1: J Affect Disord. 2001 Jan;62(1-2):17-31.
Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin.
Akiskal HS.
VA Psychiatry Service (116A), 3350 La Jolla Village Drive, San Diego, CA 92161,
USA. hakiskal@ucsd.edu
Kraepelin had a modern vision of affective illness. He hypothesized that
affective recurrences arose from enduring dispositions of depressive,
cyclothymic, irritable, or 'manic' types. These dispositions appeared as
'temperaments' in English translations of his work. In the extreme, such
temperamental gloominess or moodiness is today officially diagnosed as
'dysthymic' or 'cyclothymic'; irritable and hyperthymic (or manic) dispositions
have not received official sanction in the contemporary psychiatric
nomenclature. This paper reviews recent research which supports Kraepelin's
theoretical framework regarding dysthymic and cyclothymic dispositions both as
clinically relevant extreme forms of temperament and as precursors of major
affective episodes. Compelling lines of evidence along epidemiologic,
clinical-descriptive, familial-genetic, therapeutic, and follow-up perspectives
are summarized for each disposition. Much of what in contemporary psychiatry is
considered to be in the realm of subthreshold affective conditions, overlaps
considerably with Kraepelin's concepts of the trait affective dispositions
described herein. Most importantly, although Kraepelin's observations were based
primarily on hospitalized, severely ill affective patients, his broad vision
still guides us today for understanding etiology and instituting public health
and preventive measures in major affective episodes.
Publication Types:
Review
Review, Tutorial
PMID: 11172870 [PubMed - indexed for MEDLINE]
2: Acta Psychiatr Scand Suppl. 1994;383:19-23.
Dysthymia: clinical and external validity.
Akiskal HS.
Department of Psychiatry, University of California at San Diego.
This paper reviews current evidence in support of dysthymia as a sub-affective
disorder that precedes major affective episodes, often by more than a decade. In
cases beginning in childhood or adolescence, dysthymia is associated with high
familial rates of mood disorders, and a recurrent pattern of superimposed major
depression. At least two trait-like markers, sleep electro-encephalographic and
thyroid axis abnormalities-similar to those in major affective disorder-have
been reported. These data indicate a common pathophysiological substrate for
both dysthymia and major depressive illness. All classes of antidepressants-most
recently the serotonin re-uptake and the reversible MAO inhibitors-have been
shown to be effective. Dysthymia was fairly recently included in the US(DSM) and
WHO(ICD) classifications of mental disorders, because it characterises a
prevalent clinical presentation of depression in both psychiatric and general
medical settings. Patients given this diagnosis, instead of presenting with
acute or full-blown episodes, often complain of low-grade chronic affective
malaise for as long as they remember, yet without clinically observable signs of
depression. As a result, questions have been raised about its validity, but from
fundamentally opposite positions: (i) Is dysthymia better conceptualised as a
personality (or neurotic) rather than mood disorder? (ii) Can dysthymia be
distinguished from major depressive illness? This paper examines these and
related questions along both clinical and external validating strategies, and in
particular, the more recent accumulated evidence in support of the utility of
the concept of dysthymia.
Publication Types:
Review
Review, Tutorial
PMID: 7942064 [PubMed - indexed for MEDLINE]
3: J Nutr. 2002 Apr;132(4):719-25.
Family food insufficiency, but not low family income, is positively associated
with dysthymia and suicide symptoms in adolescents.
Alaimo K, Olson CM, Frongillo EA.
Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
kalaimo@umich.edu
Food insufficiency has been shown to be associated with poor health, academic
and psychosocial outcomes in American children, but the relationship between
food insufficiency and depressive disorders in U.S. adolescents has not been
studied. Further, there are no national estimates of the prevalence of
depressive disorders for U.S. adolescents, nor investigation of associations
with sociodemographic characteristics using national data. Therefore, we
analyzed data for 15- and 16-y-old adolescents from the Third National Health
and Nutrition Examination Survey (NHANES III). Depressive disorders and suicidal
symptoms were assessed using the Diagnostic Interview Schedule. Adolescents were
classified as "food insufficient" if a family respondent reported that the
family sometimes or often did not have enough to eat. The prevalence of
depression outcomes is reported by sociodemographic characteristics. Odds ratios
for associations with food insufficiency are reported, adjusted for
sociodemographic factors. Overall, lifetime prevalence of major depressive
disorder was 6.3% and of dysthymia, 5.4%. Almost 5% of 15- to 16-y-old
adolescents reported that they had ever attempted suicide and 38.8% reported at
least one suicidal symptom. Female adolescents were significantly more likely
than males to have had dysthymia, any depressive disorder and all symptoms of
suicide. Low income adolescents were less likely to report suicide ideation than
high income adolescents, but there were no other differences by family income.
Food-insufficient adolescents were significantly more likely to have had
dysthymia, thoughts of death, a desire to die and have attempted suicide. There
is a strong association between food insufficiency and depressive disorder and
suicidal symptoms in U.S. adolescents.
PMID: 11925467 [PubMed - indexed for MEDLINE]
4: J Affect Disord. 1996 Apr 26;38(1):13-22.
The subaffective-character spectrum subtyping distinction in primary early-onset
dysthymia: a clinical and family study.
Anderson RL, Klein DN, Riso LP, Ouimette PC, Lizardi H, Schwartz JE.
Department of Psychology, State University of New York at Stony Brook
11794-2500, USA.
In 1983, Akiskal proposed that primary early-onset dysthymia should be divided
into two subtypes: subaffective dysthymia, which is a subsyndromal form of major
mood disorder; and character spectrum disorder, which is a form of personality
disorder with secondary dysphoria. The present study attempted to validate this
distinction. Akiskal's (1983) criteria were applied to a sample of 97
early-onset dysthymic outpatients, yielding groups of 41 subaffective and 56
character spectrum patients. Patients were evaluated using structured interviews
for Axis I and II disorders, family history of psychopathology, and the early
home environment, and a comprehensive battery of questionnaires. In addition,
direct and family history interviews were conducted with their first-degree
relatives. There was mixed support for Akiskal's typology. Consistent with the
model, subaffectives exhibited higher rates of major depression, depressive
symptoms, and a number of depressive personality and cognitive features. In
addition, there was a higher rate of alcoholism among the relatives of character
spectrum patients. However, contrary to Akiskal's model, the groups did not
differ on gender, unstable personality disorders, family history of mood
disorders, or the early home environment.
PMID: 8735155 [PubMed - indexed for MEDLINE]
5: Eur Arch Psychiatry Clin Neurosci. 1991;240(6):349-54.
The Zurich Study. XI. Is dysthymia a separate form of depression? Results of the
Zurich Cohort Study.
Angst J, Wicki W.
Psychiatric University Hospital, Research Department, Zurich, Switzerland.
Dysthymia was assessed in the prospective Zurich Cohort Study of young adults.
The 1-year prevalence rate was around 3% if no exclusion criteria were applied.
Pure dysthymics without major or recurrent brief depression accounted for about
1%. Most cases of dysthymia met the symptom criteria for major depressive
disorder (MDD) and were characterized by a more continuous course. However,
evidence presented in this paper suggests that a diagnosis separate from MDD is
not warranted. The family history of dysthymic subjects did not differ from
major depressives. The smaller group of primary dysthymics, on the other hand,
did not differ from controls as regards family history for treated depression.
The low prevalence rates, taken together with methodological problems involved
in assessing dysthymia and the lack of a distinct course, suggest that dysthymia
does not constitute a valid subtype of depression in an age group of 20-30 years
of the community. Dysthymia belongs to the wide spectrum of major depressive
syndromes and represents only a subgroup characterized by specific course
characteristics.
PMID: 1831666 [PubMed - indexed for MEDLINE]
6: Aten Primaria. 2001 May 31;27(9):623-8.
[Prevalence and characteristics of major depression and dysthymia in primary
care]
[Article in Spanish]
Aragones Benaiges E, Gutierrez Perez M, Pino Fortuny M, Lucena Luque C, Cervera
Virgili J, Garreta Estrada I.
Centre d'Atencio Primaria de Constanti. Institut Catala de la Salut. Tarragona.
earagones@ptarragona.scs.es
OBJECTIVE: To find the prevalence and characteristics of depressive disorders in
patients consulting in primary care.Design. Cross-sectional descriptive study.
Two stages: screening, then structured psychiatric interview.Setting. Eight
clinics at four primary care centres. PATIENTS AND METHODS: A sample of 350
consecutive patients aged between 18 and 70 filled out Zung's Self-Rating
Depression Scale (SDS). The diagnoses of major depressive episode and dysthymia
for the 138 with positive result and the 67 with negative result were
investigated through the Structured Clinical Interview for DSM-IV Axis I
Disorders.Measurements and main results. We found a weighted prevalence of 14.7%
(95% CI: 10.7-18.7) for major depression and 4.6% (95% CI: 2.4-6.8) for
dysthymia. Mean score on the SDS was 65.6 (SD 11.6) in the group with major
depression and 63.3 (SD 8.7) in the group with dysthymia. Mean score in the
not-depressed group was 44.2 (SD 8.7), lower than the scores for both groups
with depression (p < 0.0001). Being female distinguished the depressed groups
from the not-depressed group. Lower educational level and the amount of
over-users distinguished the group with major depression from the not-depressed
group. The symptom profiles were virtually identical for the two depressed
groups, whereas the frequency of occurrence of most of the symptoms explored
differed significantly between those with and without depression. CONCLUSIONS:
Prevalence of major depression and dysthymia are high in primary care patients
in our area. Both disorders have common characteristics of demographic variables
and symptom profile.
