Major depressive disorder is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.
	This article appeared on Wikipedia's Main Page as Today's featured article on June 23, 2009.
Article milestones Date Process Result July 9, 2006 Good article nominee Listed December 31, 2006 Good article reassessment Delisted April 3, 2007 Featured article candidate Not promoted December 6, 2008 Featured article candidate Promoted Current status: Featured article

This article has not yet been rated on Wikipedia's content assessment scale. It is of interest to the following WikiProjects:

Psychology Top‑importance This article is within the scope of WikiProject Psychology, a collaborative effort to improve the coverage of Psychology on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.PsychologyWikipedia:WikiProject PsychologyTemplate:WikiProject Psychologypsychology Top This article has been rated as Top-importance on the project's importance scale. Neuroscience High‑importance This article is within the scope of WikiProject Neuroscience, a collaborative effort to improve the coverage of Neuroscience on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.NeuroscienceWikipedia:WikiProject NeuroscienceTemplate:WikiProject Neuroscienceneuroscience High This article has been rated as High-importance on the project's importance scale. Medicine Top‑importance This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.MedicineWikipedia:WikiProject MedicineTemplate:WikiProject Medicinemedicine Top This article has been rated as Top-importance on the project's importance scale. History of Science Mid‑importance This article is part of the History of Science WikiProject, an attempt to improve and organize the history of science content on Wikipedia. If you would like to participate, you can edit the article attached to this page, or visit the project page, where you can join the project and/or contribute to the discussion. You can also help with the History of Science Collaboration of the Month.History of ScienceWikipedia:WikiProject History of ScienceTemplate:WikiProject History of Sciencehistory of science Mid This article has been rated as Mid-importance on the project's importance scale. Template:Wikiproject MCB Template:WP1.0

Archives

1, 2, 3, 4, 5, 6, 7, 8, 9, 10 11, 12, 13

This page has archives. Topics inactive for 21 days are automatically archived by Lowercase sigmabot III.

This problem is fixed: [ ] NO [X] YES

Look in the Notes section and you'll see a number of errors registered - all of the form "Template:VCitation". There a number of different reasons for this. First of all I found a number of cases where the citation in the text read something like -

{{vcite|url=http://...}}

The problem here is that it should begin {{vcite web |url=...}}. These have to be found and fixed case by case, so far as I can see.

I have already fixed 34+ instances of the initial problem, in which the original "Citation" was replaced with "vCitation", throughout the article - which won't work; "vcite..." will, of course (assuming what follows it also complies with the template).

I'll get to as many of these problems as I have time for, but I won't have time for them all tonight.

When they are all fixed, someone should remove this note or check the correct box at its beginning.

Tom Cloyd (talk) 07:41, 19 April 2010 (UTC)[reply]

Appears to be a problem with the citation bot here. I'm guessing someone's written some naive code to change all "cite web" to "Citation" without checking whether it was a "vcite web". I don't have time at present to fix them. I'll alert the bot owner. Colin°^Talk 07:47, 19 April 2010 (UTC)[reply]

Is it possible to "name" a reference - as in "<ref name="{name}"...</ref>" (if I don't have this quite right, just consider it pseudo-code), then refer to it in additional contexts, each with a different page number? This makes so much sense that it surely must be possible. I currently investigating this. Meanwhile, can it be done - and if so how???

Here's my thinking. Given that

• this present article has a non-standard "blended" citation scheme (some works have their full citation in the References section and other in the Notes section), and...
• that this craziness really should be fixed, and...
• that the use of "named" references are efficient in multiple ways, and
• that use of the full citation in the article text makes it harder to read when editing,

might not it them make sense to work at having all full reference citations in the References, where they are named as I've exemplified above, with specific citations in the text referencing the reference name and the page number - ONLY???

