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Dysthymic disorder criteria


Dysthymic Disorder: Background, Etiology, Epidemiology

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.

  2. Niculescu AB 3rd, Akiskal HS. Proposed endophenotypes of dysthymia: evolutionary, clinical and pharmacogenomic considerations. Mol Psychiatry. 2001 Jul. 6(4):363-6. [QxMD MEDLINE Link].

  3. Keller MB, Harrison W, Fawcett JA, Gelenberg A, Hirschfeld RM, Klein D, et al. Treatment of chronic depression with sertraline or imipramine: preliminary blinded response rates and high rates of undertreatment in the community. Psychopharmacol Bull. 1995. 31(2):205-12. [QxMD MEDLINE Link].

  4. Klein DN, Schwartz JE, Rose S, Leader JB. Five-year course and outcome of dysthymic disorder: A prospective, naturalistic follow-up study. Am J Psychiatry. 2000 Jun. 157(6):931-9. [QxMD MEDLINE Link].

  5. Klein DN, Shankman SA, Rose S. Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry. 2006 May. 163(5):872-80. [QxMD MEDLINE Link].

  6. Kelly O, Matheson K, Ravindran A, Merali Z, Anisman H. Ruminative coping among patients with dysthymia before and after pharmacotherapy. Depress Anxiety. 2007. 24(4):233-43. [QxMD MEDLINE Link].

  7. Hermens ML, van Hout HP, Terluin B, van der Windt DA, Beekman AT, et al. The prognosis of minor depression in the general population: a systematic review. Gen Hosp Psychiatry. 2004 Nov-Dec. 26(6):453-62. [QxMD MEDLINE Link].

  8. Johnson JG, Cohen P, Kasen S, Brook JS. Personality disorder traits associated with risk for unipolar depression during middle adulthood. Psychiatry Res. 2005 Sep 15. 136(2-3):113-21. [QxMD MEDLINE Link].

  9. Ho PS, Yen CH, Chen CY, Huang SY, Liang CS. Changes in cytokine and chemokine expression distinguish dysthymic disorder from major depression and healthy controls. Psychiatry Res. 2017 Feb. 248:20-27. [QxMD MEDLINE Link].

  10. Riolo SA, Nguyen TA, Greden JF, King CA. Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III. Am J Public Health. 2005 Jun. 95(6):998-1000. [QxMD MEDLINE Link].

  11. Shankman SA, Klein DN. The impact of comorbid anxiety disorders on the course of dysthymic disorder: a 5-year prospective longitudinal study. J Affect Disord. 2002 Jul. 70(2):211-7. [QxMD MEDLINE Link].

  12. Laptook RS, Klein DN, Dougherty LR. Ten-year stability of depressive personality disorder in depressed outpatients. Am J Psychiatry. 2006 May. 163(5):865-71. [QxMD MEDLINE Link].

  13. Hayden EP, Klein DN. Outcome of dysthymic disorder at 5-year follow-up: the effect of familial psychopathology, early adversity, personality, comorbidity, and chronic stress. Am J Psychiatry. 2001 Nov. 158(11):1864-70. [QxMD MEDLINE Link].

  14. Markowitz JC, Skodol AE, Petkova E, Xie H, Cheng J, Hellerstein DJ, et al. Longitudinal comparison of depressive personality disorder and dysthymic disorder. Compr Psychiatry. 2005 Jul-Aug. 46(4):239-45. [QxMD MEDLINE Link].

  15. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov. 163(11):1905-17. [QxMD MEDLINE Link].

  16. Rush AJ, Kraemer HC, Sackeim HA, et al. Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology. 2006 Sep. 31(9):1841-53. [QxMD MEDLINE Link].

  17. Adler DA, Irish J, McLaughlin TJ, Perissinotto C, Chang H, Hood M, et al. The work impact of dysthymia in a primary care population. Gen Hosp Psychiatry. 2004 Jul-Aug. 26(4):269-76. [QxMD MEDLINE Link].

  18. Lerner D, Adler DA, Chang H, Lapitsky L, Hood MY, Perissinotto C. Unemployment, job retention, and productivity loss among employees with depression. Psychiatr Serv. 2004 Dec. 55(12):1371-8. [QxMD MEDLINE Link].

  19. Barbui C, Motterlini N, Garattini L. Health status, resource consumption, and costs of dysthymia. A multi-center two-year longitudinal study. J Affect Disord. 2006 Feb. 90(2-3):181-6. [QxMD MEDLINE Link].

