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{{SI}}                                                                 
{{SI}}                                                                 
{{CMG}} {{KS}}
{{CMG}}; {{AE}} {{Sharma}}


{{SK}} Dysthymic disorder; persistent depressive disorder; double depression
{{SK}} Dysthymic disorder; persistent depressive disorder; double depression


==Overview==
==Overview==
Dysthymia is a [[mood disorder]] that falls on the [[Clinical depression|depression spectrum]].  It is characterized by the 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 lesser distressing. The symptoms of dysthymia are often underestimated by the patients and misdiagnosed by the clinicians. Dysthymia can have a substantial impact on an individual's life by preventing effective functioning, disrupting sleep patterns, and interfering with activities of daily living (ADLs). It usually presents with mild symptoms on a day-to-day basis. Progressively, the disorder may take a more severe form, resulting in work impairment, social isolation, and high rates of [[suicide]]. Due to its chronicity and lesser severity, most of the patients suffering from dysthymia believe that it is a part of their [[Character (biology)|character]] and do not seek [[treatment]] until it gets extremely disabling.  
Dysthymia is a [[mood disorder]] that falls on the [[Clinical depression|depression spectrum]].  It is characterized by the 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 not as distressing. The symptoms of dysthymia are often underestimated by the patients and misdiagnosed by [[Clinician|clinicians]]. Dysthymia can have a substantial impact on an individual's life by preventing effective functioning, disrupting sleep patterns, and interfering with activities of daily living (ADLs). It usually presents with mild symptoms on a day-to-day basis. Progressively, the disorder may take a more severe form, resulting in work impairment, social isolation, and high rates of [[suicide]]. Due to its chronicity and lesser severity, most of the patients suffering from dysthymia believe that it is a part of their [[Character (biology)|character]] and do not seek [[treatment]] until it gets extremely disabling.


== Historical Perspective ==
==Historical Perspective==


* The historical origin of the term 'dysthymia' is basically Greek.  
*The historical origin of the term 'dysthymia' is Greek.
*In 1844, it was used first in [[psychiatry]] by C.F. Flemming. <ref name="BriegerMarneros1997">{{cite journal|last1=Brieger|first1=Peter|last2=Marneros|first2=Andreas|title=Dysthymia and cyclothymia: historical origins and contemporary development|journal=Journal of Affective Disorders|volume=45|issue=3|year=1997|pages=117–126|issn=01650327|doi=10.1016/S0165-0327(97)00053-0}}</ref>
*In 1844, dysthymia was used first in [[psychiatry]] by C.F. Flemming. <ref name="BriegerMarneros1997">{{cite journal|last1=Brieger|first1=Peter|last2=Marneros|first2=Andreas|title=Dysthymia and cyclothymia: historical origins and contemporary development|journal=Journal of Affective Disorders|volume=45|issue=3|year=1997|pages=117–126|issn=01650327|doi=10.1016/S0165-0327(97)00053-0}}</ref>
*In 1882, dysthymia was further described by Kahlbaum, and he differentiated it from the fluctuating mood of [[cyclothymia]].<ref name="pmid7942068">{{cite journal| author=Freeman HL| title=Historical and nosological aspects of dysthymia. | journal=Acta Psychiatr Scand Suppl | year= 1994 | volume= 383 | issue=  | pages= 7-11 | pmid=7942068 | doi=10.1111/j.1600-0447.1994.tb05877.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7942068  }}</ref>
*In 1882, dysthymia was further described by Kahlbaum, and he differentiated it from the fluctuating mood of [[cyclothymia]].<ref name="pmid7942068">{{cite journal| author=Freeman HL| title=Historical and nosological aspects of dysthymia. | journal=Acta Psychiatr Scand Suppl | year= 1994 | volume= 383 | issue=  | pages= 7-11 | pmid=7942068 | doi=10.1111/j.1600-0447.1994.tb05877.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7942068  }}</ref>
*In Diagnostic and Statistical Manual of Mental Disorders ([[DSM]]), dysthymia as a clinical entity has undergone complex evolution from being considered a [[personality disorder]] to an [[affective disorder]].
*In the Diagnostic and Statistical Manual of Mental Disorders ([[DSM]]), dysthymia as a clinical entity has undergone complex evolution from being considered a [[personality disorder]] to an [[affective disorder]].
*


== Classification ==


* Diagnostic and Statistical Manual of Mental Disorders ([[DSM-II]]) characterized chronic [[depression]] as a [[personality disorder]].<ref name="Freeman1994">{{cite journal|last1=Freeman|first1=H. L.|title=Historical and nosological aspects of dysthymia|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=7–11|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05877.x}}</ref>
==Classification==
*'Dysthymic disorder' was the term used in [[Diagnostic and statistical manual of mental disorders|DSM]]-III to describe depression present for a period of more than two years.
 
*The Diagnostic and Statistical Manual of Mental Disorders ([[DSM-II]]) described chronic [[depression]] as a [[personality disorder]].<ref name="Freeman1994">{{cite journal|last1=Freeman|first1=H. L.|title=Historical and nosological aspects of dysthymia|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=7–11|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05877.x}}</ref>
*'Dysthymic disorder' was the term used in [[Diagnostic and statistical manual of mental disorders|DSM]]-III to describe depression present for more than two years.
*From the [[personality disorder]] of [[DSM-II]],  [[DSM-III-R]] placed it under the affective category. <ref name="Freeman19942">{{cite journal|last1=Freeman|first1=H. L.|title=Historical and nosological aspects of dysthymia|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=7–11|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05877.x}}</ref>
*From the [[personality disorder]] of [[DSM-II]],  [[DSM-III-R]] placed it under the affective category. <ref name="Freeman19942">{{cite journal|last1=Freeman|first1=H. L.|title=Historical and nosological aspects of dysthymia|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=7–11|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05877.x}}</ref>


*[[DSM-IV]] has classified chronic depression into dysthymic disorder and [[major depressive disorder]], chronic type.
*[[DSM-IV]] has classified chronic depression into dysthymic disorder and [[major depressive disorder]], chronic type.
* Based on the [[age of onset]], [[DSM-IV]] has divided dysthymic disorders into early (before 21 years) and late-onset (after 21 years) subtypes. <ref name="pmid12858423" />
*Based on the [[age of onset]], [[DSM-IV]] has divided dysthymic disorders into early (before 21 years) and late-onset (after 21 years) subtypes. <ref name="pmid12858423" />
*Early-onset dysthymic disorder is related to a higher familial burden of [[Mood disorder|mood disorders]] and childhood adverse conditions. On the other hand, late-onset has an association with health issues and major losses.<ref name="pmid12858423">Klein DN, Santiago NJ (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12858423 Dysthymia and chronic depression: introduction, classification, risk factors, and course.] ''J Clin Psychol'' 59 (8):807-16. [http://dx.doi.org/10.1002/jclp.10174 DOI:10.1002/jclp.10174] PMID: [https://pubmed.gov/12858423 12858423]</ref>
*Early-onset dysthymic disorder is related to a higher familial burden of [[Mood disorder|mood disorders]] and childhood adverse conditions. On the other hand, late-onset has an association with health issues and major losses.<ref name="pmid12858423">Klein DN, Santiago NJ (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12858423 Dysthymia and chronic depression: introduction, classification, risk factors, and course.] ''J Clin Psychol'' 59 (8):807-16. [http://dx.doi.org/10.1002/jclp.10174 DOI:10.1002/jclp.10174] PMID: [https://pubmed.gov/12858423 12858423]</ref>
* In [[DSM-IV]], individuals having underlying dysthymic disorder who develop [[major depressive episode]] are diagnosed as having both dysthymic disorder and [[major depressive disorder]]. So, DSM-IV has categorized dysthymic disorder and major depressive episodes as separate diagnoses instead of phases of a single disorder that fluctuates in severity over time.<ref name="pmid128584232">Klein DN, Santiago NJ (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12858423 Dysthymia and chronic depression: introduction, classification, risk factors, and course.] ''J Clin Psychol'' 59 (8):807-16. [http://dx.doi.org/10.1002/jclp.10174 DOI:10.1002/jclp.10174] PMID: [https://pubmed.gov/12858423 12858423]</ref>
*In [[DSM-IV]], individuals having underlying dysthymic disorder who develop [[major depressive episode]]s are diagnosed as having both dysthymic disorder and [[major depressive disorder]]. So, DSM-IV has categorized dysthymic disorder and major depressive episodes as separate diagnoses instead of phases of a single disorder that fluctuates in severity over time.<ref name="pmid128584232">Klein DN, Santiago NJ (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12858423 Dysthymia and chronic depression: introduction, classification, risk factors, and course.] ''J Clin Psychol'' 59 (8):807-16. [http://dx.doi.org/10.1002/jclp.10174 DOI:10.1002/jclp.10174] PMID: [https://pubmed.gov/12858423 12858423]</ref>
*In spite of minor differences in the definitions of Dysthymic Disorder in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition ([[DSM-IV]])  and International Classification of Diseases Tenth Edition (ICD-l0), both the systems have been considered competent to establish the diagnosis.<ref name="Lopez IborFrances1994">{{cite journal|last1=Lopez Ibor|first1=J. J.|last2=Frances|first2=A.|last3=Jones|first3=C.|title=Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=12–18|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05878.x}}</ref>
*In spite of minor differences in the definitions of dysthymic disorder in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition ([[DSM-IV]])  and International Classification of Diseases Tenth Edition (ICD-l0), both the systems are competent to establish the diagnosis.<ref name="Lopez IborFrances1994">{{cite journal|last1=Lopez Ibor|first1=J. J.|last2=Frances|first2=A.|last3=Jones|first3=C.|title=Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=12–18|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05878.x}}</ref>
*Dysthymia and chronic major depression are both included under the new term 'Persistent depressive disorder' in [[DSM|DSM-5]].<ref name="pmid31082096">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31082096 | doi= | pmc= | url= }}</ref>
*Dysthymia and chronic major depression are both included under the new term 'persistent depressive disorder' in [[DSM|DSM-5]].<ref name="pmid31082096">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31082096 | doi= | pmc= | url= }}</ref>
*Since the introduction in [[DSM-III]], the diagnostic validity of dysthymia has been questioned. It is a [[heterogeneous]] diagnosis including various [[depressive]] and [[anxiety]] conditions. As persistent depressive disorder includes dysthymia as a component, the former is more likely to represent a [[heterogeneous]] domain diagnosis, further creating a dilemma regarding the best treatment option to be used.<ref name="pmid24270481">{{cite journal| author=Rhebergen D, Graham R| title=The re-labelling of dysthymic disorder to persistent depressive disorder in DSM-5: old wine in new bottles? | journal=Curr Opin Psychiatry | year= 2014 | volume= 27 | issue= 1 | pages= 27-31 | pmid=24270481 | doi=10.1097/YCO.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24270481  }}</ref><br />
*Since the introduction in [[DSM-III]], the diagnostic validity of dysthymia is questioned. It is a [[heterogeneous]] diagnosis including various [[depressive]] and [[anxiety]] conditions. As persistent depressive disorder includes dysthymia as a component, the former is more likely to represent a [[heterogeneous]] domain diagnosis. It limits the identification of the preferred treatment options. <ref name="pmid24270481">{{cite journal| author=Rhebergen D, Graham R| title=The re-labelling of dysthymic disorder to persistent depressive disorder in DSM-5: old wine in new bottles? | journal=Curr Opin Psychiatry | year= 2014 | volume= 27 | issue= 1 | pages= 27-31 | pmid=24270481 | doi=10.1097/YCO.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24270481  }}</ref><br />
 