This would make the article more formally consistent, give readers an author alphabetized reference list, and give editors a simpler way of citing already listed references in some new way. If it's possible...

update - I see now how to cite a work, giving the citation a name or ID, and then re-cite it, referencing that name or ID. One can append a page number to the citation, producing something like (Jones 1998 p. 199). BUT, this is not the citation system used in this depression article. I still don't have a solution. Tom Cloyd (talk) 11:05, 19 April 2010 (UTC)[reply]

update #2 - I've gotten some good information at the Village Pump - here. I'm not sure where it leaves me, as I need to digest it and experiment a bit, but it looks promising. Will report back, although not immediately.Tom Cloyd (talk) 13:48, 19 April 2010 (UTC)[reply]

I thought the referencing was pretty simple really - if a book has more than one different page reffed, the inline page references are in the Notes bit (and if you click on them you're magically transported down to the bottom), and the bookref is in the now generically-and-unhelpfully named References section. The notes are references (?!) Casliber (talk · contribs) 12:22, 19 April 2010 (UTC)[reply]

PS: Incidentally, I never think of a noun 'text' as meaning 'textbook' - so I will use 'work' instead. I contemplated cited oeuvres ...Casliber (talk · contribs) 12:26, 19 April 2010 (UTC)[reply]

I'll agree that "text" is a complex word in this context. Books that are called "texts", in my experience, are textbooks - book prepared for educational contexts, for students. The DSM is no such thing, for example. You solution works, I think.

However, my solution makes more sense in a larger context, and in fact is explicitly exemplified here - Separate lists of references and footnotes (grouping footnotes). This Notes / References distinction is a convention in the in the larger world of scholarly writing. I've lived and worked in that world for years, and I came here and was immediately struck by the, ahem, creativity of the citation system. I consider it nuts, because it's inconsistent. Some citations go one place, and others another. It just isn't done that way in the real world.

Also look at Alternative system in "Wikipedia:Referencing for beginners". What's described there is what the system used in this depression article appears to use, until one looks more closely. Note that the author distinguishes citation notes from works cited in the same way I do. It's not just me.

Notes and References can mean many things, of course. A reference can be both a pointer to a cited work and the listing of that work. In most book contexts, References is a list of works cited (in the Notes) or just used in the writing of the book, when there's no formal notes. In Wikipedia, I grant, References and Notes get used interchangeably, in that the same sort of list is called one thing in one article and the other in some other.

As I had things set up, the names of things WERE helpful, in that they conformed to long adopted standards in the publishing world (which, of course, also has its non-conformists!). What is unhelpful is the citation scheme used in this article, where some citations to go Notes and some to References. THAT's just weird, and should be fixed, I think, unless conventions don't matter and we can just make it up as we go along. Creativity is great, but there are some things one shouldn't get creative about.

Your grouping of Notes and Cited works under "References" still confuses me. My background (5 universities in the USA) tells me that citations are notes, and references are works cited. You cannot call both references. I can settle for the terms now used, though. Reluctantly. Bigger fish need to be fried!Tom Cloyd (talk) 12:52, 19 April 2010 (UTC)[reply]

Agree that named refs are best and that the actual citation should be moved out of the body text for ease of editing. This is an editor-preference thing and can't be done without seeking consensus on a per article basis. This latter point has only been possible recently with the creation of Help:Footnotes#List-defined references (see also Wikipedia:Citing sources#List-defined references. I've used this approach in Ketogenic diet.

The short refs approach works cleanest when all the notes are short and refer to pages drawn from a relatively small collection of texts/works/whatever-you-want-to-call-them. Arts and literature subjects suit this. It isn't needed if very few references are drawn from the same work (e.g., I didn't bother for the one book I referenced a few chapters from in Ketogenic diet). For medical articles, most of the references should be journal articles and some academic book chapters. I wouldn't like to get an inline citation jump to a footnote which then jumps to a reference for every journal article mentioned. The mixed approach here might be messy but it does the job. There are far, far more important things to worry about: like why does this article cite so many web pages or so many primary research papers. Colin°^Talk 16:15, 19 April 2010 (UTC)[reply]

