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Dysthymia

Dysthymia or dysthymic disorder is a form of the mood disorder of depression characterised 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 also lasts much longer than an episode of major depression. Outsiders often perceive dysthymic individuals as 'dour' and humourless. more...

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Often a stressful or overwhelming situation, like having a first baby (see postpartum depression), will throw a dysthymic individual into a major depression. When a major depressive episode occurs on top of dysthymia, clinicians may refer to the resultant condition as double depression.

Approximately 6% of the population of the United States has dysthymia.

Classical use of the term

The term dysthymia originally referred to a sub-clinical psychotic condition. The Greek roots of the term dysthymia 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 "understanding" an underlying social dynamic which is not real. This thinking pattern would lead sufferers to see themselves as "prophets" or as "highly intuitive healers". Such people may imagine that they can "feel" underlying hostilities which do not exist.

These people often endure social estrangement because they continually inject disordered judgments, which result from their abnormal "feelings". These disordered feelings and the way that dysthymics may express them within social settings are usually considered intensely strange.

This definition of dysthymia used to cover a broad band of disorders, which may very likely result in anti-social behaviors.

Treatment

Some people with dysthymia respond to treatment with antidepressant medications. For mild or moderate depression, the American Psychiatric Association in its 2000 Treatment Guidelines for Patients with Major Depressive Disorder advises that psychotherapy alone or in combination with an antidepressant may be appropriate. A 2002 study involving 375 patients found a St John's wort extract effective for treating mild to moderate depression.

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Drug treatments for patients with dysthymia
From American Family Physician, 10/1/04 by Clarissa Kripke

Clinical Question

Which drug treatments for dysthymia are most effective?

Evidence-Based Answer

All antidepressants studied have similar efficacy in the treatment of patients with dys-thymia. Side effect profiles vary. The largest comparisons support the use of tricyclic anti-depressants and selective serotonin reuptake inhibitors (SSRIs).

Practice Pointers

Patients with dysthymia have less severe but more chronic symptoms than patients with depression. De Lima and colleagues published two systematic reviews (1,2) on the treatment of dysthymia. The first review, by De Lima and Moncrieff, (1) found that anti-depressants are highly effective in treating dysthymia compared with placebo. Approximately four patients must be treated to achieve one response. However, it is not clear which antidepressant produces the best results.

To determine the most effective antidepressant, De Lima and Hotopf (2) searched for randomized and quasi-randomized controlled trials comparing at least two active drug treatments. Patients in these studies had dysthymia for at least two years and were studied for four to 12 weeks in psychiatric, primary care, and community settings.

Tricyclic antidepressants, SSRIs and mono-amine oxidase inhibitors had similar efficacy. Imipramine was the most commonly studied tricyclic antidepressant, and fluoxetine was the most commonly studied SSRI. Only one study compared SSRIs with tricyclic anti-depressants. Both drug classes had a similar effect on mood, but the SSRIs had a lower dropout rate. Therefore, medication choice should be based on the side effect profile. No data are available on optimal dosage or length of treatment.

REFERENCES

(1.) De Lima MS, Moncrieff J. Drugs versus placebo for dysthymia. Cochrane Database Syst Rev 2000;4:CD001130.

(2.) De Lima MS, Hotopf M. A comparison of active drugs for the treatment of dysthymia. Cochrane Database Syst Rev 2003;3:CD00404.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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