  20. Bernal M, Haro JM, Bernert S, Brugha T, de Graaf R, Bruffaerts R, et al. Risk factors for suicidality in Europe: results from the ESEMED study. J Affect Disord. 2007 Aug. 101(1-3):27-34. [QxMD MEDLINE Link].

  21. Bakken K, Vaglum P. Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up. Clin Pract Epidemol Ment Health. 2007. 3:20. [QxMD MEDLINE Link].

  22. Casement MD, Shestyuk AY, Best JL, Casas BR, Glezer A, Segundo MA, et al. Anticipation of affect in dysthymia: behavioral and neurophysiological indicators. Biol Psychol. 2008 Feb. 77(2):197-204. [QxMD MEDLINE Link].

  23. Klein DN, Shankman SA, Lewinsohn PM, Rohde P, Seeley JR. Family study of chronic depression in a community sample of young adults. Am J Psychiatry. 2004 Apr. 161(4):646-53. [QxMD MEDLINE Link].

  24. Keitner GI, Ryan CE, Solomon DA. Realistic expectations and a disease management model for depressed patients with persistent symptoms. J Clin Psychiatry. 2006 Sep. 67(9):1412-21. [QxMD MEDLINE Link].

  25. Airaksinen E, Larsson M, Lundberg I, Forsell Y. Cognitive functions in depressive disorders: evidence from a population-based study. Psychol Med. 2004 Jan. 34(1):83-91. [QxMD MEDLINE Link].

  26. Leichsenring F, Hiller W, Weissberg M, Leibing E. Cognitive-behavioral therapy and psychodynamic psychotherapy: techniques, efficacy, and indications. Am J Psychother. 2006. 60(3):233-59. [QxMD MEDLINE Link].

  27. Leichsenring F, Leibing E. Psychodynamic psychotherapy: a systematic review of techniques, indications and empirical evidence. Psychol Psychother. 2007 Jun. 80:217-28. [QxMD MEDLINE Link].

  28. Markowitz JC, Bleiberg KL, Christos P, Levitan E. Solving interpersonal problems correlates with symptom improvement in interpersonal psychotherapy: preliminary findings. J Nerv Ment Dis. 2006 Jan. 194(1):15-20. [QxMD MEDLINE Link].

  29. Markowitz JC, Kocsis JH, Bleiberg KL, Christos PJ, Sacks M. A comparative trial of psychotherapy and pharmacotherapy for "pure" dysthymic patients. J Affect Disord. 2005 Dec. 89(1-3):167-75. [QxMD MEDLINE Link].

  30. Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P. Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA. 2003 Jun 18. 289(23):3117-24. [QxMD MEDLINE Link].

  31. Johnson JE, Zlotnick C. A pilot study of group interpersonal psychotherapy for depression in substance-abusing female prisoners. J Subst Abuse Treat. 2008 Jun. 34(4):371-7. [QxMD MEDLINE Link].

  32. Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression. Accessed: May 19, 2009. AHRQ: Agency for Healthcare Research and Quality. Jan. 24, 2007. Available at http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=61.

  33. Carvalho AF, Cavalcante JL, Castelo MS, Lima MC. Augmentation strategies for treatment-resistant depression: a literature review. J Clin Pharm Ther. 2007 Oct. 32(5):415-28. [QxMD MEDLINE Link].

  34. Lifschytz T, Segman R, Shalom G, Lerer B, Gur E, Golzer T, et al. Basic mechanisms of augmentation of antidepressant effects with thyroid hormone. Curr Drug Targets. 2006 Feb. 7(2):203-10. [QxMD MEDLINE Link].

  35. Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev. 2004. CD004050. [QxMD MEDLINE Link].

  36. McCullough JP Jr, Klein DN, Borian FE, Howland RH, Riso LP, Keller MB, et al. Group comparisons of DSM-IV subtypes of chronic depression: validity of the distinctions, part 2. J Abnorm Psychol. 2003 Nov. 112(4):614-22. [QxMD MEDLINE Link].

  37. Kessing LV. Epidemiology of Subtypes of Depression. Acta Psychiatr Scand. 2007. 115 (Suppl 433):85-89.

  38. Murphy JA, Byrne GJ. Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. J Affect Disord. 2012 Feb 29. [QxMD MEDLINE Link].

  39. Olfson M, Liu SM, Grant BF, Blanco C. Influence of comorbid mental disorders on time to seeking treatment for major depressive disorder. Med Care. 2012 Mar. 50(3):227-32. [QxMD MEDLINE Link]. [Full Text].

