Dysthymic Disorder: A Review of Its Diagnosis and Treatment
Abstract
Dysthymic disorder is a chronic form of depression that affects an individual’s physical health, mood, and overall functioning. It is a mood disorder characterized by symptoms that last for at least two years and include depressed mood, low self-esteem, difficulty making decisions, and poor appetite or overeating. This review summarizes current knowledge of the epidemiology, diagnosis, and treatment of dysthymic disorder. Diagnostic criteria for this disorder are described, along with diagnostic tools used for assessing it. The current pharmacological and psychosocial treatments for dysthymic disorder are discussed, including the evidence for their efficacy. Finally, areas of research that may further our understanding of dysthymic disorder are highlighted.
Keywords: Dysthymic disorder, depression, diagnosis, treatment
Introduction
Dysthymic disorder, also known as dysthymia or chronic depression, is a long-term, low-grade form of depression that affects an individual’s physical health, mood, and overall functioning (American Psychiatric Association, 2013). It is a mood disorder characterized by symptoms that last for at least two years, including depressed mood, low self-esteem, difficulty making decisions, and poor appetite or overeating (American Psychiatric Association, 2013). Unlike major depression, dysthymic disorder is less severe and does not meet the criteria for a major depressive episode. However, it can still cause significant distress and impairment in functioning (American Psychiatric Association, 2013). This review summarizes current knowledge of the epidemiology, diagnosis, and treatment of dysthymic disorder.
Epidemiology
The prevalence of dysthymic disorder is estimated to be between 1.5 and 4.0% in the general population (American Psychiatric Association, 2013). It is more common in women than in men, and its prevalence increases with age (American Psychiatric Association, 2013). Dysthymic disorder is also more common in individuals with other mental health disorders, such as major depressive disorder, panic disorder, and substance use disorder (American Psychiatric Association, 2013).
Diagnosis
The diagnosis of dysthymic disorder is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013). To be diagnosed with dysthymic disorder, a person must meet the following criteria:
1. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least two years.
2. Presence, while depressed, of two (or more) of the following:
a. Poor appetite or overeating
b. Insomnia or hypersomnia
c. Low energy or fatigue
d. Low self-esteem
e. Poor concentration or difficulty making decisions
f. Feelings of hopelessness
3. No major depressive episode has been present during the first two years of the disturbance;
4. There has never been a manic or hypomanic episode;
5. The disturbance does not occur exclusively during the course of schizophrenia, schizoaffective disorder, or other psychotic disorder;
6. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Several tools are available to assist clinicians in diagnosing dysthymic disorder, including the Structured Clinical Interview for DSM-5 (SCID-5; American Psychiatric Association, 2013), the Hamilton Depression Rating Scale (HDRS; Hamilton, 1967), and the Beck Depression Inventory (BDI; Beck, 1967).
Treatment
The primary treatment for dysthymic disorder is pharmacological and/or psychosocial therapy. Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) are commonly used to treat dysthymic disorder (American Psychiatric Association, 2013). Additionally, psychotherapy, such as cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), has been found to be effective in treating dysthymic disorder (American Psychiatric Association, 2013).
Conclusion
Dysthymic disorder is a chronic form of depression that affects an individual’s physical health, mood, and overall functioning. This review has summarized current knowledge of the epidemiology, diagnosis, and treatment of dysthymic disorder. Diagnostic criteria for this disorder are described, along with diagnostic tools used for assessing it. The current pharmacological and psychosocial treatments for dysthymic disorder are discussed, including the evidence for their efficacy. Finally, areas of research that may further our understanding of dysthymic disorder are highlighted.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia, PA: University of Pennsylvania Press.
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.