Recurrent Brief Depression

🧠 Overview — What is Recurrent Brief Depression? 

Recurrent Brief Depression (RBD) is a specific pattern of mood disorder that causes sudden, severe depressive episodes which are very short in duration — only about 2–13 days — before the person’s mood returns to a near-normal baseline quite rapidly. Importantly, these episodes must recur frequently, at least once a month, for ≥ 1 year to meet the full clinical definition of RBD.

Although it is not classified as a “primary disorder” in the DSM-5-TR, RBD is recognized in psychiatry as an important specifier / clinical pattern, because a large number of patients clearly fit this profile and have functional impairment comparable to those with Major Depressive Disorder (MDD). The only reason they “fall out” of the classic MDD criteria is the short duration of episodes, since MDD requires depressive episodes to last at least 2 weeks.

The key feature of RBD is the abrupt and steep drop in mood. Patients often describe it as:

“Yesterday I was still laughing like normal. Today it feels like I suddenly fell into a black hole with no warning.”

This crash is often as severe as a full Major Depressive Episode, and may include acute suicidal thoughts or urges to self-harm during those short episodes.

Another characteristic that makes RBD complex is the “return to normality” between episodes, which often causes people around the patient to misunderstand and say things like “You’re overthinking it,” “You’re too sensitive,” or “Why are you suddenly fine again so quickly?” In reality, this is a biological pattern in the brain, where mood states switch very rapidly — it is not attention-seeking behavior.

From a medical perspective, RBD is considered a form of episodic depression with a recurrent cyclical pattern. Each depressive episode has a level of severity comparable to MDD, but the duration is distinctly shorter, reflecting a mood regulation system in the brain that is fragile and highly reactive to stressors or triggers.

Several studies also suggest that RBD may be a “close relative” of the bipolar spectrum and cyclothymia, because many patients show periodic mood shifts and strong sensitivity to the stress–sleep cycle, similar to mechanisms observed in bipolar disorders, but without clear manic or hypomanic episodes.

What the medical field emphasizes repeatedly is that even though depressive episodes in RBD are short, this is not a mild depression, and not just a “normal mood swing.” The intensity of each episode can disrupt quality of life in segments — work becomes impaired, relationships become unstable, and the risk to personal safety can be very high when symptoms peak.

In summary, Recurrent Brief Depression is a “short-episode, severe, recurrent-cyclical” form of depression that should be managed as a serious depressive condition, even if each episode only lasts a few days. The combination of high frequency and high intensity leads to a heavy cumulative impact over time, comparable to MDD or chronic dysthymia.

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⭐ Core Symptoms — Main Symptoms of Recurrent Brief Depression

Recurrent Brief Depression (RBD), even though it consists of “short episodes,” has symptom severity during the depressive crash that is comparable to a full Major Depressive Episode (MDE). This means that within just a few days, the patient experiences an intense emotional plunge, like falling off a cliff — not a slow slide into sadness like many typical depression cases. The key features can be described as follows:

• Sudden, severe depressed mood – Mood drops very quickly as if a switch has been flipped. Patients may feel meaningless, hopeless, or as if they are being pulled into a dark hole without any warning.

• Acute anhedonia – Activities that usually bring pleasure (food, games, socializing) suddenly “switch off.” The person feels numb, empty, and disinterested.

• Abrupt loss of energy – The body feels drained even right after waking up. The level of fatigue is disproportionate to the actual activity of the previous day.

• Somatic symptoms – Headaches, chest tightness or heaviness, stomach discomfort, numbness, or other bodily sensations often appear together with the crash.

• Severe sleep disruption – Either complete insomnia the whole night or sleeping more than 10–12 hours but still waking up unrefreshed.

• Rapid shifts in appetite – Some people completely lose appetite; others crave carbs/sweets, as a form of serotonergic compensation.

• Feelings of worthlessness and self-blame – The inner voice becomes extremely self-critical during episodes, saying things like “I am worthless,” “Why am I like this?”

• Sudden breakdown in concentration – Tasks that are usually easy become impossible to complete. The person has to reread things many times or thinks noticeably slower.

• Acute suicidal ideation – This is one of the most concerning hallmarks. Even though episodes are brief, the risk of suicide can be higher than people assume.

