Fluoxetine treatment in patients with recurrent brief depression

Recurrent brief depression (RBD) fulfills DSM-IV criteria for major depress ion except duration. Depressive episodes last at least 2 days but less than 2 weeks occurring at least once a month for 12 consecutive months without association to the menstrual cycle. RED has a high prevalence in the genera l population (approximately 10%). At present, there are few double-blind co ntrolled studies indicating that selective serotonine reuptake inhibitors ( SSRIs) might not be effective in treatment of RED. However, most of those s tudies include patients with a history of frequent suicide attempts and dep ressive episodes lasting shorter 2 weeks. It has previously been shown that fluoxetine was effective in patients with RED in an open-label study. The objective of our study was to reinvestigate these contradictory results con cerning the effectiveness of fluoxetine in patients,vith RED. Seventeen pat ients with RED according to DSM-IV and ICD-IO diagnostic criteria, who had no history of major depression were treated with a dosage of 20-40 mg fluox etine daily. Patients had to keep a diary in order to document psychopathol ogical symptoms according to DSM-IV. We also used the 21-item Hamilton Depr ession Rating Scale (HAM-D), the Beck Depression inventory (BDI) and the Cl inical Global Impressions (CGI). Duration of the! study was 8 weeks. The di aries of nine patients were observed for a clinical observation period of 2 0 weeks after the end of the study with continued fluoxetine treatment. Two patients who initially fulfilled diagnostic criteria for RED suffered from depressive episodes that lasted longer than 2 weeks. Therefore, their data had to be excluded from primary analysis. In the remaining 15 patients, we showed statistically significant improvement of depressive episodes measur ed by patient's diary, HAM-D, BDI and CGI that persisted over the clinical observation period. Frequency of depressive episodes showed a significant d ecrease during fluoxetine treatment. Duration and severity of the single de pressive episodes also decreased but did not reach statistical significance . In accordance with previous studies, fluoxetine could be a treatment opti on for patients with RED. Treatment of RED with SSRIs has been discussed co ntroversially In the literature. Our study shows the effectiveness of fluox etine in this depressive disorder. To confirm these preliminary results, a double-blind controlled study is necessary. (C) 2001 Lippincott Williams & Wilkins.