PMID: 11412553 [PubMed - indexed for MEDLINE]
7: Acta Med Port. 1998 Dec;11(12):1095-9.
[The concept of dysthymia. Its clinical usefulness and nosological status]
[Article in Portuguese]
Arriaga F, Cavaglia F, Lara E.
Departamento de Psiquiatria, Faculdade de Medicina de Lisboa, Hospital de Santa
Maria.
Dysthymia is currently conceived as an independent diagnostic category in the
area of mood disorders, but the concept is controversial, both from a
theoretical and clinical point of view. This article reviews the concept of
dysthymia as well as its history. The clinical usefulness and validity are
examined, taking into special consideration the influential classificatory
notions of DSM-IV.
Publication Types:
Review
Review, Tutorial
PMID: 10192984 [PubMed - indexed for MEDLINE]
8: Wien Med Wochenschr. 1999;149(18):503-10.
[Dysthymia: a chronic illness and its treatment]
[Article in German]
Aschauer HN.
Klinischen Abteilung fur Allgemeine Psychiatrie, Universitatsklinik fur
Psychiatrie, Wien. Harald.Aschauer@akh-wien.ac.at
Dysthymia is a chronic disease with a high psychosocial burden. Age of onset
frequently is in young adulthood. It is clinically characterized by very mild
but continuous chronic depressive symptoms. The quality of symptoms seems to be
similar to episodic depressive disorders, but the severity criteria for major
depression are not fulfilled. After more than 2 years of dysthymia a depressive
episode may occur (double depression). Neurobiological and genetic findings
indicate a relation of dysthymia to affective disorders. Antidepressants are
proven to be effective without a difference between various types of drugs.
Psychotherapy is also proven to be effective (e.g. behaviour therapy) and should
be prescribed in combination or alone, if a patient refused to take drugs.
Because of the preferable side-effect profile of newer antidepressant compounds,
they should be prescribed as first choice. A prophylactic treatment for 2 years
is recommended. The dose of antidepressants should be in the therapeutic range
for treatment of major depression.
Publication Types:
Review
Review, Tutorial
PMID: 10637954 [PubMed - indexed for MEDLINE]
9: J Affect Disord. 2002 May;69(1-3):193-9.
Prevalence and underrecognition of dysthymia among psychiatric outpatients in
Sao Paulo, Brazil.
Avrichir BS, Elkis H.
Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao
Paulo, Brazil.
BACKGROUND: Dysthymia is a highly prevalent disorder with rates varying from 3
to 6%. It is estimated that 7% of primary care and up to 36% of the psychiatric
outpatients have this disorder. Dysthymia is characterized by a pattern of low
intensity and long duration depression, leading to impairment in many aspects of
the patient's life (work, family). However, it is a condition which is not
frequently diagnosed, thereby remaining untreated and leading to chronification,
risk of developing depression and substance abuse. Despite the well-known fact
that dysthymia is underdiagnosed, there are no studies in Brazil regarding this
problem. This paper presents a study on the prevalence of dysthymia in an
outpatient psychiatric population in Sao Paulo, Brazil, identifying factors
associated with the underdiagnosis of dysthymia. METHODS: Two raters carried out
a study of 81 patients from a university outpatient clinic in Sao Paulo, using
the SCID-I/P. The kappa coefficient was used to measure the inter-rater
reliability for the dysthymia diagnosis. The SCID-I/P diagnosis was compared to
consulting psychiatrist's diagnosis. Factors associated with underdiagnosis were
identified. RESULTS AND CONCLUSIONS: 27% of the sample had SCID dysthymia. They
presented more comorbidities than non-dysthymics. Only 27% of these SCID
dysthymics were considered 'pure' dysthymics. Clinicians had identified only 37%
of these SCID diagnosed cases as dysthymic. The main reason for missing
diagnosis of dysthymia in this sample was axis I comorbidity. LIMITATION: As we
did not investigate the presence of personality disorder, the impact of axis II
on misdiagnosis of dysthymia could not be investigated in our sample.
PMID: 12103466 [PubMed - indexed for MEDLINE]
10: Depress Anxiety. 1999;10(2):41-9.
Diagnostic discriminability of dysthymia and depressive personality disorder.
Bagby RM, Ryder AG.
Department of Psychiatry, University of Toronto, Ontario, Canada.
bagbym@cs.clarke.inst.on.ca
The Depressive Personality Disorder (DPD) is currently being considered for
inclusion in future editions of DSM. However, there is little empirical research
on DPD as currently defined in DSM-IV, including whether this disorder is
sufficiently distinct from Dysthymic Disorder (Dysthymia). The goal of this
study was to explore the relationship between DPD and Dysthymia with a sample of
depressed outpatients. Scales were developed for the diagnostic criteria for
both DPD and Dysthymia. These scales were then analyzed using cluster and factor
analysis. Retroactive diagnostic assignment for these two disorders was also
made using these scales. It was hypothesized that if DPD is a viable diagnostic
category, then the DPD traits and Dysthymia symptoms would fall into different
clusters, produce separate factors, and the comorbidity would be small. Two
clusters and two factors, each with a close correspondence to DPD and Dysthymia,
were statistically extracted from combined symptom and trait scales. However,
95% of those cases identified as meeting diagnostic criteria for DPD also met
criteria for Dysthymia. Despite the ability to distinguish statistically DPD
traits from Dysthymia symptoms, there was a high degree of comorbidity,
compromising the clinical utility of DPD. The results do suggest, however, that
DPD might be best conceptualized as a subcategory of Dysthymia.
PMID: 10569125 [PubMed - indexed for MEDLINE]
11: J Fam Pract. 2001 May;50(5):405-12.
Comment in:
J Fam Pract. 2001 May;50(5):413.
Treatment of dysthymia and minor depression in primary care: a randomized trial
in patients aged 18 to 59 years.
Barrett JE, Williams JW Jr, Oxman TE, Frank E, Katon W, Sullivan M, Hegel MT,
Cornell JE, Sengupta AS.
Department of Community and Family Medicine, Dartmouth Medical School, Hanover,
NH 03755, USA. James.Barrett@Dartmouth.edu
OBJECTIVE: The researchers evaluated the effectiveness of paroxetine and
Problem-Solving Treatment for Primary Care (PST-PC) for patients with minor
depression or dysthymia. STUDY DESIGN: This was an 11-week randomized
placebo-controlled trial conducted in primary care practices in 2 communities
(Lebanon, NH, and Seattle, Wash). Paroxetine (n=80) or placebo (n=81) therapy
was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC
was provided (n=80). There were 6 scheduled visits for all treatment conditions.
POPULATION: A total of 241 primary care patients with minor depression (n=114)
or dysthymia (n=127) were included. Of these, 191 patients (79.3%) completed all
treatment visits. OUTCOMES: Depressive symptoms were measured using the 20-item
Hopkins Depression Scale (HSCL-D-20). Remission was scored on the Hamilton
Depression Rating Scale (HDRS) as less than or equal to 6 at 11 weeks.
Functional status was measured with the physical health component (PHC) and
mental health component (MHC) of the 36-item Medical Outcomes Study Short Form.
RESULTS: All treatment conditions showed a significant decline in depressive
symptoms over the 11-week period. There were no significant differences between
the interventions or by diagnosis. For dysthymia the remission rate for
paroxetine (80%) and PST-PC (57%) was significantly higher than for placebo
(44%, P=.008). The remission rate was high for minor depression (64%) and
similar for each treatment group. For the MHC there were significant outcome
differences related to baseline level for paroxetine compared with placebo. For
the PHC there were no significant differences between the treatment groups.
CONCLUSIONS: For dysthymia, paroxetine and PST-PC improved remission compared
with placebo plus nonspecific clinical management. Results varied for the other
outcomes measured. For minor depression, the 3 interventions were equally
effective; general clinical management (watchful waiting) is an appropriate
treatment option.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11350703 [PubMed - indexed for MEDLINE]
12: Psychiatry Res. 2001 Sep 20;103(2-3):219-28.
Clinical features of dysthymia and age: a clinical investigation.
Bellino S, Patria L, Ziero S, Rocca G, Bogetto F.
