene 01:19, 1 December 2007 (UTC)

Don't care. Their opinion trumps an anonymous editor's opinion. If you want to find a more reputable source that contradict them, feel free (and I'm not being an asshole here, I'm serious--if CES has little real research behind it, I'd be very interested to know), but the onus is on you. Also, I'm currently compiling a list of supporting links (see below)--Lode Runner 03:43, 1 December 2007 (UTC)

You are wrong. Please see the WP policy on reliable sources: "Articles should rely on reliable, third-party published sources with a reputation for fact-checking and accuracy. Sources should be appropriate to the claims made. The material has been thoroughly vetted by the scholarly community." The Journal of Neurotherapy has zero reputation in scientific community, as evidenced by its absence in PubMed and Thomson's Scientific Journal of Citation Reports.

This isn't listed as being a mainstream, well-researched treatment. It's being listed alongside treatments such as "hypnotherapy", which have never received any positive reviews in any prestigious journals. The arguments you are giving me apply to the other treatments listed as "Other" (e.g. "alternative") 100000x more than they apply to CES. Also, no where does it say that every single source must have come from a source with widespread scientific reputation. A common newspaper article has 0 scientific reputation, and yet I've seen them used as preliminary sources plenty of times. --Lode Runner 06:01, 1 December 2007 (UTC)

Agreed, on both counts. This section has no place in the article if more legitimate sources can not show that it has actually been studied very specifically for clinical depression. That study can not be considered a reliable nor legitimate source when the study was conducted by the manufacturer of the CES devices and, so far, no good quality studies are being presented to back up this one's claim. My quick searching finds no one even publishing this study except sells and makers of CES devices. AnmaFinotera 01:40, 1 December 2007 (UTC)

Then I propose the entire "Other Treatment Methods" section be deleted, with a few exceptions. I don't know how you can say with a straight face that CES has no place in the article, but crap like hypnotherapy and "herbal treatments" does. --Lode Runner 03:43, 1 December 2007 (UTC)

I disagree with AnmaFinotera about the study not being legitimate "when the study was conducted by the manufacturer" - that would disqualify many marketed drugs. The point is there have been no double-blind studies, or even any other properly controlled studies, for clinical depression even by the manufacturer. On the other hand, the data for pain treatment seem to be of a better quality. Paul gene 02:45, 1 December 2007 (UTC)

Unless you have information that the paper I cited is purposefully deceitful, you are spreading lies. According to the paper, there HAVE been multiple double-blind studies, and it gives you the name of a meta-paper that lists 126 studies. And I'm giving you even more links (below) that confirm what the first paper says... --Lode Runner 03:43, 1 December 2007 (UTC)

• CES has not been approved by the FDA in the conventional sense of that phrase, that is approved as safe and efficient for the treatment of a certain disorder. The FDA approval of CES devices is based on a legacy waver, because sufficiently similar devices had been marketed before 1976, when new regulations requiring controlled testing of medical devices were introduced. As a matter of fact CES devices are classified by the FDA as the class III devices - "devices for which insufficient information exists to assure that general controls (Class I) and special controls (Class II) provide reasonable assurance of safety and effectiveness" - see http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?FR=882.5800 http://www.fda.gov/cdrh/ode/515iltr.html. Paul gene 02:59, 1 December 2007 (UTC)

Regardless, only one or two of the methods listed under "Other Treatment Methods" have received any FDA approval at all. Or am I wrong--has even St. John's Wort (one of the more popular and backed-by-research "herbal" options) received any level of FDA approval? And many/most of them haven't been subjected to double-blind studies (unlike CES, which HAS.) Why are you singling out CES for deletion from the article?

Thanks for the explanation of class III, though, I was wondering about that.

