Talk:Clinical depression/Archive 2

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Archive 1

Contents 1 Complementary and alternative therapies 2 Alternative medicine 2.1 References 2.1.1 Citations to alternative medicine research 3 png? 4 "Melancholia" 5 Chiropractic for depression 5.1 DSM rants 6 BioMechanical-Neurological causes 7 Recent Edits by CloudSurfer 8 Types of Depression 8.1 Unipolar vs bipolar disorder 9 "Small"? 10 Will really untreated clinical depression resolve from 6 to 24 months? 11 External Links

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 [1]. 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)

My psychotherapist is Jungian, which ought to impress the pants off "alternative" people from the start, but she would take your pseudo-New-Age-crystal-healing-aura vibes-Urantian crap and stick it right up your excretory orifices so far you would complain loudly, Mr. Sock Puppet. I will not dispute you for a =second= if you decided to begin an encyclopedia called "Gullipedia." In the meantime, get your sad ass and your silly sock puppets out of here and see if you can't cadge a few quarters on a streetcorner somewhere. Denni 02:13, 2004 Jun 5 (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. Kd4ttc 20:17, 5 Jun 2004 (UTC)

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)

I for one am not receiving any pyschotherapy. You have my condolences. I suggest that you educate yourself, some. I have no duty to educate people who are 30 years out of date. Cheers ... -- John Gohde 07:23, 5 Jun 2004 (UTC)

Oh good. At least we know where you stand now. I have not sought to denigrate you personally, but your comments about my lack of education pretty much mark you out as unlikeable. Worse, for a Wikipedian, you're unable to write informatively, with grace or with authority. Rest assured I will not put so much effort into stating why I've removed your edits in the future. Perhaps you should find an alternative medicine to cure your spite. --bodnotbod 14:53, Jun 6, 2004 (UTC)

Since these science people have only demonstrated bigoted, obnoxious, time wasting behavior towards this WikiProject they are clearly more interested in trolling then in improving Wikipedia. Everywhere we have actually bothered to state our views, our ASBs etc. have been deleted / vandalized. Everywhere where we have wasted time doing what you people have asked for our ASBs etc. have been deleted / vandalized. Do you really think that I am going to waste my time wading through the above garbage that was written by a bunch of ignorant bigots? ::-- John Gohde 14:29, 6 Jun 2004 (UTC)

Personally, I have found science more reliable as a guide to predictable behavior than pseudoscience. Neither astrology or entrail-reading have proven too useful, and medical science in particular has brought considerably more benefit than chelation therapy, crystal healing, pyramidal hats, and other nonsense that seems to cause you to to writhe in ecstacy. My suggestion to you is to start your own Wiki. "WikiSilly" and "WikiFoolish" spring immediately to mind, and I have no doubt you could collect a huge following in short order, considering the number of gullible people who seem to collect wherever easy answers to hard questions can be found. I am neither ignorant nor a bigot, but I am absolutely intolerant of deliberate fools. Not pointing any fingers, of course. Denni ⇔ 03:06, 2004 Jun 8 (UTC)

Well John, I hope you will see from my contributions that I have not vandalised any of your articles. I hope you'll also acknowledge that the Depression and Alternative Medicine section remains in the article despite the resrervations voiced here. As for wasting your time wading through the above: I would suggest that if you don't you are likely to waste more of your own time, and more of everyone elses since without debate all that can happen is a) nothing, or b) an edit war without meaningful discussion. --bodnotbod 16:00, Jun 8, 2004 (UTC)

While I generally think alternative medicine is a pile of hogwash, it's arguable that much psychiatry is a similar pile of hogwash. In particular, an increasing number of studies are showing that antidepressants have a long-term effect indistinguishable from "active placebos". More generally, the entire "medical model" of modern psychiatry (the "pill-pusher model", if you wish to be derogatory) is increasingly controversial. This article doesn't really address the controversy, being more of a regurgitation of the DSM, which represents only one particular view (and a somewhat extremist one at that) than an actual encyclopedia article on all sides of the issue. --Delirium 07:00, Jun 8, 2004 (UTC)

Well please do add info on those issues, I would be most interested to read them. --bodnotbod 15:56, Jun 8, 2004 (UTC)

