Talk:Management of depression/Archive 2

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Archive 1 Archive 2

article structure

OK... so I think that structure wise, we need to come to some rationale for how to structure.. right now it is a pretty big jumble. The WP:MEDMOS guideline offers little guidance for a "Management of X" like this. In the section on Diseases, it does describe a management section, as follows:

  • Treatment or Management: This might include any type of currently used treatment, such as diet, exercise, medication, palliative care, physical therapy, psychotherapy, self care, surgery, watchful waiting, and many other possibilities. Consider discussing treatments in a plausible order in which they might be tried, or discussing the most common treatments first. Avoid experimental/speculative treatments and preventive measures (e.g., prophylactic vaccines or infection-avoidance techniques). As per the policy of WP:NOTHOW, Wikipedia articles should not be written in a "how-to" style, but this does not prevent adding official guidelines of treatments or managements if these can be presented in an objective manner and with medically reliable sources.

So... that is pretty loose. And like I said, we have a jumble of stuff, that I guess I would summarize as follows:

  • common behavioral recommendations (sleep hygiene, exercise, diet, stop smoking)
  • therapy
  • drugs + therapy
  • drugs
    • drugs approved in the EU that are supplements in the US (oy) (SAMe, maybe st johns wort?)
    • note: Merck manual mentions herbal supplements here - specifically st johns wort and omega3.
  • approved medical devices (Merck Manual includes phototherapy here!)
  • Alternative approaches: eg aromatherapy, herbs (here or above??), bodywork, sleep deprivation, etc,
  • some things we should just delete maybe (like CES, since it is actually not recommended; ketamine, which is not approved for this anywhere)

That is my sense of the right order, based on the Management recommendation above and the Merck Manual linked in the lead. What do ya'all think? Jytdog (talk) 23:08, 20 February 2014 (UTC)

problem with terminology in the intro.

"This article addresses the management of the psychiatric syndrome known as major depressive disorder or often called simply "depression"." A syndrome is not a disorder, in fact the syndrome is simply "depression". Major depressive disorder is a disorder that 'include' the syndrome (there are other disorders that are related to syndrome). Basically a syndrome is "a collection of symptoms and findings without necessarily tying them to a single identifiable pathogenesis" like the wiki syndrome page states. Major depressive disorder is a single identifiable pathogenesis. Depression is related to many identifiable pathogenesis, disorders related to the depression syndrome are psychotic depression, major depressive disorder, Bipolar disorder etc.

I suggest deciding whether this article is about one disorder (major depressive disorder) or several disorders and change the text accordingly. 79.180.197.168 (talk) 08:54, 3 August 2014 (UTC)

Saint John's Wort summary does not seem like a fair summary of the scientific evidence

First, the evidence cited in favor of efficacy is a systematic review- that is, a meta-analysis of many different studies. These studies are considered something of a gold standard in terms of studying whether a treatment works; the idea is that one study might say something works (or doesn't) by chance or because of poor research design, but by looking at everything you get a clear consensus of the evidence. So the consensus of lots of studies it that it works, and then there's a single study presented that says no, it doesn't. Second, one or two studies finding no difference from placebo... well the exact same can be said of any number of antidepressants. There are lots of studies that find that an antidepressant is no less effective than placebo. But the scientific consensus is that they do work (whether many people would be better off just exercising instead is another issue, of course). This is going to be pretty standard for any effective treatment- run enough studies and you'll get a few cases where it doesn't work. The research out there (summarized in the systematic review) suggests that Saint John's Wort is an antidepressant, and functions in a similar way- by preventing reuptake of neurotransmitters (serotonin, dopamine, and norepinephrine). As written the article makes it out as if the evidence pro and con is equivalent- it isn't- as does putting it in the "Alternative" section. The scientific evidence strongly supports antidepressant effects, using a mechanism similar to man-made antidepressants, for the active component hypericin. This doesn't belong in the "Alternative" section, any more than morphine is alternative medicine because it comes from the poppy plant. It's only "alternative" in the sense that psychiatrists don't prescribe it, but the scientific consensus is clear: the stuff works at least as well as synthetic antidepressants, with fewer side effects. — Preceding unsigned comment added by 138.38.86.139 (talk) 19:30, 25 January 2014 (UTC)