• Rapid mood dynamics within the episode – The first 1–3 days tend to be the most severe, then symptoms gradually ease. This intra-episode profile is a signature of RBD.

• Hyper-emotional sensitivity – Small events, such as minor comments or everyday stressors, can trigger a 10/10 emotional crash.

• Cognitive constriction (“tunnel vision”) – During episodes, patients can only see the negative side of everything. They cannot perceive any way out, even when the reality of the situation is not objectively that bad.

• Panic-like features – Rapid heart rate, cold hands, free-floating fear or dread occurring together with sadness.

• High irritability – Some individuals have increased irritability, anger, or emotional outbursts as part of the episode.

• Feelings of detachment from self or reality (derealization / depersonalization) – Some report that the world feels strange, unreal, or that they themselves “don’t feel like themselves.”

• Sudden drop in work performance – Functioning can collapse abruptly within 48 hours, such as being unable to submit work, communicate clearly, or carry out normal tasks.

• Social withdrawal – Not wanting to talk, not replying to messages, closing the door, not leaving the room.

• Inability to self-soothe – Strategies that usually help relieve stress no longer work during the episode.

• “Crash–recover–crash again” emotional pattern – Some people experience micro-episodes or mini-crashes nested within a single short depressive episode.

• Confusion after the episode ends – Once the episode passes, patients may feel confused and think, “What was wrong with me yesterday?” and then return to functioning as if nothing had happened.

Between episodes (inter-episode):

• Patients can return to near-normal functioning.
• Some have no residual sadness at all.
• Because of this, people around them often do not understand the severity of what happens during the crash.

All of the above form the signature profile of RBD — short, but very severe, and capable of returning quickly.

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⭐ Diagnostic Criteria — Diagnostic Criteria for RBD

Although DSM-5-TR does not provide a dedicated official criterion set for RBD, it conceptualizes it under “Other Specified Depressive Disorder – Recurrent Brief Depression.” However, in clinical practice and research, the following criteria are typically used:

⭐ A) Episode Duration

• Depressive episodes last at least 2 consecutive days.
• But do not exceed 14 days (2–13 days).
• The average observed duration is 3–7 days.
• If an episode lasts ≥ 14 days, it meets criteria for MDD instead.

⭐ B) Frequency

• Episodes must occur at least once per month.
• Persisting for ≥ 12 consecutive months.
• If episodes occur only once or twice a year, this does not qualify as RBD.

This frequency is what distinguishes RBD from “situational sadness” or isolated short-lived depressive reactions.

⭐ C) Severity of Symptoms

Each depressive episode must be severe enough to be equivalent to a Major Depressive Episode.
That is, there must be at least 5 symptoms (including either depressed mood or anhedonia):

• Severe depressed mood
• Loss of interest or pleasure
• Insomnia or hypersomnia
• Poor appetite or overeating
• Fatigue or loss of energy
• Feelings of worthlessness
• Decreased concentration or indecisiveness
• Recurrent thoughts of death, suicidal ideation, or suicide attempts

Even though the duration is brief, the intensity must reach this level.

⭐ D) Inter-episode Interval

• Between episodes, the person may be fully asymptomatic.
• Or have mild depressive symptoms, but not enough to meet full MDD criteria.
• If there is chronic, persistent low mood for ≥ 2 years plus RBD episodes → it may be a case of Dysthymia (Persistent Depressive Disorder) with RBD overlay.

⭐ E) Not better explained by another mood disorder

RBD must be clearly differentiated from the following:

• Bipolar II / Cyclothymia – If there has ever been even one hypomanic episode, it is not RBD.

• Borderline Personality Disorder – Mood can shift multiple times per day, rather than distinct episodes of 3–7 days.

• PMDD – If depressive crashes are clearly tied to the menstrual cycle, PMDD must be considered.

• Grief reaction / Adjustment disorder – If symptoms are tied to a specific identifiable stressor only, it is not RBD.

• Substance-induced depression – e.g., heavy drinking, drug use, medication effects, or withdrawal.

⭐ F) Not due to substances, medication, or medical conditions

• Substances: recreational drugs, ADHD medications, steroids, interferon, etc.
• Medical conditions: thyroid dysfunction, brain inflammation, seizures, and others.

If any of these are primary causes, the depression is classified differently, not as RBD.

