Dysthymia

Dysthymia is a chronic condition lasting at least two years, characterized by depressed mood more than half the days of the year, but not meeting the criteria for a major depressive episode.

Some patients have so-called "double depression," in which episodes of major depression occur against the background of persistent dysthymia. This condition can make it difficult to assess the effectiveness of treatment, since outside of an exacerbation, the mood level corresponds to dysthymia, not euthymia. Patients with dysthymia usually look sad and depressed. They find it difficult to answer the question of when they last felt good. Since the persistently depressed mood becomes an almost integral part of their own "I," such patients complain of a bad mood much less than patients with major depression. In adulthood, dysthymia is 2-3 times more common in women than in men. Its prevalence is 3%, while during life it is detected in 6% of the population. The onset of dysthymia usually occurs in childhood, adolescence, or young adulthood.

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Symptoms of Dysthymia

Depressed mood (according to subjective feelings or observations of others) most of the day for more than half the days of the year for at least 2 years.

Note: In children and adolescents, mood changes may present as irritability and symptoms must have lasted for at least 1 year.

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

• Poor appetite or overeating
• Insomnia or hypersomnia
• Loss of strength or fatigue
• Low self-esteem
• Difficulty concentrating or making decisions
• Feeling of hopelessness

Over 2 years (in children and adolescents - 1 year) of the disorder's existence, the symptoms listed above were absent for no more than 2 months in a row.

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

Note: a previous major depressive episode is allowed, provided that there was complete remission (absence of clinically significant symptoms for at least 2 months) before the onset of dysthymia. In addition, after 2 years of dysthymia (in children and adolescents - after 1 year), episodes of major depression may occur against its background, and both diagnoses can be made if the symptoms meet the criteria for a major depressive episode.

No manic, mixed or hypomanic episodes have ever been observed; symptoms do not meet criteria for schillothymia

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 direct physiological effects of exogenous substances (including addictive substances or drugs) or a general disease (eg, hypothyroidism)

Symptoms cause clinically significant discomfort or disruption of the patient's life in social, professional or other important areas

Treatment of dysthymia

Dysthymia is a chronic affective disorder that affects 3-6% of the U.S. population. Dysthymia patients account for about a third of all patients in psychiatric clinics. Dysthymia patients often have comorbid conditions: anxiety disorders, substance abuse, and major depression. Although only a small number of studies have been conducted evaluating the effectiveness of drug therapy for dysthymia, they have shown that medications used for major depression are apparently effective in treating dysthymia. However, improvement in dysthymia may be slower than in major depression. Scientists conducted a double-blind, placebo-controlled study of the effectiveness of fluoxetine in 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 patients taking placebo. Of the patients who initially failed to respond, approximately half showed improvement within 3 months after the fluoxetine dose was increased to 40 mg/day. The efficacy of sertraline and imipramine in dysthymia was confirmed in a large, double-blind, placebo-controlled study of 416 patients with early-onset primary dysthymia without concomitant major depression. Significant and marked improvement (Clinical Global Impression score of 1 or 2) was observed in 64% of patients taking imipramine, 59% of patients taking sertraline, and 44% of patients taking placebo. Fewer side effects were observed with SSRIs than with TCAs.