Folks, I am really confused here. My understanding of alternative therapies is largely as defined in Alternative medicine. That is something that "diverges from generally accepted medical methods." Whilst there is certainly robust debate about CBT and has been for many decades, CBT follows the accepted scientific process in assessing its effects and is seen as a valid and useful form of therapy by most in the tradtional health professions. In 25 years of working in the field of mental health I have never heard it categorised as alternative. I realise that this is a pretty cold arguement but I have only just come across it. --CloudSurfer 06:41, 12 Sep 2004 (UTC)

---

Alternative medicine

This section was largely the work of Mr Natural Health and I've removed it, in part, because of [2], note the 3 month ban imposed. I do not say it should necessarily all go, but what is worth keeping needs substantial rewriting to keep it relevant to the article I feel. But, at any rate, we can talk it out here. --bodnotbod 10:55, Jun 26, 2004 (UTC)

- There are complementary and alternative treatments for depression. 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 improves their quality of life.

- According to a recent survey, 4.5% of the adult American population ([3] p9) use complementary and alternative medicine to treat anxiety or depression. "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons" (page 4). These mind-body therapies along with product based therapies, that use St. John's Wort (12% of population, table 2 on page 9) for example, are the CAM treatments that are most effective against anxiety/depression as shown below. Consistent with previous studies this study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine. - - 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 in depressed patients who were on antidepressants improved when given ethyl-eicosapentaenoate for 12 weeks. This is a good example of basic research being brought to clinical benefit. However, ethyl-eicosapentaenoate was not studied alone. The study was in patients already on antidepressants. The compound used, ethyl-eicosapentaenoate, is not what is commonly knows as fish oil. This is an example where the distinction between complementary medicine and mainstream medicine are blurred. - - The American Psychiatric Association's American Journal of Psychiatry has published studies showing a relationship between depression levels and deficient vitamin B₁₂ blood levels in elderly people in 2000 [4] and 2002 [5]. Folate deficiency and anemia were not associated with depression. - - Chiropractic, Osteopathic, and Manual Medicine MDs are practioners of manipulative therapy. The purpose of manipulative therapy is to reduce mechanical dysfunction of spine and articulations and correct soft tissue pathologies (tight muscles, trigger points, etc.), thereby returning the body to its normal neurological tone. The depression-causing mechanism appears to be disturbances of normal neurological tone in the viscera which occur due to inflammation, trauma, and dysfunctional reflex in the nerve centres.

end of MNH stuff, though some of it was further edited by others and I'm sorry if this mass removal offends them --bodnotbod 10:55, Jun 26, 2004 (UTC)

References

related references to the above, moved from article to here:

Citations to alternative medicine research

• 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
• 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

--bodnotbod 11:06, Jun 26, 2004 (UTC) (signing cos I moved them from the article, not because I had anything to do with them, let me be clear on that).

png?

All I'm getting for the .png is a black rectangle. Mintguy (T) 10:06, 27 Jun 2004 (UTC)

Yes it's the same for me, I don't know what the problem is. --bodnotbod 20:06, Jun 28, 2004 (UTC)

Hopefully I've fixed it, but it's more by luck than judgement. Putting the width in pixels in seems to have cured the problem for me. Can you both see it now? theresa knott 07:27, 30 Jun 2004 (UTC)

"Melancholia"

I've removed some stuff saying approximately "melancholia is the worst form of major depression". Please can we stick to using generally recognized clinical terms, please? Otherwise, we'll be saying things like "lunacy is the worst form of bipolar disorder".

To counterbalance smipping this text out, I've added a small section to mention melancholia and other historical concepts, with a link to the article on melancholia.

I approve. --bodnotbod 20:26, Jun 30, 2004 (UTC)

Chiropractic for depression

Hello I am new to this site and have not studied the protocols for submission yet. I need help to learn proper procedures and I welcome corrective criticism. There are many different points of view here and I realize that a lot of people will violently disagree with my post as I disagree with a number of theirs. The orthodox medical and psychological theapy is very well covered and nicely done. I think for the sake of completeness an alternative medcine section should be included. I am a Chiropractic physician and have worked side by side with Medical doctors for 42 years. I have many pts. that I treat for back problems and simultaneously treat psychological problems such as depression, anxiety,panic attacks, suicidal tendencies,anorexia,bulemia. The results are breath-taking these people usually with the advice of their doctor eliminate or reduce medication. If anyone would like to edit my post to improve the sense of the article-please do. I would appreciate it if you don't eliminate the article because you don't agree.