⭐ G) Clinically significant distress or impairment

• Interferes with work, study, and relationships.
• Causes life to fall apart in “segments” corresponding to episodes.
• Increases risk to personal safety (suicidality).

⭐ H) Additional clinical signature features of RBD

• Symptoms are often “sharpest” in the first 2–3 days.
• Episodes tend to recur in repeating patterns, such as on weekends, around PMS, or after poor sleep.
• Some cases report feeling like there are “seasons of crashing” (seasonality).
• After an episode, patients often feel “relieved–confused–reset,” similar to an emotional reboot.

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Subtypes or Specifiers — Subgroups / Important Specifiers

Although RBD is not subdivided into formal subtypes in standard manuals like MDD, in clinical work and research it can be conceptualized as subgroups or recurring patterns, such as:

Pure Recurrent Brief Depression

• Has short depressive episodes consistent with RBD.
• No full Major Depressive Episodes lasting ≥ 2 weeks.
• No history of hypomania or mania.
• The term “pure” is used to separate it from forms with significant comorbid mood disorders.

RBD with Intermittent Major Depressive Episodes

• In addition to frequent short RBD episodes, there are occasional full-blown MDE episodes.
• The life pattern resembles chronic mood vulnerability, where the brain is very fragile with respect to mood regulation.

RBD with Anxiety Features

• Depressive crashes often co-occur with panic attacks, generalized anxiety, or overwhelming worry.
• The inner dialogue is fast, self-critical, guilt-driven, and harsh.

RBD with Borderline Traits

• Mood swings fluctuate between severe sadness, anger, and emptiness.
• Often associated with self-harm patterns or unstable relationships.
• Some cases are classified as BPD with brief depressive episodes rather than pure RBD.

RBD with Cyclothymic / Bipolar Spectrum Features

• There are phases of elevated or energized mood (though not clearly meeting hypomania criteria).
• There is a family history of Bipolar disorder or other mood disorders in first-degree relatives.
• This is a group clinicians often monitor closely, as it may “convert” into full Bipolar disorder later.

RBD with Seasonal Pattern

• Short episodes occur more frequently during certain seasons (e.g., winter or periods of low sunlight).
• Similar to Seasonal Affective Disorder, but the pattern consists of recurrent short episodes.

RBD with Premenstrual Exacerbation (in women)

• Short depressive crashes overlap with the luteal phase (pre-menstrual period).
• Must be distinguished carefully from PMDD: is it classic PMDD, or RBD episodes being “triggered” by hormonal changes?

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🧠 Brain & Neurobiology — Neural and Biological Mechanisms of Recurrent Brief Depression 

Although research on RBD (Recurrent Brief Depression) is still less extensive than for MDD or Bipolar disorder, converging evidence suggests that RBD is not just “emotion from the mind”, but arises from brain systems that switch modes more quickly, more intensely, and more dramatically than normal. Biological data indicate that it is an episodic depressive condition with several distinctive features:

⭐ 1. Imbalance in Mood Regulation Circuits

The brain circuits regulating emotion (emotion regulation circuits) include:

• Amygdala (threat detection, sadness, fear)
• Anterior cingulate cortex – ACC (emotional pain, error monitoring, guilt, social distress)
• Prefrontal cortex – PFC (reasoning, self-control, top-down regulation)

In RBD, typical findings are:

• The amygdala is hyper-reactive, responding to small triggers as if they were major threats.
• The ACC is hyper-reactive, amplifying guilt, a sense of being a burden, and negative self-focus.
• The PFC temporarily “loses power,” leading to slower thinking, poor decisions, and difficulty disengaging from negative thoughts.

This “high activation / low regulation” imbalance explains why depressive crashes in RBD rise quickly, hit hard, and resolve in a few days, yet reach severity comparable to a full MDE.

⭐ 2. Serotonin / Dopamine / Noradrenaline Imbalance — “Episodic Crash”

In many patients, we see that:

• Serotonin levels may drop sharply within 24–48 hours before the depressive crash.
• Dopamine and noradrenaline fall abruptly, leading to loss of energy, motivation, and interest.
• After the episode, neurotransmitter systems “reboot”, which corresponds with rapid symptomatic improvement.

This highlights a key difference between RBD and chronic MDD:

• MDD = neurotransmitters are chronically reduced or dysregulated.
• RBD = neurotransmitter levels “drop in waves”, then rebound.