  40. Ryder AG, Schuller DR, Bagby RM. Depressive personality and dysthymia: evaluating symptom and syndrome overlap. J Affect Disord. 2006 Apr. 91(2-3):217-27. [QxMD MEDLINE Link].

  41. Masi G, Millepiedi S, Mucci M, Pascale RR, Perugi G, Akiskal HS. Phenomenology and comorbidity of dysthymic disorder in 100 consecutively referred children and adolescents: beyond DSM-IV. Can J Psychiatry. 2003 Mar. 48(2):99-105. [QxMD MEDLINE Link].

  42. Hellerstein DJ, Batchelder S, Miozzo R, Kreditor D, Hyler S, Gangure D. Citalopram in the treatment of dysthymic disorder. Int Clin Psychopharmacol. 2004 May. 19(3):143-8. [QxMD MEDLINE Link].

Persistent depressive disorder - Symptoms and causes

Overview

Persistent depressive disorder is a continuous, long-term form of depression. You may feel sad and empty, lose interest in daily activities and have trouble getting things done. You may also have low self-esteem, feel like a failure and feel hopeless. These feelings last for years and may interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions. You may be described as having a gloomy personality, constantly complaining or not able to have fun. Persistent depressive disorder is not as severe as major depression, but your current depressed mood may be mild, moderate or severe.

Because persistent depressive disorder is long term, coping with depression symptoms can be challenging. A combination of talk therapy and medicine can be effective in treating this condition.

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Symptoms

Persistent depressive disorder symptoms usually come and go over a period of years. The intensity of symptoms can change over time. But symptoms usually don't disappear for more than two months at a time. Also, major depression episodes may occur before or during persistent depressive disorder.

Symptoms of persistent depressive disorder can cause major problems in your life and may include:

  • Sadness, emptiness or feeling down.
  • Loss of interest in daily activities.
  • Tiredness and lack of energy.
  • Low self-esteem, self-criticism or feeling you're not capable.
  • Trouble focusing clearly and trouble making decisions.
  • Problems getting things done well and on time.
  • Quickly becoming annoyed, impatient or angry.
  • Avoidance of social activities.
  • Feelings of guilt and worries over the past.
  • Poor appetite or overeating.
  • Sleep problems.
  • Hopelessness.

In children, symptoms of persistent depressive disorder may include depressed mood and being irritable, which means easily becoming annoyed, impatient or angry.

When to see a doctor

If these feelings have been going on for a long time, you may think they'll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.

Talk to your health care provider about your symptoms or seek help from a mental health professional. Or you can reach out to someone else who may be able to help guide you to treatment. This could be a friend or loved one, a teacher, a faith leader, or another person you trust.

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 888-628-9454 (toll-free).

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Causes

The exact cause of persistent depressive disorder is not known. As with major depression, it may involve more than one cause, such as:

  • Biological differences. People with persistent depressive disorder may have physical changes in their brains. It's not clear how these changes affect the disorder, but they may eventually help determine the causes.
  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals. Research indicates that changes in neurotransmitters may play a large part in depression and its treatment.
  • Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
  • Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people.

Risk factors

Persistent depressive disorder often begins early — in childhood, the teen years or young adult life — and continues for a long time. Certain factors appear to increase the risk of developing persistent depressive disorder, including:

  • Having a first-degree blood relative, such as a parent or sibling, with major depressive disorder or other depressive disorders.
  • Traumatic or stressful life events, such as the loss of a loved one or major financial problems.
  • Personality traits that include negativity, such as low self-esteem, being too dependent or self-critical, or always thinking the worst will happen.
  • History of other mental health disorders, such as a personality disorder.

Complications

Conditions that may be linked with persistent depressive disorder include:

  • Lower quality of life.
  • Major depression, anxiety disorders and other mood disorders.
  • Substance misuse.
  • Relationship difficulties and family conflicts.
  • School or work problems and trouble getting things done.
  • Continuing pain and general medical illnesses.
  • Suicidal thoughts or behavior.
  • Personality disorders or other mental health disorders.

Prevention

There's no sure way to prevent persistent depressive disorder. Because it often starts in childhood or during the teenage years, identifying children at risk of the condition may help them get early treatment.

Strategies that may help reduce or prevent symptoms include the following:

  • Take steps to control stress, to increase your ability to recover from problems — which is called resilience — and to boost your self-esteem.
  • Reach out to family and friends, especially in times of crisis, to help you get through rough spells.
  • Get treatment at the earliest sign of a problem to help prevent symptoms from worsening.
  • Consider getting long-term treatment to help prevent a relapse of symptoms.

