Misplaced Pages

Talk:Major depressive disorder

Article snapshot taken from Wikipedia with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.

This is an old revision of this page, as edited by Bodnotbod (talk | contribs) at 22:50, 4 June 2004 (→Complementary and alternative therapies: Need help here from someone who knows about licensing laws and whether "unlicensed medicine" = "alternative medicine".). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Revision as of 22:50, 4 June 2004 by Bodnotbod (talk | contribs) (→Complementary and alternative therapies: Need help here from someone who knows about licensing laws and whether "unlicensed medicine" = "alternative medicine".)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)

Right, SE. Watch and learn as I incorporate your opinions into the text. -- The Anome

The first edit: my first para goes, except for two sentences which drop down lower (and are phrased in non-dogmatic terms that can be backed up by cites if you wish). Your correction becomes the first para, except that 'may or may not' becomes 'often'. Here endeth the first edit. -- The Anome

The second edit: I incorporate your correction re non-loss medical reason into the para above. -- The Anome

The third edit: now your correction is incorporated into the para above, it is no longer needed. So it goes.

Now I have incorporated your corrections into the article. I have

  • replaced my words (or someone else's?) with yours for correction 1
  • incorporated the sense of correction 2 into my text, and deleted the redundant correction

You should now be happy - if not, please tell me why. -- The Anome

This article merges discussion of depression in general and unipolar depression. I'm wondering if anyone else feels it might be better to have one page called "Depression", and another called "Unipolar disorder" or "Clinical depression" or "Major depression" to discuss particulars. -- Ryguasu

I agree that a simplification and rationalization of these topics makes sense. Beans

Here's a link to a useful public domain booklet; material from this can be freely copied into the article: Enchanter

WikiProject Psychopathology started, please feel free to join.

This article, like most of the psychiatry articles on Misplaced Pages, currently basically reads like the "party line" from the DSM-IV, which, while influential, is hardly the only word on the topic. Things that I would like to see eventually included: critical viewpoints that do not accept the "medical model" (Szasz is the most notorious, but there's a wide range); literary connections (van Gogh, Rothko, etc.); controversy over treatment; etc. As with most things relating to the human psyche, it is possible to view depression as simply a biological condition, but this is not the only viewpoint. --Delirium 23:58, Dec 9, 2003 (UTC)

Actually, to keep things manageable, perhaps this article (at clinical depression) should remain a dispassionate exposition of the medical model viewpoints (as dictated by the APA and NIMH, among others), but there should be a more general article as well, exploring varying viewpoints on the condition, literary and artistic connections, the history of "melancholia" and social reactions to it, etc. --Delirium 00:00, Dec 10, 2003 (UTC)
I'd like to say that the medical establishment with regards to depression reminds me of the dentistry establishment with regards to mercury amalgam fillings. The attitude towards depression tends to be that it is purely caused by psychological and genetic factors and is a disease like diabetes, and the way to treat it is with psychoptherapy and psychotropic drugs. The whole biological role in causing and treating depression is not taken very seriously. For example, oftentimes depressed people have deficiency in serotonin synthesis, so that is treated with costly SSRI drugs. Actually treating the biological problem, such as dietary mineral deficiencies or heavy metal poisoning, just isn't cricket. I suppose you could be cynical and say that the medical companies would not make any money that way, nor would the psychologists, and the doctors would turn their nose at making themselves sound like their enemies the naturopaths. For whatever reason, the causes are medically known just like how mecury fillings emit mercury vapour, but people in the white coats are not listening.
That strikes me as a pretty POV stance to take. I agree with Delirium that this needs to be an article without bias, and if bias needs discussing, it can be done in another article on Controversial issues in psychiatric medicine, for instance.

Medical researchers are currently following physiological/genetic approaches to depression with great vigor, both in terms of chemical pathways and genes that modify the operation of these pathways. They are also aware that there is a two-way traffic between psychology and brain activity. One case in point is the work of Stoll et al on the effect of essential fatty acids on depression, which is absolutely mainstream medical research that looks at diet as a crucial factor. You might also want to look at the work on phototherapy for depression, which is also entirely mainstream. -- The Anome 08:22, 18 May 2004 (UTC)

  • You're most definitely on the money with your obsevations. Genetics is almost certainly a factor (as the article notes), and cognitive therapy recognises the role between attitude and brain chemistry. I know that phototherapy is widely recognised as an effective way to treat SAD, and I suspect it would be of benefit in typical depression as well. Considering that normal people feel better in the sunshine than shut up in a dark room, I believe the same applies to the depressed individual. Denni 16:38, 2004 May 18 (UTC)

"About twice as many women as men experience depression, though the gap is shrinking."

Would it be more accurate to say seek treatment for than experience? --bodnotbod 20:55, May 9, 2004 (UTC)


No. Many (if not most) people suffering from depression never seek treatment. Even though they know what they're dealing with, the stigma of having been formally diagnosed is too much for some to handle. Others do not appreciate the serious nature of their illness and choose to live with its symptoms. Experts say roughly ten percent of the population will experience an episode of clinical depression sometime in their lives. Denni 00:38, 2004 May 10 (UTC)

So how are the figures obtained that state women are twice as likely to suffer from depression as men? --bodnotbod 01:53, May 10, 2004 (UTC)

People will discuss it with their doctors, and often, doctors are able to spot depression even when a patient does not realize that's the problem (when you know what you're looking for, it's not hard to tell). Just because a doctor tells you you have depression doesn't mean you'll agree to treatment, any more than if the dentists says you need a root canal, you'll go along with him/her. Denni 04:52, 2004 May 18 (UTC)

parts that need fixin'

  • "Most people who have not experienced clinical depression do not properly understand its emotional impact..." (double negative)
    • A double negative is an issue only when it inverts what the person intends. If I say "I don't got no marbles," I probably mean I don't have any marbles, but what I'm actually saying is that I do have marbles. So don't give me no more argument. Besides, I lost my marbles years ago.Denni 04:42, 2004 May 18 (UTC)
  • "...to the person's own efforts to feel better." So the depressed person makes efforts to feel better, but does not respond to it? is that what that is saying?
    • Yes. Cognitive therapy often focuses in part on what is called "negative self-talk'—"I'm just a loser. I have no friends. I have no reason to live." Therapists ask clients to focus on the positives in their life. Some therapists have their clients keep journals of things like "three things I am grateful for today" or creating and stating affirmations such as "I am a caring, loving person". In major depression, sufferers may see this as just so much feel-good BS, and even though they may attempt it, the negative self-talk wins out in the end.Denni 04:42, 2004 May 18 (UTC)
  • "Because of its intractible nature..." intractible? Please explain what that means and how it applies here.
    • "Intractible", according to my trusty Oxford Dictionary of Current English (I know you would not expect less :) ) means "stubborn or difficult to control". Depression most assuredly is that.Denni 04:42, 2004 May 18 (UTC)

sincerely, Kingturtle 06:24, 11 May 2004 (UTC)

Despite being a double negative it makes sense. Would you prefer it is largely those that have suffered from CD that understand its impact...? Sounds odd to me. --bodnotbod 09:36, May 11, 2004 (UTC)

I think, perhaps, that the section on psychotherapy treatments could be fleshed out a bit, as to how the specific approaches may be employed. Would this be better left as it is, except changed to link to the relavent articles? (I admit I havn't read them as yet...) - Xgkkp

  • I have added links to the various types of psychotherapy. I think they're important enough for stand-alone articles, but I will not commit to writing them. My next job is to see what kind of shape the Bipolar disorder article is in. Denni 04:42, 2004 May 18 (UTC)

Complementary and alternative therapies

I'm showing the reasons for my edits to the complementary and alternative medicine section here. bodnotbod (username added by Denni)

I'm ading my comments as well, in this color Denni
My first reaction on reading what was added was sadness and disappointment. First, the addition is badly flawed in terms of style and composition, and brings an otherwise decent article to a jarring conclusion. Second, it wanders aimlessly in a desert of lower back pain, fish oil, and palliative care, which not only have nothing whatsoever to do with depression but which, in their contexts, come across strongly as excuses for adding this additional component.

There is a strong association between depression and complementary and alternative medicine.

