dysthymia; persistent depressive disorder

Epidemiology

2% of elderly

Clinical manifestations

• mood disorder characterized by depressed mood (mild symptoms of depression*), loss of interest or pleasure in customary activities, with some additional signs & symptoms of depression (including weight loss)
• symptoms present most of the time for at least 2 years

* patient may manage activities of daily living independently despite depression

Diagnostic criteria

DSM IV

• depressed mood most of the time for at least 2 years
• presence , while depressed of 2 or more of the following:
  • poor appetite or overeating
  • sleep disorder: insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem
  • poor concentration of difficulty making decisions
  • feelings of hopelessness
• during a 2 year period, never without symptoms for more than 2 months
• symptoms not due to physiological effects of substance or medical condition
• symptoms cause disruption in important areas of function

Complications

• many patients with dysthymia go on to develop major depressive episodes.
• increased risk of suicide Diffferential diagnosis:
• dysthymia vs depression

Management

• similar to that of major depression
• selective serotonin reuptake inhibitor plus psychotherapy
  • both are effective, but the combination is more effective than either alone

More general terms

• mood disorder
• sign/symptom

Additional terms

• depression
• major depression