Lou (new member)

Lou, your contribution was removed by another editor, who invited you to do better. Please see Wikipedia:Welcome, newcomers, Wikipedia:Avoiding common mistakes, and Wikipedia:Verifiability. Also, if you register for a username, it will be easier to communicate. --Zigger 18:44, 2004 Jul 11 (UTC)

Zigger

I would like to discuss with the editor what was wrong with the article. I would think it would be a matter of courtesy to at least explain the errors to me or edit it in someway, but to just eliminate it without comment seems rude.

Lou

DSM rants

Is this truly necessary, at least how it is worded: "The DSM IV list of criteria is controversial because one may be suffering really badly from four of the symptoms, and someone else quite mildly from the required five symptoms. Who then gets treatment? If the clinician keeps strictly to DSM IV, only the latter." First of all, all of the DSM is "controversial", but I don't think it needs to be discussed in every other mental health article. At the very least, it is worded poorly - it sounds like somebody's personal ramblings, not an objective sentence. We should leave the DSM rantings on a DSM page. -- Marumari 04:17, 19 Jul 2004 (UTC)

• I agree entirely, it's a very poor contribution. --bodnotbod 10:17, Jul 19, 2004 (UTC)

• I have replaced this with: Andrew Solomon in his book The Noonday Demon (p.20) states that the DSM IV list of symptoms is, "entirely arbitrary [and] having slight versions of all the symptoms may be less of a problem than having severe versions of two symptoms". I think the wording is now better (it's mostly Solomon!) Solomon's point relates directly to this list of symptoms and is, I think, a very important one.

---

BioMechanical-Neurological causes

This entry by 80.116.217.117 on 13 June 2004 troubles me.

"Excessive stimulation of the neuroloigical system may lead to clinical depression. The degree and persistence of the depression is directly related to the degree and persistence of the stimulation. This neurological reflex is part of the bodies natural defenses,that have evolved through evolution,to protect itself from harm. Over work,physically or mentally, may over stimulate the neurological system which reflexively responds by creating a sense of tiredness mentally and physically-the desire to do anything is much reduced."

It reads like a 19th century tract on "nerves". I feel more inclined to delete it than to correct the typos. Can anyone substantiate this entry? Isidore 00:04, 25 Jul 2004 (UTC)

Well, I went ahead and removed it and added a sentence about stress under "Life experiences". Isidore 19:06, 27 Jul 2004 (UTC)

Recent Edits by CloudSurfer

Having justs contributed several edits to this page I find they have been reverted by Denni without explanation. This page is somewhat jumbled, at times repetitive and otherwise unclear. Others have noted that it needs some rewriting. Anyone intersted can view my changes in the page history. For the moment I will pause my rewriting until this issue is clarified. --CloudSurfer 21:23, 12 Sep 2004 (UTC)

Hi CloudSurfer, it looks to me as though Denni intended to restore the heading and the roll-back went too far. I've restored your changes, and what I believe Denni intended with his. -- sannse (talk) 21:46, 12 Sep 2004 (UTC)

Thanks for that. You have added unipolar to the list which of course makes perfect sense. I also now understand Denni's reasons. I have tried to be NPOV while at the same time attempting to clarify some of the issues. --CloudSurfer 21:50, 12 Sep 2004 (UTC)

Types of Depression

OK folks. Under the heading Types of Depression we have two subheadings, Unipolar depression and Bipolar depression. Under the first heading we then have a description of subtypes of depression. Since some of these subtypes can occur in both unipolar and bipolar depression it seems to me that a better structure for this section would be:

No subheading of Unipolar depression with the text down to the second heading as is. This then follows the main heading of Types of Depression.

Unipolar vs bipolar disorder

Bipolar disorder is a cyclical illness in which moods fluctuate between mania (extreme happiness or giddiness and frantic activity) and clinical depression. Bipolar disorder has also been commonly called "manic depression", although this usage is now unpopular with psychiatrists, who have standardised on Kraepelin's usage of the term manic depression to describe the whole bipolar spectrum that includes both bipolar disorder and unipolar depression; they now usually use the term bipolar disorder. This then leaves the term unipolar depression which is used to differentiate it from bipolar disorder.

