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Dysthymia
ICD-10 F34.1
ICD-9 300.4
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Dysthymic disorder or dysthymia is a form of the mood disorder of depression characterized by a lack of enjoyment/pleasure in life that continues for at least two years. It differs from clinical depression in the severity of the symptoms. While dysthymia usually does not prevent a person from functioning, it prevents full enjoyment of life.

Dysthymia may seem a paradoxical disorder in that sufferers exhibit fairly mild symptoms on a day-to-day basis, however, over a life time it can have severe effects: high rates of suicide, work impairment, and social isolation. Dysthymia typically lasts much longer than an episode of major depression, and outsiders often perceive dysthymic individuals as dour and humorless. When a major depressive episode occurs on top of dysthymia, clinicians may refer to the resultant condition as double depression.

Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) characterizes Dysthymic Disorder as a chronic depression, but with less severity than a major depression. The essential symptom involves the individual feeling depressed almost daily for at least two years, but without the criteria necessary for a major depression. Low energy, disturbances in sleep or in appetite, and low self-esteem typically contribute to the clinical picture as well. Note the following diagnostic criteria:

  1. On the majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.
  2. When depressed, the patient has 2 or more of:
    1. Appetite decreased or increased
    2. Sleep decreased or increased
    3. Fatigue or low energy
    4. Poor self-image
    5. Reduced concentration or indecisiveness
    6. Feels hopeless
  3. During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
  4. During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
  5. The patient has had no Manic, Hypomanic or Mixed Episodes.
  6. The patient has never fulfilled criteria for Cyclothymic Disorder.
  7. The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
  8. The symptoms are not directly caused by a general medical condition (eg uncontrolled diabetes) or the use of substances, including prescription medications.
  9. The symptoms cause clinically important distress or impair work, social or personal functioning.

Epidemiology

Treatment

As with other forms of depression, a number of treatments exist for dysthymia. Doctors most commonly use psychotherapy or cognitive therapy to help change the mind-set of the individual affected. Additionally doctors may prescribe a variety of antidepressant medications[1], with most individuals with dysthymia responding to Prozac and Tofranil in a positive manner. For mild or moderate depression, the American Psychiatric Association in its 2000 Treatment Guidelines for Patients with Major Depressive Disorder advises psychotherapy alone or in combination with an antidepressant as possibly appropriate.

Some limited evidence suggests that St John's Wort extract might also prove effective in treating mild to moderate forms of depression such as dysthymia. A 2002 study involving 375 patients with mild to moderate major depression found it effective with side-effects similar to placebo [2]. However, a 2006 study involving 150 patients with minor depressive symptoms or dysthymia found St. John's Wort extract ineffective for the patients with dysthymia. [3]

Classical use of the term

The term dysthymia originally referred to a sub-clinical psychotic condition, and the Greek roots of the term dysthymia (dys- (bad) and thymia) suggest the interpretation: "abnormal or disordered feelings". Classical dysthymia refers to "feeling" something as a reality which is not a reality (for example "feeling" that one knows what others think) - or to "understanding" an underlying social dynamic which is not real. This definition of dysthymia used to cover a broad band of disorders, many of which may very likely result in anti-social behaviors. In ancient times, it was believed that the thymus "gland" was the heart of all emotions, and if one were to be depressed, said person had a "dysfunctional thymus" or "Dysthymia". Dysthymia was not considered a specific disorder, but this name was given to any type of depression in general.

Dysthymia in history

Dysthymia dates back at least as far as ancient Greek and Roman civilization as recorded in the works of Sophocles and Virgil. Many societal occurrences of dysthymia occur within groups of individuals leading stressful lives. Clinical descriptions of dysthymia date from 1881, when Jean de Caseet-Maneut, a leading physician at that time, investigated the phenomemon in Paris. Records also appear sporadically in medical and psychological journals.

See also


References

  1. ^  Lima MS, Moncrieff J. "Drugs versus placebo for dysthymia". Cochrane Database Syst Rev. 2000;(4):CD001130. PMID 11034701
  2. ^  Lecrubier et al. "Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial." Am J Psychiatry. 2002 Aug;159(8):1361-6.
  3. ^  C. Randløv, J. Mehlsen, C.F. Thomsen, C. Hedman, H. von Fircks and K. Winther. "The efficacy of St. John's Wort in patients with minor depressive symptoms or dysthymia - a double-blind placebo-controlled study" Phytomedicine. 2006 March;13(4):215-221

Bibliography

  1. ^ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Further reading

  • Group, W. P. A. D. W. (1995). Dysthymia in clinical practice. British Journal of Psychiatry, 166(2), 174-183.
  • Klein, D. N., & Riso, L. P. (1991). The utility of the dysthymia construct. PsycCRITIQUES, 36(10), 851-852.
  • Kocsis, J. H., & Frances, A. J. (1987). A critical discussion of DSM-III dysthymic disorder. American Journal of Psychiatry, 144(12), 1534-1542.
  • Koponen, H., Lepola, U., & Leinonen, E. (1995). Dysthymia: A review. Nordic Journal of Psychiatry, 49(2), 129-132.


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