--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)

• First, we are talking about CES not stjohns wort or hypnotherapy. If you cannot find the evidence that the treatment has been approved by FDA you should remove at should remove at least that part. Second, just give me ONE DOUBLE-BLIND TRIAL FOR CLINICAL DEPRESSION SPECIFIC QUOTATION. I do not need "tons" and "many". I do not fault you -- the problem is that the individuals promoting the CES devices tend to misrepresent the facts, for example, claim the treatment to be FDA-approved when it is not, or that there have been "many" double-blind studies for depression, while there have been few, and those were for depression related to pain or alcoholism or caused by drug withdrawal. But not for the CLINICAL DEPRESSION, which is what this least that part. Second, just give me ONE DOUBLE-BLIND TRIAL FOR CLINICAL DEPRESSION SPECIFIC QUOTATION. I do not need "tons" and "many". I do not fault you -- the problem is that the individuals promoting the CES devices tend to misrepresent the facts, for example, claim the treatment to be FDA-approved when it is not, or that there have been "many" double-blind studies for depression, while there have been few, and those were for depression related to pain or alcoholism or caused by drug withdrawal. But not for the CLINICAL DEPRESSION, which is what this article is about.

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'm merging CES with the rTMS section. Lode Runner is right in that all such protoscience techniques should be dealt with together. Regards, Ben Aveling 20:16, 1 December 2007 (UTC) PS. Twelve subjects does not constitute a reliable study.

I disagree with how it's written now. "There are unproven and unsupported claims"--I don't think that existence of multiple double-blind studies (some of which involve as many as 80 subjects) constitutes an "unsupported" status. "Unproven", yes. Also, twelve subjects can indeed constitute a reliable (if not exhaustive) study when dealing with involuntary measurements (as contrasted to patient surveys), if you take the proper statistical precautions. Unless you have information that the clinph-journal paper did not take proper precautions, you do not have a right to dismiss their study of involuntary EEG readings. Therefore, I am re-instating that line and removing the word "unsupported." For now, I will not re-instate the line that states "some researcher's" opinion of CES vs. SSRIs, since (upon reconsideration) it may give them undue weight. I do, however, think that the double-blind studies should be mentioned, if for no other reason than so many people here actively denied that they have taken place.

A Reminder to Everyone: This is not Citizendium, and no one here has claimed to be a scientist. If you want to question the validity of a study, it will take more than your own personal opinion to have it removed. Paul's observation was that the scientific journal some of the papers were published in apparently isn't a mainstream one--that's a good start, but still insufficient to justify removal of a source. Ben's justification--that he doesn't think 12 subjects in the clinph-journal study is enough--isn't valid at all. If you think that's a flaw in the study, you can apply to be a peer reviewer and critique it there. --Lode Runner 22:18, 1 December 2007 (UTC)

Edits made. I have no problem with strong language emphasizing the lack of real evidence--I even said "to date there exists no consensus or even prospective clinical trials to support its use", which isn't even supported by the sources per se--I had to do a bit of assuming and extrapolation of multiple sources to arrive at this tentative conclusion. But, I don't mind a little bit of license taken, so long as we clearly outline the evidence that supports CES efficacy and apparent mechanism of action (clinph-journal study). --Lode Runner 22:32, 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)

The discussion does indeed belong on the talk page. It does not belong in the article, nor has one taken place in the article. The "unsupported claims" you are removing are supported by half a dozen sources. They are relevant as a VERY brief explanation of the device's function and its scientific basis. If you dispute their applicability, explain. If you dispute their authority, provide a source that casts doubt on their authenticity. If you remove sourced information again without explanation, you will be treated as a vandal. --Lode Runner 02:03, 2 December 2007 (UTC)

For comparison, see how in-depth Light Therapy is explained, or drug therapy, or psychotherapy, or electroconvulsive therapy. CES is not overly long or detailed and most of the details present are actually anti-CES instead of pro-CES (UNLIKE most of the other therapies mentioned.) --Lode Runner 02:09, 2 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)

There have been no double-blind trials of CES for clinical depression

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)

I'm sorry, but that's NOT how it works. If there haven't been any controlled studies, then you must find a source that says that. Your (or my) inability to find a source that says there has been a controlled study does not mean you can claim, without sources, that there have never been any. --Lode Runner 17:11, 2 December 2007 (UTC)

Also, we need to take care not to devolve into (as Ben previously, but prematurely, warned) a very lengthy discussion of pros and cons in the middle of this article. The full analysis should be reserved for the cranial electrotherapy stimulation article. In particular, I think that discussion of specific trials is inappropriate; rather, the results over all the trials should be summarized.