Depressive and Anxiety Disorders Unit, Department of Neuroscience, University of
Turin, via Cherasco 11, 10126, Turin, Italy. bellino.silvio@libero.it
A few authors have described the clinical picture of dysthymia in groups of
elderly patients and pointed out differences from literature reports of
dysthymia in younger adults. The present study, an attempt to analyze age
effects on clinical characteristics of dysthymia throughout a lifetime, was
performed in a sample of 106 patients, all aged > or =18 years, who were
diagnosed according to DSM-IV. The patients were evaluated using: (1) a
semistructured interview to assess clinical features, family history and
previous treatments; (2) the Hamilton Depression Rating Scale; (3) the Interview
for Recent Life Events; and (4) the Structured Clinical Interview for DSM-IV
Disorders. Statistical analysis with stepwise logistic regression revealed that
age was positively related to concomitant medical illnesses and to the total
score of recent life events, but negatively related to the presence of avoidant
or dependent personality disorders. The data suggested different etiologic
pathways in older and younger patients. Dysthymia appeared to be associated in
younger adults with abnormalities of personality; in the elderly, with a history
of health problems and life losses.
PMID: 11549409 [PubMed - indexed for MEDLINE]
13: Drugs Aging. 2000 Feb;16(2):107-21.
Recognition and treatment of dysthymia in elderly patients.
Bellino S, Bogetto F, Vaschetto P, Ziero S, Ravizza L.
Department of Neuroscience, Psychiatric Unit, University of Turin, Torino,
Italy. bogetto@molinette.unito.it
This review focuses on recent literature concerning dysthymia in the elderly
population. Epidemiological data and clinical picture, diagnostic and
therapeutic issues are evaluated and discussed. Although depressive syndromes
are common in older patients, prevalence rates of dysthymia in the elderly are
lower than in younger adults. This finding may be the consequence of the
diagnostic criteria provided by the Diagnostic and Statistical Manual of Mental
Disorders (DSM) which are not specific for older adults. Other factors that
complicate making diagnoses of dysthymia in older individuals are comorbid
general conditions, cognitive deterioration and disorders, and frequent adverse
life events (e.g. bereavement). The effects of these factors should be better
defined to clarify whether elderly dysthymia is underestimated and if modified
diagnostic criteria should be provided. A few researchers have identified a
series of clinical features that are clearly different in the elderly and in
young adult patients with dysthymia. These features are particularly related to
the late onset and to the peculiar comorbidity of this disorder and suggest that
dysthymia is a different disorder in the elderly. Drug treatment of depressive
conditions in the elderly is currently based on new antidepressants [selective
serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, norepinephrine
(noradrenaline) reuptake inhibitors, benzamides]. These agents have an improved
adverse effect profile compared with some of the older agents. Moreover, very
few systematic studies have been performed using these drugs in samples of older
patients with dysthymia and available data do not allow conclusions on drug
choice and dosage. Besides, no specific data are available concerning the
psychotherapy of dysthymia in this age group. All these topics need to be
further investigated in studies comparing the elderly with control groups of
younger patients with dysthymia.
Publication Types:
Review
Review, Tutorial
PMID: 10755327 [PubMed - indexed for MEDLINE]
14: Am J Psychiatry. 1993 Aug;150(8):1194-8.
An empirical study of defense mechanisms in dysthymia.
Bloch AL, Shear MK, Markowitz JC, Leon AC, Perry JC.
Payne Whitney Clinic, New York, NY.
OBJECTIVE: The psychodynamic approach to understanding dysthymia has rarely been
empirically tested. In this pilot study the Defense Mechanism Rating Scales were
used to examine psychodynamic data from patients with dysthymia and patients
with panic disorder in order to test the hypotheses that 1) dysthymic patients
would be similar to panic patients in endorsing primarily lower-maturity defense
mechanisms, 2) dysthymic patients would use a distinct pattern of defense
mechanisms, different from that of panic patients, and 3) dysthymic patients
would endorse more frequently than panic patients four individual defenses that
tend to handle anger and low self-esteem poorly: devaluation, passive
aggression, projection, and hypochondriasis. METHOD: Twenty-two subjects meeting
the DSM-III-R criteria for primary early-onset dysthymia and 22 subjects meeting
the DSM-III-R criteria for primary panic disorder were interviewed on videotape
and rated on the Defense Mechanism Rating Scales. RESULTS: The dysthymic
subjects scored significantly higher on narcissistic, disavowal, and action
defense levels and on the four individual defenses of devaluation, projection,
passive aggression, and hypochondriasis, as predicted, as well as on two
additional defenses, acting out and projective identification. Both groups
tended to use lower-maturity defense mechanisms. CONCLUSIONS: The defense
mechanism profile identified for dysthymia differs from that for panic disorder
and supports particular psychodynamic hypotheses about chronic depression. It
could be useful in devising treatment strategies and as a measure of treatment
efficacy.
PMID: 8328563 [PubMed - indexed for MEDLINE]
15: Biol Psychiatry. 1999 Jun 15;45(12):1533-41.
Comment in:
Biol Psychiatry. 1999 Jun 15;45(12):1531-2.
Dehydroepiandrosterone treatment of midlife dysthymia.
Bloch M, Schmidt PJ, Danaceau MA, Adams LF, Rubinow DR.
Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda,
MD 20892-1276, USA.
BACKGROUND: This study evaluated the efficacy of the adrenal androgen,
dehydroepiandrosterone, in the treatment of midlife-onset dysthymia. METHODS: A
double-blind, randomized crossover treatment study was performed as follows: 3
weeks on 90 mg dehydroepiandrosterone, 3 weeks on 450 mg dehydroepiandrosterone,
and 6 weeks on placebo. Outcome measures consisted of the following.
Cross-sectional self-ratings included the Beck Depression Inventory, and visual
analogue symptom scales. Cross-sectional objective ratings included the Hamilton
Depression Rating Scale, the Cornell Dysthymia Scale and a cognitive test
battery. Seventeen men and women aged 45 to 63 years with midlife-onset
dysthymia participated in this study. Response to dehydroepiandrosterone or
placebo was defined as a 50% reduction from baseline in either the Hamilton
Depression Rating Scale or the Beck Depression Inventory. RESULTS: In 15
patients who completed the study, a robust effect of dehydroepiandrosterone on
mood was observed compared with placebo. Sixty percent of the patients responded
to dehydroepiandrosterone at the end of the 6-week treatment period compared
with 20% on placebo. A significant response was seen after 3 weeks of treatment
on 90 mg per day. The symptoms that improved most significantly were anhedonia,
loss of energy, lack of motivation, emotional "numbness," sadness, inability to
cope, and worry. Dehydroepiandrosterone showed no specific effects on cognitive
function or sleep disturbance, although a type II error could not be ruled out.
CONCLUSIONS: This pilot study suggests that dehydroepiandrosterone is an
effective treatment for midlife-onset dysthymia.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10376113 [PubMed - indexed for MEDLINE]
16: Versicherungsmedizin. 1998 Dec 1;50(6):215-8.
[Dysthymia and cyclothymia--serious consequences of rarely diagnosed disorders]
[Article in German]
Brieger P, Marneros A.
Klinik und Poliklinik fur Psychiatrie und Psychotherapie,
Martin-Luther-Universitat Halle-Wittenberg, Halle, Saale.
Dysthymia and cyclothymia are chronic affective disorders with a minimum
duration of 2 years. Both ICD-10 and DSM-IV define cyclothymia as a bipolar
disorder with low intensity. This disorder is rare and little research has been
done on it. Its economic and social consequences vary from case to case. In
contrast dysthymias, chronic depressive disorders, are frequent (prevalence
3-6%) and cause considerable distress. They have serious economic and social
consequences, which are comparable to those caused by other chronic conditions
such as arthritis or diabetes mellitus. Despite widely held conviction a
majority of dysthymias improves under consequent pharmaco- and psychotherapy.
Publication Types:
Review
Review, Tutorial
PMID: 9889692 [PubMed - indexed for MEDLINE]
17: J Affect Disord. 1997 Sep;45(3):117-26.
Dysthymia and cyclothymia: historical origins and contemporary development.
Brieger P, Marneros A.
Psychiatric Hospital, Martin Luther University, Halle-Wittenberg, Germany.
peter.brieger@medizin.uni-halle.de
The aim of this article is to review and put in their historical context today's
data, methodologies and concepts concerning subaffective disorders. The historic
roots of dysthymic and cyclothymic disorders--part of the subaffective
spectrum--are essentially Greek, but the first use of the word 'dysthymia' in
psychiatry was by C.F. Flemming in 1844. E. Hecker introduced the term
'cyclothymia' in 1877. K.L. Kahlbaum (1882) further developed the concepts of
hyperthymia, cyclothymia and dysthymia--with possible subthreshold
symptomatology--in 1882. After Kraepelin's rubric of 'manic-depressive
insanity', the term 'dysthymia' was widely forgotten, and 'cyclothymia' became
ill defined. Nowadays the latter term is used in three, partially contradictory,
senses: (1) a synonym for bipolar disorder (K. Schneider), (2) a temperament (E.
Kretschmer) and (3) a subaffective disorder (DSM-IV, ICD-10). A renaissance of
subaffective disorders began with the development of DSM-III. Therapeutically
important research has focused on dysthymic disorder and its relationship to
major depressive disorder, while cyclothymic disorder is relatively neglected;
nonetheless, operationalized as a subaffective dimension or temperament,
cyclothymia appears to be a likely precursor or ingredient of the construct of
bipolar II disorder.
Publication Types:
Historical Article
PMID: 9298424 [PubMed - indexed for MEDLINE]
18: Fortschr Neurol Psychiatr. 1995 Oct;63(10):411-20.