By Mayo Clinic Staff

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Symptoms of dysthymia, treatment of dysthymia at the Allianz Central Medical Health Center

Dysthymia is a long-term mild depression that, in terms of the severity of symptoms, does not reach the classic depression, but in terms of duration it exceeds it. At various times, this condition was called neurotic depression, endoreactive dysthymia, chronic depressive disorder. One thing remains constant, dysthymia is a disorder that can and should be treated.

Despite the "lightness" - low severity of manifestations, dysthymia significantly affects the life and performance of a person. Therefore, it must be treated by a psychotherapist. nine0003

Signs and symptoms of dysthymia

The diagnostic criteria for the disorder are difficult to recognize in practice, even for a specialist.

Dysthymia, the symptoms of which are similar to those of recurrent depression, can begin as early as adolescence. Compared to a recurrent disorder, its manifestations are less pronounced and stretched over time - for two years or more. If the maturation of the personality occurs under the distorting influence of dysthymia, then such a person, having matured, perceives the signs of the disorder as part of his "melancholy nature". And only a professional can separate the constitutional and personal characteristics of a person from the symptoms of the disease. nine0003

Below are the main signs that must be present for at least two years in a row (at adolescence - 1 year). There may be episodes of improvement lasting no more than a few weeks.

  • decreased ability to concentrate;
  • negative assessment of the future, present, and past. Alternatively, the past can, on the contrary, be idealized, and then the state acquires the features of a nostalgic depression;
    • nine0017 feeling of uselessness, hopelessness;
  • decreased or, rarely, increased appetite;
  • insomnia, daytime sleepiness;
  • decline in vitality;
  • reduced self-confidence, self-esteem;
  • decreased libido;
  • lack of pleasure from what used to bring joy.

The longer a person is sick, the worse his quality of life becomes - other diseases join (addiction to psychoactive substances, panic attacks, social phobia), the transition of the disease to bipolar affective disorder is also possible. nine0003

Important

If the disorder is not treated, against the background of the above described signs of dysthymia, severe depressive episodes occur - the so-called double depressions.

Dysthymia diagnostics

The diagnosis is made by a psychotherapist after a clinical and anamnestic examination. It includes an assessment of symptoms, the order in which they appear, and their connection with events in a person's life - stress, overload, trauma, infectious or other diseases. nine0003

To confirm the diagnosis, a clinical psychologist performs a pathopsychological study. It gives a conclusion about the characteristics of the patient's personality and reveals deviations in cognitive processes (thinking, memory, attention).

For differential diagnosis, instrumental and laboratory studies are carried out:

  • EEG - with organic damage to the nervous system;
  • Neurophysiological test system and Neurotest with endogenous diseases (schizophrenia, schizotypal disorder). nine0018

Dysthymia - treatment

After confirming the diagnosis of "dysthymia", treatment is prescribed individually and includes three main areas:

  1. Psychotherapy.
  2. Medical support.
  3. Treatment of associated diseases.

Psychotherapy. From the point of view of evidence-based medicine, the direction of choice is cognitive-behavioral therapy, however, depending on the specific situation, personal characteristics, as well as the preferences of the client, rational, family, group psychotherapy, biofeedback therapy or psychoanalytic therapy are used. nine0003

Some researchers attribute dysthymia to personality disorders (congenital character traits). This confirms that the main method of treatment is psychotherapy, that is, the joint work of the patient and the doctor on attitudes, attitudes towards life, the ability to deal with symptoms and achieve goals.

Drug therapy is aimed at neutralizing the symptoms of dysthymia and maintaining the mood and emotional-volitional sphere of the individual within the normal range. Medical way out of the state of chronic depression allows the development of psychotherapeutic intervention. nine0003

Treatment of associated diseases - secondary diseases that have developed against the background of dysthymia: addiction to psychoactive substances, panic attacks and generalized anxiety disorder, social phobia. This group also includes general medical diseases, the course of which can renew dysthymia in a predisposed person. To exclude these diseases and ensure the adequacy of treatment, a full-fledged diagnosis by a psychotherapist is required.

Dysthymia

During all this time, people around him can characterize the patient as a gloomy, hopeless pessimist who does not know how to notice the good in anything and constantly talks about how bad it is to live.