I also have a major problem with your specifying, in detail and with quotes, each and every negative study and not mentioning any of the positive studies.

Re: the results from the studies, I am looking into this further. If what you claim is true, then some of the papers I've listed are severely misrepresenting those studies. In the meantime, I'm adding a disputed tag to the section. There are way too many people here out for blood for me to accept any of this at face value. --Lode Runner 17:19, 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:

The threshold for inclusion in Wikipedia is verifiability, not truth. "Verifiable" in this context means that any reader should be able to check that material added to Wikipedia has already been published by a reliable source. Editors should provide a reliable source for quotations and for any material that is challenged or is likely to be challenged, or it may be removed.

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)

We are all aware the article is in need of massive clean up. Efforts began, but I know I've personally been side tracked a bit, and other editors get to deal with things like this CES instead of the article clean up needed. If you look back on the article history, however, you will see where clean up started. I personally was working from the top down and got through the intro and diagnosis. You are wrong, however, about not including treatments. A section on treatment is appropriate and important per the medical article MOS. Once the clean up is done, if the treatment section is still extremely large, it will probably be split off into a subarticle, but first it all needs cleaning. I don't think anyone is arguing that the treatment section as is now is perfect (see previous convos as well), but it doesn't make the cleaning up any easier if inappropriate material continues to be added to the article unchecked. AnmaFinotera 20:42, 2 December 2007 (UTC)

You misunderstand. Paul isn't saying "these studies didn't have controls"--he's basically saying "NO ONE HAS EVER DONE A CONTROLLED STUDY, EVER, IN THE HISTORY OF MANKIND." I agree, the former claim doesn't need a source--we merely need to observe the studies and report whether or not they have controls (incidentally, I haven't yet confirmed Paul's assertion that none of them do.) The latter claim most definitely requires a source. At first he didn't have a source at all--but now, he's relying one of the papers he previously dismissed as unreliable. Basically, he's saying that this formerly-unreliable paper now represents a definitive compendium of every single CES/electrosleep study done in the past 50 years, and we can therefore infer that, since no controlled study is mentioned, no controlled study has ever been done.

This strikes me as being just a WEE bit hypocritical. I'm pretty sure it's a clear violation of good faith (WP:FAITH) to use a source you previously dismissed as unreliable (when being used to support the addition of information you don't want to see inserted) as a very sketchy proof-by-omission source for the exclusion of similarly unwanted (by Paul) material.

Re: treatments--they should be mentioned... either in this article or in a spin-off article (e.g. Treatment of Depression). And the "voodoo" methods can be mentioned, so long as there is evidence of use and all disclaimers and negative scientific findings (and/or lack of conclusive study) are mentioned. --Lode Runner 20:07, 2 December 2007 (UTC)

A citation that is poor for one purpose (demonstrating that CES works) may be perfectly good for another purpose (demonstrating that there is little to no evidence that CES works). Even if there are a few studies showing that it works, medical science doesn't really work like that. Individual studies, even when done properly, can return strange results sometimes. New theories, to be accepted, generally require repeated independent studies returning broadly consistent results. If we can't find any evidence of that, then that is fairly clear evidence that there isn't much to find. One confusing factor is that a large number of patients will recover under any treatment, or no treatment, and even more will recover if given a placebo treatment. So it's easy to be fooled into thinking that a treatment is working, because it is getting good results. The question is, are these results demonstrably better than than a placebo would be?

I agree that there should be a treatments section, and that it should mention CES. I just think that the CES part is about 3 times as long as it should be.

And Lode Runner, there's no need to accuse anyone of hypocrisy and no reason for shouting; you have your own reasons for believing in CES and we have reasons for believing that it doesn't. Regards, Ben Aveling 22:36, 2 December 2007 (UTC)

I don't "believe" in CES. I've never used one. I have never known anyone that's used one. I simply want some semblance of objectivity here. It's taken quite a bit of legwork on my part to even get to the point where people acknowledge that we should even have a CES section.

