What is Recurrent Depressive Disorder?
Recurrent depressive disorder is a disorder characterized by repeated depressive episodes of mild, moderate or severe degree, without anamnestic data on individual episodes of high spirits, hyperactivity that could meet the criteria for mania. However, this category can be used if there is evidence of short episodes of mild high spirits and hyperactivity that meet the criteria for hypomania that follow immediately after a depressive episode (sometimes they can be triggered by the treatment of depression).
The prevalence in the population is quite high and according to various sources ranges from 0.5 to 2%
Causes of Recurrent Depressive Disorder
As a rule, it is rather difficult to identify the exact cause of recurrent depressive disorder, among the main etiological factors there are: endogenous (genetically determined predisposition), psychogenic (depression is the most typical human reaction to mental trauma) and organic (residual-organic inferiority, the consequences of neuroinfections, intoxication, head injuries, etc.). The first episodes of recurrent depressive disorder are usually caused by external provocation (often by traumatic circumstances), however, factors unrelated to external circumstances predominate in the occurrence and development of repeated phases.
Pathogenesis during Recurrent Depressive Disorder
The first episode occurs later than with bipolar disorder, at the age of about 40 years, although often the disease begins much later. The duration of the episodes is 3-12 months (average duration of about 6 months). The period between attacks is at least 2 months, during which no significant affective symptoms are observed. Although recovery is usually complete in between attacks, a small proportion of patients exhibit chronic depression, especially in old age. Usually, late seizure lengthening is noted. An individual or seasonal rhythm is quite distinct. The structure and typology of seizures correspond to endogenous depressions. Additional stress can alter the severity of depression. Individual episodes of any severity are often provoked by a stressful situation and, in many cultural conditions, are observed 2 times more often in women than in men.
Symptoms of Recurrent Depressive Disorder
Main symptoms
- depressed mood;
- a decrease in interest or pleasure from activities that were previously pleasant to the patient;
- decreased energy and increased fatigue.
Additional symptoms
- decreased self-esteem and self-confidence;
- unreasonable sense of self-condemnation and guilt;
- ideas or actions aimed at self-harm or suicide;
- decreased ability to focus and attention;
- a gloomy and pessimistic vision of the future;
- sleep disturbance;
- change in appetite.
Diagnosing Recurrent Depressive Disorder
The main symptom of recurrent depressive disorder is the presence of recurring depressive episodes (at least 2 episodes should last at least 2 weeks and should be separated by an interval of several months without any significant mood disorders). The possibility of a manic episode in a patient with recurrent depressive disorder cannot be completely excluded, no matter how many depressive episodes in the past. If an episode of mania occurs, the diagnosis should be changed to bipolar affective disorder.
Recurrent depressive disorder can be subdivided by designating the type of current episode, and then (if there is sufficient information) the prevailing type of previous episodes into mild, moderate or severe.
- Mild recurrent depressive disorder is characterized by the presence of at least two main symptoms and two additional symptoms. Subdivided into:
– Mild recurrent depressive disorder without somatic symptoms (there are, but not necessarily, only some somatic symptoms)
– Mild recurrent depressive disorder with somatic symptoms (there are 4 or more somatic symptoms, or only 2 or 3, but quite severe)
- Moderate recurrent depressive disorder is characterized by the presence of at least two main symptoms and three to four additional symptoms. Subdivided into:
– Moderate recurrent depressive disorder without somatic symptoms (only some are present or are absent)
– Moderate recurrent depressive disorder with somatic symptoms (there are 4 or more somatic symptoms, or only 2 or 3, but an unusually severe degree)
- Severe recurrent depressive disorder is characterized by the presence of all the main symptoms and four or more additional symptoms. Subdivided into:
– Severe recurrent depressive disorder without psychotic symptoms (no psychotic symptoms)
– Recurrent depressive disorder, current severe episode with psychotic symptoms (delusions, hallucinations, depressive stupor should be present). Delusions and hallucinations can be classified as appropriate or not appropriate for mood.
Differential diagnosis
Recurrent depressive disorder should be differentiated from schizoaffective disorder and organic affective disorder. In schizoaffective disorders, the structure of productive experiences contains schizophrenia symptoms, and in organic affective disorders, the symptoms of depression accompany the underlying disease (endocrine, brain tumor, consequences of encephalitis).
Treating Recurrent Depressive Disorder
The treatment takes into account exacerbation therapy (antidepressants, electroconvulsive therapy, sleep deprivation, benzodiazepines and antipsychotics), psychotherapy (cognitive and group therapy) and maintenance therapy (lithium, carbamazepine or sodium valproate).