--CloudSurfer 22:02, 12 Sep 2004 (UTC)

Since there has been no comment on this suggested change I have gone ahead and made the changes. --CloudSurfer 04:00, 15 Sep 2004 (UTC)

I feel that unipolar depression is hardly even mentioned in this section, its as if it didnt exist as a medical condition. I propose a new section on Unipolar disorder, or that it be more explicitly explained. I'm not a good enough wikipedian for some perhaps, maybe someone is willing to do it?--Grappo6x6 22:07, 26 Nov 2004 (GMT+1)

"Small"?

CloudSurfer removed the adjective "small" from the description of ECT because he felt that it was NPOV. I think that is highly extreme; surely NPOV still allows us to note that skyscrapers are "tall", Antarctica is "cold", and dosages of current applied medically to the central nervous system are "small"? However, it might be best to replace it with a more precise descriptive adjective: low-wattage? low-voltage? low-amperage? -- Antaeus Feldspar 02:18, 13 Sep 2004 (UTC)

My logic was as follows. Small compared with what? Since there is no implied comparison as there is with skyscrapers or continents (the examples you have given) the only reason I could see for "small" was to qualify it with a value judgement. The previous version is below.

Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs a small and carefully controlled current of electricity to induce an artificial epileptic seizure while the patient is under general anesthesia.

I changed it to:

Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs a carefully controlled current of electricity to induce an artificial epileptic seizure while the patient is under general anesthesia.

It still reads that it is a carefully controlled current and that is the crucial point. As a psychiatrist who wholeheartedly supports ECT for the appropriate indications I am not in any way trying to undermine support for it. I can assure you that if ever I was seriously depressed that I would want to receive ECT. It is however a subject that raises the ire of some and is thus best put in NPOV terms as much as possible.

As a side point, I have once or twice collected bit of that electricity while administering ECT and it is not what I would regard as a small current compared with other shocks I have had in my life (and I live in a 240 volt country). It gives a kick not unlike that from an electric fence and it should be pointed out that I only got side currents. The voltages used are in the range of 150-400 volts after all. --CloudSurfer 04:47, 13 Sep 2004 (UTC)

I still do not think it's a problem from an NPOV perspective, but what you've told me about the voltage makes me think that "small" may be an inaccurate adjective, if they can actually be higher voltage than wall (mains) current. I concede. -- Antaeus Feldspar 05:33, 13 Sep 2004 (UTC)

Will really untreated clinical depression resolve from 6 to 24 months?

CloudSurfer has made a number of nice contributions to the article, but one particular sentence strikes me, it is the following one

Although if left untreated it will generally resolve within six months to two years treatment can shorten the period of distress to a matter of weeks. While depressed the person may damage themselves socially (e.g. the break up of relationships), occupationally (e.g. loss of a job), financially and physically, treatment of depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life saving.

I am in no way a doctor, and he said he is a psychiatrist. But, is this always true? Can't clinical depressions persist indefinitely? Can't they get worse and/or become chronic? --xDCDx 12:55, 13 Sep 2004 (UTC)

Six years running for me. I disagree with this passage, the whole point of clinical depression is that you usually just don't snap out of it without help. I'm excising it, with a note to discuss here. CloudSurfer? Any comment? --Golbez 16:40, Sep 13, 2004 (UTC)

I am restoring it, since you apparently did not understand its meaning when you excised it. As xDCDx quoted, the key word is "generally". Xdcdx asked "is this always true?" and the twofold answer is "of course not, and it was never claimed that it was." Clinicial depressions can persist indefinitely, they can get worse and they can get chronic, they can persist for six years and this in no way falsifies a statement about the course they generally run. That's why it's "generally", not "universally". If you have a reason for opposing CloudSurfer's statement on the general course that depressions take, then bring it up here and edit. But what you've provided so far isn't it. -- Antaeus Feldspar 17:18, 13 Sep 2004 (UTC)