[The dysthymia concept: current and historical aspects--an overview]
[Article in German]
Brieger P, Marneros A.
Klinik und Poliklinik fur Psychiatrie der Martin-Luther-Universitat
Halle-Wittenberg.
The article reviews the historical development of the understanding of dysthymia
from C. F. Flemming (1844) to DSM-IV and to Akiskal's concepts. Recent results
on epidemiology, comorbidity, neurobiology, familial patterns, clinical course,
psychological characteristics, psycho- and pharmacotherapy of dysthymia are
discussed. Although present concepts of dysthymia have led to results of high
scientific and clinical relevance, the classification of chronic depression and
their relation to both personality disorders and affective psychoses need
further clarification. The development of dysthymia reflects the differences
between Anglo-American operational psychiatric systems and the rich tradition of
psychopathology in German-speaking psychiatry.
Publication Types:
Review
Review, Tutorial
PMID: 8529990 [PubMed - indexed for MEDLINE]
19: J Affect Disord. 1999 Jan-Mar;52(1-3):275-90.
Dysthymia: clinical picture, extent of overlap with chronic fatigue syndrome,
neuropharmacological considerations, and new therapeutic vistas.
Brunello N, Akiskal H, Boyer P, Gessa GL, Howland RH, Langer SZ, Mendlewicz J,
Paes de Souza M, Placidi GF, Racagni G, Wessely S.
Center of Neuropharmacology, Institute of Pharmacological Sciences, University
of Milan, Italy. brunello@isfunix.farma.unimi.it
Dysthymia, as defined in the American Psychiatric Association and International
Classification of Mental Disorders, refers to a prevalent form of subthreshold
depressive pathology with gloominess, anhedonia, low drive and energy, low
self-esteem and pessimistic outlook. Although comorbidity with panic, social
phobic, and alcohol use disorders has been described, the most significant
association is with major depressive episodes. Family history is loaded with
affective, including bipolar, disorders. The latter finding explains why
dysthymia, especially when onset is in childhood, can lead to hypomanic
switches, both spontaneously and upon pharmacologic challenge in as many as 30%.
Indeed, antidepressants from different classes -tricyclic antidepressants
(TCAs), monoamine oxidase inhibitors (MAOIs), reversible inhibitors of monoamine
oxidase A (RIMAs), selective serotonin-reuptake inhibitors (SSRIs) and, more
recently, amisulpride, and spanning noradrenergic, serotonergic as well as
dopaminergic mechanisms of action - have been shown to be effective against
dysthymia in an average of 65% of cases. This is a promising development because
social and characterologic disturbances so pervasive in dysthymia often, though
not always, recede with continued pharmacotherapy beyond acute treatment.
Despite symptomatic overlap of dysthymia with chronic fatigue syndrome -
especially with respect to the cluster of symptoms consisting of low drive,
lethargy, lassitude and poor concentration - neither the psychopathologic
status, nor the pharmacologic response profile of the latter syndrome is
presently understood. Chronic fatigue today is where dysthymia was two decades
ago. We inverted question mark submit that the basic science - clinical paradigm
that has proven so successful in dysthymia could, before too long, crack down
the conundrum of chronic fatigue as well. At a more practical level, we raise
the possibility that a subgroup within the chronic fatigue group represents a
variant of dysthymia.
Publication Types:
Review
Review, Tutorial
PMID: 10357046 [PubMed - indexed for MEDLINE]
20: Eur Neuropsychopharmacol. 1995;5 Suppl:103-7.
Lifetime prevalence of major depression and dysthymia: results of a community
survey in Sardinia.
Carta MG, Carpiniello B, Kovess V, Porcedda R, Zedda A, Rudas N.
Institute of Clinical Psychiatry, Cagliari University, Italy.
Epidemiological data about depressive disorders emerging from European and North
American community surveys are not easily comparable due to several
methodological differences. Only in recent years have studies performed with the
Composite International Diagnostic Interview (CIDI) supplied comparable data.
They support the evidence of higher prevalence rates of major depression
(DSM-IIIR criteria) in European than in US and Canadian community studies
carried out in the 1980s. Moreover, a new nationwide USA survey, using CIDI,
confirmed a higher frequency of depressive disorders compared to ECA results.
This report is part of a survey ('Health in Sardinia') which involved five urban
districts of Cagliari, three rural areas and the same mining district involved
in a previous community study. The present data concern four of the five urban
districts and one rural area. Subjects were clinically interviewed with the CIDI
Simplified, in the Italian version. Diagnoses were made according to DSM-IIIR
criteria. Our study seems to confirm the general trend toward higher prevalence
rates of major depression (lifetime prevalence 13.3) shown in earlier community
studies.
PMID: 8775768 [PubMed - indexed for MEDLINE]
21: Am J Psychiatry. 1994 Feb;151(2):205-9.
Symptom differences in major depression, dysthymia, panic disorder, and
generalized anxiety disorder.
Clark DA, Beck AT, Beck JS.
Department of Psychology, University of New Brunswick, Fredericton, Canada.
OBJECTIVE: The authors compared symptom features of specific subtypes of
depressive and anxiety disorders. METHODS: Psychiatric outpatients with moderate
levels of psychopathology and DSM-III diagnoses of major depression, dysthymia,
panic disorder, or generalized anxiety disorder were given five standard
measures of symptoms of anxiety and depressive disorders. Most of the
outpatients were white, and most were middle-class. RESULTS: Principal
components analysis revealed 12 orthogonal symptom components. Discriminant
function analysis indicated that anxiety was distinguished by specific autonomic
arousal symptoms, threat-related cognitions, and subjective anxiety and tension.
Discriminant function analysis also indicated that depression was distinguished
by anhedonia, cognitions of personal loss and failure, and dysphoric mood.
CONCLUSIONS: As nosological categories, major depression and panic disorder were
better differentiated by specific symptom markers than dysthymia and generalized
anxiety disorder.
PMID: 8296890 [PubMed - indexed for MEDLINE]
22: Drug Saf. 2003;26(1):55-64.
Benefits and risks of pharmacotherapy for dysthymia: a systematic appraisal of
the evidence.
De Lima MS, Hotopf M.
Universidade Federal de Pelotas, Rio Grande do Sul, Brazil. mslima@terra.com.br
BACKGROUND: Dysthymia is a prevalent form of subthreshold depressive disorder,
associated with considerable disability and high co-morbidity. This paper
systematically appraises the evidence for the efficacy and acceptability of the
pharmacological treatment for this condition. METHODS: Randomised, controlled
trials evaluating the efficacy of drug therapies for dysthymia were included. A
comprehensive search of the literature was performed, aiming to avoid
publication bias. Pooled relative risks (RR) and 95% CIs were calculated with
the Random Effect Model method. The number needed to treat (NNT) and number
needed to harm (NNH) were estimated for statistically significant results.
RESULTS: Twenty-five trials were included for the main comparisons. Regarding
placebo-controlled trials (n = 16), similar results were obtained in terms of
efficacy for different groups of drugs, such as tricyclic antidepressants
(TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase
inhibitors (MAOIs) and other drugs (sulpiride, amineptine, and ritanserin). The
pooled RR for treatment response was 0.68 (95% CI 0.57-0.81) for TCA and the NNT
was 4.3 (95% CI 3.2-6.5); 0.68 (95% CI 0.56-0.82) for SSRIs (NNT 5.1; 95% CI
3.9-7.7); 0.59 (95% CI 0.48-0.71) for MAOIs (NNT 2.9; 95% CI 2.2-4.3). Other
drugs (amisulpride, amineptine and ritanserin) showed similar results. The
equivalent efficacy between antidepressants as found in trials where active
medications were compared confirmed the efficacy findings from placebo trials.
In general, patients treated with a TCA were more likely to report adverse
events, compared with placebo and SSRIs. CONCLUSIONS: Pharmacotherapy for
dysthymia appears to be an effective short-term treatment for dysthymic
disorder. Newer antidepressants are equally effective and have better
acceptability than TCAs, although their higher cost must be balanced against
this assumed advantage.
Publication Types:
Review
Review, Tutorial
PMID: 12495364 [PubMed - indexed for MEDLINE]
23: Psychol Med. 1999 Nov;29(6):1273-89.
The efficacy of drug treatments for dysthymia: a systematic review and
meta-analysis.
de Lima MS, Hotoph M, Wessely S.
Departamento de Saude Mental, Faculdade de Medicina, Universidade Federal de
Pelotas, RS, Brazil.