Thanks for your note! I checked the NCAM website and their advice has changed; it now aligns nicely with the Cochrane review. And you were right, in that a single study should never be used to "balance" something as high quality as a Cochrane review. Fortunately this was easy resolve due to NCAM updating their advice. However, I don't agree that St John's Wort belongs in the same section as drugs. The key difference -- and it is essential -- is that the manufacturing of drugs is strictly controlled and regulated. We know what is in a Prozac pill. We have very little idea what is in any given capsule labelled "St John's Wort". The day somebody gets regulatory approval to market a hypericum extract as a drug - with all the manufacturing controls that go along with that - we can move it to the drug section. Until then it remains Alternative. If you are not aware of the vagaries of dietary supplement manufacturing, please see here and elsewhere. Jytdog (talk) 20:36, 25 January 2014 (UTC)

I am not sure I agree with that. The definition of "Alternative Medicine" put forward by Wikipedia is "any practice that is put forward as having the healing effects of medicine but is not based on evidence gathered using the scientific method". Going by this definition, Saint John's Wort is medicine, not Alternative Medicine, because its efficacy is upheld by scientific studies. Also, if some companies like Perika use standardized testing to produce consistent hyperforin levels, but others don't, how does that work? Is the one brand 'Alternative Medicine' and the other isn't, or can several unreputable companies turn an entire class of compounds from real medicine to "Alternative"? That just doesn't make sense. — Preceding unsigned comment added by 86.168.27.71 (talk) 03:45, 31 January 2014 (UTC)

I am sorry, what is it exactly that you say is "medicine"? Again, if you say "Prozac" I know exactly what we are talking about. If you say "St Johns Wort" I am very very unsure. High quality CMC is one of the most important qualities of a medicine. Moving on... I don't know what you are talking about with respect to Perika's process.. do you have some reliable source that describes it? Finally, please note that if this is the product you are talking about, the label is for a dietary supplement - something that supports the structure or function of the body; in this case "Helps maintain a healthy emotional outlook". This is not the label for a pharmaceutical drug, which would describe treatment of a disease, like Prozac's label: "PROZAC® is a selective serotonin reuptake inhibitor indicated for: Acute and maintenance treatment of Major Depressive Disorder (MDD) in adult and pediatric patients aged 8 to 18 years (1.1); Acute and maintenance treatment of Obsessive Compulsive Disorder (OCD) in adult and pediatric patients aged 7 to 17 years (1.2); Acute and maintenance treatment of Bulimia Nervosa in adult patients (1.3); Acute treatment of Panic Disorder, with or without agoraphobia, in adult patients (1.4)". So even the product itself does not describe itself as a drug.Jytdog (talk) 04:12, 31 January 2014 (UTC)

You're being logically inconsistent: your argument is that it is alternative medicine because of manufacturing standards, then it was pointed out that this has nothing to do with whether it's alternative medicine or not: it's whether it's based on scientific evidence and the scientific method, but you've persisted in the argument that this is alternative medicine. If you're so unclear about what medicine is, you could try looking up the Wikipedia article: medicine is " is the field of applied science related to the art of healing by diagnosis, treatment, and prevention of disease". Again, the defining criterion about what separates medicine from alternative medicine is the scientific method- observation, induction, hypothesis testing- and by those criteria, Saint John's Wort is medicine, not "alternative medicine". And the manufacturers of several brands tests do the product to maintain a consistent level of the compound hyperforin, a monoamine reuptake inhibiting compound that has been shown in numerous clinical studies to be comparable to man-made antidepressants in efficacy, with fewer side effects- but more drug interactions. — Preceding unsigned comment added by 138.38.184.152 (talk) 15:38, 31 January 2014 (UTC)

