A case of "double" depression under outpatient treatment conditions

During his professional practice the author encountered a case of coexistence of "major depression" with psychic depressive attacks (dysthymic attacks) of so-called temporal epilepsy. Apart from major depression of medium intensity, other manifestations developed. These were independent of the time of the day, suddenly occurring within several seconds, developing without any cause, attacks of very strong dejection, sadness, breakdown, feeling of lacking sense and hopelessness of life with slight lessening of consciousness and strong groundless fear. Detailed psychiatric examinations, observations of the patient during such attacks and EEG records confirmed the diagnosis of dysthymic attacks of temporal epilepsy. The author treated the patient with sertraline starting at a low dose and increasing up to 100 mg daily - administered orally once daily in the morning, clonazepam in oral doses 1 mg in the morning, 1 mg at lunchtime, 2 mg in the evening, and carbamazepine 200 mg tablets from low doses to 400 mg administered once daily in the evening. Complete remission of major depression and complete regression of dysthymic attacks of "temporal epilepsy" were obtained.