Some of the things that Paul has come up with has been useful (class 3 info, links to individual studies) and I have thanked him for that on at least one occasion. I have re-read the meta-paper, and found that I linked to the wrong study (Passini--possibly the ONLY study that showed no benefit. It is discussed at greater length in the meta-paper.) Instead of Paul saying "these studies aren't sufficient", he has proceeded to declare victory and declare a falsehood in large, section-title letters (see below.)

Finally, I must object in the strongest possible terms to your bizarre reasoning that a source cannot be used--in a literal, direct-quote fashion--to support CES, yet can be used in a weasel-y, proof-by-omission fashion (again, these devices have been around for at least 40 years so that's a LOT of papers that could have potentially been missed in the overview) against CES.

As far as small-scale studies not really working like that--I fully understand. But if the meta-papers I linked to early on are truthful (and yes, they very well could be biased) then the positive indicators do outweigh the negative indicators, and thus the potential is there. Without major trials, I might estimate it to be only a 20% potential...I really wouldn't be surprised at all if it ultimately turned out that CES wasn't a good idea. Again, I am not pro-CES--I am pro-objectivity. --Lode Runner 23:00, 2 December 2007 (UTC)

Another study

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)

Please don't accuse people of lying. He, or I, or you or all of us may be wrong. I don't believe anyone here is lying. Regards, Ben Aveling 22:38, 2 December 2007 (UTC)

He linked to a double-blind study that measured depression. He then proceeded to call his section "There have been no double-blind trials of CES for clinical depression". I'm sorry, that is a lie. (The non-lie version, if his assertions are correct, might be something like "the two double-blind studies I've bothered to read show no statistically significant link") I might be willing to be charitable and call it an oversight, except that he repeated the same lie multiple times earlier, and has engaged in other bad-faith activities as detailed above. He has repeatedly removed sourced material and inserted his own POV unsourced material. He treats sources as worthless when they're used for positions he disagrees with, then turns around and treats them as golden (worthy of proof-by-omission) when he can use them for his own positions. Now he's taken one of his older fabrications and repeated it again as a large, visible section title.

I see no reason to give him the benefit of the doubt.--Lode Runner 22:45, 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)

Article problems

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)

Um, the entire first part of the article is properly sourced from current materials from experts in the field, and was, in fact, fairly recently redone. A physical exam is what is supposed to be done before the presumption of depression. Unfortunately, not all doctors bother, and if you've had it for 40 years, its doubtful you would have the same experiences as someone who has never been to a doctor. And yeah, some doctors just plain suck. But one of Wikipedias core policies is neutrality and another is verifiability. This article, as all others, strives towards that. Now, if you can find reliable sources that totally dispute the opening sections, by all means, post them here and they will be evaluated and the article updated accordingly. AnmaFinotera (talk) 17:30, 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)

Not quite, we are here to report VERIFIABLE reality. Find a reliable source that says that most patients are not being given medical exams, then it should be included. Anecdotal evidence is not enough, however, to just remove verified, cited notes on what the proper procedure should be from a very reliable source. If we used anecdotal evidence to modify the articles, I could write a whole section on self-treatment, but that, like all anecdotal evidence, is just original research, not to mention irresponsible. AnmaFinotera (talk) 20:28, 16 December 2007 (UTC)

I never said we should use my anecdotal-only evidence. If many people have the same anecdotal evidence, though, it's a sign that we should look for an actual source to support it.

Regardless,it's a misrepresentation of the source to say that "physicians WILL" do blah blah blah. This implies it's a common and/or required procedure. The exact quote is "A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests." Can, not will, and for that matter the Mayo Clinic isn't (to my knowledge) an authoritative or policy-setting source. I'm editing the article accordingly. --Lode Runner (talk) 22:28, 16 December 2007 (UTC)

No we do not have to report reality. WP:verifiability:"The threshold for inclusion in Wikipedia is verifiability, not truth. "Verifiable" in this context means that any reader should be able to check that material added to Wikipedia has already been published by a reliable source. Editors should provide a reliable source for quotations and for any material that is challenged or is likely to be challenged, or it may be removed."

