Dysthymic Disorder

Aka: Dysthymic Disorder, Dysthymia

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II. Epidemiology

  1. Prevalence
    1. General population: 3%
    2. Primary care: 5 to 15%
    3. Mental health: 22 to 36%
  2. Twice as common in women

III. Comorbid conditions

  1. Major Depression (Double Depression)
  2. Personality Disorder (50%)
    1. Avoidant Personality Disorder
    2. Self-defeating Personality Disorder
    3. Dependent Personality disorder
    4. Borderline Personality Disorder
  3. Social Phobia (15%)
  4. Chronic Medical Conditions
    1. Cerebrovascular Accident
    2. Multiple Sclerosis
    3. Acquired Immunodeficiency Syndrome (AIDS)
    4. Premenstrual Dysphoric Disorder (PMS)
    5. Postcardiac Transplantation
    6. Hypothyroidism
    7. Fibromyalgia
    8. Chronic Fatigue Syndrome
  5. Psychosocial stressors (losses)
    1. Death of spouse
    2. Changes in income or housing
    3. Abandonment by adult children

IV. Diagnosis: DSM IV Criteria

  1. Depressed mood for most of day
    1. Children: One year duration
    2. Adult: Two year duration
  2. Symptoms associated with depression (2 or more)
    1. Poor appetite or Overeating
    2. Insomnia or Hypersomnia
    3. Low energy or Fatigue
    4. Low self esteem
    5. Poor concentration or difficulty making decisions
    6. Feelings of hopelessness
  3. No symptom-free period >2 months (in 2 year period)
  4. No Major Depression during 2 year period
  5. No prior history of mania or Hypomania
  6. Symptoms not exclusively tied to chronic Psychosis
  7. No secondary cause for symptoms
    1. No concurrent Substance Abuse
    2. No general medical condition responsible for symptoms
  8. Symptoms result in impaired functioning or distress

V. Management

  1. Psychotherapy
  2. Selective Serotonin Reuptake Inhibitor (SSRI)

VI. References

  1. APA (1994) DSM IV, APA, p. 345-9
  2. Sansone (1996) Postgrad Med 99(6): 233-49 [PubMed]
  3. Sansone (1996) Am Fam Physician 53(8):2588-94 [PubMed]

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