i see where the problem is coming from. i fixed the section header in the article. Jytdog (talk) 16:10, 31 January 2014 (UTC)
That doesn't quite get at the problem. Again, getting back to the articles on "Medicine" and "Alternative Medicine" the difference is not the mode of manufacture, it is the scientific evidence- or lack thereof- that they work. There are several different levels of evidence- (i) treatments that have repeatedly been proven by thorough scientific investigation (multiple double-blind, placebo-controlled studies), which would include things like SSRIs and Saint John's Wort (ii) treatments supported by more limited scientific evidence (some evidence they work, but evidence isn't yet definitive), which would include things like eicosapentaenoic acid (fish oil), zinc supplementation, or acupuncture, and (iii) treatments that so far have no scientific evidence of working, which would include things like Reiki or flower oils. Lumping a scientifically validated treatment like Saint John's Wort- prescribed by doctors in Germany- into the same category as pseudoscience isn't helpful. The best thing to do might be to simply jettison the real Alternative Medicine- that is, treatments for which there are no scientific studies suggesting that they work- from the article entirely, and create sections like "Herbal Medicine" for things like St. John's Wort and Rhodiola and "Supplements" for things like Zinc, Creatine etc. It still seems a bit silly to call it "herbal medicine", after all if you go to Europe and they shoot you up with morphine, that's going to be made from the head of a flower, just like Saint John's Wort extracts. — Preceding unsigned comment added by 86.168.27.71 (talk) 01:03, 1 February 2014 (UTC)
you did not answer my question about Perika's process.Jytdog (talk) 02:37, 1 February 2014 (UTC)

I think it should be alternative because it's an unusual and uncommon treatment. I agree that article should reflect it's effectiveness based on systematic reviews. Plus I think some clarifications about availability, extracts strength and the like is in order (I've heard that in some countries therapeutic extracts are hard to get, in some of those countries extracts with questionable therapeutic value are sold)79.180.197.168 (talk) 09:14, 3 August 2014 (UTC)

Proposal to clarify withdrawal symptoms of antidepressant medication

Adding this helps clarify what may occur if someone were to discontinue their medication without consultation of their physician.


"Patients who abruptly discontinue their medication can produce withdrawal symptoms such as depression and anxiety within hours of the missed drug dosage.[1]"

  1. ^ Kirsch, Irving (2009). The Emperor's New Drugs. The Bodley Head. p. 152. ISBN 9781409086369. Retrieved November 14, 2014.
There is a better wikilink, Antidepressant discontinuation syndrome. And there are much better sources on that page as well. There is no reason to use a 5 year old book when we have recent review articles. please see WP:MEDRS about sourcing health-related content. Jytdog (talk) 21:49, 19 November 2014 (UTC)

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Therapy Data Table?

Hey wiki people! I'm pretty new to this, but I was looking over the Management of Depression page and I think it could benefit from a more cohesive comparison and presentation of the numerous therapies offered for treatment. Similar to the table under the medication section, a table comparing the types of therapies could help many people find out which is right for them in terms of efficacy, comfort, and time. I know that there has been talk of merging/deleting this page in the past, so I think that adding such a structured, detailed element could vamp up this page's information and keep it higher in standards for readers. Let me know what y'all think... Thanks! Cd1994 (talk) 17:20, 18 October 2017 (UTC)