The publication in question is a reliable source because it is an academic publication, published by NIH. It is vetted by several experts ("This brochure is a new version of the 1994 edition of Plain Talk About Depression and was written by Margaret Strock, Information Resources and Inquiries Branch, Office of Communications and Public Liaison, National Institute of Mental Health (NIMH). Expert assistance was provided by Raymond DePaulo, MD, Johns Hopkins School of Medicine; Ellen Frank, MD, University of Pittsburgh School of Medicine; Jerrold F. Rosenbaum, MD, Massachusetts General Hospital; Matthew V. Rudorfer, MD, and Clarissa K. Wittenberg, NIMH staff members. Lisa D. Alberts, NIMH staff member, provided editorial assistance."). Therefore it qualifies as a reliable source according to a WP policy--WP:RS: "Reliable sources are authors or publications regarded as trustworthy or authoritative in relation to the subject at hand. Reliable publications are those with an established structure for fact-checking and editorial oversight. In general, the most reliable sources are peer-reviewed journals and books published in university presses; university-level textbooks; magazines, journals, and books published by respected publishing houses; and mainstream newspapers. As a rule of thumb, the greater the degree of scrutiny involved in checking facts, analyzing legal issues, and scrutinizing the evidence and arguments of a particular work, the more reliable it is."

On the other hand, if you can find a publication, which states that most GPs do not perform physical examination before prescribing antidepressants, go ahead, put it in there. However, I disagree with your, Lode Runner, reading of the NIH guide. That's what it states: "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. A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective." Paul gene (talk) 03:03, 17 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)

Regarding the "civility" of the above post--I find it much more offensive to spam someone with paragraph after paragraph of irrelevant rules quotes than it is to indirectly call someone "delusional". I'm sorry, but I have been more than patient. It's become clear that Paul isn't interested in any objective balance at all--he prefers, instead, to remove sourced material to fit his own points of view and lecture people on the rules of Wikipedia, even when he's the only one who has violated said rules.

I don't have a major problem with this last edit, Paul, but you should really think about simply making it and explaining why the source supports the change, instead of giving a condescending and erroneous lecture about how you are absolutely and objectively in the right and I am in the wrong. Given your biased and rule-breaking behavior re:CES devices, I'm not inclined to cut you much slack, and we don't need the extra clutter on this talk page. --Lode Runner (talk) 03:01, 18 December 2007 (UTC)

References problem

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. --Kyoko 21:22, 19 December 2007 (UTC)

Fixed. There was an open ref tag at the end of the sentence with no content and no closing ref, so it was basically attempting to throw the whole rest of the article into a footnote :P AnmaFinotera (talk) 21:51, 19 December 2007 (UTC)

Where do we put Styron, Solomon

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)

Merge from Depression and natural therapies

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)

Agreed. No reason to have that seperate at all. AnmaFinotera 17:38, 4 October 2007 (UTC)

Keep these articles separate but have them interlink better. Currently, Clinical depression doesn't link to this article, for instance. There seems to be enough info here to justify having a separate article. That being said, Depression and natural therapies should be expanded perhaps to discuss in greater detail the history behind using natural therapies to treat depression. I think that would certainly make the article even more encyclopedic. (Based on the thread just above, this article already seems to be pushing the file size threshhold. Merging would certainly cause a size issue.) -- Levine2112 ^discuss 17:31, 10 October 2007 (UTC)

If going with separate articles, then wouldn't it better to have the entire treatment section as a separate interlined article rather than just the natural therapies aspect? AnmaFinotera 21:12, 11 October 2007 (UTC)

Exactly. Then we don't have the povfork issues. --Ronz 21:15, 11 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)

It appears to be a POV fork, whether that was the actual intention or not. For whatever reason, you did not add it to the main article, but instead created a new article that that only discusses "natural" therapies with no clear definition of what "natural" is except that it isn't anti-depressants. The list could quite easily and snuggly fit into the main from the get go, which would have served to improve the original. If you felt the article was already too large (though other articles about medical issues are just as long if not longer), then the better option would be a separate treatment page all together. Instead, you made no attempt to contribute to this article, but created a page that focuses only on the treatments of interest to you. To me, that is very much a POV fork. AnmaFinotera 14:12, 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)

