Dysthymia: Difference between revisions
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:*First-degree relatives with persistent depressive disorder | :*First-degree relatives with persistent depressive disorder | ||
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*Polysomnographic abnormalities<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Polysomnographic abnormalities<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
Revision as of 13:17, 20 October 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Synonyms and keywords: Dysthymic depression; persistent depressive disorder
Overview
Dysthymia is a mood disorder that falls on the depression spectrum. It is typically characterized by a lack of enjoyment or pleasure, clinically referred to as anhedonia, that continues for an extended period. Dysthymia differs from major depression in that it is both longer-lasting and less disabling. Dysthymia can prevent a person from functioning effectively, disrupt sleep patterns, and interfere with activities of daily living (ADLs). Many dysthymia sufferers have a more specific subtype called Atypical depression. Dysthymia sufferers exhibit fairly mild symptoms on a day-to-day basis. Over a lifetime the disorder may have more severe effects, such as a high rate of suicide, work impairment, and social isolation. The psychiatric term describing a personality with opposite characteristics to dysthymia is hyperthymia.
Differential Diagnosis
- Depressive or bipolar and related disorder due to another medical condition
- Major depressive disorder
- Personality disorders
- Psychotic disorders
- Substance/medication-induced depressive or bipolar disorder[1]
Epidemiology and Demographics
Prevalence
The 12 month prevalence of dysthymia is 500 per 100,000 (0.5%)for persistent depressive disorder of the overall population.[1]
The 12 month prevalence of dysthymia is 1500 per 100,000 (1.5%) for chronic major depressive disorder of the overall population.[1]
Risk Factors
- Genetic predisposition
- First-degree relatives with persistent depressive disorder
- Parental loss or separation
- Polysomnographic abnormalities[1]
Natural History,Complications, and Prognosis
Prognosis
Poor prognostic factors
- Anxiety disorders
- Conduct disorder
- Greater symptom severity
- Higher levels of neuroticism
- Poorer global functioning[1]
Symptoms
The symptoms of dysthymia are similar to those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, lack of interest in things most people find enjoyable, and a loss of energy (not all patients feel this effect). Appetite and weight can be increased or decreased. The person may sleep too much or have trouble sleeping. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a negative self-image.
The symptoms can grow into a full blown episode of major depression. This situation is sometimes called "double depression"[2] because the intense episode exists with the usual feelings of low mood. People with dysthymia have a greater-than-average chance of developing major depression. While major depression often occurs in episodes, dysthymia is more constant, lasting for long periods, sometimes beginning in childhood. As a result a person with dysthymia tends to believe that depression is a part of his or her character. The person with dysthymia may not even think to talk about this depression with doctors, family members or friends. Dysthymia, like major depression, tends to run in families. It is two to three times more common in women than in men. Some sufferers describe being under chronic stress. When treating diagnosed individuals, it is often difficult to tell whether they are under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.
Diagnostic criteria
DSM-V Diagnostic Criteria for Dysthymia[1]
| “ |
This disorder represents a consolidation of DSM-lV-defined chronic major depressive disorder and dysthymic disorder.
Note:In children and adolescents, mood can be irritable and duration must be at least 1 year.
AND
AND
AND H. The symptoms cause clinically significant distress or impairment in social, occupational,or other important areas of functioning.
|
” |
Note:Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted.
Specify if:
- With anxious distress
- With mixed features
- With melancholic features
- With atypical features
- With mood-congruent psychotic features
- With mood-in congruent psychotic features
- With péripartum onset
Specify if:
- In partial remission
- In full remission
Specify if:
- Early onset: If onset is before age 21 years.
- Late onset: If onset is at age 21 years or older.
Specify if (for most recent 2 years of persistent depressive disorder):
- With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years.
- With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period.
- With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode.
- With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.
Specify current severity:
- Mild
- Moderate
- Severe
Treatments
Medications
The most commonly prescribed anti-depressants for this disorder are the selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). SSRIs are easy to take and relatively safe compared with older forms of anti-depressants.[3]. Other new anti-depressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), and duloxetine (Cymbalta).
Sometimes two different anti-depressant medications are prescribed together, or a doctor may prescribe a mood stabilizer or anti-anxiety medication in combination with an anti-depressant.
Side Effects of Medications
Some side effects for SSRI’s are "sexual dysfunction, nausea…diarrhea, sleepiness or insomnia, short-term memory loss and tremors". Sometimes antidepressants don’t work for patients. Older antidepressants, such as a tricyclic antidepressant or an MAOI can be tried in such cases. Tricyclic antidepressants are more effective but have worse side effects. Side effects for tricyclic antidepressants are "weight gain, dry mouth, blurry vision, sexual dysfunction, and low blood pressure".
Psychotherapy
Some evidence suggests the combination of medication and psychotherapy may result in the greatest improvement. The type of psychotherapy that will help depends on a number of factors, including the nature of any stressful events, the availability of family and other social support, and personal preference. Therapy should include education about depression. Support is essential. Cognitive behavioral therapy is designed to examine and help correct faulty, self-critical thought patterns and correct the cognitive distortions that persons with mood disorders commonly experience. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms.
References
See also
- Anhedonia, a similar symptom of schizophrenia and clinical depression involved absence of or decreased sense of pleasure
- Blunted affect, a symptom of PTSD, schizophrenia, and ASPD involving decreased or absent emotional response
- Atypical depression
- Clinical depression
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