*
 
*


== Pathophysiology ==
==Pathophysiology==


* Brain-derived neurotrophic factor ([[Brain-derived neurotrophic factor|BDNF]]) has been found to play a major role in the long-term potentiation, functioning of [[neurons]] and therefore, affecting [[neuroplasticity]]. <ref name="pmid22114158">Cao G, Harris KM (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22114158 Developmental regulation of the late phase of long-term potentiation (L-LTP) and metaplasticity in hippocampal area CA1 of the rat.] ''J Neurophysiol'' 107 (3):902-12. [http://dx.doi.org/10.1152/jn.00780.2011 DOI:10.1152/jn.00780.2011] PMID: [https://pubmed.gov/22114158 22114158]</ref>
*[[Brain-derived neurotrophic factor]] ([[Brain-derived neurotrophic factor|BDNF]]) has been found to play a major role in the long-term potentiation, functioning of [[neurons]] and therefore, affecting [[neuroplasticity]]. <ref name="pmid22114158">Cao G, Harris KM (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22114158 Developmental regulation of the late phase of long-term potentiation (L-LTP) and metaplasticity in hippocampal area CA1 of the rat.] ''J Neurophysiol'' 107 (3):902-12. [http://dx.doi.org/10.1152/jn.00780.2011 DOI:10.1152/jn.00780.2011] PMID: [https://pubmed.gov/22114158 22114158]</ref>
* It has been observed that [[BDNF]] is significantly lower in individuals with dysthymia, compared to control subjects. <ref name="pmid21312291">{{cite journal| author=Yoshimura R, Umene-Nakano W, Hoshuyama T, Ikenouchi-Sugita A, Hori H, Katsuki A | display-authors=etal| title=Plasma levels of brain-derived neurotrophic factor and interleukin-6 in patients with dysthymic disorder: comparison with age- and sex-matched major depressed patients and healthy controls. | journal=Hum Psychopharmacol | year= 2010 | volume= 25 | issue= 7-8 | pages= 566-9 | pmid=21312291 | doi=10.1002/hup.1155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21312291  }}</ref>
*Compared to controls, [[BDNF]] is significantly lower in individuals with dysthymia. <ref name="pmid21312291">{{cite journal| author=Yoshimura R, Umene-Nakano W, Hoshuyama T, Ikenouchi-Sugita A, Hori H, Katsuki A | display-authors=etal| title=Plasma levels of brain-derived neurotrophic factor and interleukin-6 in patients with dysthymic disorder: comparison with age- and sex-matched major depressed patients and healthy controls. | journal=Hum Psychopharmacol | year= 2010 | volume= 25 | issue= 7-8 | pages= 566-9 | pmid=21312291 | doi=10.1002/hup.1155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21312291  }}</ref>
* [[Interleukin-6]] ([[IL-6]])  levels are higher in dysthymic patients as compared to controls. Individuals with [[major depressive disorder]] also have higher levels of [[IL-6]]. <ref name="pmid213122912">{{cite journal| author=Yoshimura R, Umene-Nakano W, Hoshuyama T, Ikenouchi-Sugita A, Hori H, Katsuki A | display-authors=etal| title=Plasma levels of brain-derived neurotrophic factor and interleukin-6 in patients with dysthymic disorder: comparison with age- and sex-matched major depressed patients and healthy controls. | journal=Hum Psychopharmacol | year= 2010 | volume= 25 | issue= 7-8 | pages= 566-9 | pmid=21312291 | doi=10.1002/hup.1155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21312291  }}</ref>
*[[Interleukin-6]] ([[IL-6]])  levels are higher in dysthymic patients as compared to controls. Individuals with [[major depressive disorder]] also have higher levels of [[IL-6]]. <ref name="pmid213122912">{{cite journal| author=Yoshimura R, Umene-Nakano W, Hoshuyama T, Ikenouchi-Sugita A, Hori H, Katsuki A | display-authors=etal| title=Plasma levels of brain-derived neurotrophic factor and interleukin-6 in patients with dysthymic disorder: comparison with age- and sex-matched major depressed patients and healthy controls. | journal=Hum Psychopharmacol | year= 2010 | volume= 25 | issue= 7-8 | pages= 566-9 | pmid=21312291 | doi=10.1002/hup.1155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21312291  }}</ref>
* The expression of [[cytokines]] has also been found to have a significant role in the [[pathophysiology]] of dysthymia. Macrophage inflammatory protein-1α and Interferon-γ-induced protein10 have a [[Correlation (statistics)|correlation]] with the clinical response to treatment.<ref name="Lopez IborFrances19943">{{cite journal|last1=Lopez Ibor|first1=J. J.|last2=Frances|first2=A.|last3=Jones|first3=C.|title=Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=12–18|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05878.x}}</ref>
*The expression of [[cytokines]] has also been found to have a role in the [[pathophysiology]] of dysthymia. [[Macrophage inflammatory protein]]-1α and [[Interferon-gamma|Interferon]]-γ-induced [[Protein|protein10]] have a [[Correlation (statistics)|correlation]] with the response to treatment.<ref name="Lopez IborFrances19943">{{cite journal|last1=Lopez Ibor|first1=J. J.|last2=Frances|first2=A.|last3=Jones|first3=C.|title=Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=12–18|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05878.x}}</ref>
*The elevated [[Interleukin 1|Interleukin-1β]] associated with dysthymia fails to reach the normal range even after symptom resolution. It further suggests that [[IL-1|IL-1β]] can be the trait marker of dysthymia and can help in early detection of the illness.<ref name="BrunelloAkiskal1999">{{cite journal|last1=Brunello|first1=N.|last2=Akiskal|first2=H.|last3=Boyer|first3=P.|last4=Gessa|first4=G.L.|last5=Howland|first5=R.H.|last6=Langer|first6=S.Z.|last7=Mendlewicz|first7=J.|last8=Paes de Souza|first8=M.|last9=Placidi|first9=G.F.|last10=Racagni|first10=G.|last11=Wessely|first11=S.|title=Dysthymia: clinical picture, extent of overlap with chronic fatigue syndrome, neuropharmacological considerations, and new therapeutic vistas|journal=Journal of Affective Disorders|volume=52|issue=1-3|year=1999|pages=275–290|issn=01650327|doi=10.1016/S0165-0327(98)00163-3}}</ref>
*The elevated [[Interleukin 1|Interleukin-1β]] associated with dysthymia fails to reach the normal range even after symptom resolution. It further suggests that [[IL-1|IL-1β]] can be the trait marker of dysthymia and can help in early detection of the illness.<ref name="BrunelloAkiskal1999">{{cite journal|last1=Brunello|first1=N.|last2=Akiskal|first2=H.|last3=Boyer|first3=P.|last4=Gessa|first4=G.L.|last5=Howland|first5=R.H.|last6=Langer|first6=S.Z.|last7=Mendlewicz|first7=J.|last8=Paes de Souza|first8=M.|last9=Placidi|first9=G.F.|last10=Racagni|first10=G.|last11=Wessely|first11=S.|title=Dysthymia: clinical picture, extent of overlap with chronic fatigue syndrome, neuropharmacological considerations, and new therapeutic vistas|journal=Journal of Affective Disorders|volume=52|issue=1-3|year=1999|pages=275–290|issn=01650327|doi=10.1016/S0165-0327(98)00163-3}}</ref>


