In addition, it should be mentioned that for bipolar depression there is also reasonably good evidence for monotherapy with the mood stabilizers lithium and 1amotrigine, as well as with the atypical antipsychotics olanzapine and quctiapine.71 However, there is no evidence so

far that these treatment regimens may be superior in efficacy when compared with antidepressants.72 Dysthymia and MDD in combination with dysthymia Diagnostic criteria for dysthymia and depressive disorders differ in the severity and duration of the symptoms. Dysthymia is characterized by a chronic depressive syndrome Inhibitors,research,lifescience,medical of lower intensity of symptoms than severe depression, although it produces very Inhibitors,research,lifescience,medical similar levels of disabilities. Also, an additional and superimposing major depressive episode can occur in patients already suffering from dysthymia, then diagnosed as a “double depression”

or “double major depressive disorder.” The differential diagnosis of both disorders is difficult if a dysthymic episode follows a depressive episode, because the symptoms of dysthymia are then indistinguishable from the (reduced) symptoms of a depressive Inhibitors,research,lifescience,medical disorder with only partial remission, which should be diagnosed in this case. Only after a full remission lasting at least 6 Selleckchem Fasudil months, the subsequent dysthymic symptoms can be diagnosed as dysthymia. Because the same antidepressant therapies are efficacious in both diagnostic entities, the acute treatment plans can be identical for depressive Inhibitors,research,lifescience,medical disorders, dysthymia, and double depression. In addition, treatment with certain antipsychotics such as amisulpride73-74 predominantly at lower doses, may be of use. Due to the chronic nature of dysthymic Inhibitors,research,lifescience,medical disorders, an earlier implementation of psychotherapeutic approaches

can be of use. In addition, the treatment goals should be formulated somewhat more cautiously because dysthymia seems to have a lesser probability for a complete recovery.75 Recurrent brief depression Recurrent brief depression (RBD) is characterized by at least monthly occurring depressive episodes of short duration that last only a few days.76 Within DSM-IV-TR, recurrent brief depression can only be diagnosed as subthreshold MDD; within ICD-10 it is a diagnostic category of recurrent enough depressive disorder. The combination of severe depressive disorders and RBD is sometimes called “combined depression” (CD).76 The combination of depressive disorders and RBD shows a relatively high prevalence. The substantially higher risk for suicidal ideations in such cases represents a specific concern. Most trials investigating antidepressant therapies were designed to judge the therapeutic efficacy in major depressive disorders.