Chronic depressive disorder greatly affects the quality of life. It's pretty hard to fight him. Yet effective treatments exist, and there are specialist doctors who know how to deal with this problem. The main treatments for dysthymia are antidepressants and psychotherapy. nine0003

A little about terminology

In the main document of doctors - the International Classification of Diseases (abbreviated - ICD) - dysthymia is included in a group of diseases called persistent mood disorders . There are two main conditions here:

  • Cyclothymia , when the emotional background periodically fluctuates. A person either falls into depression or is in high spirits, but none of these states is expressed strongly enough. Often, over time, cyclothymia transforms into bipolar disorder. nine0018
  • Dysthymia - a condition in which the mood is constantly bad for a long time, several years. The disease can be mild, moderate or severe.

Why does chronic depressive disorder occur?

The exact causes, as for other types of depression, are unknown. There are only a few assumptions:

  • It is believed that people suffering from dysthymia have some peculiarities in the structure of the brain. This issue is not fully understood, but the researchers hope that work in this direction will help shed more light on the causes of the disease and find new treatments. nine0018
  • Depressed people don't work properly neurotransmitters - substances that transmit signals in the brain. As a result, the mechanisms responsible for stabilizing mood are violated.
  • Plays a role and heredity. Observations show that the risk of chronic depressive disorder is increased in people who have relatives with a similar disease. Perhaps this is due to some genes that have yet to be discovered.
    • nine0017 The onset of the disease is usually provoked by various negative events in life. These can be traumatic events, physical trauma and serious illness, bereavement, severe and chronic stress. Troubles in the family, at work, frequent conflicts, difficult financial situation - because of all this, depression can begin.

Although the causes of dysthymia are not fully known, there are effective treatments. Doctors do not know why the disease occurs, but they know how to successfully deal with it. nine0003

Symptoms of dysthymia

Over several years, the symptoms of chronic depressive disorder gradually come and go, wax and wane. They usually persist for at least two months. There are no major mood swings. But sometimes episodes of major depressive disorder can occur against the background of dysthymia. This condition is called double depression .

The main manifestations of dysthymia:

  • Depression, low mood, feeling of "internal emptiness". nine0018
  • Loss of interest in business. Even activities that used to be fun no longer please.
  • Constant feeling of tiredness. A person feels like a “squeezed lemon”, he has “no energy” for anything.
  • Increased irritability. Various events for no apparent reason cause outbursts of anger.
  • Low self-esteem. It seems to a person that he is not capable of anything, useless.
  • Decreased performance. Tasks that used to be easy, began to take more time, efficiency fell. nine0018
  • Frequent feelings of guilt, events in which a person made a mistake, acted badly, found himself in an awkward situation are constantly scrolling in his head.
  • Avoidance of society. I do not want to communicate with anyone, participate in any common affairs.
  • Sleep disturbance.
  • Poor appetite or constant overeating.

What happens if you don't get treated? A person suffering from chronic depressive disorder cannot live a full life. And over time, this condition only gets worse. Like a snowball of growing problems at work or at school, there is no normal relationship with the family. In an attempt to forget about the problems at least for a while, many patients begin to abuse alcohol, sometimes it comes to psychoactive substances. In some cases, dysthymia becomes the starting point for the development of mental illness. The patient may commit suicide. nine0003

If symptoms of dysthymia develop before the age of 21, this is called early onset . If a person over 21 years of age sees a doctor for the first time, this is late start .

Diagnosis of dysthymia

Diagnosis is made during the conversation. The doctor primarily focuses on the patient's complaints. There are fairly clear criteria for chronic depressive disorder:

  • For adults : depressed mood persists most of the day, and this condition persists for more than two years. nine0018
  • For children : depressed mood persists most of the day for a year or more.

How to treat chronic depressive disorder?

First of all, antidepressants are prescribed. This is a large group of drugs, many of them have serious side effects and are not suitable for all people. It is important to choose a drug or a combination of them that will be optimal for a particular person. It doesn't always work out the first time. You may need to try different types of drugs. You should not wait for an immediate effect: usually the drugs begin to act after a few weeks. Do not stop taking medications on your own without consulting your doctor. This can lead to withdrawal syndrome , depression will return with renewed vigor. Treatment is carried out for a long time.

The second direction in the treatment of dysthymia is psychotherapy. It also comes in different types. Most often resort to cognitive-behavioral psychotherapy. Working with a psychotherapist helps to change patterns of thinking and behavior, learn to control your condition and cope with life's difficulties without falling into depression.

Some people who suffer from dysthymia for a long time, especially if it began in childhood, perceive their condition as habitual, as a "bad character" that "nothing can be done about it." In fact, this problem can and should be dealt with.

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