Certainly agree, as to priorities. My sense is that every section needs to be revised and reduced to core summary material as much as possible. Secondary references won't always be available, but seem too often to be set aside, at present.Tom Cloyd (talk) 22:17, 19 April 2010 (UTC)[reply]

Can anyone obtain this reference for me? I would like to replace a primary source with it, depending on its quality and what it covers (I don't want to cite a title, guessing what it says, even though I am pretty sure what it will say). :) It would be much appreciated.--Literaturegeek | T@1k? 00:50, 12 May 2010 (UTC)[reply]

Here we have medscape [1] and here we have the abstract [2] Doc James (talk · contribs · email) 01:22, 14 May 2010 (UTC)[reply]

The lead states "Most patients are treated with antidepressant medication". Usually we shy away from using the word patient and second do we have reference for this? Doc James (talk · contribs · email) 16:06, 13 May 2010 (UTC)[reply]

I've rephrased the line a bit to do away with "most" (which certainly would need to be sourced), but I obviously would favour a sourced line over an unsourced one. I also have reservations about the word "patient", at least in general, but in the context of that sentence I don't really see what else could be intended: Of course many people with MDD are never treated at all or are never treated with antidepressants; however, it's probably safe, I'd think, to refer to those who are so treated as psychiatric patients. Cosmic Latte (talk) 22:59, 18 May 2010 (UTC)[reply]

Most people are now treated by primary care provider but that is a different issue. Yes I agree and will change it back.Doc James (talk · contribs · email) 00:16, 19 May 2010 (UTC)[reply]

Why don't you rephrase this:"A large number of sufferers of depression are treated with antidepressant medication".Karlp295 (talk) 07:30, 26 July 2010 (UTC)[reply]

I like sufferers even less than patients. Will leave as patients. Doc James (talk · contribs · email) 07:02, 28 July 2010 (UTC)[reply]

In this case sufferers and patients are not interchangeable: to be medicated somebody has to be a "patient" (i.e: go to the doctor), while "sufferers" (i.e: people with the disorder, independently of whether they have been diagnosed or not, or wether they attend to the doctor or not) will have lower rates of antidepressant use (you can not use medication if you do not go to the doctor).--Garrondo (talk) 08:05, 28 July 2010 (UTC)[reply]

Yes we all agree that people with depression have increased risks of suicide. The fact that pharmaceuticals does not change this and may infact increase the risk should be mentioned in the lead IMO. Here is an interesting paper on the topic [3] Doc James (talk · contribs · email) 16:22, 13 May 2010 (UTC)[reply]

Interesting paper, I knew this was the case with paroxetine, which seems to be the most controversial SSRI; first I have heard the overall suicidal risk was raised with the whole class of SSRIs. Be WP:BOLD and add your source, if other editors disagree, and if sources are available they can always add an opposing view for balance etc. :)--Literaturegeek | T@1k? 17:08, 13 May 2010 (UTC)[reply]

On second thoughts, the reference is specific to SSRIs, so might be undue weight to add to thee lead here. Perhaps the main SSRI and perhaps also the paroxetine page would be more appropriate? You could still mention it Major_depressive_disorder#Antidepressants here.--Literaturegeek | T@1k? 23:28, 13 May 2010 (UTC)[reply]

On third thoughts, I dunno, maybe it is worth a mention in the lead, ah my brain is dying, indecision, a sign that I am getting tired and need sleep. :)--Literaturegeek | T@1k? 23:47, 13 May 2010 (UTC)[reply]

We do state that SSRIs are the primary treatment for depression. The list we should do is mention there limitations.Doc James (talk · contribs · email) 01:17, 14 May 2010 (UTC)[reply]

I think it'd be undue weight in the lead. As far as I can tell it isn't a review article as such (?) Definitely needs to be somewhere prominent on a page on the SSRIs and also somewhere on a page on antidepressants though. Casliber (talk · contribs) 04:05, 14 May 2010 (UTC)[reply]

Both the FDA and the health ministry of Japan have applied warning on the boxes of SSRIs stating this. If we are going to say suicide is common in depression, than say SSRIs are the main treatment for suicide, we should at least say that SSRIs do not decrease suicide but infact increase it in certain patient populations. I am not using the ref above but am basing this on the FDAs statement found in the text of this article. I can find a review tomorrow if you like but I think a major governmental statement is okay as well. Otherwise people might just jump to the conclusion that SSRI prevents suicide which is in fact what they have done post GSK 2000s marketing campaign in Japan which left out the third and most important point.