(via edit conflict) I've being told that this is so for the majority - not a case of "snaping out of it", but a natural recovery in 6 months to 2 years. That was the pattern before medication was widely available and studies have shown this to be the likely course since - perhaps Cloudsurfer may have a reference?. But, of course, that is for the majority, not for all (and I'm one of the minority it seems - three years for me). I think that the view on-line is probably somewhat distorted because those who do recover in a relatively short time are less likely to be as vocal as those of us still suffering after several years. (Antaeus, you could have said the above in a more friendly manner you know) -- sannse (talk) 17:25, 13 Sep 2004 (UTC)

Fair enough. I don't revert such changes, and I acted too quickly. --Golbez 17:50, Sep 13, 2004 (UTC)

My apologies if I offended. Re-reading what I wrote without the headache that I had when I wrote it, I can see how it might come off as too brusque. I was, truth be told, annoyed that the word "generally" was right there in the quoted material but its significance was never looked at before making the change. -- Antaeus Feldspar 18:56, 13 Sep 2004 (UTC)

The reason I put that point in is that it is my understanding of what happened in the days before effective treatment. That most people with depression would come out of it after six months to two years. The entire section reads:

"Although if left untreated it will generally resolve within six months to two years treatment can shorten the period of distress to a matter of weeks. While depressed the person may damage themselves socially (e.g. the break up of relationships), occupationally (e.g. loss of a job), financially and physically. Treatment of depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life saving."

My thoughts in putting this in were to show why treatment was a good idea and really the only sensible thing to do. However, I wanted to show the alternative which was to leave it and wait months or years for it to resolve, during which time the person's life may have been damaged significantly. It is important that depressed people have a choice in the matter. Also, any relative or friend reading this is less likely to say, "Forget about those pills. You'll be all right." The previous version had said something like "treatment was imperative" but had not really given a full justification for this view. We have to remember that many people are out there resisting the idea of treatment for themselves and their relatives and friends. I hope I have put the whole thing in a NPOV framing that will allow people to make a choice that reduces the suffering.

However you have all made a very good point about chronic depression and I have edited the section to that effect. The relevant changes now read:

"If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. Treatment can shorten the period of distress to a matter of weeks."

I have also added a section on treatment resistance under the heading of Treatment.

This is the joy of this collaborative process. Well done all.

--CloudSurfer 18:23, 13 Sep 2004 (UTC)

I asked because, to me, 'generally' seemed a too broad percentage, but probably sannse is right and the online view of depression is somewhat skewed. Many people want to, by all means, avoid going to the doctor and prefer not to be treated, and choice of the patient is important, of course, but reading the phrase before actually made me think "Forget about those pills. You'll be all right". In my opinion, it is better now, after CloudSurfer tweaked it. --xDCDx 20:24, 13 Sep 2004 (UTC)

It is of the UTMOST importance to realize that while some may "snap out" of depression within six months to two years, many, many people "snap out" of depression by committing suicide. The WHO cites, and has cited with persistence the past several years, that suicide as a result of depression is the second most common cause of death following heart disease. This "snap out" argument is as specious as the one used by employment statisticians calculating the unemployment rate, who fail (for whatever reason) to calculate in those who have simply given up looking for work. For many seriously depressed individuals, it is an issue of having given up looking for a rewarding life. Denni☯ 01:03, 2004 Sep 14 (UTC)

Denni, if you read the entire section then it should be clear that what I have written does not support the idea of waiting to "snap out" of it. This is an encyclopaedia article, not an article aimed at people suffering with clinical depression. There are other sites for that purpose. It should be balanced and contain relevant facts. What I have added mentions the damage that depressed people sometimes do to themselves because of their illness. Suicide is certainly mentioned and says "suicide which is otherwise a common and tragic outcome." No one who has contributed to this talk is advocating leaving depression untreated and that is certainly not my view. The WHO does indeed stress the disability caused by depression and suicide from depression. (This brings up the whole concept of disability ajusted life years (DALYs) and years lived with disability (YLDs) which are not mentioned in this article.)

I have just had a quick look at the article on suicide and the word depression occurs only twice and on the second occasion it is in the negative! This article clearly needs some additions to clarify the role of depression as a cause.