This is consistent with the fact that mood in RBD crashes briefly in short episodes, often following patterns related to menstrual cycles, sleep, stress, seasons, etc.

⭐ 3. Kindling Effect — The Brain Learns the Crash Pattern

Similar to mechanisms in Bipolar disorder:

• Early episodes often require significant triggers (severe stress, relationship collapse, sleep deprivation).
• Over time, the brain “learns” this pattern. New episodes occur more easily, even without major triggers.
• Frequency increases, severity intensifies, and the episodic pattern becomes more established.

This explains why RBD often moves from infrequent episodes → monthly episodes → a more predictable pattern over the years.

⭐ 4. Circadian Rhythm Dysregulation

The circadian system (internal body clock) regulates:

• Sleep–wake cycles
• Hormones
• Energy levels
• Body temperature
• Emotional sensitivity

In RBD, we often see:

• Just a few nights of disrupted sleep can precipitate a crash.
• Night-shift work, jet lag, or heavy screen use at night can trigger a mood switch within 1–2 days.
• Some brains have “circadian instability,” meaning their internal timing systems change unusually quickly.

This underlies why depressive episodes in RBD commonly occur:

• Before menstruation
• After periods of insufficient sleep
• After several days of accumulated stress
• During seasonal changes

⭐ 5. HPA Axis Dysregulation — Stress System Firing in Short, Sharp Bursts

The HPA axis (hypothalamic–pituitary–adrenal axis) links the brain to the adrenal glands, producing stress hormones such as cortisol. In RBD:

• During crashes, morning cortisol spikes significantly.
• It then drops unusually quickly.
• This rapid “swing” pattern causes the brain to experience intense but short-lived stress and mood dysregulation.

This mechanism contributes to:

• Feeling exhausted
• Feeling foggy or drained
• Intensifying negative thinking
• Wanting to cry
• Headache and chest heaviness
• Rapid heartbeat or discomfort

All of this typically occurs within the first 48–72 hours of the crash.

⭐ 6. Rapidly Fluctuating Neuroplasticity

RBD is associated with changes in synaptic plasticity:

• Temporary reduction in neural flexibility
• The brain over-reacts to life events in a short, exaggerated burst
• After the episode, neural functioning returns closer to baseline

Researchers refer to this as transient neuroplasticity disruption, which is different from the more chronic neuroplasticity impairment seen in MDD.

⭐ 7. Relationship to the Bipolar Spectrum

Population-level evidence shows that:

• Patients with RBD have a higher-than-average likelihood of having relatives with bipolar disorder.
• Some patients later evolve into bipolar II disorder.
• Short, severe, recurrent mood episodes are considered a warning sign of possible bipolar spectrum involvement.

However, it is critical to emphasize that “RBD is not the same as bipolar disorder”, but it is biologically related in some individuals.

⭐ Summary at the Brain Level

RBD is a condition in which brain systems shift mood states rapidly in an episodic pattern:

• Abrupt mood crashes
• Fast “chemical” crashes in the brain
• Over-reactive emotion circuits
• Disrupted circadian timing
• Stress systems that spike and drop quickly

All of this adds up to:

“Short episodes, but very severe” — this is the true neurological signature of RBD, not a personality trait or mere emotional oversensitivity.

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🧬 Causes & Risk Factors — Detailed Overview 

RBD does not arise from a single cause. It is the result of a “sum of biological, psychological, and environmental factors” interacting with each other. Patients usually develop RBD when multiple factors converge, such as:

⭐ 1. Genetics

Research shows that:

• Having first-degree relatives with MDD, Bipolar disorder, or Anxiety disorders
• Having a family history of suicide

all significantly increases the risk for RBD.

This risk is associated with genes related to:

• Serotonin transporter (5-HTTLPR)
• Dopamine receptors
• Circadian genes such as CLOCK, PER3
• Genes controlling the HPA axis

This explains why some people crash so intensely, while others do not, even when facing similar life events.

⭐ 2. Trauma and Chronic Childhood Stress

Many RBD patients have histories of:

• Neglect
• Physical or emotional abuse
• Growing up in unpredictable households
• Living in homes with high emotional volatility or frequent conflict

These experiences train the brain to:

• Use emotional swings as survival responses
• Maintain an amygdala that is set to high alert
• Keep the HPA axis easily activated

As adults, such brains respond to minor stressors as if they were major threats → leading to rapid mood crashes.

