Recurrent brief depressive episodes - epidemiology, clinical diagnostics, and therapy

Recurrent brief depression (RBD), an affective disorder with a similarly hi gh risk of suicidal behavior as major depression (MD), is characterized by depressive episodes occurring about once a month that last only a few days. The combination of RED and MD,called combined depression (CD), increases t he risk of suicidal behavior enormously,Whereas patients with CD are usuall y in the care of psychiatrists or neurologists, epidemiological data demons trate that RED patients usually see only general practitioners and are not recognized as suffering from an affective disorder. Diagnostic criteria for RED can be found in the ICD-10 and are helpful in both research and clinic al routine. Recurrent brief psychiatric syndromes should be taken into diff erential diagnostic consideration and are discussed in detail in this revie w. However, the possibility of prospective diagnostic confirmation of RED a nd the way of evaluating drug responses in prophylactic intervention of RED differ essentially from those in treatment of MD and are more related to c linical procedures used in treating migraine or epilepsy. Differences in th e courses of RED and MD are responsible for different requirements in the d esign of drug treatment studies. Denial of special methodological needs and highly selected patient samples have probably been responsible for false n egative results in double-blind, placebo-controlled treatment studies. Alth ough several authors reported successful treatment of RED with different co mpounds in about 60 patients, no treatment algorithm can be given. Future t reatment studies without the limitations of previous studies are clearly ne eded in the field of RBD.