Sydney is a country, not a medical condition and those are not POV forks. The natural therapies article is not a seperate aspect moved, it is a POV fork and will be merged. After the merge, and the during the clean up discussed below, if appropriate, neutral sections will be broken out covering ALL treatment options, not just your fork. AnmaFinotera 13:38, 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)

Absolutely no need for merge as page is already 63k long! We should be looking to split articles off this one not merging it... Johnfos (talk) 01:37, 3 January 2008 (UTC)

Three months have passed and there is no consensus to merge, so I'm removing the tag... Johnfos (talk) 01:00, 5 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)

What should be done

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)

While I agree, in theory, that the Treatment section could likely support being a sub-article, I think this article as a whole should be fixed first. Some fixes were done to the first bit, but the majority of it has problems with sourcing, neutrality, etc. With the article as a whole in better shape, then we can better evaluate if one (or even two) sub-articles might be needed. Otherwise, we'll just have the same problems in two places instead of one. As for the potential of massive detailed analysis on some stuff, if there is enough information to support that kind of thing (like CES), then it should be in its own article with the depression article briefly mentioning its releveance specifically here with a main link at the top of that section. I disagree with your categorizing Paul's work as sabotage efforts. As this article deals with a medical topic, it is vital that we are especially vigilant about the sources being used so as not to present misinformation. While Wikipedia is, of course, not a medical text, people will look here and read what's in the article and may very well act on it. So that what is here is verifiable and well sourced are of extra importance. AnmaFinotera (talk) 10:34, 6 January 2008 (UTC)

Please, do me a favor: Stop lecturing me on the rules of Wikipedia. I am not violating them. I am not suggesting we violate them. Paul, in fact, is the only one who has violated them--he has repeatedly misrepresented sources (WP:V), removed sourced material (WP:OR, WP:UNDUE), and used untruthful phrases (WP:VAN).

If I seem a little sensative about this, it's because the tactic is getting old. On this page alone I've been subjected to it like a half dozen times already. Don't like what someone is saying? Just link to the WPs, repeatedly, at every opportunity, even if they don't apply to the current situation, and just hope you wear them down.

I have never argued for anything other than good verifiability. On the other hand, Paul has repeatedly removed my SOURCED material and inserted his own erroneous interpretation of a source that he didn't even believe was authoritative to begin with (he argued it shouldn't be used at all), but now claims it's a comprehensive overview of every CES study done prior to 2003, and thus can be used as a proof-by-omission. He's also repeatedly edited the section to claim that there is only "inconclusive and negative" studies, when in fact most studies in the sources show at least a small positive outcome, with several showing major positive effects. There's an entire paragraph devoted to negative-outcome studies right now, even though the sources I've given clearly show that they are the minority.

The statements in the article should represent reality, period. To this end, I have written and supported the inclusion of anti-CES material (e.g. "to date there exists no consensus or even prospective clinical trials to support its use") as well as pro-CES material. Paul has never once written or supported anything remotely pro-CES, and I believe every pro-CES line currently in the article has been COMPLETELY REMOVED by Paul at least once. Even in their CURRENT form, he's loaded them full of inane disclaimers such as "according to the authors"... what the hell? OF COURSE it's "according to the authors". You could put that disclaimer after every single source in Wikipedia.

This is turning into a rant, sorry, but it's imperative that people understand how insidiously and relentlessly POV his edits have been, and how cynical and hypocritical his rationalizing has been. You weren't exactly openminded yourself, but I suppose this can be for the benefit of others. This is what Paul said about the first source I found:

The current supporting source for this chapter is a promotional material and is not acceptable.

(I don't think he is referring to *precisely* the same paper, but he makes the connection between them himself a little later on. Says they're basically the same, and the criticism applies to both.)

He also said:

...is a link to a promotional brochure, and not a peer reviewed publication so it is not very reliable.

