Recurrent brief depression – more investigations in clinical samples are now required

Abstract

Classifications of depression based on secondary care samples may have little relevance in primary care settings, where many patients do not fulfil criteria for major depression; for example, through having depressive symptoms that are either too mild or too brief. And yet many such patients receive antidepressant treatments (antidepressants and various psychotherapies). At a time when the appropriate recognition and treatment of people with depressive symptoms is the subject of much discussion, and there is concern about the burgeoning number of new psychiatric diagnoses, the burden and hazards of depressive disorders need to be emphasized. The paper by Pezawas et al. (2003) (in this issue) reports the findings of an epidemiological study in adolescents and young adults, and provides a detailed description of the prevalence and features of one such disruptive disorder, namely recurrent brief depression.

Lack of efficacy of moclobemide or imipramine in the treatment of recurrent brief depression

“…In the DSM-5 (American Psychiatric Association, 2013), RBD is placed within the group 'other specified depressive disorder': to meet the diagnosis, depressive episodes must be characterized by at least five symptoms and must be associated with functional impairment, but should last less than 14 days. However, the only large randomized placebo-controlled trial, of the selective serotonin reuptake inhibitor fluoxetine in patients with RBD and repeated suicide attempts, found no evidence of efficacy (Montgomery et al, 1994), and treatment studies with paroxetine have also yielded disappointing results (Kasper et al, 1995): there is a persistent need for additional placebo-controlled treatment studies in clinical samples (Baldwin, 2003). Case reports and small case series suggest that patients with RBD may benefit from treatment with nimodipine (Pazzaglia et al, 1993), tranylcypromine (Joffe, 1996), mirtazapine (Stamenkovic et al, 1998), lithium (Corominas et al, 1998), fluoxetine (Stamenkovic et al, 2001), reboxetine (Pezawas et al, 2002), lamotrigine (Ravindran and Ravindran, 2007) and olanzapine (De la Fuente, 2008).…”