Dysthymia

Dysthymia is a chronic condition that lasts at least two years, characterized by a depressed mood for more than half a day of the year, but does not meet the criteria for a major depression episode.

In some patients, there is a so-called "double depression", in which episodes of major depression occur against a background of constantly existing dysthymia. In this condition, there may be difficulties in assessing the effectiveness of treatment, since outside the exacerbation the mood level corresponds to dysthymia, and not euthymia. Patients with dysthymia usually look sad and depressed. They find it difficult to answer the question when they felt good for the last time. As the constantly depressed mood becomes almost an integral part of their own "I", such patients complain much less of a bad mood than patients with a large depression. In adulthood, dysthymia is 2-3 times more common in women than in men. Its prevalence is 3%, whereas during life it is detected in 6% of the population. The debut of dysthymia usually falls on children's, youthful or young age.

[1], [2], [3], [4], [5], [6]

Symptoms of dysthymia

Depressed mood (on subjective sensations or observations of others) most of the day for more than half a day in a year at least 2 years.

Note: in children and adolescents, mood changes can be irritable, and the duration of symptoms should be at least 1 year.

During periods of depressed mood, there are 2 or more of the following symptoms:

• Poor appetite or overeating
• Insomnia or hypersomnia
• Failure or fatigue
• Low self-incidence
• Violation of concentration or difficulty in making decisions
• Feeling of hopelessness

For 2 years (in children and adolescents - for 1 year) of the existence of the disorder, the above symptoms were absent for no more than 2 months to a number.

During the first 2 years of the existence of the disorder (in children and adolescents - for 1 year) there was not a single major depressive episode, i.e. Symptoms can not be better explained by the presence of a chronic form of major depression or major depression in a state of partial remission.

Note: the presence of a previous Major depressive episode is allowed, provided that before the onset of dysthymia, there was complete remission (no clinically significant symptoms for at least 2 months). In addition, after 2 years of dysthymia (in children and adolescents after 1 year), there may be episodes of major depression, and both diagnoses can be displayed if the symptoms meet the criteria of the Great Depression episode.

There have never been manic, mixed or hypomaniacal episodes; Symptoms do not meet the criteria of amyotomy

The disorder does not arise solely in connection with the development of a chronic psychotic disorder, such as schizophrenia or delusional disorder

Symptoms are not caused by the direct physiological action of exogenous substances (including addictive substances or drugs) or a common disease (eg, hypothyroidism)

Symptoms cause clinically significant discomfort or disability of the patient in social, professional or other important areas

Treatment of dysthymia

Dysthymia is a chronic affective disorder that occurs in 3-6% of the US population. Patients with dysthymia account for about a third of all patients in psychiatric clinics. In patients with dysthymia, comorbid conditions are often detected: anxiety disorders, dependence on psychotropic substances, major depression. Although only a small number of studies have evaluated the effectiveness of pharmacotherapy in dysthymia, they have shown that drugs used for major depression appear to be effective in the treatment of dysthymia. But improvement in dysthymia may occur more slowly than with major depression. Scientists conducted a double-blind, placebo-controlled trial of fluoxetine for dysthymia. After 3 months of treatment, improvement was noted in 58% (42 of 72) of patients taking fluoxetine (20 mg / day) and only 36% (11 of 39) of those taking placebo. Among patients who initially did not respond to treatment, an improvement was noted in about half of the patients within the next 3 months after increasing the dose of fluoxetine to 40 mg / day. The efficacy of sertraline and imipramine in dysthymia was confirmed in a large double-blind, placebo-controlled study that included 416 patients with early-onset primary dysthymia without concomitant major depression. A significant and marked improvement (with an overall clinical impression score of 1 or 2 points) was noted in 64% of patients taking imipramine in 59% of patients taking sertraline and 44% of patients taking placebo. When taking SSRIs, fewer side effects were noted than with TCAs.