He never once wavered--he REPEATEDLY said that this source was untrustworthy. Then, a little later, he apparently decided (without explanation) that it was a 100% comprehensive paper, and used it as proof-by-omission that no other studies have been conducted: According to a 2002 review, there have been no controlled trials of SES for clinical depression as a primary diagnosis. This is a lie. The paper makes no such claim. I called him on it, removed the passage, explained that proof-by-omission isn't strong enough to make such a boldfaced claim (at best, it's WP:SYN--which is forbidden), and he reverted my edits anyway. I believe there was another edit-revert exchange before I gave up. I just now removed the passage once again--let's see if Paul re-inserts his old lie yet again. --Lode Runner (talk) 13:44, 6 January 2008 (UTC)

Please check your temper and reread what I wrote (and if you are noticing that you are ranting while posting, why not just step away from the keyboard and calm down first). Ranting doesn't help and I wasn't lecturing you. I was primarily offering my view on the discussion you started, including my view that before we look at splitting, we clean the article as a whole and pointing out the issues with the article that I see. I wikified stuff because other people will read this discussion and some of those folks may not know much about that, and personally I like quick links whenever anyone refers to a policy or guideline in case I want to check it in light of the discussion. I also gave a one sentence (apparently ill placed since you focused almost entirely on that) saying that I disagreed with your assessment of Paul's actions. I get you vehemently disagree with Paul's actions, but I'd rather this discussion actually stay focused and not get into yet another argument with no resolution. This is an extremely important article and it needs attention, not editors bickering. AnmaFinotera (talk) 14:05, 6 January 2008 (UTC)

I was in the middle of clarifying my annoyed tone when you replied. I do not need you to tell me to calm down, nor spam me with WP links. Suffice it to say, I'M AWARE OF THE RULES OF WIKIPEDIA. I've already been reminded of them in a very long-winded fashion on this very page. I find it *at best* extremely condescending to link to the WPs at every opportunity, even (or especially) when they don't apply. It's a non-sequitur. It basically allows people to sidestep the issue and blow off everything you say.

If you meant it sincerely then I apologize for my tone, but I strongly urge you to ditch the habit. I am innately distrustful of anyone who needlessly spams WPs. And, if you'll care to note, I didn't "focus almost entirely on" that one sentence. In fact, before I added the clarification, it only had one very short (3 sentence) paragraph. --Lode Runner (talk) 14:15, 6 January 2008 (UTC)

Can you take this side discussion somewhere else please? I'll happily participate. --Ronz (talk) 21:09, 6 January 2008 (UTC)

I agree with the proposal for Treatment of Depression. It will remove the problems with the pov fork, and greatly reduce the size of this article. --Ronz (talk) 21:11, 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)

The problem with separating the treatment of depression into a separate article is that the treatment parts in the main Depression and Treatment of depression articles will soon get out of sync. This will require constant updating and watching. Then there will be challenges to the treatment parts of the Depression article from the people who did not read the specific Treatment of depression. The literature references will then have to be duplicated, etc. I do not really see the necessity of getting into this unholy mess. The Depression article (64 kB) is not so big and is not pushing any limits. For comparison, the length of the following medicine-related featured articles is: Aids – 115 kB; DNA -86 kB, Schizophrenia-96 kB; Autism – 85 kB; Influenza – 84 kB. For the reader it is also convenient to have the disorder and the treatment in one place. Paul gene (talk) 04:30, 9 January 2008 (UTC)

Agreed. You said it better than I could figure out how to say. :) Thanks for the examples. Medical and health related articles, I think, are going to lend themselves to being fairly lengthy because we want to give the topics thorough coverage (and they also tend to have some of the the hugest amount of resources). I'd much rather see us focusing on cleaning up this article than having to deal with the issues of maintaining two articles. AnmaFinotera (talk) 04:35, 9 January 2008 (UTC)

Genetic Research Study

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)

No it would not be appropriate. We do not link current or on-going medical studies. AnmaFinotera (talk) 19:33, 9 January 2008 (UTC)

Thanks. Can I ask why not? 171.65.2.53 (talk) 19:45, 9 January 2008 (UTC)

It doesn't fit the external link guidelines, and it would go against Wikipedia's neutrality policy. Wikipedia articles are not intended to be a collection of links nor an advertisement service. Study results, published in reliable, notable media can be used as references for articles, but an active study seeking participants does not add to the encyclopedic value of the article. AnmaFinotera (talk) 19:49, 9 January 2008 (UTC)

Evolutionary Advantages...

