Recurrent brief depression in celiac disease.

As demonstrated recently, celiac disease may be considered as a significant risk factor for mood disorders [1]. A study of 36 adult celiac patients from the Internal Medicine Department of the University of Cagliari (Sardinia, Italy) and 144 healthy controls from the community celiac patients showed significantly elevated risks for major depressive disorders (OR = 2.7), dysthymic disorders (OR = 6.2), adjustment disorders (OR = 5.3) and panic disorders (OR = 7.3). We hypothesised that the association may be due to malabsorption of tryptophan leading to a decreased central serotonin synthesis [2]. Other mechanisms may also be related to the autoimmune pathogenesis of celiac disease [1]; cytokines produced by immune reactions may exert an effect on brain circuits related to mood regulation; several neuroendocrine secretory systems are involved in the control of immune reactions. Therefore, there may be an important pathogenetic links between autoimmune disease and affective disorders [3,4]. A new epidemiological study in Sardinia identified another important group of affective disorders, Recurrent Brief Depression (RBD), as being very common in the community with a lifetime prevalence rate of 7.6% (males 5.8%, females 9.0%); RBD was especially prevalent in young adults aged 18 to 24 years and strongly associated with major depression (combined depression) [5], suicide attempts and substance abuse [6]. Comparable to double depression [7] combined depression is a more severe disorder than pure major depression. RBD is therefore a relevant health problem as shown in previous studies [8]. Today there is still no large scale investigation of RBD, although various community surveys [6] and the large World Health Organization (WHO) study on psychiatric diseases in general medical practice showed a considerable prevalence of