== Clinical Features ==
==Clinical Features==


* The predominant features of dysthymia are-
*The main features of dysthymia are
**Low or irritable [[mood]], lack of interest in previously enjoyed activities, and a loss of energy
**Low or irritable [[mood]]
** Increased or decreased [[appetite]]
**Lack of interest in previously enjoyed activities
**Loss of [[energy]] or easy [[Fatigue|fatigability]]
**Increased or decreased [[appetite]]
**[[Weight gain]] or loss
**[[Weight gain]] or loss
** Excessive sleepiness or [[insomnia]]
**Excessive [[sleepiness]] or [[insomnia]]
** Difficulty concentrating
**Difficulty [[Concentrate|concentrating]]
** Indecisiveness and having pessimistic thoughts  
**Indecisiveness and having pessimistic thoughts
**Negative self-image
**Negative self-image
*While comparing dysthymia with [[major depression]], it would be appropriate to state that dysthymia tends to be less intense and persist for a longer duration.
*Dysthymia as compared to [[major depression]], tends to be less intense and persists for a longer duration.
*Other than the variation in magnitude of severity, both these conditions exhibit similar symptomatology.  
*Other than the variation in magnitude of severity, both these conditions exhibit similar symptomatology.
*To diagnose [[Major depressive disorder]], the symptoms should be present for a minimum duration of 14 days (2 weeks) whereas for dysthymia, the criteria is a minimum of 2 years.
*To diagnose [[major depressive disorder]], the symptoms should be present for a minimum duration of 14 days (2 weeks) whereas, dysthymia symptoms should be present for at least 2 years.
 
*The symptoms of dysthymia can grow into a full-blown episode of major depression. The intense episode often exists with the underlying feelings of low mood and this resulting condition is called "double [[depression]]"<ref name="dd">[http://www.sciencedaily.com/releases/2007/07/070723160142.htm ''Double Depression: Hopelessness Key Component Of Mood Disorder''] retrieved July 17, 2008, </ref>
* The symptoms can grow into a full-blown episode of major depression, this conditon is called "double depression"<ref name="dd">[http://www.sciencedaily.com/releases/2007/07/070723160142.htm ''Double Depression: Hopelessness Key Component Of Mood Disorder''] retrieved July 17 2008</ref> because the intense episode exists with the underlying feelings of low mood.
*As compared to the general population, the people with dysthymia have a greater-than-average chance of developing [[major depression]].
* People with dysthymia have a greater-than-average chance of developing [[major depression]].
*While major depressive disorder mostly occurs in episodes, dysthymia lasts for longer periods, is consistent, and sometimes begins in [[childhood]].  Therefore, persons with dysthymia tend to consider depression as a part of their character.
* 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.
*Dysthymia and [[major depression]], both are [[Heritability|inheritable]].
* The person with dysthymia may not even think to discuss the symptoms with doctors, family members or friends.
* Dysthymia, like [[major depression]], tends to run in families.  
*Some individuals describe dysthymia as being under [[chronic stress]].
*Some individuals describe dysthymia as being under [[chronic stress]].
* When treating diagnosed cases, it is often difficult to distinguish if they are actually under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.
*When treating cases, it is often difficult to distinguish if these people are actually under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.


==Differential Diagnosis==
==Differential Diagnosis==
The differential diagnosis of dysthymia includes the following: <ref name="Lopez IborFrances19942">{{cite journal|last1=Lopez Ibor|first1=J. J.|last2=Frances|first2=A.|last3=Jones|first3=C.|title=Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=12–18|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05878.x}}</ref>
The differential diagnosis of dysthymia includes the following: <ref name="Lopez IborFrances19942">{{cite journal|last1=Lopez Ibor|first1=J. J.|last2=Frances|first2=A.|last3=Jones|first3=C.|title=Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=12–18|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05878.x}}</ref>


*Mood disorder secondary to General Medical Condition
*Mood disorder secondary to general medical condition
*[[Major depressive disorder]]
*[[Major depressive disorder]]
*[[Recurrent depressive disorder]]
*[[Recurrent depressive disorder]]
*[[Personality disorders]]
*[[Personality disorders]]
*[[Generalized Anxiety Disorder]]
*[[Generalized Anxiety Disorder]]
*Mixed anxiety and depressive disorder
*Mixed anxiety and [[Depressive disorders|depressive disorder]]
*Substance induced mood disorder
*Substance-induced [[mood disorder]]
*[[Neurasthenia]]
*[[Neurasthenia]]
*[[Adjustment disorders|Adjustment disorder]]
*[[Adjustment disorders|Adjustment disorder]]
Line 82: Line 78:
===Prevalence===
===Prevalence===


* The 12 month [[prevalence]] of dysthymia is 500 per 100,000 (0.5%) of the overall population.<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>
*The 12-month [[prevalence]] of dysthymia is approximately 500 per 100,000 (0.5%) of the overall population.<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>


=== Age ===
===Age===


* Individuals of all the age groups may develop dysthymia.
*Individuals of all age groups may develop dysthymia.
*Based on the [[age of onset]], the [[etiology]] of dysthymia varies.
*Based on the [[age of onset]], the [[etiology]] of dysthymia varies.
*The individuals with early-onset dysthymia have a history of physical or sexual abuse. They have also been found to have poor relationship with both the parents.<ref name="LizardiKlein1995">{{cite journal|last1=Lizardi|first1=Humberto|last2=Klein|first2=Daniel N.|last3=Ouimette|first3=Paige Crosby|last4=Riso|first4=Lawrence P.|last5=Anderson|first5=Rochelle L.|last6=Donaldson|first6=Shauna K.|title=Reports of the childhood home environment in early-onset dysthymia and episodic major depression.|journal=Journal of Abnormal Psychology|volume=104|issue=1|year=1995|pages=132–139|issn=1939-1846|doi=10.1037/0021-843X.104.1.132}}</ref>
*The individuals with early onset dysthymia often have a history of physical or sexual [[abuse]]. They have also been found to have poor relationships with both the parents.<ref name="LizardiKlein1995">{{cite journal|last1=Lizardi|first1=Humberto|last2=Klein|first2=Daniel N.|last3=Ouimette|first3=Paige Crosby|last4=Riso|first4=Lawrence P.|last5=Anderson|first5=Rochelle L.|last6=Donaldson|first6=Shauna K.|title=Reports of the childhood home environment in early-onset dysthymia and episodic major depression.|journal=Journal of Abnormal Psychology|volume=104|issue=1|year=1995|pages=132–139|issn=1939-1846|doi=10.1037/0021-843X.104.1.132}}</ref>
*Compared to [[Adolescent|adolescents]], the [[children]] display lesser symptoms of dysthymia. '[[Anhedonia]]' has been observed to be more common in [[Adolescent|adolescents]]. <ref name="MasiFavilla2001">{{cite journal|last1=Masi|first1=Gabriele|last2=Favilla|first2=Letizia|last3=Mucci|first3=Maria|last4=Poli|first4=Paola|last5=Romano|first5=Roberta|title=Depressive Symptoms in Children and Adolescents with Dysthymic Disorder|journal=Psychopathology|volume=34|issue=1|year=2001|pages=29–35|issn=0254-4962|doi=10.1159/000049277}}</ref>
*Compared to [[Adolescent|adolescents]], [[children]] display lesser variability in the symptoms of dysthymia.
*In younger adults, dysthymia is related to the abnormalities of [[personality]] whereas in the [[elderly]], there is a strong association with losses in life and other health related issues. <ref name="BellinoPatria2001">{{cite journal|last1=Bellino|first1=Silvio|last2=Patria|first2=Luca|last3=Ziero|first3=Simona|last4=Rocca|first4=Giuseppe|last5=Bogetto|first5=Filippo|title=Clinical features of dysthymia and age: a clinical investigation|journal=Psychiatry Research|volume=103|issue=2-3|year=2001|pages=219–228|issn=01651781|doi=10.1016/S0165-1781(01)00274-8}}</ref>
*'[[Anhedonia]]' is a common characteristic in [[Adolescent|adolescents]] with dysthymia. <ref name="MasiFavilla2001">{{cite journal|last1=Masi|first1=Gabriele|last2=Favilla|first2=Letizia|last3=Mucci|first3=Maria|last4=Poli|first4=Paola|last5=Romano|first5=Roberta|title=Depressive Symptoms in Children and Adolescents with Dysthymic Disorder|journal=Psychopathology|volume=34|issue=1|year=2001|pages=29–35|issn=0254-4962|doi=10.1159/000049277}}</ref>
 
*In younger adults, dysthymia is related to the abnormalities of [[personality]] whereas, the [[elderly]] have a strong association with losses in life and other health-related issues. <ref name="BellinoPatria2001">{{cite journal|last1=Bellino|first1=Silvio|last2=Patria|first2=Luca|last3=Ziero|first3=Simona|last4=Rocca|first4=Giuseppe|last5=Bogetto|first5=Filippo|title=Clinical features of dysthymia and age: a clinical investigation|journal=Psychiatry Research|volume=103|issue=2-3|year=2001|pages=219–228|issn=01651781|doi=10.1016/S0165-1781(01)00274-8}}</ref>
*
 