Further note SSRIs may decrease the risk of suicide in older men I was reading somewhere. Doc James (talk · contribs · email) 04:12, 14 May 2010 (UTC)[reply]

Maybe add it to the antidepressant section of this article, reduced risk of suicide in older people, increased in younger etc but leave it out of the lead and add it to the SSRI articles as suggested by casliber.--Literaturegeek | T@1k? 23:52, 14 May 2010 (UTC)[reply]

I must say I disagree. The lead should pull a person into the article. We all know suicide is associated with depression and that SSRIs are common treatments. What many do not know is that even though they are lead to believe that SSRIs decrease rates of suicide this is not infact the case. We do state this in the body of the text with references. Here is the most recent Cochrane review on the topic Hetrick S, Merry S, McKenzie J, Sindahl P, Proctor M (2007). "Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents". Cochrane Database Syst Rev (3): CD004851. doi:10.1002/14651858.CD004851.pub2. PMID 17636776.{{cite journal}}: CS1 maint: article number as page number (link) CS1 maint: multiple names: authors list (link)Doc James (talk · contribs · email) 04:29, 15 May 2010 (UTC)[reply]

I think that if it is added to the lead, that it should be sourced in the body of the article to high quality sources. Maybe evidence that use of antidepressants in people younger than 24 years old is associated with increased suicide but older individuals decreased suicide risk?--Literaturegeek | T@1k? 20:34, 15 May 2010 (UTC)[reply]

(undent) Well we have the 2007 Cochrane review above along with the FDA. I have not seen a good quality source for the second point that it might decreases risk in older males but will try to find one. BTW it is risk for suicide rather than suicides themselves. There is no change in overall suicide rate but the number are too small to determine a statistical difference at this point.Doc James (talk · contribs · email) 20:44, 15 May 2010 (UTC)[reply]

This statement - " Treatment with medications however has not been shown to decrease the risk of suicide" needs to be clarified as it contrasts with the body where it states "Furthermore, lithium dramatically decreases the suicide risk in recurrent depression" as supported by this and this. There are caveats and issues to discuss to the point that I feel a one-sentence statement is too sweeping. At least change it to 'SSRI antidepressant' meds not just 'medication'. Not sure on literature of TCAs and suicide. Casliber (talk · contribs) 08:47, 13 July 2010 (UTC)[reply]

Also, one line is added to the lead but am I missing something as I can't see where it is discussed in the article (??). Casliber (talk · contribs) 08:49, 13 July 2010 (UTC)[reply]

I agree with you about the statement " Treatment with medications however has not been shown to decrease the risk of suicide". To me, this sounds like POV. At least we should write something like "concerning the question if medications decrease the risk of suicide, the results are conflicting," with references both to research that finds decreases and to research that doesn't find decreases. Lova Falk talk 18:24, 13 July 2010 (UTC)[reply]

PS I just removed this sentence. When there is neither consensus about content, nor a source, it should not be in the article. Lova Falk talk 18:34, 13 July 2010 (UTC)[reply]

This was reflecting the black box warning. I have added another review article. Not sure how this is POV? The black box warning states "SSRI and other antidepressant medications". Most believe that medications in fact increase suicide risk. Doc James (talk · contribs · email) 20:36, 15 July 2010 (UTC)[reply]

I have added three other reviews/meta-analyses, in order to make the section more balanced Lova Falk talk 19:36, 16 July 2010 (UTC)[reply]