BACKGROUND: Dysthymia is a common mental disorder, associated with considerable
disability and high co-morbidity. This review assessed the role of
pharmacological treatment. METHODS: All randomized-controlled trials that
compared active drug versus placebo for dysthymic patients were included. Pooled
relative risks (RR) and 95% confidence intervals (CI) were calculated with the
Random Effect Model method. Where possible, number needed to treat and number
needed to harm were estimated. RESULTS: Fifteen trials were included for the
main comparisons. Similar results were obtained in terms of efficacy for
different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake
inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs
(sulpiride, amineptine, and ritanserin). The pooled RR treatment response was
0.68 (95% CI 0.59-0.78) for TCA, 0.64 (95% CI 0.55-0.74) for SSRIs, 0.59 (95% CI
0.48-0.71) for MAOIs. Other drugs (amisulpride, amineptine and ritanserin)
showed similar results. Patients treated on TCA were more likely to report
adverse events, compared with placebo. There were no differences in response to
active treatment when dysthymia was compared to either dysthymia plus major
depression or briefer non-major depressive states. CONCLUSIONS: Drug treatment
appears to be effective in the short-term management of dysthymic disorder. The
choice of drug should take into account specific side-effects profile of each
drug.
Publication Types:
Meta-Analysis
PMID: 10616934 [PubMed - indexed for MEDLINE]
24: Am J Psychiatry. 1994 Nov;151(11):1592-9.
Is dysthymia a different disorder in the elderly?
Devanand DP, Nobler MS, Singer T, Kiersky JE, Turret N, Roose SP, Sackeim HA.
Late Life Depression Clinic, New York State Psychiatric Institute, College of
Physicians and Surgeons of Columbia University, New York 10032.
OBJECTIVE: This study evaluated elderly dysthymic patients in a late life
depression clinic and compared their clinical features to previous findings in
young adult dysthymic patients. METHOD: Of 224 consecutive elderly outpatients,
40 (17.9%) met criteria for dysthymic disorder. A semistructured interview was
used to obtain history, the Structured Clinical Interview for DSM-III-R--Patient
Version and the Structured Clinical Interview for DSM-III-R Personality
Disorders were used to make DSM-III-R diagnoses, and standard rating instruments
for depression were administered. RESULTS: The gender distribution was equal and
major stressors were common. The mean age at onset of dysthymia was 55.2 years
(SD = 15.4), with an average illness duration of 12.5 years (SD = 14.2). Early
onset (before 21 years of age) and secondary dysthymia were rare. A history of
major depression earlier during the course of dysthymic illness, comorbid
anxiety disorders, and personality disorders were relatively uncommon.
Cross-sectionally, cognitive and functional symptoms were more prominent than
vegetative symptoms. CONCLUSIONS: Dysthymia is not uncommon among depressed
elderly outpatients who present for treatment. Elderly dysthymic patients differ
from young adult dysthymic patients, who are mostly female with an early onset
and who frequently have comorbid axis I and axis II disorders. Most elderly
dysthymic patients do not appear to be young dysthymic patients who simply grew
older, and the DSM-III-R subtyping of dysthymia into early/late onset and
primary/secondary may not apply to the elderly. Further clinical studies of
"pure" dysthymic disorder appear feasible in the elderly, and these are clearly
needed.
PMID: 7943446 [PubMed - indexed for MEDLINE]
25: Pflugers Arch. 1996;431(6 Suppl 2):R303-4.
Hypersomnia in association with dysthymia in comparison with idiopathic
hypersomnia and normal controls.
Dolenc L, Besset A, Billiard M.
Hopital Gui-de-Chauliac, Montpellier, France.
Polysomnographic studies in hypersomniac patients with mood disorders are rare.
Previous studies investigated patients with a severe mood disorder, but our
study was done in patients with dysthymia, who complained of sleepiness. Mean
sleep latency test (MSLT) and continuous polysomnographic recording (CPR) were
done in 12 dysthymic patients, in comparison with 12 idiopathic hypersomnia
patients, and 12 normal controls. In dysthymic patients mean sleep latency on
the MSLT (13 +/- 1) was normal, and when CPR was done during 24 hours, no
hypersomnia was found (553 +/- 24). Dysthymic patients showed an abnormal
macrostructure of sleep (characterised by an excess of sleep stage I and a
decrease of stages 3 and 4), which could be related to their complaint of
hypersomnia.
Publication Types:
Clinical Trial
PMID: 8739385 [PubMed - indexed for MEDLINE]
26: Am J Drug Alcohol Abuse. 1998 Nov;24(4):541-50.
Substance use and abuse among patients with comorbid dysthymia and substance
disorder.
Eames SL, Westermeyer J, Crosby RD.
Minneapolis VA Medical Center, Department of Psychiatry, University of
Minnesota, USA.
This study determines the substance use and abuse patterns among patients with
comorbid substance-related disorder (SRD) and dysthymia in SRD-dysthymia as
compared with patients with SRD only. Differences in use and abuse patterns
could be useful for (a) understanding motivations for use, such as
self-treatment, and (b) assisting clinicians to identify cases of dysthymia
among SRD patients. Retrospective and current data were obtained regarding
history of substance use and current SRD diagnoses. Two university medical
centers with alcohol-drug programs located within departments of psychiatry were
the settings. A total of 642 patients was assessed. of whom 39 had SRD-dysthymia
and 308 had SRD only. Data on past usc were collected by a research associate
using a questionnaire. Current SRD and dysthymia diagnoses were made by
psychiatrists specializing in addiction. The patients with SRD-dysthymia and SRD
only did not differ with regard to use of alcohol, tobacco, and benzodiazepines.
The patients with SRD-dysthymia started caffeine use at an earlier age, had
shorter "use careers" of cocaine, amphetamines, and opiates, and had fewer days
of cocaine and cannabis use in the last year. They also had a lower rate of
cannabis abuse/dependence. This study indicated that patients with dysthymia and
SRD have exposure to most substances of abuse that is comparable to patients
with SRD only. However, they selectively use certain substances less often than
patients with SRD only. Early use of caffeine may reflect self-treatment for
depressive symptoms among patients with SRD-dysthymia.
PMID: 9849767 [PubMed - indexed for MEDLINE]
27: Psychopharmacol Bull. 1997;33(1):101-3.
A preliminary study on the efficacy of sertraline and imipramine on anger
attacks in atypical depression and dysthymia.
Fava M, Nierenberg AA, Quitkin FM, Zisook S, Pearlstein T, Stone A, Rosenbaum
JF.
Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114,
USA.
There is clinical and biological evidence suggesting that patients with anger
attacks, sudden spells of anger accompanied by intense autonomic activation, may
represent a distinct psychopathological subgroup of patients with depressive
disorders. We compared the prevalence of anger attacks in 168 outpatients with
atypical depression or primary dysthymia with 38 normal subjects and tested the
effect of treatment on anger attacks in a double-blind, placebo-controlled trial
of sertraline versus imipramine. Patients were randomly assigned to sertraline
(n = 56), imipramine (n = 52), or placebo (n = 60) and were administered the
Anger Attacks Questionnaire before and after treatment. Depressed outpatients
were significantly more likely to report anger attacks than controls. Anger
attacks ceased in 53 percent of the patients receiving sertraline, 57 percent of
those receiving imipramine, and 37 percent of those in the placebo group. Our
findings support previous studies indicating that anger attacks are more
prevalent among depressed outpatients than normals. Our results also suggest
that sertraline and imipramine may be more effective than placebo in reducing
the number of anger attacks following treatment although the differences were
not statistically significant. Larger studies are needed to confirm our
findings.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 9133758 [PubMed - indexed for MEDLINE]
28: J Am Acad Child Adolesc Psychiatry. 2001 Sep;40(9):1070-8.
Phenomenology, psychosocial correlates, and treatment seeking in major
depression and dysthymia of adolescence.
Flament MF, Cohen D, Choquet M, Jeammet P, Ledoux S.
CNRS-UMR 7593, La Salpetriere Hospital, Paris, France. flament@ext.jussieu.fr
OBJECTIVE: To compare phenomenology, psychosocial correlates, and treatment
seeking in DSM-Itt-R major depression and dysthymia among adolescents diagnosed
as cases in a community-based study. METHOD: A self-report questionnaire,
including psychosocial data, life events, eating behaviors, depressive symptoms,
substance use, pathological behaviors, and family and school functioning was
administered to a nonselected sample (N = 3,287, 93.2% of targeted population)
of adolescents aged 11 to 20 years from several Haute-Marne communities in
France in 1988-1989. Subgroups of subjects (n = 205, 84.7% of eligible subjects)
were interviewed with a structured diagnostic schedule, and adolescents with
major depression (n = 49), dysthymia (n = 21) and controls (n = 135) were
compared. RESULTS: Nearly 30% of controls had at least one current symptom of
depression. Patterns of affective symptoms were similar in major depression and
dysthymia, but significant differences emerged in comorbid conditions (more
anxiety disorders, suicidal behaviors, and alcohol intoxications associated with
major depression) and stressor at onset (more severe in major depression).
Experiences of loss during the prior 12 months were associated with both forms
of affective disorder, while poor family relationships were specific correlates
of dysthymia. In contrast, peer relationships and pathological behaviors did not
differ between depressed subjects and controls. Although psychosocial
functioning was significantly impaired in both groups of depressed adolescents,
treatment seeking was limited to 34.7% for major depressive subjects and 23.8%
for dysthymic subjects. CONCLUSION: The results provide evidence that major
depression and dysthymia in adolescence are equally severe but may have distinct
patterns in associated factors. Despite free access to health care, the rate of
treatment seeking for mood disorders in France is similar to that reported in
U.S. studies.