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)

You are probably right. I tried before, but I found it hard to even summarize the main article. It seems like a fringe theory and someone personal essay with sections tossed it. I debated whether it belonged at all (and am still debating AfDing it as a fringe and being unnotable).AnmaFinotera (talk) 07:44, 9 February 2008 (UTC)

I have added an example - psychic pain - and cited how such theories may be useful in counselling. Colonel Warden (talk) 17:50, 10 February 2008 (UTC)

Causes

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)

I don't think that would be an appropriate addition. It reads very much like a term paper, and seems to be based primarily around a single person's research. Are the references you mentioned all from his own work or do others in the medical community back up his theories? Also can you post the references here as well so it can be properly evaluated? AnmaFinotera (talk) 00:57, 8 January 2008 (UTC)

Where are the references? --Ronz (talk) 00:59, 8 January 2008 (UTC)

Here is the reference: Gerald C. Davison, John M. Neale, Abnormal Psychology, 8th edition, pages 247-250. 2001, John Wiley & Sons, Inc.--Luke (talk) 01:30, 8 January 2008 (UTC)

I think that it will be a good addition, because it tells some more about the causes. If no one says no, I will add it by January 12 --Luke (talk) 01:35, 8 January 2008 (UTC)

You've already had one no and one asking for a reference. Do not add unless you have a consensus of support. AnmaFinotera (talk) 03:44, 10 January 2008 (UTC)

AnmaFinotera, no one said no. You asked me some questions, and I have rewritten the passage to address your concerns. And why shouldn't it be added? Is their any good reason, or simply your whims? --Luke (talk) 04:20, 10 January 2008 (UTC)

Okay...let me clarify. In saying I didn't think it was appropriate, I was saying no it should not be added. It is not an appropriate addition. It reads like a term paper (which from our earlier conversations, I presume is at least part of), not an encyclopedic reporting of neutral, verifiable information from reliable sources. I also don't see what new information it would be adding to the existing causes section. Wikipedia is not the place to publish your original research or writing. It has nothing to do with "my whim" but Wikipedia policies and guidelines. AnmaFinotera (talk) 04:52, 10 January 2008 (UTC)

It's not an original research paper, chap. All the material came out from the book I referenced. And none is my individual and original research; I'm 17, in high school, and cannot possibly find new theories in psychology. The book is very verifiable and accurate. My passage will surly add information; the current article does not include any such information. Your argument makes no sense because none of it is true. Thanks. --Luke (talk) 05:02, 10 January 2008 (UTC)

The article has a rather large causes section. What specifically in your piece is not already covered there? As I said, it reads just like a high school a term paper and is not of an appropriate tone for a Wikipedia article. You never answered my earlier question as to whether the author's theories have been supported by other researchers or in other reliable sources? If not, it is a WP:FRINGE theory, and doesn't really need such a lengthy mention. AnmaFinotera (talk) 05:27, 10 January 2008 (UTC)

May I suggest a compromise? Beck's theory is certainly not a fringe theory, and it actually served as a basis for development of cognitive behaviour therapy, which as we know works. However, in keeping with the general summary style of the article, it would help to simplify the theory description, and to keep it to 100-150 words. (Nice work on that has already been done in the CBT article. Maybe you could just extract information from there?). What would also be interesting to see is the link to practical applications (CBT) and experimental work which has been done to confirm the theory (another 100-150 words, perhaps). If your textbook does not have any references to that you should probably dump it. Paul gene (talk) 11:38, 10 January 2008 (UTC)

How about this? Let's stop focusing on THEORIES and focus more on FACTS. Prowikipedians (talk) 10:25, 19 March 2008 (UTC)

Nutrition

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)

AGREED. Nutrition and such factors DO play a role in Clinical Depression. Must be mentioned. Prowikipedians (talk) 10:21, 19 March 2008 (UTC)

Listing bulletpoints

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)