⭐ 3. Baseline Temperament / Personality

High-risk profiles include:

• High neuroticism = strong sensitivity to negative emotions
• High emotional reactivity = intense responses to internal and external events
• Borderline traits = fast, intense mood swings
• Cyclothymic temperament = mood cycles that resemble short waves

These traits increase the likelihood of accumulating stress quickly and crashing harder over short periods.

⭐ 4. Hormones and Menstrual Cycle (in women)

Female sex hormones directly influence mood cycles:

• Drops in estrogen before menstruation can be key triggers.
• The postpartum period
• Perimenopause
• Imbalances between progesterone and estrogen

Many women cannot easily distinguish between:

• PMDD
• RBD that appears prominent around the menstrual cycle

The two conditions may partially overlap in some individuals.

⭐ 5. Sleep Patterns

Sleep is a major trigger for RBD episodes:

• Sleeping less than 6 hours
• Irregular sleep schedules
• Night-shift work
• Late-night screen exposure
• Multiple days of sleep deprivation

These factors disrupt the circadian system and cause mood to crash in the same recurring patterns.

⭐ 6. Cumulative Stress

RBD does not always follow a major life stressor. Many patients describe:

• Stress that accumulates in “small daily doses”
• Once the system reaches its threshold → it collapses into an episode

Triggers include issues related to:

• Relationships
• Work
• Family
• Finances

In brains that are highly sensitive, even minor events like a negative comment can trigger an episode.

⭐ 7. Comorbidities

Common co-occurring conditions:

• Generalized Anxiety Disorder
• Panic Disorder
• ADHD
• ASD
• Substance Use Disorders
• Bipolar spectrum conditions
• Borderline Personality Disorder

Such comorbidities make emotional regulation more complex, leading to more frequent and more intense crashes.

⭐ 8. Social and Environmental Factors

These include:

• Unstable or insecure relationships (unstable attachment)
• Bullying
• High-pressure work environments
• Financial instability
• Lack of social support

All of these increase baseline stress levels in life → making the brain more fragile and prone to crash.

⭐ 9. Individual Biological Sensitivity

Some people have a “highly sensitive nervous system”:

• They feel sensations and emotions more intensely than average.
• They process emotional stimuli faster.
• They adapt more slowly after being triggered.

This type of nervous system is more vulnerable to episodic mood crashes like those seen in RBD.

⭐ Overall Summary

RBD arises from a combination of:

• Genetics
• Brain sensitivity
• Childhood experiences
• Hormonal factors
• Sleep patterns
• Accumulated stress
• Baseline personality
• Environmental context

When these layers overlap, the brain develops a pattern of short, severe, recurrent depressive episodes, which is the clinical profile of RBD.

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Treatment & Management — Approaches to Care and Management

Managing RBD requires thinking in two dimensions:

• Reducing risk and damage during the crash episodes
• Reducing the frequency and severity of episodes in the long term

1. Medication (Pharmacological)

Antidepressants (SSRIs / SNRIs / etc.)

• Used to reduce the frequency and intensity of depressive episodes.
• Even though episodes last only 2–7 days, maintenance antidepressant treatment can help stabilize the brain and prevent severe crashes when triggers arise.

Mood stabilizers (e.g., lithium, lamotrigine) — in selected cases

• Indicated when there are signs of bipolar spectrum involvement or clearly alternating good–bad mood states.
• Used to reduce mood volatility.

Anxiolytics or other medications

• May be used very short term during acute episodes.
• Must be prescribed carefully due to the risk of dependence.

All medication use in RBD should be under the care of a psychiatrist, because the pattern is short and rapidly fluctuating. It must be carefully evaluated whether we are treating:

• Pure RBD,
• MDD with RBD-like episodes, or
• Bipolar / Borderline conditions with brief depressive episodes.

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2. Psychotherapy

CBT (Cognitive Behavioral Therapy)

• Helps patients identify thought patterns that “bend toward self-destruction” during episodes.
• Builds skills for managing automatic thoughts like “I am worthless” or “Everything is over.”

Emotion Regulation / DBT Skills

• Particularly useful when there is emotional dysregulation or borderline traits.
• Teaches distress tolerance and strategies to handle intense emotions in the moment.