PMID: 11556631 [PubMed - indexed for MEDLINE]
29: Acta Psychiatr Scand Suppl. 1994;383:7-11.
Historical and nosological aspects of dysthymia.
Freeman HL.
From the time of Hippocrates, the problem of persistently depressed mood has
been recognised clinically. The first modern description of dysthymia was by
Kahlbaum, who distinguished it from the fluctuating mood of cyclothymia.
However, there has been continuous difficulty in separating low-grade depressive
disorder from an abnormal personality trait. DSM-II defined chronic depression
as a personality disorder, but Akiskal subsequently reclassified it as a mood
disorder. In DSM-III, all chronic depression lasting more than two years was
defined as 'Dysthymic disorder'. DSM-III-R brought together dysthymic and
cyclothymic disorders into an affective category. ICD-10 dysthymia subsumes a
number of categories which include recurrent depression of mood. The primary
distinction between Dysthymia and Major Depressive Disorder is that Dysthymia is
chronic, but symptomatically less severe. A number of unresolved problems remain
in relation to its nosological status.
Publication Types:
Historical Article
PMID: 7942068 [PubMed - indexed for MEDLINE]
30: J Affect Disord. 1999 Aug;54(3):283-6.
Six months of desipramine for dysthymia: can dysthymic patients achieve normal
social functioning?
Friedman RA, Markowitz JC, Parides M, Gniwesch L, Kocsis JH.
The New York Hospital, Cornell Medical Center, NY 10021, USA.
BACKGROUND: There is evidence that antidepressant medication improves social
dysfunction during acute treatment in dysthymic patients but it is unknown if
the gain in social functioning persists or progresses with longer-term
antidepressant treatment. We examine the effect of 6 months of desipramine
treatment on social functioning in dysthymic patients. METHODS: Forty-six
subjects with DSM-III-R dysthymia (70% with superimposed major depression) who
had responded to 10 weeks of open-label desipramine (DMI) treatment received 16
additional weeks of continuation DMI. Social functioning was measured at weeks
0, 10 and 26 with the Social Adjustment Scale-Self Report. RESULTS: Euthymia was
maintained and a marginally significant trend for further improvement in overall
social functioning appeared during continuation treatment. Only 24% of subjects
achieved normative level of social adjustment after 6 months of DMI treatment.
LIMITATIONS: The main limitation was the lack of a placebo control group.
CONCLUSION: Acute improvement in social functioning persists during continuation
treatment. However, most dysthymic patients did not achieve a community level of
social adjustment. Significant social dysfunction persists in dysthymic patients
with low levels of depressive symptomatology after 6 months of intense DMI
treatment.
Publication Types:
Clinical Trial
PMID: 10467972 [PubMed - indexed for MEDLINE]
31: J Clin Psychopharmacol. 1995 Aug;15(4):280-3.
Predictors of response to desipramine in dysthymia.
Friedman RA, Parides M, Baff R, Moran M, Kocsis JH.
Department of Psychiatry, New York Hospital, Cornell Medical Center, Payne
Whitney Clinic, New York 10021, USA.
Little is known about factors that may predict the response of dysthymia or
other forms of chronic depression to treatment with antidepressant medication.
We investigated several sociodemographic and clinical variables for their
relationship to the acute treatment response to desipramine in subjects with
DSM-III-R dysthymia. Subjects with DSM-III-R dysthymia were treated with
desipramine in an open fashion for 10 weeks. Various clinical and
sociodemographic variables were assessed at baseline. Ratings of depressive
symptoms and severity and determination of categorical outcome were done during
treatment. Baseline extended family adjustment as measured by the Social
Adjustment Scale Self-Report was significantly better in the responders compared
with the nonresponders (2.1 +/- 0.5 vs. 2.6 +/- 0.8; t = 2.84, df = 52.11, p =
0.006). There was a trend (p = 0.06) for overall baseline social impairment
(SAS-SR) to be higher in nonresponders versus responders. Older age was a
significant predictor of higher depressive severity (Cornell Dysthymia Rating
Scale) and global impairment in the last week of the study. No other variable
significantly distinguished responders from non-responders. Although few of the
variables that were examined were found to affect acute treatment response,
better extended family adjustment as reported on the SAS-SR was a significant
predictor of good acute treatment response to desipramine in patients with
dysthymia.
Publication Types:
Clinical Trial
PMID: 7593711 [PubMed - indexed for MEDLINE]
32: J Am Acad Child Adolesc Psychiatry. 1997 Apr;36(4):458-65.
Incidence of major depressive disorder and dysthymia in young adolescents.
Garrison CZ, Waller JL, Cuffe SP, McKeown RE, Addy CL, Jackson KL.
Department of Epidemiology and Biostatistic, University of South Carolina,
Columbia 29208, USA.
OBJECTIVE: An epidemiological study conducted between 1987 and 1989 in a single
school district in the southeastern United States investigated the incidence,
transition probabilities, and risk factors for major depressive disorder (MDD)
and dysthymia in adolescents aged 11 to 16 years. METHOD: Diagnoses were based
on the Schedule for Affective Disorders and Schizophrenia for School-Age
Children, which was administered to 247 mother-adolescent pairs at 12-month
intervals. RESULTS: One-year MDD and dysthymia incidences were 3.3% (n = 11) and
3.4% (n = 9), respectively. Transition probabilities demonstrated movement from
disorder to no disorder over time. Family cohesion (odds ratio = 0.95) was the
only significant predictor of incident MDD. No factors were significant for
dysthymia. While baseline MDD was a significant risk factor for depression at
follow-up, 80% of subjects with baseline MDD did not meet the criteria for
diagnosis at follow-up. CONCLUSION: Findings suggest perceived family support or
cohesion may be more important to adolescent mental health than family
structure.
PMID: 9100419 [PubMed - indexed for MEDLINE]
33: Acta Psychiatr Scand. 1999 May;99(5):332-40.
Personality disorders in dysthymia and major depression.
Garyfallos G, Adamopoulou A, Karastergiou A, Voikli M, Sotiropoulou A, Donias S,
Giouzepas J, Paraschos A.
Community Mental Health Center of the Northwestern District of Thessaloniki,
Greece.
OBJECTIVE: The purpose of the present study was to investigate the comorbidity
of personality disorders in patients with primary dysthymia compared to those
with episodic major depression. METHOD: A total of 177 out-patients with primary
dysthymia and 187 outpatients with episodic major depression were administered a
structured diagnostic interview for DSM-III-R Axis II disorders. In addition,
all of these patients completed the BDI, and those with the appropriate level of
education also completed the Minnesota Multiphasic Personality Inventory (MMPI).
RESULTS: A significantly higher proportion of dysthymic patients than patients
with major depression met the criteria for a personality disorder, for
borderline, histrionic, avoidant, dependent, self-defeating types and for
personality disorders of clusters B and C. Further analysis revealed that the
above differences were mainly due to the subgroup of patients with 'early-onset
dysthymia'. Finally, patients with a personality disorder, both dysthymics and
those with major depression, had significantly higher scores on the BDI and on
the majority of the MMPI scales compared to those without a personality
disorder. CONCLUSION: The data indicated that (i) dysthymia--mainly that of
early onset--is associated with significantly higher personality disorder
comorbidity than episodic major depression, and (ii) the presence of a
personality disorder is related to more severe overall psychopathology.
PMID: 10353448 [PubMed - indexed for MEDLINE]
34: J Am Acad Child Adolesc Psychiatry. 2000 Jun;39(6):761-70.
Major depression and dysthymia in children and adolescents: discriminant
validity and differential consequences in a community sample.
Goodman SH, Schwab-Stone M, Lahey BB, Shaffer D, Jensen PS.
Department of Psychology, Emory University, Atlanta, GA 30322, USA.
psysg@emory.edu
OBJECTIVES: To evaluate evidence, in a community sample, for discriminant
validity between major depression (MDD) and dysthymia (Dy) in children and
adolescents and to examine differential consequences of the 2 disorders for
functioning. METHOD: The National Institute of Mental Health (NIMH) Methods for
the Epidemiology of Child and Adolescent Mental Disorders (MECA) study consists
of probability samples of youths. Data for this study are derived from
interviews with 1,285 complete parent-youth pairs aged 9 to 17 years from 4
geographic areas in the United States. Youths with MDD were contrasted with
those with Dy and those with both (MDD-Dy) on the NIMH Diagnostic Interview
Schedule for Children, Non-Clinician Children's Global Assessment Scale,
Columbia Impairment Scale, and the Service Utilization and Risk Factors Module.
RESULTS: Groups with MDD, Dy, or MDD-Dy did not differ on sociodemographic,
clinical, or family and life event variables. Youths with combined MDD-Dy were
significantly less competent and more impaired than youths with either disorder
alone. CONCLUSIONS: The findings do not provide support for the differentiation
of MDD and Dy but strongly suggest the importance of addressing the needs of
youths who meet criteria for both MDD and Dy because this combination is likely
to be both serious and disruptive of normal developmental processes.
PMID: 10846311 [PubMed - indexed for MEDLINE]
35: Mol Psychiatry. 2000 May;5(3):242-61.