*


=== Gender ===
===Gender===


* Dysthymia affects both men and women.
*Dysthymia affects both men and women.
*The [[prevalence]] of dysthymia is more in [[women]] compared to [[men]].<ref name="BeekmanDeeg2004">{{cite journal|last1=Beekman|first1=A.T.F.|last2=Deeg|first2=D.J.H.|last3=Smit|first3=J.H.|last4=Comijs|first4=H.C.|last5=Braam|first5=A.W.|last6=de Beurs|first6=E.|last7=van Tilburg|first7=W.|title=Dysthymia in later life: a study in the community|journal=Journal of Affective Disorders|volume=81|issue=3|year=2004|pages=191–199|issn=01650327|doi=10.1016/S0165-0327(03)00138-1}}</ref>
*The [[prevalence]] of dysthymia is more in [[women]] compared to [[men]].<ref name="BeekmanDeeg2004">{{cite journal|last1=Beekman|first1=A.T.F.|last2=Deeg|first2=D.J.H.|last3=Smit|first3=J.H.|last4=Comijs|first4=H.C.|last5=Braam|first5=A.W.|last6=de Beurs|first6=E.|last7=van Tilburg|first7=W.|title=Dysthymia in later life: a study in the community|journal=Journal of Affective Disorders|volume=81|issue=3|year=2004|pages=191–199|issn=01650327|doi=10.1016/S0165-0327(03)00138-1}}</ref>
*The symptomatic profile is similar between [[males]] and [[females]] in [[Adolescence|adolescent]] population. While comparing the symptoms of dysthymia in both genders, no specific symptom predominance has been observed. <ref name="MasiFavilla20012">{{cite journal|last1=Masi|first1=Gabriele|last2=Favilla|first2=Letizia|last3=Mucci|first3=Maria|last4=Poli|first4=Paola|last5=Romano|first5=Roberta|title=Depressive Symptoms in Children and Adolescents with Dysthymic Disorder|journal=Psychopathology|volume=34|issue=1|year=2001|pages=29–35|issn=0254-4962|doi=10.1159/000049277}}</ref>
*The symptomatic profile is similar in [[males]] and [[females]] of the [[Adolescence|adolescent]] population. While comparing the symptoms of dysthymia in both genders, no specific symptom predominance has been noticed. <ref name="MasiFavilla20012">{{cite journal|last1=Masi|first1=Gabriele|last2=Favilla|first2=Letizia|last3=Mucci|first3=Maria|last4=Poli|first4=Paola|last5=Romano|first5=Roberta|title=Depressive Symptoms in Children and Adolescents with Dysthymic Disorder|journal=Psychopathology|volume=34|issue=1|year=2001|pages=29–35|issn=0254-4962|doi=10.1159/000049277}}</ref>
* Gender differences have been noted for the development of dysthymia in the [[elderly]] population.
*Gender differences have been noted in the [[elderly]] population.
* In [[elderly]] [[men]], dysthymia was more related to lower educational level and in those receiving [[nursing home]]/ institutional care. No relation was found based on occupation or marital status.<ref name="KiveläPahkala1989">{{cite journal|last1=Kivelä|first1=Sirkka-Liisa|last2=Pahkala|first2=Kimmo|title=Dysthymic disorder in the aged in the community|journal=Social Psychiatry and Psychiatric Epidemiology|volume=24|issue=2|year=1989|pages=77–83|issn=0933-7954|doi=10.1007/BF01788630}}</ref>
*In [[elderly]] [[men]], dysthymia is more related to lower educational levels and in those receiving [[nursing home]]/ institutional care. No relation has been found based on occupation or marital status.<ref name="KiveläPahkala1989">{{cite journal|last1=Kivelä|first1=Sirkka-Liisa|last2=Pahkala|first2=Kimmo|title=Dysthymic disorder in the aged in the community|journal=Social Psychiatry and Psychiatric Epidemiology|volume=24|issue=2|year=1989|pages=77–83|issn=0933-7954|doi=10.1007/BF01788630}}</ref>
* As opposed to this, in [[elderly]] [[Female|females]] dysthymia was predominant in older individuals (70 years +), married and in those with [[Education|higher education]] level. It was not found to be related to marital status, occupation or form of health care received. <ref name="KiveläPahkala19892">{{cite journal|last1=Kivelä|first1=Sirkka-Liisa|last2=Pahkala|first2=Kimmo|title=Dysthymic disorder in the aged in the community|journal=Social Psychiatry and Psychiatric Epidemiology|volume=24|issue=2|year=1989|pages=77–83|issn=0933-7954|doi=10.1007/BF01788630}}</ref>
*As opposed to this, in [[elderly]] [[Female|females]], dysthymia is predominant in older individuals (70 years +), married, and in those with [[Education|higher education]] levels. It is not related to marital status, occupation, or form of health care received. <ref name="KiveläPahkala19892">{{cite journal|last1=Kivelä|first1=Sirkka-Liisa|last2=Pahkala|first2=Kimmo|title=Dysthymic disorder in the aged in the community|journal=Social Psychiatry and Psychiatric Epidemiology|volume=24|issue=2|year=1989|pages=77–83|issn=0933-7954|doi=10.1007/BF01788630}}</ref>
 
*


=== Race ===
===Race===


* Dysthymia has higher [[lifetime prevalence]] in individuals of Mexican American and African American background. This can be explained by a number of factors like- <ref name="pmid15914823">{{cite journal| author=Riolo SA, Nguyen TA, Greden JF, King CA| title=Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III. | journal=Am J Public Health | year= 2005 | volume= 95 | issue= 6 | pages= 998-1000 | pmid=15914823 | doi=10.2105/AJPH.2004.047225 | pmc=1449298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15914823 }}</ref>
*Dysthymia has a higher [[lifetime prevalence]] in individuals of Mexican American and African American backgrounds. This can be explained by a number of factors dominating these populations: <ref name="pmid15914823">{{cite journal| author=Riolo SA, Nguyen TA, Greden JF, King CA| title=Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III. | journal=Am J Public Health | year= 2005 | volume= 95 | issue= 6 | pages= 998-1000 | pmid=15914823 | doi=10.2105/AJPH.2004.047225 | pmc=1449298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi
dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15914823 }}</ref>
**Lower [[education]] level
**Lower [[education]] level
**Poverty
**Poverty
**Hesitancy in seeking help
**Hesitancy in seeking help
**Lesser utilization of mental health services  
**Lesser utilization of mental health services
**Non-[[compliance]] to the [[treatment]]
**Failure to comply with [[treatment]]
**The cultural beliefs  
**Various cultural beliefs
 
*


==Risk Factors==
==Risk Factors==
Common risk factors in the development of Dysthymia are the following:<ref name="DSMV" /><ref name="HölzelHärter2011">{{cite journal|last1=Hölzel|first1=Lars|last2=Härter|first2=Martin|last3=Reese|first3=Christina|last4=Kriston|first4=Levente|title=Risk factors for chronic depression — A systematic review|journal=Journal of Affective Disorders|volume=129|issue=1-3|year=2011|pages=1–13|issn=01650327|doi=10.1016/j.jad.2010.03.025}}</ref>
Common risk factors in the development of dysthymia are:<ref name="DSMV" /><ref name="HölzelHärter2011">{{cite journal|last1=Hölzel|first1=Lars|last2=Härter|first2=Martin|last3=Reese|first3=Christina|last4=Kriston|first4=Levente|title=Risk factors for chronic depression — A systematic review|journal=Journal of Affective Disorders|volume=129|issue=1-3|year=2011|pages=1–13|issn=01650327|doi=10.1016/j.jad.2010.03.025}}</ref>


*[[Genetic predisposition]]- First-degree relatives with persistent depressive disorder
*[[Genetic predisposition]]
*Family history of [[Mood disorder|mood disorders]]
*First-degree relatives with persistent depressive disorder
*[[Major depressive disorder]] in first-degree relatives
*Family history of other [[Mood disorder|mood disorders]]
*Lower social integration
*Lower social integration
*Co-morbid [[Substance abuse|substance use disorder]]
*Co-morbid [[Substance abuse|substance use disorder]]
*Parental loss or separation
*Parental loss or separation
*Physical or sexual abuse
*Physical or sexual abuse
*<nowiki/><nowiki/><nowiki/>[[Education|Lower education l]]<nowiki/>evel
*<nowiki/><nowiki/><nowiki/>Lower educational l<nowiki/>evels
*<nowiki/><nowiki/><nowiki/>Polysomnographic <nowiki/>abnormalities  
*<nowiki/><nowiki/><nowiki/>Polysomnographic <nowiki/>abnormalities


==Natural History,Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


* Individuals with dysthymia have a greater risk of developing [[Major depressive disorder|major depressive disorder.]]
*Individuals with dysthymia have a higher risk of developing [[major depressive disorder]] in the future.
* Similar to adults, the children and adolescents have a higher risk for developing [[depression]]. <ref name="Keller1994">{{cite journal|last1=Keller|first1=M. B.|title=Course, outcome and impact on the community|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=24–34|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05880.x}}</ref>
*Similar to adults, children and adolescents with dysthymia are also more likely to develop [[depression]]. <ref name="Keller1994">{{cite journal|last1=Keller|first1=M. B.|title=Course, outcome and impact on the community|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=24–34|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05880.x}}</ref>
* These children have [[Scholastic performance|poor scholastic performance]] and deteriorating [[quality of life]].<ref name="Keller19943">{{cite journal|last1=Keller|first1=M. B.|title=Course, outcome and impact on the community|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=24–34|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05880.x}}</ref>
*These children have a [[Scholastic performance|poor scholastic performance]] and deteriorating [[quality of life]].<ref name="Keller19943">{{cite journal|last1=Keller|first1=M. B.|title=Course, outcome and impact on the community|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=24–34|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05880.x}}</ref>
* Dysthymia has an impact on personal relationships, financial state as well as physical and mental well-being.<ref name="Keller19942">{{cite journal|last1=Keller|first1=M. B.|title=Course, outcome and impact on the community|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=24–34|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05880.x}}</ref>
*Dysthymia has an impact on personal relationships, financial state as well as physical and mental well-being.<ref name="Keller19942">{{cite journal|last1=Keller|first1=M. B.|title=Course, outcome and impact on the community|journal=Acta Psychiatrica Scandinavica|volume=89|issue=s383|year=1994|pages=24–34|issn=0001-690X|doi=10.1111/j.1600-0447.1994.tb05880.x}}</ref>
* Dysthmia is associated with higher [[Suicide|suicide rates]] and significant [[disability]].<ref name="Gureje20112">{{cite journal|last1=Gureje|first1=Oye|title=Dysthymia in a cross-cultural perspective|journal=Current Opinion in Psychiatry|volume=24|issue=1|year=2011|pages=67–71|issn=0951-7367|doi=10.1097/YCO.0b013e32834136a5}}</ref>
*Dysthymia is associated with higher [[Suicide|suicide rates]] and significant [[disability]].<ref name="Gureje20112">{{cite journal|last1=Gureje|first1=Oye|title=Dysthymia in a cross-cultural perspective|journal=Current Opinion in Psychiatry|volume=24|issue=1|year=2011|pages=67–71|issn=0951-7367|doi=10.1097/YCO.0b013e32834136a5}}</ref>


===Prognosis===
===Prognosis===
Overall, dysthymia has a worse [[prognosis]] than [[Major depressive disorder|major depressive disorder.]] <ref name="Gureje2011">{{cite journal|last1=Gureje|first1=Oye|title=Dysthymia in a cross-cultural perspective|journal=Current Opinion in Psychiatry|volume=24|issue=1|year=2011|pages=67–71|issn=0951-7367|doi=10.1097/YCO.0b013e32834136a5}}</ref>
Overall, dysthymia has a worse [[prognosis]] than [[Major depressive disorder|major depressive disorder.]] <ref name="Gureje2011">{{cite journal|last1=Gureje|first1=Oye|title=Dysthymia in a cross-cultural perspective|journal=Current Opinion in Psychiatry|volume=24|issue=1|year=2011|pages=67–71|issn=0951-7367|doi=10.1097/YCO.0b013e32834136a5}}</ref>


Poor prognostic factors related to dysthymia include: <ref name="DSMV" /><ref name="BeekmanDeeg20042">{{cite journal|last1=Beekman|first1=A.T.F.|last2=Deeg|first2=D.J.H.|last3=Smit|first3=J.H.|last4=Comijs|first4=H.C.|last5=Braam|first5=A.W.|last6=de Beurs|first6=E.|last7=van Tilburg|first7=W.|title=Dysthymia in later life: a study in the community|journal=Journal of Affective Disorders|volume=81|issue=3|year=2004|pages=191–199|issn=01650327|doi=10.1016/S0165-0327(03)00138-1}}</ref>
Poor [[Prognosis|prognostic]] factors related to dysthymia are: <ref name="DSMV" /><ref name="BeekmanDeeg20042">{{cite journal|last1=Beekman|first1=A.T.F.|last2=Deeg|first2=D.J.H.|last3=Smit|first3=J.H.|last4=Comijs|first4=H.C.|last5=Braam|first5=A.W.|last6=de Beurs|first6=E.|last7=van Tilburg|first7=W.|title=Dysthymia in later life: a study in the community|journal=Journal of Affective Disorders|volume=81|issue=3|year=2004|pages=191–199|issn=01650327|doi=10.1016/S0165-0327(03)00138-1}}</ref>


*[[Anxiety disorders]]
*[[Anxiety disorders]]
Line 149: Line 140:
*[[Conduct disorder]]
*[[Conduct disorder]]
*Familial loading for [[Depression|chronic depression]]
*Familial loading for [[Depression|chronic depression]]
*History of poor maternal relationship in childhood
*History of poor [[maternal]] relationship in childhood
*History of [[Abuse|childhood sexual abuse]]
*History of [[Abuse|childhood sexual abuse]]
*Longer duration of symptoms
*Longer duration of symptoms
*Co-morbid [[personality disorder]]
*[[Comorbid]] [[personality disorder]]
*Increased severity of the symptoms
*Increased severity of the symptoms
*Higher levels of neuroticism
*Higher levels of [[neuroticism]]
*Poorer global functioning
*Poorer global functioning


==Diagnostic Criteria==
==Diagnostic Criteria==


===DSM-5 Diagnostic Criteria for Dysthymia ===
===DSM-5 Diagnostic Criteria for Dysthymia===
<br />


* Persistent Depressive Disorder (Dysthymia) is diagnosed using DSM-5 Criteria.<ref name="DSMV" />
*Persistent Depressive Disorder (Dysthymia) is diagnosed using [[Diagnostic and statistical manual of mental disorders|DSM]]-5 Criteria.<ref name="DSMV" />
* Dysthymia is a combination of  dysthymic disorder and chronic major depressive disorder (DSM-IV)


{| class="wikitable"
{| class="wikitable"
|+
|+
!DSM-5 DIAGNOSTIC CRITERIA FOR DYSTHYMIA
!'''DSM-5 DIAGNOSTIC CRITERIA FOR DYSTHYMIA'''
!SPECIFIERS
!'''SPECIFIERS'''
|-
|-
! rowspan="5" |The following criteria should be fulfilled-
! rowspan="5" |The following criteria should be fulfilled-




A. For at least 2 years, depressed for most of the day as observed by the individual or others. Irritable mood lasting at least 1 year for adolescents and children.
 
 
A. For at least 2 years, depression for most of the day as observed by the individual himself/herself or others. Irritable mood lasting at least 1 year for adolescents and children.




Line 194: Line 185:




D. Criteria for mthem ajor depressive disorder may be present regularly for two years.
 
D. Criteria for major depressive disorder may be present continuously for two years.




Line 208: Line 200:
H. Presence of clinically significant impairment in occupational, social,  and other domains of functioning.
H. Presence of clinically significant impairment in occupational, social,  and other domains of functioning.


 
!''Specify if''-
!Specify if-
With anxious distress
With anxious distress


Line 216: Line 207:
With atypical features
With atypical features


With mood-inconguent psychotic features
With mood-incongruent psychotic features


With mood-congruent psychotic features
With mood-congruent psychotic features
Line 224: Line 215:
With peripartum onset
With peripartum onset
|-
|-
!Specify if-
!''Specify if-''
In partial remission
In partial remission


In full remission
In full remission
|-
|-
!Specify if-
!''Specify if-''
Early onset (before 21 years)
Early-onset (before 21 years)


Late onset (at or after 21 years)
Late-onset (at or after 21 years)
|-
|-
!Specify if-
!''Specify if''-
With pure dysthymic syndrome
With pure dysthymic syndrome


Line 241: Line 232:
With intermittent major depressive episodes, with current episode
With intermittent major depressive episodes, with current episode


With intermittent major depressive episodes,without current episode
With intermittent major depressive episodes, without an ent episode
|-
|-
!Specify if-
!''Specify if-''
Mild
Mild


Line 252: Line 243:


<br />
<br />
==Treatment==
==Treatment==


=== Medications ===
===Medications===


==== Selective Serotonin Re-uptake Inhibitors (SSRI) ====
====Selective Serotonin Reuptake Inhibitors (SSRI)====


* The most commonly prescribed anti-depressants for this disorder are the [[selective serotonin reuptake inhibitors]] (SSRI), which include [[fluoxetine]] (Prozac), [[sertraline]] (Zoloft), [[paroxetine]] (Paxil), and [[citalopram]] (Celexa).  
*The most commonly prescribed [[Antidepressants|anti-depressants]] for dysthymia are the [[selective serotonin reuptake inhibitors]] ([[SSRI]]), which include [[fluoxetine]] ([[Prozac]]), [[sertraline]] ([[Zoloft]]), [[paroxetine]] ([[Paxil]]), and [[citalopram]] ([[Celexa]]).
* [[Selective serotonin reuptake inhibitor|SSRI]] have a very high affinity for [[Serotonin|Serotonin (5-HT) receptors]] whereas low affinity for [[noradrenaline]] uptake receptors. SSRI act by inhibiting the [[reuptake]] of [[5-HT]] from the [[Synaptic cleft|synaptic cleft,]] increasing its [[concentration]] and contributing to the [[therapeutic effect]].<ref name="SangkuhlKlein2009">{{cite journal|last1=Sangkuhl|first1=Katrin|last2=Klein|first2=Teri E.|last3=Altman|first3=Russ B.|title=Selective serotonin reuptake inhibitors pathway|journal=Pharmacogenetics and Genomics|volume=19|issue=11|year=2009|pages=907–909|issn=1744-6872|doi=10.1097/FPC.0b013e32833132cb}}</ref>
*[[Selective serotonin reuptake inhibitor|SSRI]]<nowiki/>s have a very high affinity for [[Serotonin|Serotonin (5-HT) receptors]] whereas low affinity for [[noradrenaline]] uptake [[receptors]]. They act by inhibiting the [[reuptake]] of [[5-HT]] from the [[Synaptic cleft|synaptic cleft,]] increasing its [[concentration]] and contributing to the [[therapeutic effect]].<ref name="SangkuhlKlein2009">{{cite journal|last1=Sangkuhl|first1=Katrin|last2=Klein|first2=Teri E.|last3=Altman|first3=Russ B.|title=Selective serotonin reuptake inhibitors pathway|journal=Pharmacogenetics and Genomics|volume=19|issue=11|year=2009|pages=907–909|issn=1744-6872|doi=10.1097/FPC.0b013e32833132cb}}</ref>
* The different SSRI have variability in efficacy and side-effect profile, which requires a thorough clinical consideration before prescribing them.<ref name="SangkuhlKlein20092">{{cite journal|last1=Sangkuhl|first1=Katrin|last2=Klein|first2=Teri E.|last3=Altman|first3=Russ B.|title=Selective serotonin reuptake inhibitors pathway|journal=Pharmacogenetics and Genomics|volume=19|issue=11|year=2009|pages=907–909|issn=1744-6872|doi=10.1097/FPC.0b013e32833132cb}}</ref>
*The different [[Selective serotonin reuptake inhibitor|SSRIs]] have variability in [[efficacy]] and side-effect profile, which requires thorough clinical consideration before prescribing them.<ref name="SangkuhlKlein20092">{{cite journal|last1=Sangkuhl|first1=Katrin|last2=Klein|first2=Teri E.|last3=Altman|first3=Russ B.|title=Selective serotonin reuptake inhibitors pathway|journal=Pharmacogenetics and Genomics|volume=19|issue=11|year=2009|pages=907–909|issn=1744-6872|doi=10.1097/FPC.0b013e32833132cb}}</ref>
* [[Selective serotonin reuptake inhibitor|SSRI]] are easy to take and relatively safe compared with older forms of anti-depressants.<ref>National Institute of Mental Health</ref>
*[[Selective serotonin reuptake inhibitor|SSRIs]] are easy to take and relatively safer compared with the other older forms of anti-depressants.<ref>National Institute of Mental Health</ref>


====Side Effects of SSRI====
====Side Effects of SSRI====


* [[Selective serotonin reuptake inhibitor|SSRI]] are associated with some [[side effects]] like [[sleep disturbances]], [[nausea]], [[vomiting]], [[sexual dysfunction]], [[weight gain]], cognitive disturbances and [[SSRI discontinuation syndrome]].<ref name="Ferguson2001">{{cite journal|last1=Ferguson|first1=James M.|title=SSRI Antidepressant Medications|journal=The Primary Care Companion to The Journal of Clinical Psychiatry|volume=03|issue=01|year=2001|pages=22–27|issn=1523-5998|doi=10.4088/PCC.v03n0105}}</ref>
*[[Selective serotonin reuptake inhibitor|SSRI]] are associated with some [[side effects]] like [[sleep disturbances]], [[nausea]], [[vomiting]], [[sexual dysfunction]], [[weight gain]], cognitive disturbances and [[SSRI discontinuation syndrome]].<ref name="Ferguson2001">{{cite journal|last1=Ferguson|first1=James M.|title=SSRI Antidepressant Medications|journal=The Primary Care Companion to The Journal of Clinical Psychiatry|volume=03|issue=01|year=2001|pages=22–27|issn=1523-5998|doi=10.4088/PCC.v03n0105}}</ref>
* The [[sleep disturbances]] are more prominent initially in the treatment course. These are in the form of earlier onset of [[Rapid eye movement|rapid eye movement (REM) sleep]], increased duration of [[REM sleep|REM]] sleep and lesser slow-wave sleep.<ref name="Ferguson20012">{{cite journal|last1=Ferguson|first1=James M.|title=SSRI Antidepressant Medications|journal=The Primary Care Companion to The Journal of Clinical Psychiatry|volume=03|issue=01|year=2001|pages=22–27|issn=1523-5998|doi=10.4088/PCC.v03n0105}}</ref>
*The [[sleep disturbances]] are more prominent initially in the treatment course. These are in the form of earlier onset of [[Rapid eye movement|rapid eye movement (REM) sleep]], increased duration of [[REM sleep|REM]] sleep, and lesser slow-wave sleep.<ref name="Ferguson20012">{{cite journal|last1=Ferguson|first1=James M.|title=SSRI Antidepressant Medications|journal=The Primary Care Companion to The Journal of Clinical Psychiatry|volume=03|issue=01|year=2001|pages=22–27|issn=1523-5998|doi=10.4088/PCC.v03n0105}}</ref>
* The immediate [[adverse effects]] of [[SSRIs|SSRI]] is due to increased concentration of [[serotonin]] at particular [[Receptor (biochemistry)|receptor]] subtypes in various parts of the brain. The [[Post-synaptic|post-synaptic receptor desensitization]] in these regions lead to [[tolerance]] to these [[side effects]] after some time. <ref name="Stahl1998">{{cite journal|last1=Stahl|first1=Stephen M.|title=Mechanism of action of serotonin selective reuptake inhibitors|journal=Journal of Affective Disorders|volume=51|issue=3|year=1998|pages=215–235|issn=01650327|doi=10.1016/S0165-0327(98)00221-3}}</ref>
*The immediate [[adverse effects]] of [[SSRIs|SSRI]]s are due to increased concentration of [[serotonin]] at particular [[Receptor (biochemistry)|receptor]] subtypes in various parts of the [[brain]]. The [[Post-synaptic|post-synaptic receptor desensitization]] in these regions leads to [[tolerance]] to these [[side effects]] after some time. <ref name="Stahl1998">{{cite journal|last1=Stahl|first1=Stephen M.|title=Mechanism of action of serotonin selective reuptake inhibitors|journal=Journal of Affective Disorders|volume=51|issue=3|year=1998|pages=215–235|issn=01650327|doi=10.1016/S0165-0327(98)00221-3}}</ref>


====Other medications====
====Other medications====


* Some patients do not respond to [[SSRIs|SSRI]] or have to discontinue them due to inability to tolerate the [[Adverse effect (medicine)|adverse effects]].  
*Some patients do not respond to [[SSRIs|SSRI]]s or have to discontinue them due to inability to tolerate the [[Adverse effect (medicine)|adverse effects]].
* Older antidepressants, such as a [[tricyclic antidepressant]] (TCA) or an [[MAOI]] can be tried in such cases.  
*Older [[antidepressants]], such as a [[tricyclic antidepressant]] (TCA) or a [[monoamine oxidase inhibitor]] [[MAOI|(MAOI]]) can be prescribed in such cases.
* TCA have [[anticholinergic]] side-effects like weight gain, [[dry mouth]], urinary retention, [[constipation]], blurry vision, [[sexual dysfunction]], and low blood pressure.
*[[Tricyclic antidepressant|TCAs]] have [[anticholinergic]] side-effects like weight gain, [[dry mouth]], urinary retention, [[constipation]], and blurry vision.
* These medications should be avoided in elderly patients.
*Some individuals on TCA also develop [[sexual dysfunction]], cardiac side-effects and [[orthostatic hypotension]].
* Other anti-depressants that can be used are [[bupropion]] (Wellbutrin), [[venlafaxine]] (Effexor), [[mirtazapine]] (Remeron), and [[duloxetine]] (Cymbalta).
*These [[Medication|medications]] should be avoided in elderly patients.
*[[MAOI|MAOIs]] can predispose to [[serotonin syndrome]] if used with [[SSRIs]] as an [[adjuvant therapy]] or if insufficient time is given for washout of [[Selective serotonin reuptake inhibitor|SSRI]]s before switching to [[Monoamine oxidase inhibitor|MAOI]]s. <ref name="MalikJunglee2015">{{cite journal|last1=Malik|first1=A.|last2=Junglee|first2=N.|title=A Case of the Serotonin Syndrome Secondary to Phenelzine Monotherapy at Therapeutic Dosing|journal=Case Reports in Medicine|volume=2015|year=2015|pages=1–4|issn=1687-9627|doi=10.1155/2015/931963}}</ref>
*A considerable approach to deal with this problem is to give at least a [[Washout|washout period]] of 14 days while switching from [[Selective serotonin reuptake inhibitor|SSRI]]s to [[Monoamine oxidase inhibitor|MAOI]]s or vice-versa.<ref name="Keltner2009">{{cite journal|last1=Keltner|first1=Norm|title=Serotonin Syndrome: A Case of Fatal SSRI/MAOI Interaction|journal=Perspectives in Psychiatric Care|volume=30|issue=4|year=2009|pages=26–31|issn=00315990|doi=10.1111/j.1744-6163.1994.tb00446.x}}</ref>
*[[Fluoxetine Hcl|Fluoxetine]] has a longer [[half-life]] as compared to other [[Selective serotonin reuptake inhibitor|SSRIs]], therefore a longer washout period (a minimum of 5 weeks) is required to switch from [[Fluoxetine hydrochloride|Fluoxetine]] to another [[MAOI]].<ref name="pmid10598311">{{cite journal| author=Gury C, Cousin F| title=[Pharmacokinetics of SSRI antidepressants: half-life and clinical applicability]. | journal=Encephale | year= 1999 | volume= 25 | issue= 5 | pages= 470-6 | pmid=10598311 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10598311  }}</ref>
*Other [[antidepressants]] that can be used for treating dysthymia are [[bupropion]] ([[Wellbutrin]]), [[venlafaxine]] ([[Effexor]]), [[mirtazapine]] ([[Remeron]]), and [[duloxetine]] ([[Cymbalta]]).


===Psychotherapy===
===Psychotherapy===


* Some evidence suggests the combination of medication and [[psychotherapy]] may result in the greatest improvement.
*Evidence suggests the combination of [[pharmacotherapy]] and [[psychotherapy]] provides the greatest improvement in dysthymia. <ref name="BrowneSteiner2002">{{cite journal|last1=Browne|first1=Gina|last2=Steiner|first2=Meir|last3=Roberts|first3=Jacqueline|last4=Gafni|first4=Amiram|last5=Byrne|first5=Carolyn|last6=Dunn|first6=Edward|last7=Bell|first7=Barbara|last8=Mills|first8=Michael|last9=Chalklin|first9=Lori|last10=Wallik|first10=David|last11=Kraemer|first11=James|title=Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs|journal=Journal of Affective Disorders|volume=68|issue=2-3|year=2002|pages=317–330|issn=01650327|doi=10.1016/S0165-0327(01)00343-3}}</ref>
* There are different types of psychotherapies. The type of therapy chosen depends upon a number of factors like the nature of any stressful events, the availability of family and other social support, and personal preference.
*On the contrary, some studies point towards the inferiority of [[psychotherapy]] in treating dysthymia.<ref name="Cuijpersvan Straten2010">{{cite journal|last1=Cuijpers|first1=Pim|last2=van Straten|first2=Annemieke|last3=Schuurmans|first3=Josien|last4=van Oppen|first4=Patricia|last5=Hollon|first5=Steven D.|last6=Andersson|first6=Gerhard|title=Psychotherapy for chronic major depression and dysthymia: A meta-analysis|journal=Clinical Psychology Review|volume=30|issue=1|year=2010|pages=51–62|issn=02727358|doi=10.1016/j.cpr.2009.09.003}}</ref>
* Psychotherapy focuses on the education about the disease model.
*There are different types of [[Psychotherapy|psychotherapies]]. The type of therapy chosen depends upon a number of factors like the nature of any stressful events, the availability of family and other social support, and personal preference.
* 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.
*[[Psychotherapy]] focuses mainly on education about the disease model, correcting the underlying [[cognitive]] distortions, and building up support.
* [[Psychodynamic psychotherapy|Psychodynamic]], insight-oriented, or [[interpersonal psychotherapy]] (IPT) can help a person sort out conflicts in important relationships or explore the history behind the symptoms.
*[[Cognitive-behavioral therapy]] is designed to examine and help correct the faulty, self-critical thought patterns and correct the [[cognitive]] distortions that persons with mood disorders commonly experience.<ref name="Cuijpersvan Straten20102">{{cite journal|last1=Cuijpers|first1=Pim|last2=van Straten|first2=Annemieke|last3=Schuurmans|first3=Josien|last4=van Oppen|first4=Patricia|last5=Hollon|first5=Steven D.|last6=Andersson|first6=Gerhard|title=Psychotherapy for chronic major depression and dysthymia: A meta-analysis|journal=Clinical Psychology Review|volume=30|issue=1|year=2010|pages=51–62|issn=02727358|doi=10.1016/j.cpr.2009.09.003}}</ref>
* [[Interpersonal psychotherapy|IPT]] emphasizes on resolving the conflict in current relationships that are exacerbating the depressive symptoms.
*[[Psychodynamic psychotherapy|Psychodynamic]], insight-oriented, or [[interpersonal psychotherapy]] (IPT) can find out the origin of the symptoms, address them appropriately, and explore the conflicts in important relationships which are further deteriorating the illness.<ref name="SchrammZobel2011">{{cite journal|last1=Schramm|first1=Elisabeth|last2=Zobel|first2=Ingo|last3=Dykierek|first3=Petra|last4=Kech|first4=Sabine|last5=Brakemeier|first5=Eva-Lotta|last6=Külz|first6=Anne|last7=Berger|first7=Mathias|title=Cognitive behavioral analysis system of psychotherapy versus interpersonal psychotherapy for early-onset chronic depression: A randomized pilot study|journal=Journal of Affective Disorders|volume=129|issue=1-3|year=2011|pages=109–116|issn=01650327|doi=10.1016/j.jad.2010.08.003}}</ref>
* Both [[Cognitive-behavioral therapy|CBT]] and [[Interpersonal psychotherapy|IPT]] are effective for adolescents. An adapted version for [[Interpersonal psychotherapy|IPT]] is used because these individuals are in conflict with their parents as well as peers, limiting the outlet options for their emotional burden.  
*[[Interpersonal psychotherapy|IPT]] emphasizes resolving the conflict in current relationships that are exacerbating the depressive symptoms.<ref>{{cite journal|title=Psychotherapy of dysthymia|journal=American Journal of Psychiatry|volume=151|issue=8|year=1994|pages=1114–1121|issn=0002-953X|doi=10.1176/ajp.151.8.1114}}</ref>
*Both [[Cognitive-behavioral therapy|CBT]] and [[Interpersonal psychotherapy|IPT]] are effective for adolescents. [[Psychoeducation]] and [[Psychosocial|psychosocial support]] provided to the parents of adolescents with dysthymia plays a very important role in the early and satisfactory response to these therapies.<ref name="NobileCataldo2003">{{cite journal|last1=Nobile|first1=Maria|last2=Cataldo|first2=Giulia M|last3=Marino|first3=Cecilia|last4=Molteni|first4=Massimo|title=Diagnosis and Treatment of Dysthymia in Children and Adolescents|journal=CNS Drugs|volume=17|issue=13|year=2003|pages=927–946|issn=1172-7047|doi=10.2165/00023210-200317130-00001}}</ref>
*An adapted version for [[Interpersonal psychotherapy|IPT]] is used for adolescents because they are in conflict with their parents as well as peers, limiting the outlet options for their emotional burden.<ref name="MufsonFairbanks1996">{{cite journal|last1=Mufson|first1=Laura|last2=Fairbanks|first2=Janet|title=Interpersonal Psychotherapy for Depressed Adolescents: A One-Year Naturalistic Follow-up Study|journal=Journal of the American Academy of Child & Adolescent Psychiatry|volume=35|issue=9|year=1996|pages=1145–1155|issn=08908567|doi=10.1097/00004583-199609000-00012}}</ref>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category: Up-To-Date]]
[[Category: Up-To-Date]]

Latest revision as of 20:52, 19 February 2021

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List of terms related to Dysthymia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vatsala Sharma; M.B.B.S[2]

Synonyms and keywords: Dysthymic disorder; persistent depressive disorder; double depression

Overview

Dysthymia is a mood disorder that falls on the depression spectrum. It is characterized by the 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 not as distressing. The symptoms of dysthymia are often underestimated by the patients and misdiagnosed by clinicians. Dysthymia can have a substantial impact on an individual's life by preventing effective functioning, disrupting sleep patterns, and interfering with activities of daily living (ADLs). It usually presents with mild symptoms on a day-to-day basis. Progressively, the disorder may take a more severe form, resulting in work impairment, social isolation, and high rates of suicide. Due to its chronicity and lesser severity, most of the patients suffering from dysthymia believe that it is a part of their character and do not seek treatment until it gets extremely disabling.

Historical Perspective

  • The historical origin of the term 'dysthymia' is Greek.
  • In 1844, dysthymia was used first in psychiatry by C.F. Flemming. [1]
  • In 1882, dysthymia was further described by Kahlbaum, and he differentiated it from the fluctuating mood of cyclothymia.[2]
  • In the Diagnostic and Statistical Manual of Mental Disorders (DSM), dysthymia as a clinical entity has undergone complex evolution from being considered a personality disorder to an affective disorder.