Section is looking good now. Casliber (talk · contribs) 21:28, 16 July 2010 (UTC)[reply]

Agree and will try to add to it. I added a single line to the lead attempting to summarize this section in neutral language. Doc James (talk · contribs · email) 21:37, 16 July 2010 (UTC)[reply]

(undent) Last night I thought this section was too elaborate for this article and decided to move it to SSRI and write a summary here. This morning I did just this - and I did not even read what you had written here (shame on me). Anyway, please revert if you prefer the longer version... Lova Falk talk 17:20, 17 July 2010 (UTC)[reply]

I have a concern about this line "However, a few studies show either no such connection or a negative correlation between SSRI prescriptions and suicide rates amongst children.^[1]" This is based on a single primary study and is being used to refute the reviews. If you read the Cochrane review that was used to support this line it says "MAIN RESULTS: Twelve trials were eligible for inclusion, with ten providing usable data. At 8-12 weeks, there was evidence that children and adolescents 'responded' to treatment with SSRIs (RR 1.28, 95% CI 1.17 to 1.41). There was also evidence of an increased risk of suicidal ideation and behaviour for those prescribed SSRIs (RR 1.80, 95% CI 1.19 to 2.72)"Thus I think it supports the association rather than refutes it. Doc James (talk · contribs · email) 05:33, 21 July 2010 (UTC)[reply]

This is another case in which a primary study is being used to refute the conclusions of reviews "and yet other studies found that the widespread use of antidepressants in the new “SSRI-era” appeared to have led to highly significant decline in suicide rates in most countries with traditionally high baseline suicide rates.^[2]" It is only one study not studies. Please see WP:MEDRS Doc James (talk · contribs · email) 05:46, 21 July 2010 (UTC)[reply]

The article is over 140 168 kb and will put most casual readers from reading it all. Several sub-sections of the causes section I feel are too big, per WP:UNDUE, I did mention this a while back when I was advocating for a small section on substance induced major depression but nothing was done. Specifically, this subsection, Major_depressive_disorder#Biological and this subsection, Major_depressive_disorder#Psychological need shortening. I think that some article content should be split off into a new article, causes of depression. What are other editors thoughts?--Literaturegeek | T@1k? 17:08, 13 May 2010 (UTC)[reply]

I agree. It would be a good idea to move some of the content of the bio and psychological sections to the subarticles. I do not know if we need a causes section as it will add one more layer of links to get to the final article. Doc James (talk · contribs · email) 17:23, 13 May 2010 (UTC)[reply]

(sigh) we trimmed it quite a bit when it went to FAC. Articles like this often slowly grow over time. I will take a look later today. Luckily we have daughter article to move content to. Also, luckily DSM V has been pushed back to 2013 I heard....Casliber (talk · contribs) 23:21, 13 May 2010 (UTC)[reply]

Cool beans, it sure needs pruning. I just realised that I was mistaken, I dunno where I got 140 kb from, it is actually 168 kb if you can believe that!--Literaturegeek | T@1k? 23:45, 13 May 2010 (UTC)[reply]

Another good Cochrane review which I will add soon. Arroll B, Elley CR, Fishman T; et al. (2009). "Antidepressants versus placebo for depression in primary care". Cochrane Database Syst Rev (3): CD007954. doi:10.1002/14651858.CD007954. PMID 19588448. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: article number as page number (link) CS1 maint: multiple names: authors list (link) Doc James (talk · contribs · email) 04:32, 15 May 2010 (UTC)[reply]

They also seem to favour sertraline over all the rest Cipriani A, La Ferla T, Furukawa TA; et al. (2010). "Sertraline versus other antidepressive agents for depression". Cochrane Database Syst Rev. 4: CD006117. doi:10.1002/14651858.CD006117.pub4. PMID 20393946. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: article number as page number (link) CS1 maint: multiple names: authors list (link) Doc James (talk · contribs · email) 04:34, 15 May 2010 (UTC)[reply]