table

It is here -- moved here for discussion

Therapeutic Treatments

Classification Therapy Goal Effectiveness
Behavioral Therapies Cognitive Behavioral Therapy (CBT) Focuses on developing personal strategies for coping with current issues involving thoughts, feelings, attitudes, behaviors, and emotional regulation.[1][2] It it a problem-focused and action-oriented, emphasizing skill learning and practice.[3] Can be effective in less severe cases when used alone, however can be more effective when paired with psychotropic medications.[1] More recent research shows that it can be equally as effective.[4] A systematic review of data comparing low-intensity CBT (such as guided self-help by means of written materials and limited professional support, and website-based interventions) with usual care found that patients who initially had more severe depression benefited from low-intensity interventions at least as much as less-depressed patients.[5]
Dialectical Behavior Therapy (DBT) Works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions. Assumes that people are doing their best but lack the skills needed to succeed, or are influenced by positive reinforcement or negative reinforcement that interferes with their ability to function appropriately.[6] A Duke University study of compared treatment of depression by antidepressant medication to treatment by antidepressants and dialectical behavior therapy. A total of 34 chronically depressed individuals over age 60 were treated for 28 weeks. Six months after treatment, statistically-significant differences were noted in remission rates between groups, with a greater percentage of patients treated with antidepressants and dialectical behavior therapy in remission.[7]
Psychoanalytic Therapies Psychoanalysis A school of thought founded by Sigmund Freud that emphasizes the resolution of unconscious mental conflicts. Is used by its practitioners to treat clients presenting with major depression.[8] Duration is long-term and frequent; up to 4-5 sessions per week. This allows for a deeper relationship between therapist and patient and helps develop personal treatment strategies from the root of the issue. [8] Effective in treating depression; In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis "to make psychodynamic psychotherapy an 'empirically validated' treatment." [9]
Psychodynamic Psychotherapy (PPT) Loosely based on psychoanalysis and has an additional social and interpersonal focus.[9] In a meta-analysis of three controlled trials, psychodynamic psychotherapy was found to be as effective as medication for mild to moderate depression.[10]
Social Therapies Interpersonal Psychotherapy (IPT) Focuses on the social and interpersonal triggers that may cause depression. Here, the therapy takes a structured course with a set number of weekly sessions (often 12) as in the case of CBT; however, the focus is on relationships with others.[6] There is evidence that it is an effective treatment for depression. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him or her to communicate more effectively and reduce stress.[6]
Mindfulness Acceptance and Commitment Therapy (ACT) A form of CBT where pairing acceptance and mindfulness strategies is used as a technique to change behaviors and commitments and increase psychological flexibility.[10] Similar effects to CBT when it comes to treatment efficacy, however not a lot of research is there to support this therapy as a treatment. It has scored higher than placebo in trials.[11] With its roots in behavioral analysis, it can be effective such as other like-therapies. [2][4][3]
Mindfulness-Based Cognitive Therapy (MBCT) A mindfulness form of CBT designed to improve retention rates. Very similar to CBT, but focuses on changing behaviors and cognitions through mindful strategies and coping mechanisms. Mixes Eastern meditation methodology with CBT framework.[12] Can be effective for patients Major Depressive Disorder.[13] The emphasis on depressive thoughts and strategies when using meditation methods of awareness help alleviate depressive symptoms. A review of four studies on the effectiveness of suggests that MBCT may have an additive effect when provided with the usual care in patients who have had three or more depressive episodes, although the usual care did not include antidepressant treatment or any psychotherapy, and the improvement observed may have reflected non-specific or placebo effects.[5]
Other Options Expressive Therapies
Mental Health Counselor Shared Care Art Therapy
Social Worker Group Therapy Music Therapy

