The phenomenology of recurrent brief depression with and without hypomanic features.
BACKGROUND
The nosologic status of recurrent brief depression (RBD) is debated. We studied the phenomenology of RBD in a clinical sample of outpatients.


METHODS
Forty patients (mean age 33; 73% females) and 21 age- and gender-matched mentally healthy controls were examined (clinical interview, M.I.N.I. neuropsychiatric interview, MADRS, Stanley Foundation Network Entry Questionnaire). Exclusion criteria were bipolar I or II disorders, a history of psychosis, concurrent major depressive episode, organic brain or personality disorders (clusters A and B).


RESULTS
The mean age of onset of RBD was 20 years with a mean of 14 episodes/year with brief (mean 3 days) severe depressive episodes. Nineteen (47%) reported additional short episodes of brief hypomania (>1 day duration; RBD-H) of which nine (23%) never had experienced a major depression. Twenty-one (53%) patients reported RBD only (RBD-O) with or without (n=12) past history of major depression or dysthymia. During the last depressive episode, 76% of the RBD-O and 90% of the RBD-H patients had a melancholic depression. Seventy-one % of the RBD-O and 79% of the RBD-H reported at least two out of three atypical symptoms. Nineteen (48%) of the patients reported anger attacks and panic disorder, the latter being more prevalent in the RBD-H subgroup (68% versus 29%, p=0.012).


CONCLUSIONS
Cross-sectional study of self-referrals or patients referred by primary care physicians or psychiatrists.


CONCLUSIONS
The study supports the validity of RBD as a disorder separate from bipolar II, cyclothymia and recurrent major depression. A brief episode of hypomanic symptoms is a severity marker of RBD.
Institute of Psychiatry, University of Oslo, Norway; Department of Neuropsychiatry and Psychosomatic Medicine, Division of Clinical Neurosciences, Rikshospitalet University Hospital, Oslo, Norway. hans.lovdahl@sshf.no
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H
Lövdahl
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S
Andersson
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Hynnekleiv
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UF
Malt
D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D002908:Chronic Disease; D015897:Comorbidity; D035061:Control Groups; D003527:Cyclothymic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires