Depression is one of the most common and best known types of disorders in the population . It may involve a high degree of affectation in the individual’s life, with both inactivity and high irritability.

Traditionally, it was noted that a person was truly depressed if the depressive episode in question lasted more than 14 days. If it didn’t, the person usually wasn’t diagnosed with the disorder.

However, in recent years, extensive research has been conducted which, while it may still seem tentative, has indicated that real depression can occur in short episodes of time. These episodes are not a mild version of what has been called major depression, since the degree of involvement in the individual’s life may be such that he or she may even commit suicide.

We are going to talk about a disorder whose duration has generated a wide debate: the recurrent brief depressive disorder . We will explain what it is, what its historical background is, what the WHO and the APA think about it and how it differs from other mood disorders.

What is recurrent brief depressive disorder?

Recurrent brief depressive disorder, also called relapsing brief depression , is a psychological disorder characterized by intermittent depressive episodes. These episodes are not linked to the menstrual cycle in women, and have a short duration of between 2 and 14 days, usually lasting between 5 and 7 days. The episodes occur about 6-12 times a year. After a year, the sum of the days when you have been depressed can add up to about a month.

Although the episodes are brief, the degree of depression that is reached is so severe that it can affect the person’s functionality , as well as carry out autolytic attempts and commit suicide. In addition, people who suffer from it often have anxiety and irritability.

Due to the characteristics of the disorder it can be confused with major depression and other associated disorders, being differentiated not by the severity of the symptoms, but by the duration of the depressive episode.

History of diagnostic labeling

Since the 19th century, some disorders have been seen to appear occasionally and in short episodes, ranging from hours to days. In the past, this type of mood problems, especially if they appeared in the form of depression, received various names , such as ‘periodic melancholy’ or ‘intermittent depression’.

When the DSM-III (Diagnostic and Statistical Manual of Mental Disorders) was published, based on a large body of psychiatric research, the criteria for depression explicitly specified that the depressive episode should last longer than two weeks. Thus, there was no diagnostic label that covered the same symptoms as major depression but with a shorter duration.

Jules Angst, a Swiss psychiatrist, coined in 1985 the term ‘recurrent brief depression’ based on epidemiological data and proposed a series of criteria to be able to diagnose this type of mood disorder. As a result of this, and thanks to several studies at the European level, the World Health Organization did include it in the tenth version of the ICD (International Classification of Diseases) in 1992, while the APA chose to offer provisional diagnostic criteria for this disorder in the fourth edition of the DSM.

Symptoms

Generally, people with recurrent brief depressive disorder suffer the same symptoms as in major depression. They are anxious and irritable and show hypersomnia .

Depression, in general terms, is a symptom and set of disorders that can produce a high degree of deterioration in the person’s functioning and adaptation. In addition, patients’ lives can be disrupted as a result of this, and the schedules and routines that the person has acquired while not suffering from the episode can be altered.

Differential diagnosis

In ICD-10 ( ), recurrent brief depressive disorder is defined as a disorder that meets criteria for mild, moderate and severe depressive episodes. The particularity that makes this disorder different from major depression is that lasts less, with depressive episodes lasting less than two weeks .

Thus, short-term relapsing depression is not different from major depression in the severity of its symptoms, nor should it be viewed as a mild form of this type of disorder. In depressive episodes, although brief, they are particularly dangerous because of the person’s risk of committing suicide. That’s why major depression and brief relapsing depressive disorder are considered two related but different disorders.

Also differs from major depression with seasonal pattern of recurrence by the fact that the depressive episodes in recurrent brief depressive disorder occur every month and are of shorter duration.

As for bipolar disorder with rapid cycling, recurrent brief depression does not have hypomanic or manic episodes. Premenstrual dysphoric disorder differs from it in that it is not associated with the menstrual cycle.

This disorder has a high co-morbidity with anxiety disorders, such as generalized anxiety, and can also lead to substance abuse and addiction.

Causes

The cause of recurrent brief depression is still unknown, and it is most likely a multi-causal phenomenon, with many variables influencing its occurrence. However, it has been suggested that there could be some type of relationship between this disorder and bipolar disorder , in addition to being related to possible genetic factors.

A small group of patients diagnosed with this disorder have been found to have temporal lobe epilepsy.

Prevalence

Although research on this disorder has so far yielded rather little data, it is estimated that about 5% of the population may experience an episode that meets the above characteristics at some point in their lives. This frequency reaches 10% in young adults between the ages of 20 and 30 .

Treatment

People who are going through an episode of this kind can acquire a greater degree of well-being by going to psychotherapy . This facilitates the adoption of habits that weaken the presence of the disorder, until its effects fade away or become much less powerful on people.

In addition, psychotropic drugs, specifically SSRIs, mood stabilizers such as lithium, and antiepileptic drugs are prescribed in clinical practice. However, the drugs alone do not make the disorder go away, and their aim is to mitigate the symptoms in the medium term.

Bibliographic references:

  • Pezawas L., Wittchen H. U., Pfister H., Angst J., Lieb R., Kasper (2003). Recurrent brief depressive disorder reinvestigated: a community sample of adolescents and young adults. Psychol Med; 33(3): 383-6.
  • Pezawas L., Angst J., Gamma A., Ajdacic V., Eich D., Rossler W. (2003) Recurrent brief depression- past and future. Prog Neuropsychopharmacol Biol Psychiatry; 27(1): 75-83.
  • Corominas A, Bonet P, Nieto E (1998). Breve depresión recurrente tratada con éxito con litio. Biol Psychiatry; 44(9): 927-9.
  • Angst J., Hochstrasser B. (1994). Breve depresión recurrente: el estudio de Zurich. J Clin psychiatry; 55(suppl): 3-9.
  • Carta M. G., Altamura A. C., Hardoy M. C., Pinna F., Medda S., Dell’Ossol J., y otros (2003) ¿Es la depresión breve recurrente una expresión de los trastornos del espectro del estado de ánimo en los jóvenes? Resultados de una amplia muestra de 3 comunidades. Eur Arch Psychiatry Clin Neurosci; 253(3): 149-53.
  • Pezawas L., Angst J., Kasper S. (2005). Recurrent brief depression revisited. International Review of psychiatry. A bingdon; 17(1): 63.
  • Stamenkovic M., Blasbichier T., Riederer F., Pezawas L., Brandstatter N., Aschauer H. N., y otros (2001) Fluoxetine treatment in patients with recurrent brief depression. Int Clin Psychopharmacol; 16(4): 221-6.
  • Montgomery D. B., Roberts A., Green M., Bullock T., Baldwin D., Montgomery S. A. (1994). Falta de eficacia de la fluoxetina en la depresión breve recurrente y en los intentos de suicidio. Eur Arch Psychiatry Clin Neurosci; 244: págs. 211 a 215.