References

  1. ^ a b Beck JS (2011), Cognitive behavior therapy: Basics and beyond (2nd ed.), New York, NY: The Guilford Press, pp. 19–20
  2. ^ a b Benjamin CL, Puleo CM, Settipani CA, et al. (2011), "History of cognitive-behavioral therapy in youth", Child and Adolescent Psychiatric Clinics of North America, 20 (2): 179–189, doi:10.1016/j.chc.2011.01.011, PMC 3077930 , PMID 21440849
  3. ^ a b Schacter DL, Gilbert DT, Wegner DM (2010), Psychology (2nd ed.), New York: Worth Pub, p. 600
  4. ^ a b Roth, Anthony; Fonagy, Peter (2006). "Cognitive-Behavioral Therapy Alone and in Combination with medication: University of Minnesota and University of Pennsylvania–Vanderbilt University Studies". What Works for Whom?: A Critical Review of Psychotherapy Research(2nd ed.). Guilford Press. pp. 76–8. ISBN 978-1-59385-272-6.
  5. ^ a b Bower, Peter; Kontopantelis, Evangelos; Sutton, Alex; Kendrick, Tony; Richards, David A; Gilbody, Simon; Knowles, Sarah; Cuijpers, Pim; Andersson, Gerhard; Christensen, Helen; Meyer, Björn; Huibers, Marcus; Smit, Filip; van Straten, Annemieke; Warmerdam, Lisanne; Barkham, Michael; Bilich, Linda; Lovell, Karina; Liu, Emily Tung-Hsueh (2013). "Influence of initial severity of depression on effectiveness of low intensity interventions: Meta-analysis of individual patient data". BMJ. 346: f540. doi:10.1136/bmj.f540. PMC 3582703 . PMID 23444423.
  6. ^ a b c "An Overview of Dialectical Behavior Therapy - Psych Central". 17 May 2016. Retrieved 2015-01-19.
  7. ^ Lynch, Thomas (January–February 2003). "Dialectical Behavior Therapy for Depressed Older Adults: A Randomized Pilot Study". The American Journal of Geriatric Psychiatry. 11 (1): 33-45. doi:10.1097/00019442-200301000-00006. Retrieved 16 November 2017.
  8. ^ a b For session length, Thompson, M. Guy. The Ethic of Honesty: The Fundamental Rule of Psychoanalysis, Rodopi, 2004, 75. For session frequency, Hinshelwood, Robert D. "Surveying the Maze", in Serge Frisch, Robert D. Hinshelwood, and Jean-Marie Gauthier (eds.). Psychoanalysis and Psychotherapy: The Controversies and the Future, Karnac Books, 2001, 128.
  9. ^ a b Gerber AJ, Kocsis JH, Milrod BL, Roose SP, Barber JP, Thase ME, Perkins P, Leon AC: A quality-based review of randomized controlled trials of psychodynamic psychotherapy" Am J Psychiatry 2011 Jan;168(1) 19-28. Epub 2010 Sep 15.
  10. ^ a b Hayes, Steven. "Acceptance & Commitment Therapy (ACT)". ContextualPsychology.org.
  11. ^ A-Tjak, JG; Davis, ML; Morina, N; Powers, MB; Smits, JA; Emmelkamp, PM (2015). "A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems". Psychotherapy and psychosomatics. 84 (1): 30–6. doi:10.1159/000365764. PMID 25547522.
  12. ^ Manicavasgar, V.; Parker, G.; Perich, T. (2011). "Mindfulness-Based Cognitive Therapy Vs. Cognitive Behaviour Therapy as a Treatment for Non-Melancholic Depression". Journal of Affective Disorders. 130 (1–2): 138–144. doi:10.1016/j.jad.2010.09.027. PMID 21093925.
  13. ^ Piet, J.; Hougaard, E. (2011). "The Effect of Mindfulness-Based Cognitive Therapy for Prevention of Relapse in Recurrent Major Depressive Disorder: a Systematic Review and Meta-Analysis". Clinical Psychology Review. 31 (6): 1032–1040. doi:10.1016/j.cpr.2011.05.002.

-- Jytdog (talk) 01:22, 6 December 2017 (UTC)


discussion

Some of the sources are primary and fail WP:MEDRS. Tables are also not good for people on mobile who are about half of our readers. 01:22, 6 December 2017 (UTC)

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Esketamine/ketamine no longer are experimental

esketamine is now FDA approved as an antidepressant and should therefore no longer be considered experimental nor listed under that heading. But, are esketamine and ketamine the same thing? Does ketamine still get listed as experimental separate from esketamine? SSyntaxin (talk) 13:46, 3 September 2019 (UTC)

Delete the image with the description : Isoniazid, the first compound called antidepressant.

As it should be in a history section. Better to remove it for more simplicity and clarity of the article.Walidou47 (talk) 01:38, 12 January 2020 (UTC)

This statement seems very biased and has no citation

There is evidence a prominent side-effect of antidepressants, emotional blunting, is confused with a symptom of depression itself. The cited study, according to Professor Linda Gask[57] was: ‘funded by a pharmaceutical company (Servier) and two of its authors are employees of that company’, which may bias the results. The study authors’ note: "emotional blunting is reported by nearly half of depressed patients on antidepressants and that it appears to be common to all monoaminergic antidepressants not only SSRIs". Additionally, they note: "The OQuESA scores are highly correlated with the HAD depression score; emotional blunting cannot be described simply as a side-effect of antidepressant, but also as a symptom of depression...More emotional blunting is associated with a poorer quality of remission.

It is questionable if this is the correct article or the correct place in this article to place this. Also it needs another citation. To me this seems biased towards the idea that antidepressants are "bad" and a big pharma scam. — Preceding unsigned comment added by SSyntaxin (talk • contribs) 03:33, 13 November 2020 (UTC)

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