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

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

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

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

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

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

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

I'm doubtful about the statement that excess sugar consumption alters mood. I believe this was recently disproven in children^[1], and since the section doesn't have a reference (the footnote at the end of the paragraph refers only to the claims about alcohol's effect on depression), I propose that it be edited out. Minerva9 (talk) 05:19, 29 April 2008 (UTC)[reply]

These 2 sentences are misleading:

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

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

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

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

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

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

Under "Causes - Sleep Quality"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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