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10-12-2008 | Mental health | Article

Recurrent brief depression a 'valid diagnostic category'


Free abstract

MedWire News: Recurrent brief depression (RBD) is a valid diagnostic category that can be separated from bipolar II disorder, cyclothymia, and recurrent major depression, study findings indicate.

The researchers admit, however, that it remains unclear what the best treatment options for RBD are.

"Our own and others clinical experiences, and the many clinical features observed in this study suggesting a link between RBD and the bipolar spectrum, may suggest that mood stabilizers should be the first line treatment of ICD-10-defined RBD," Hans Lövdahl (Sørlandet Hospital, Arendal, Norway) and colleagues comment in the Journal of Affective Disorders.

Psychiatric disorders characterized by periods with depressive episodes lasting hours to days have been described since 1852 and have been labeled "periodic melancholia," "intermittent depressive disorder," or "very brief depression."

Nevertheless, there is controversy about the classification of RBD. The third version of the DSM diagnostic criteria requires at least 14 days duration for a diagnosis of depression; as such it included no category allocated to depressive episodes of shorter duration, such as those in RBD.

By contrast, RBD was included in the 10th classification of mental and behavioral disorders (ICD-10) published by the World Health Organization in 1992 and was defined as mild to severe depressive episodes of less than two weeks but typically two to three days.

To investigate, the researchers informed personnel working in the psychiatric health services about RBD and a proposed study on the disorder.

Forty patients with possible RBD were referred to the project by either a psychiatrist or a general practitioner, and were subsequently interviewed and compared with 21 mentally healthy controls.

The mean age of onset of RBD was 20 years, with a mean of 14 episodes per year with severe depressive episodes lasting 3 days on average. In all, 19 (47%) of these patients reported additional short episodes of brief hypomania (>1 day duration), of whom nine (23%) had never experienced a major depression.

Furthermore, 21 (53%) patients reported RBD only with or without (n=12) past history of major depression or dysthymia. Nineteen (48%) of the patients reported anger attacks and panic disorder, the latter being more prevalent in the subgroup with hypomania than in those without (68% versus 29%).

Lövdahlet al comment: "Our study confirms epidemiological studies indicating that RBD is a valid diagnostic category that can be separated from bipolar II disorder, cyclothymia, and recurrent major depression.

"Our findings further suggest that a history of hypomanic symptoms in addition to recurrent brief depressive episodes is a marker of severity."

By Andrew Czyzewski