Poorly worded. One interpretation of this sentence is that clinical depression often follows any foray into the world of alternative medicine (perhaps due to the loss of your hard won earnings). I might be tempted to agree with that but I'm sure that's not what is intended. I suggest:

There are complementary and alternative treatments for depression.

Bodnotbod's interpretation of this sentence is how I would read it as well. I would also agree that such an outcome is a distinct possibility.

The strongest connection can be found in complementary medicine which is well known for using palliative care to treat cancer patients. Some research has strongly suggested that treating depression in cancer patients extends both their quality of life and survival duration.

I can't confirm or dispute this, so I'll leave it.

"strongly suggested"? While there may be some benefit to quality of life, it almost angers me to see the implied connection between mood and life extension. May I see citations?

Orthomolecular medicine, a form of alternative medicine, uses nutritional supplements like fish-oil and vitamins B-12 to affect both physical and mental health. Dr. Malcolm Peet of the Swallownest Court Hospital in Sheffield, England and his colleague found that depressed patients who received a daily dose of 1 gram of an omega-3 fatty acid for 12 weeks experienced a decrease in their symptoms, such as sadness, anxiety and sleeping problems. "Vitamin B12 may be causally related to depression, whereas the relation with folate is due to physical comorbidity," say investigators from Erasmus Medical Centre in Rotterdam, the Netherlands.

I've read a few articles on B12 and fish oils myself in the past, it's been widely reported. See for eg . I'm unhappy about having the reference to Orthomolecular medicine, however the article does say that critics state diet alone might be better than huge supplemental doses, which would be my argument. But I can't justify deleting this, I guess.

I see no need to delete the references to fish oils and fatty acids. There is a connection between diet and mood, but there is no need to invoke orthomolecular medicine or alternative medicine when mainstream clinicians accept that diet and mood are related. Please note that mood is only a symptom of depression. It is not the illness itself. And there is, unless Mr. N-H can provide supporting documentation, no evidence I am aware of that either of these treatments addresses the underlying pathology.

The treatment of depression with adjunctive psychological therapy is a well know part of complementary medicine. The Mind-Body or Psychosocial Interventions of alternative medicine are preoccupied with using the power of the mind to affect physical health. Depression has a major effect on both mental and physical health. Researchers have mapped what happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form of psychological treatment aimed at breaking the bad habits of thought that bring people low. Using cognitive behavioral therapy to treat the medical condition called clinical depression is a form of alternative medicine.

I'm deleting this paragraph since therapy has a section of its own which includes CBT which I don't feel is commonly regarded as an alternative therapy. I've never heard of alternative therapy or complementary medicine being used in the same breath as CBT. And I'm undergoing CBT and have been encouraged by my therapist to read about it, so this isn't just an idle objection.

I just love how people reason, I am not aware of it so it obviously is not true. I got the same response in alternative medicine. Well it is in alternative medicine along with some citations. I want most of this paragraph back as it is really the most important link. -- John Gohde 08:31, 4 Jun 2004 (UTC)
OK. So we have a legitimate debate. The question being is: is CBT alternative medicine? You've pointed me to the article alternative medicine which has a lot of citations. I'd be grateful if you'd put the link or links to the specific citations here so that I can see them. I say this with genuine interest. --bodnotbod 22:44, Jun 4, 2004 (UTC)
I speak in the same breath as Bodnotbod on this one. If mainstream treatment uses certain techniques to achieve certain goals, it serves no purpose to mention in an article unrelated to alternative medicine that alternative medical treatments do the same. And quite frankly, I have a hard time believing this one anyway.

Many different branches of alternative medicine are famous for treating lower back pain. The researchers, from the University of Alberta, followed a random sample of nearly 800 adults who started out without neck or back pain. They found those suffering from depression were four times more likely to develop intense or disabling neck and lower back pain than those who were not depressed. The treatment of back pain, would be another application of adjunctive psychological therapy, or the Mind-Body / Psychosocial Interventions which are the bread and butter of many fields of alternative medicine (See cited research shown below).