Dysthymia: a review of pharmacological and behavioral factors.
Griffiths J, Ravindran AV, Merali Z, Anisman H.
Department of Psychiatry, University of Ottawa, Ottawa, Canada.
Although dysthymia, a chronic, low-grade form of depression, has a morbidity
rate as high as that of major depression, and increases the risk for major
depressive disorder, limited information is available concerning the etiology of
this illness. In the present report we review literature concerning the
biological and characterological features of dysthymia, the effectiveness of
antidepressant treatments, the influence of stressors in the precipitation and
maintenance of the disorder, and both quality of life and psychosocial
correlates of the illness. We also provisionally suggest that dysthymia may stem
from disturbances of neuroendocrine and neurotransmitter functioning (eg,
corticotropin releasing hormone and arginine vasopressin within the
hypothalamus, or alternatively monoamine variations within several
extrahypothalamic sites), and may also involve cytokine activation. The central
disturbances may reflect phenotypic variations of neuroendocrine processes or
sensitization of such mechanisms. It is suggested that chronic stressor
experiences or stressors encountered early in life lead to the phenotypic
neurochemical alterations, which then favor the development of the dysthymic
state. Owing to the persistence of the neurochemical disturbances, vulnerability
to double depression is increased, and in this instance treatment with
antidepressants may attenuate the symptoms of major depression but not those of
the basal dysthymic state. Moreover, the residual features of depression
following treatment may be indicative of underlying neurochemical disturbances,
and may also serve to increase the probability of illness recurrence or relapse.
Publication Types:
Review
Review, Academic
PMID: 10889527 [PubMed - indexed for MEDLINE]
36: Psychol Med. 2002 Oct;32(7):1239-49.
Childhood adversity and anxiety versus dysthymia co-morbidity in major
depression.
Harkness KL, Wildes JE.
Department of Psychology, University of Oregon, USA.
BACKGROUND: Childhood adversity places individuals with major depression at risk
for anxiety and dysthymia co-morbidity. The goal of the present paper is to
broaden this area of research by examining specificity between the type of
adversity (e.g. abuse versus neglect/indifference) and the resulting co-morbid
disorder (e.g. anxiety versus dysthymia co-morbidity). METHOD: The volunteer
sample consisted of 76 women meeting Diagnostic and Statistical Manual (DSM-IV)
criteria for major depression. Of these, 28 were diagnosed with a co-morbid
anxiety disorder and 21 were diagnosed with co-morbid dysthymia. Childhood
physical abuse, sexual abuse, psychological abuse, antipathy and indifference
were assessed using a contextual interview and rating system. RESULTS: Severe
sexual abuse and psychological abuse were significantly and preferentially
associated with co-morbid anxiety, while severe physical abuse was significantly
and preferentially associated with co-morbid dysthymia. Indifference and
antipathy were significantly associated with both co-morbid anxiety and
dysthymia. Multivariate analyses revealed that severe sexual abuse was the
adverse childhood experience most strongly associated with co-morbid anxiety.
CONCLUSIONS: These results suggest that particular adverse experiences in
childhood do set up specific vulnerabilities to the expression of anxiety versus
dysthymia co-morbidity in adulthood major depression. Cognitive mediators of
these associations are discussed as avenues of future research.
PMID: 12420893 [PubMed - indexed for MEDLINE]
37: J Clin Psychiatry. 1999 Aug;60(8):508-18.
The long-term outcome of dysthymia in private practice: clinical features,
temperament, and the art of management.
Haykal RF, Akiskal HS.
Charter Lakeside Behavioral Health System, University of Tennessee, Memphis,
USA.
BACKGROUND: With the clinical availability of fluoxetine in the United States,
we were interested in documenting improvements in the clinical care of dysthymic
patients beyond what was reported from our clinic 2 decades earlier during the
"tricyclic (TCA) era." METHOD: In open treatment of 42 consecutive DSM-III-R
primary dysthymic patients who were personally followed up in our mood clinic
since 1988, response was defined as sustained remission, i.e., no longer meeting
criteria for dysthymia and achieving DSM-III-R Axis V Global Assessment of
Functioning (GAF) score > 70 throughout much of the mean follow-up of 5 years.
RESULTS: Compared to patients with nondysthymic episodic major depressive
disorder (N = 42), dysthymic patients had a significantly earlier mean age at
onset (12.6 vs. 34 years), were more likely to have never been married, had a
greater frequency of superimposed major depressive episodes (except for the 14%
[N = 6] with "pure" dysthymia), and had more psychiatric and fewer medical
comorbidities; furthermore, patients with dysthymia had significantly greater
familial loading of both unipolar and bipolar disorders. Continued treatment
with TCA-type antidepressants or fluoxetine (including various augmenting
strategies) led to an overall robust and sustained response rate of 76% (N = 32)
among dysthymic patients; in tandem, major depressive episodes and suicidality
were prevented in all responders. Females treated with fluoxetine had the
highest response rate (85% [N = 17]); some were able to walk out of dependent
abusive relationships for the first time in their lives. However, dramatic
responses with "hyperthymic" switches in temperament occurred in only 12% of
dysthymic patients; nearly all were males with bipolar family history. The more
prototypic positive change among dysthymic responders consisted of coping with
daily hassles without being overwhelmed. Qualitatively, the highest level of
adaptive functioning was observed among fluoxetine-treated dysthymics (50% of
responders [N = 12] achieved DSM-III-R GAF score of 81-90). Of TCA-treated
patients, 39% had intolerable side effects, necessitating switch-over to
fluoxetine. Agitation occurred in 11% of fluoxetine-treated patients (N = 4) and
was associated with nonresponse and/or dropout; otherwise, this selective
serotonin reuptake inhibitor was well tolerated, thereby contributing to
long-term compliance. More provocatively, patients with dysthymia who had
required extensive psychotherapeutic attention prior to state-of-the-art
pharmacotherapy no longer required such therapy. CONCLUSION: These data extend
and enrich what has been learned from controlled trials among dysthymic
patients. With sustained pharmacotherapy and specialized clinical care in a
private mood clinic, 3 of 4 patients immersed in gloom for much of their lives
achieved for the first time good to superior levels of functioning that were
maintained for an average of 5 years. Although the art of clinical management of
dysthymia should be fully grounded in understanding the interpersonal context of
depression, we submit that SSRIs such as fluoxetine appear broadly efficacious
in areas previously deemed to be the domain of formal psychotherapy.
Publication Types:
Clinical Trial
PMID: 10485632 [PubMed - indexed for MEDLINE]
38: J Psychother Pract Res. 2001 Spring;10(2):93-103.
Adding group psychotherapy to medication treatment in dysthymia: a randomized
prospective pilot study.
Hellerstein DJ, Little SA, Samstag LW, Batchelder S, Muran JC, Fedak M, Kreditor
D, Rosenthal RN, Winston A.
Department of Psychiatry, Beth Israel Medical Center, New York, USA.
Patients with dysthymia have been shown to respond to treatment with
antidepressant medications, and to some degree to psychotherapy. Even patients
successfully treated with medication often have residual symptoms and impaired
psychosocial functioning. The authors describe a prospective randomized 36-week
study of dysthymic patients, comparing continued treatment with antidepressant
medication (fluoxetine) alone and medication with the addition of group therapy
treatment. After an 8-week trial of fluoxetine, medication-responsive subjects
were randomly assigned to receive either continued medication only or medication
plus 16 sessions of manualized group psychotherapy. Results provide preliminary
evidence that group therapy may provide additional benefit to
medication-responding dysthymic patients, particularly in interpersonal and
psychosocial functioning.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11264333 [PubMed - indexed for MEDLINE]
39: Prog Neuropsychopharmacol Biol Psychiatry. 1996 Apr;20(3):427-42.
Follow-up assessment of medication-treated dysthymia.
Hellerstein DJ, Samstag LW, Cantillon M, Maurer M, Rosenthal J, Yanowitch P,
Winston A.
Psychiatric Outpatient Services, Beth Israel Medical Center, New York, N.Y.,
USA.
1. The objective was to assess long-term efficacy of antidepressant medications
in dysthymia. 2. In a naturalistic study, patients with DSMIII-R dysthymia who
had participated in previous antidepressant trials with fluoxetine and trazodone
were evaluated at a mean of 40.0 weeks of follow-up to assess whether medication
response persisted over time. A multivariate analysis was performed for patients
on vs. off medication. Relapse rates (with relapse defined as HDRS score > 13)
were also compared for these two groups. 3. Of 40 patients, the 24 still on
medication showed significantly lower scores on most rating scales (HDRS,
Cornell Dysthymia Rating Scale, and CGI, but not on the SCL-58) than the
heterogeneous group of 16 patients not taking medication. Relapse was low
(17.4%) among patients remaining on medication. 4. These preliminary findings
suggest that dysthymia patients who remain on medication maintain improvement
over time.
Publication Types:
Clinical Trial
PMID: 8771599 [PubMed - indexed for MEDLINE]
40: Br J Psychiatry Suppl. 1994 Dec;(26):23-30.
Major depression, dysthymia and depressive personality disorder.
Hirschfeld RM.