I think we are all batting on the same side on this issue. --CloudSurfer 06:54, 14 Sep 2004 (UTC)

I think the description of this as a "snap out of it argument" is misleading. There is quite a difference between being told to "snap out of it" and being told that, in general, most people will naturally recover from depression in time (if, of course, they to manage survive that long). That's not to say that, in that time, they will not experience considerable distress and long-term damage in several ways. And it's not to say that it is not better to get treatment than to suffer through those months or years. But I think that we should remove the idea that reporting the facts of the condition's prognosis is in anyway endorsing either refusing treatment or endorsing the idea that depressed people can somehow simply choose to be well. -- sannse (talk) 13:47, 14 Sep 2004 (UTC)

How about this suggested edit? Original as at --CloudSurfer 04:14, 15 Sep 2004 (UTC)

If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. Treatment can shorten the period of distress to a matter of weeks.

Suggested change:

If left untreated it will generally resolve spontaneously within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. There is no evidence to suggest that people can, by an act of will, produce this remission. However, active treatment can shorten the period of distress to a matter of weeks.

The main shaky part of this is the claim that there is no evidence for this. I have not seen evidence but that doesn't mean there is not evidence. Please comment and let's try to get this section sorted out.--CloudSurfer 04:14, 15 Sep 2004 (UTC)

I completely agree that the Suicide article needs some more emphasis in depression being a frequent cause leading to killing one self. --xDCDx 14:47, 14 Sep 2004 (UTC)

That version sounds fine to me CloudSurfer. -- sannse (talk) 18:49, 15 Sep 2004 (UTC)

External Links

Golbez has voiced concerns about the last external link in a tag to an update to the main page. I have had a brief look at the link and although it is being run by a commercial organisation and does have paid ads the information appears to be OK. What concerns, if any, are there about this link? --CloudSurfer 18:12, 15 Sep 2004 (UTC)

An anonymous user adding external links to a bunch of mental health-related articles all at once screams "advertising" to me. It simply raised a red flag. I looked myself, though, and found the information kosher and at least partially original, so it's not just a link farm. I put up the comment while making an unrelated edit to see if anyone else had any thoughts on the subject. --Golbez 18:29, Sep 15, 2004 (UTC)

I was hoping we could replace this with the same information directly from the WHO site, but it seems to be unavailable there. Without that alternative I think this looks OK. (Though I understand Golbez's concern - we have so much of that around here at times) -- sannse (talk) 18:51, 15 Sep 2004 (UTC)

Just introducing myself since I'm the one that caused the concern here. My name is Sean Bennick and I run Mental Health Matters (and Get Mental Help, Inc.). The links I've posted weren't intended to be advertising but additional resources. I apologize if I was out of line and also for not registering prior to posting. I wasn’t aware this would be a problem. We have a good amount of content on our sites and can hopefully help those in need. I’d be happy to answer any questions and if any of the links I have added or add in the future are inappropriate please remove them and let me know.--Seanetal 08:55, 16 Sep 2004 (UTC)

Sannse, if you want the ICD-10 info grab it from Mental Health Matters (I do think my site has more to offer than just that and would love to see the links remain of course but understand if they need to go). The WHO doesn't restrict access to the info as long as credit is given (I asked and received permission). You'll see that we have alot of work to do still on some of the pages on MHM but I have the ICD-10 Classification Of Mental and Behavioural Disorders available and will be typing out the criteria as I have time.--Seanetal 09:26, 16 Sep 2004 (UTC)

Sean, welcome to Wikipedia. From my very brief look at your site it looked good as was its stated purpose. Best of luck with it. If people can make a profit out of an ethical project then in my book that is fine. I haven't looked to see if you have linked to the Wikipedia site but you might like to do that. Various authors are slowly expanding the sections on mental illness to the point where some of the articles on Wikipedia carry information that would be hard to find, even in comprehensive textbooks of psychiatry. This process will never finish and articles will be updated to reflect new knowledge. It also of course benefits from not having the lag required for publishing. --CloudSurfer 21:41, 16 Sep 2004 (UTC)

Cloud, Thanks! I've got to go through and get a list of all the disorder pages on Wikipedia so I can add them to our resource pages, I know there are other pages I'll want to add too but that'll be a good start. Based on the content I've seen here many Wikipedia pages will be posted. I'll probably get more of my links up on disorder pages where appropriate - we have some disorder pages with little info right now.--seanetal 23:44, 16 Sep 2004 (UTC)