This is reaching, isn't it? You seem to be leaping on a number of distantly parted stepping stones to get to a very broad and unhelpful conclusion:

  • The first sentence is baffling the reader of a depression article, as it refers only to back pain.
  • You link back pain with depression - but it is really only talking about those in the venn diagram suffering both back pain and depression, so this is not useful to anyone not suffering from both.
  • You then mention psychological therapy which is a controversial use of the words alternative and complementary, and is an area already detailed earlier in the article outside of this section.
  • (passing comment: bread and butter may not be a helpful phrase to the non US/British reader, so I would lose it).
  • You make a sweeping statement which seeks to pull talking therapies into the realm of alt and comp. medicine.

Essentially this whole paragraph is based on one piece of research. There is a vast wealth of research on depression, why pluck this one out of the air? Is it useful? I would say that it should be replaced with something more general for my venn diagram reason: ie use research that concentrates solely on depression not those who suffer depression and pain.

The only saving grace of this dog's breakfast of a paragraph is that it mentions my alma mater. Depression nearly killed me, but I never had a moment's back pain. My mother suffered incredible lower back pain, and her bad days were as a consequence of it, not the other way round. I like Bodnotbod's Venn diagram reasoning, and I would further note that if depression and lower back pain go together, it is far more likely that the latter is the cause of the former.

So, to the references:

Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9. PMID: 12365878 Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12365878&dopt=Abstract)

I have absolutely no clue what this means, so I'll keep it and hope someone else throws it out for being unhelpful to the reader.

  • It is intersting that in the article the patients were being treated with usual antidepressants. The study was done by physicians. Not alternative medicine, just good research.

Tiemeier H, Van Tuijl HR, Hofman A. Vitamin b(12), folate, and homocysteine in depression: the rotterdam study. Am J Psychiatry. 2002 Dec;159(12):2099-101. PMID: 12450964 Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12450964&dopt=Abstract)

I don't object to this, although I always think layman's press coverage of subjects is more helpful to the reader, ie the BBC article.

Kimberly Goldapple, Zindel Segal, Helen Mayberg. Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy. Arch Gen Psychiatry. 2004;61:34-41. Abstract (http://archpsyc.ama-assn.org/cgi/content/abstract/61/1/34)

Deleted because CBT was discussed earlier in the article before the alternative therapy section appeared, the claim that CBT is an alternative treatment is controversial.

Why don't I put it in terms that you can relate to. When your psychologist starts practicing medicine without a license by treating a medical condition with CBT he does it legally as a form of alternative medicine. Also, need I point out that there is a new field called Health pyschology where psychologists are also practising medicine legally with a license. -- John Gohde 08:37, 4 Jun 2004 (UTC)
My therapist (I don't think she would call herself a psychologist) has had training and has achieved qualifications. I'm not qualified to speak about licensing. Perhaps the legal position is different here in England (where I live and receive treatment) to where you reside. Your argument is hampered somewhat by the fact that Health psychology is not an article as yet. --bodnotbod 22:50, Jun 4, 2004 (UTC)

Carroll LJ, Cassidy JD, Cote P. Depression as a risk factor for onset of an episode of troublesome neck and low back pain. Pain. 2004 Jan;107(1-2):134-9. PMID: 14715399 Abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14715399&dopt=Abstract)

Since the paragraph it relates to is now deleted I've deleted the reference, although I think it is interesting and could be used in a different context.

All of the above is just my opinion of course, and I'll be actively canvasing for comments on what I've done.

I see nothing to disagree with in Bodnotbod's analysis. The alternative therapies addition to this article has not listed any real alternative therapies, such as, say, crystal healing, and everything else which has been added strikes me a lot like tying a giant tuna to the top of your car. Yes, with difficulty you can do it. But why in heaven's name would you want to? Denni 17:54, 3 Jun 2004 (UTC)
Yeah, the impression I get is that the contributions were more an attempt to get something, anything complementary into this article but were not written with a good knowledge of how the field applies in this case. There is an alternative treatment which has received a lot of coverage. But first the coverage was very positive and then more recently it was very negative. I'm talking about St. John's Wort. --bodnotbod 18:37, Jun 3, 2004 (UTC)


--bodnotbod 14:18, Jun 3, 2004 (UTC)