Classification

  • DSM-IV has classified chronic depression into dysthymic disorder and major depressive disorder, chronic type.
  • Based on the age of onset, DSM-IV has divided dysthymic disorders into early (before 21 years) and late-onset (after 21 years) subtypes. [5]
  • Early-onset dysthymic disorder is related to a higher familial burden of mood disorders and childhood adverse conditions. On the other hand, late-onset has an association with health issues and major losses.[5]
  • In DSM-IV, individuals having underlying dysthymic disorder who develop major depressive episodes are diagnosed as having both dysthymic disorder and major depressive disorder. So, DSM-IV has categorized dysthymic disorder and major depressive episodes as separate diagnoses instead of phases of a single disorder that fluctuates in severity over time.[6]
  • In spite of minor differences in the definitions of dysthymic disorder in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) and International Classification of Diseases Tenth Edition (ICD-l0), both the systems are competent to establish the diagnosis.[7]
  • Dysthymia and chronic major depression are both included under the new term 'persistent depressive disorder' in DSM-5.[8]
  • Since the introduction in DSM-III, the diagnostic validity of dysthymia is questioned. It is a heterogeneous diagnosis including various depressive and anxiety conditions. As persistent depressive disorder includes dysthymia as a component, the former is more likely to represent a heterogeneous domain diagnosis. It limits the identification of the preferred treatment options. [9]

Pathophysiology

Clinical Features

  • The main features of dysthymia are
  • Dysthymia as compared to major depression, tends to be less intense and persists for a longer duration.
  • Other than the variation in magnitude of severity, both these conditions exhibit similar symptomatology.
  • To diagnose major depressive disorder, the symptoms should be present for a minimum duration of 14 days (2 weeks) whereas, dysthymia symptoms should be present for at least 2 years.
  • The symptoms of dysthymia can grow into a full-blown episode of major depression. The intense episode often exists with the underlying feelings of low mood and this resulting condition is called "double depression"[15]
  • As compared to the general population, the people with dysthymia have a greater-than-average chance of developing major depression.
  • While major depressive disorder mostly occurs in episodes, dysthymia lasts for longer periods, is consistent, and sometimes begins in childhood. Therefore, persons with dysthymia tend to consider depression as a part of their character.
  • Dysthymia and major depression, both are inheritable.
  • Some individuals describe dysthymia as being under chronic stress.
  • When treating cases, it is often difficult to distinguish if these people are actually under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.

Differential Diagnosis

The differential diagnosis of dysthymia includes the following: [16]

Epidemiology and Demographics

Prevalence

  • The 12-month prevalence of dysthymia is approximately 500 per 100,000 (0.5%) of the overall population.[17]

Age

  • Individuals of all age groups may develop dysthymia.
  • Based on the age of onset, the etiology of dysthymia varies.
  • The individuals with early onset dysthymia often have a history of physical or sexual abuse. They have also been found to have poor relationships with both the parents.[18]
  • Compared to adolescents, children display lesser variability in the symptoms of dysthymia.
  • 'Anhedonia' is a common characteristic in adolescents with dysthymia. [19]
  • In younger adults, dysthymia is related to the abnormalities of personality whereas, the elderly have a strong association with losses in life and other health-related issues. [20]

Gender

  • Dysthymia affects both men and women.
  • The prevalence of dysthymia is more in women compared to men.[21]
  • The symptomatic profile is similar in males and females of the adolescent population. While comparing the symptoms of dysthymia in both genders, no specific symptom predominance has been noticed. [22]
  • Gender differences have been noted in the elderly population.
  • In elderly men, dysthymia is more related to lower educational levels and in those receiving nursing home/ institutional care. No relation has been found based on occupation or marital status.[23]
  • As opposed to this, in elderly females, dysthymia is predominant in older individuals (70 years +), married, and in those with higher education levels. It is not related to marital status, occupation, or form of health care received. [24]

Race

  • Dysthymia has a higher lifetime prevalence in individuals of Mexican American and African American backgrounds. This can be explained by a number of factors dominating these populations: [25]
    • Lower education level
    • Poverty
    • Hesitancy in seeking help
    • Lesser utilization of mental health services
    • Failure to comply with treatment
    • Various cultural beliefs

Risk Factors

Common risk factors in the development of dysthymia are:[17][26]

Natural History, Complications, and Prognosis

Prognosis

Overall, dysthymia has a worse prognosis than major depressive disorder. [31]

Poor prognostic factors related to dysthymia are: [17][32]

Diagnostic Criteria

DSM-5 Diagnostic Criteria for Dysthymia

  • Persistent Depressive Disorder (Dysthymia) is diagnosed using DSM-5 Criteria.[17]
DSM-5 DIAGNOSTIC CRITERIA FOR DYSTHYMIA SPECIFIERS
The following criteria should be fulfilled-



A. For at least 2 years, depression for most of the day as observed by the individual himself/herself or others. Irritable mood lasting at least 1 year for adolescents and children.


B. With depressed mood, presence of two or more of-

1.Reduced appetite or overeating

2. Fatigue or less energy

3.Low self-esteem

4.Indecisiveness or low concentration

5.Hyper or insomnia

6.Hopelessness


C. The person has never been without the symptoms mentioned in Criteria A and B for greater than 2 months at a time.


D. Criteria for major depressive disorder may be present continuously for two years.


E. Criteria have never been met for Cyclothymia and there has never been a hypomanic or manic episode.


F. The condition can not be explained by schizophrenia, delusional disorder, schizoaffective disorder, or other schizophrenia spectrum disorder.


G. The symptomatology is not secondary to the effects of a substance or other medical condition.


H. Presence of clinically significant impairment in occupational, social, and other domains of functioning.

Specify if-

With anxious distress

With mixed features

With atypical features

With mood-incongruent psychotic features

With mood-congruent psychotic features

With melancholic features

With peripartum onset

Specify if-

In partial remission

In full remission

Specify if-

Early-onset (before 21 years)

Late-onset (at or after 21 years)

Specify if-

With pure dysthymic syndrome

With persistent major depressive episode

With intermittent major depressive episodes, with current episode

With intermittent major depressive episodes, without an ent episode

Specify if-

Mild

Moderate

Severe


Treatment

Medications

Selective Serotonin Reuptake Inhibitors (SSRI)

Side Effects of SSRI

Other medications

Psychotherapy

  • Evidence suggests the combination of pharmacotherapy and psychotherapy provides the greatest improvement in dysthymia. [42]
  • On the contrary, some studies point towards the inferiority of psychotherapy in treating dysthymia.[43]
  • There are different types of psychotherapies. The type of therapy chosen depends upon a number of factors like the nature of any stressful events, the availability of family and other social support, and personal preference.
  • Psychotherapy focuses mainly on education about the disease model, correcting the underlying cognitive distortions, and building up support.
  • Cognitive-behavioral therapy is designed to examine and help correct the faulty, self-critical thought patterns and correct the cognitive distortions that persons with mood disorders commonly experience.[44]
  • Psychodynamic, insight-oriented, or interpersonal psychotherapy (IPT) can find out the origin of the symptoms, address them appropriately, and explore the conflicts in important relationships which are further deteriorating the illness.[45]
  • IPT emphasizes resolving the conflict in current relationships that are exacerbating the depressive symptoms.[46]
  • Both CBT and IPT are effective for adolescents. Psychoeducation and psychosocial support provided to the parents of adolescents with dysthymia plays a very important role in the early and satisfactory response to these therapies.[47]
  • An adapted version for IPT is used for adolescents because they are in conflict with their parents as well as peers, limiting the outlet options for their emotional burden.[48]

References

  1. Brieger, Peter; Marneros, Andreas (1997). "Dysthymia and cyclothymia: historical origins and contemporary development". Journal of Affective Disorders. 45 (3): 117–126. doi:10.1016/S0165-0327(97)00053-0. ISSN 0165-0327.
  2. Freeman HL (1994). "Historical and nosological aspects of dysthymia". Acta Psychiatr Scand Suppl. 383: 7–11. doi:10.1111/j.1600-0447.1994.tb05877.x. PMID 7942068.
  3. Freeman, H. L. (1994). "Historical and nosological aspects of dysthymia". Acta Psychiatrica Scandinavica. 89 (s383): 7–11. doi:10.1111/j.1600-0447.1994.tb05877.x. ISSN 0001-690X.
  4. Freeman, H. L. (1994). "Historical and nosological aspects of dysthymia". Acta Psychiatrica Scandinavica. 89 (s383): 7–11. doi:10.1111/j.1600-0447.1994.tb05877.x. ISSN 0001-690X.
  5. 5.0 5.1 Klein DN, Santiago NJ (2003) Dysthymia and chronic depression: introduction, classification, risk factors, and course. J Clin Psychol 59 (8):807-16. DOI:10.1002/jclp.10174 PMID: 12858423
  6. Klein DN, Santiago NJ (2003) Dysthymia and chronic depression: introduction, classification, risk factors, and course. J Clin Psychol 59 (8):807-16. DOI:10.1002/jclp.10174 PMID: 12858423
  7. Lopez Ibor, J. J.; Frances, A.; Jones, C. (1994). "Dysthymic disorder: a comparison of DSM-IV and ICD-10 and issues in differential diagnosis". Acta Psychiatrica Scandinavica. 89 (s383): 12–18. doi:10.1111/j.1600-0447.1994.tb05878.x. ISSN 0001-690X.
  8. "StatPearls". 2020. PMID 31082096.
  9. Rhebergen D, Graham R (2014). "The re-labelling of dysthymic disorder to persistent depressive disorder in DSM-5: old wine in new bottles?". Curr Opin Psychiatry. 27 (1): 27–31. doi:10.1097/YCO.0000000000000022. PMID 24270481.
  10. Cao G, Harris KM (2012) Developmental regulation of the late phase of long-term potentiation (L-LTP) and metaplasticity in hippocampal area CA1 of the rat. J Neurophysiol 107 (3):902-12. DOI:10.1152/jn.00780.2011 PMID: 22114158
  11. Yoshimura R, Umene-Nakano W, Hoshuyama T, Ikenouchi-Sugita A, Hori H, Katsuki A; et al. (2010). "Plasma levels of brain-derived neurotrophic factor and interleukin-6 in patients with dysthymic disorder: comparison with age- and sex-matched major depressed patients and healthy controls". Hum Psychopharmacol. 25 (7–8): 566–9. doi:10.1002/hup.1155. PMID 21312291.
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Mental and behavioral disorders