Interpersonal Therapy (IPT)

• Focuses on relationships and interpersonal triggers of episodes.
• Especially important when RBD episodes are tightly connected with conflicts in relationships.

Psychoeducation

• Helps patients and families understand that “3–7 day episodes” are not just being overly sensitive but reflect real brain patterns.
• Reduces self-stigma and decreases blaming language such as “You’re too dramatic” or “Why can’t you control yourself?”

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3. Lifestyle & Crisis Plan

Stabilizing sleep, light exposure, and daily routine

• Sleep enough and as close to the same time each day as possible.
• Expose the body to natural light to support circadian stability.

Mood Diary / App Tracking

• Track mood, triggers, menstrual cycle, sleep, and stress levels.
• Helps the patient and clinician identify the “cycle” of RBD.

Crisis Plan for suicidal thinking

• Prepare a list of: people to contact immediately, emergency numbers, nearest hospitals.
• Create a pre-agreed sequence of actions: “If suicidal thoughts reach this level → I will do X, then Y, then Z.”

Adjusting work / responsibilities

• If episodes are known to occur periodically, flexible arrangements may help, such as lighter responsibilities during vulnerable times or backup planning for key tasks.

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Notes — Important Clinical and Practical Points

• RBD is not “fake depression.”

Short episodes do not equal low risk. Suicidal risk can be very high during these brief windows.

• Often overlooked or misdiagnosed

Because patients may appear “fine” by the time they see a doctor, a detailed longitudinal history is crucial.

• Can co-exist with other disorders

Such as MDD, bipolar spectrum, anxiety disorders, and personality disorders. Many clinicians conceptualize RBD more as a brain-based pattern than a standalone disease.

• Quality of life is eroded piece by piece

Even though individual episodes are short, if they occur monthly (or more often), real life gets divided into segments of “surviving” and “crashing.”

• Support from others is critical

People around the patient are often confused: “Yesterday you were laughing, today you’re crying like you’re dying.” Education can reduce conflict and prevent unintentionally harmful remarks like “Why are you so sensitive?”

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📚 References — Main References (Formal + Practically Usable)

DSM / ICD and Core Psychiatry Texts

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: APA; 2022.
• World Health Organization. International Classification of Diseases 11th Revision (ICD-11): Mental, Behavioural and Neurodevelopmental Disorders. Geneva: WHO; 2019–2022.
• American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. APA; 2010–2020 updates.
• Kaplan & Sadock’s. Synopsis of Psychiatry. 12th Edition. Lippincott Williams & Wilkins; 2022.

Research specifically on Recurrent Brief Depression (RBD)

• Angst J., et al. Recurrent brief depression: Short depressive episodes in the community and clinical settings. Journal of Affective Disorders.
• Angst J. The emerging epidemiology of hypomania and bipolar II disorder. Bipolar Disorders.
• Merikangas K., Angst J. Mood disorder subtyping: Brief depressive episodes and bipolar spectrum. Psychological Medicine.
• Judd LL, Akiskal HS. Recurrent brief depressive episodes: Clinical significance and relationship to mood spectrum disorders. Archives of General Psychiatry.
• Montgomery SA. Recurrent brief depression: Diagnostic boundaries and clinical relevance. European Psychiatry.

Neurobiology of episodic depression

• Drevets WC, Price JL, Furey ML. Brain circuits in mood disorders. Neuron.
• Hasler G. Pathophysiology of depression: Neurobiology of mood regulation and dysregulation. Dialogues in Clinical Neuroscience.
• Pariante CM, Lightman SL. The HPA axis in major depression and stress-related psychiatric disorders. Nature Reviews Neuroscience.

Circadian rhythm / Sleep / Hormone studies

• McClung CA. How might circadian rhythms control mood? Nature Reviews Neuroscience.
• Walker MP, Van Der Helm E. Sleep and emotional regulation. Current Opinion in Neurobiology.
• Halbreich U. Hormonal factors in mood disorders. Endocrine Reviews.

Personality / Trauma / Risk Factors

• Zanarini MC. Childhood adversity and affective instability. Journal of Personality Disorders.
• Kendler KS. Stress, genetics, and major depression. American Journal of Psychiatry.

(You can add numbers, DOIs, or full APA-style formatting if needed for academic articles.)

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