Psychiatry and Behavioral Sciences, University of Texas, Galveston 77555.
The separation of persistent depression into meaningful and useful
subcategories, including major depression, dysthymia, recurrent brief
depression, and depressive personality disorder, is the subject of much debate.
Depressions can be grouped on the basis of their type and severity of symptoms,
aetiology, clinical course, or their association with other psychiatric
illnesses. Several investigators have conducted epidemiologic and family studies
to evaluate the prevalence of depressive disorders, their diagnostic stability
over time, and the amount of overlap among the disorders. Although progress has
been made toward a better understanding of the different disorders, insufficient
evidence exists to support the hypothesis that these disorders are separate and
distinct from one another. However, preliminary data suggest that depressive
personality disorder is separate from the other disorders. Additionally, several
questions have been raised, particularly the extent to which differentiation
between the depressive disorders, specifically major depression and dysthymia,
has an impact on treatment decisions.
Publication Types:
Review
Review Literature
PMID: 7873134 [PubMed - indexed for MEDLINE]
41: Eur Neuropsychopharmacol. 1997 Oct;7 Suppl 3:S329-36.
Antidepressant efficacy in the treatment of dysthymia.
Invernizzi G, Mauri MC, Waintraub L.
Psychiatry Department 1, University of Milan, IRCCS Ospedale Maggiore di Milano,
Italy.
Although the existence of chronic depression has been recognized for a long
time, their definition was too inaccurate to enable reliable studies concerning
their treatment. Among the numerous diagnostic classes that patients with
chronic depression were assigned to, neurotic depression was the most common
one, and was often considered to be unresponsive to antidepressant medication.
Since DSM-III introduced 'Dysthymic Disorder', a new research was developed on
the efficacy of tricyclic antidepressants, MAOIs or new antidepressants, whose
results reversed previous opinion on its unresponsiveness. However the
interpretation of those studies are hampered by methodological problems, yet
unresolved, pertaining to the difficulty to differentiate dysthymia and major
depression, to the frequency of 'double-depression', the usual mildness of
symptoms in dysthymia, and the need of long-term trials.
Publication Types:
Review
Review, Tutorial
PMID: 9405959 [PubMed - indexed for MEDLINE]
42: J Abnorm Psychol. 1990 Nov;99(4):412-21.
Depressive personality: reliability, validity, and relation to dysthymia.
Klein DN.
Department of Psychology, State University of New York, Stony Brook 11794-2500.
The reliability and validity of Schneider's (1958) construct of depressive
personality was evaluated in a sample of 177 outpatients, who were administered
structured diagnostic and family history interviews, an extensive battery of
inventories, and a 6-month follow-up assessment. The criteria for depressive
personality had moderate to good interrater reliability, internal consistency,
and test-retest stability, and the assessment of depressive personality traits
was not influenced by patients' clinical states. In addition, preliminary
support for the convergent and discriminant validity of the depressive
personality construct was obtained. Although there were significant relations
between the depressive personality and Diagnostic and Statistical Manual of
Mental Disorders (3rd ed. and rev. 3rd ed.; American Psychiatric Association,
1980, 1987) diagnoses of dysthymia, the depressive personality was not entirely
subsumed by existing mood disorders.
PMID: 2266217 [PubMed - indexed for MEDLINE]
43: J Clin Psychiatry. 1998;59 Suppl 10:13-5.
Geriatric dysthymia.
Kocsis JH.
Cornell Medical Center, New York Hospital, New York 10021, USA.
This article reviews what is known about the epidemiology, clinical
characteristics, and treatment of dysthymia in the geriatric age group. Although
less common in the elderly than in young adults, dysthymia may have its onset in
middle or late life. Geriatric dysthymia appears to have less associated
psychiatric comorbidity and closer links to severe life stresses, particularly
medical illnesses, than dysthymia with early-age onset. Preliminary reports of
response to antidepressant medications are encouraging in the elderly, but
randomized, placebo-controlled clinical trials are needed in samples of
dysthymic patients in this age group.
Publication Types:
Review
Review, Tutorial
PMID: 9720477 [PubMed - indexed for MEDLINE]
44: Acta Psychiatr Scand Suppl. 1994;383:42-8.
Pharmacological therapy of dysthymia.
Lapierre YD.
Department of Psychiatry, Faculty of Medicine, Royal Ottawa Hospital, Ontario,
Canada.
For a number of years, dysthymia was considered to be non-responsive to
antidepressant treatment. During the last decade, early studies with tricyclic
antidepressants (TCAs) demonstrated the superiority of the TCAs over placebo.
The side effect profile of the TCAs and the moderate degree of symptomatology
resulted in reduced compliance and thus to the clinical impression of lack of
efficacy. The newest generation of antidepressants, the SRRIs and the RIMAs,
with their more acceptable side effect profiles, allowed for the adequate
evaluation of pharmacotherapy in dysthymia. The initial open studies with SSRIs
indicate a clear efficacy of this group of antidepressants. Likewise, a 5HT2
antagonist, ritanserin, has been shown to be superior to placebo. More recently,
a large placebo-controlled study of moclobemide, a RIMA, clearly demonstrated
the superiority of this drug over placebo. Based on this evidence, it is now
appropriate to consider antidepressants as a clearly effective method of
treating dysthymia.
Publication Types:
Review
Review, Tutorial
PMID: 7942067 [PubMed - indexed for MEDLINE]
45: Cochrane Database Syst Rev. 2000;(4):CD001130.
Update of:
Cochrane Database Syst Rev. 2000;(2):CD001130.
Drugs versus placebo for dysthymia.
Lima MS, Moncrieff J.
Department of Mental Health, Universidade Federal de Pelotas, Avenida Duque de
Caxias, 250, Pelotas, Rio Grande do Sul, BRAZIL, 96100. mslima@nutecnet.com.br
OBJECTIVES: Dysthymia is a depressive disorder of chronic nature but of less
severity than major depression, which depressive symptoms are more or less
continuous for at least two years. The aim of this review was to conduct a
systematic review of all RCTs comparing drugs and placebo for dysthymia. SEARCH
STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT,
Biological Abstracts and LILACS; reference searching; personal communication;
conference abstracts; unpublished trials from the pharmaceutical industry; book
chapters on the treatment of depression. SELECTION CRITERIA: The inclusion
criteria for all randomised controlled trials were that they should focus on the
use of drugs versus placebo for dysthymic patients. Exclusion criteria were: non
randomised, mixed major depression/ dysthymia (trials not providing separate
data) and depression secondary to other disorders (e.g. substance abuse). DATA
COLLECTION AND ANALYSIS: The reviewers extracted the data independently. In
order to achieve an intention-to-treat analysis, when trials failed to report it
was assumed that people who died or dropped out had no improvement. Authors of
relevant trials were contacted for additional and missing data. Absence of
treatment response as defined by authors was the main measure of outcome used.
Relative Risks (RR) and 95% confidence intervals (CI) of dichotomous data were
calculated with the Random Effects Model. Where possible, number needed to treat
(NNT) and number needed to harm (NNH) were estimated, taking the reciprocal of
the absolute risk reduction. MAIN RESULTS: Currently the review includes 15
trials. Similar results were obtained in terms of efficacy for different groups
of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors
(SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride,
amineptine, and ritanserin). The pooled RR for absence of treatment response was
0.68 (95% CI 0.59-0.78) for TCA and the NNT was 4.3 (95% CI 3.2-6.5). SSRIs
showed similar RR for this outcome: 0.64 (95% CI 0.55-0.74), the NNT being 4.7
(95% CI 3.5-6.9). Concerning MAOIs, the RR was 0.59 (95% CI 0.48-0.71) and the
NNT was 2.9 (95% CI 2.2-4.3). Other drugs (amisulpride, amineptine and
ritanserin) showed similar results in terms of absence of treatment response.
Using more stringent criteria for improvement - full remission - the results
were unchanged. Patients treated on TCA were more likely to report adverse
events, compared with placebo. REVIEWER'S CONCLUSIONS: Drugs are effective in
the treatment of dysthymia with no differences between and within class of
drugs. Tricyclic antidepressants are more likely to cause adverse events and
dropouts. As dysthymia is a chronic condition, there remains little information
on quality of life and medium or long-term outcome.
Publication Types:
Review
Review, Academic
PMID: 11034701 [PubMed - indexed for MEDLINE]
46: Am J Psychiatry. 1994 Aug;151(8):1114-21.
Comment in:
Am J Psychiatry. 1995 Aug;152(8):1241.
Psychotherapy of dysthymia.
Markowitz JC.
Department of Psychiatry, Cornell University Medical College, New York, NY
10021.
OBJECTIVE: The author reviews empirical research on the psychotherapy of
dysthymia. Dysthymia, a prevalent mood disorder, has been shown frequently to
respond to antidepressant medication. The need for a treatment for dysthymic
subjects unable or unwilling to take, or unresponsive to, medication still
remains. METHODS: Studies were located by computerized search and the author's
knowledge of the literature. All reports of studies on psychotherapy outcome for
dysthymic patients, except studies of late-life chronic major depression, were
included. RESULTS: Psychotherapy research on dysthymia has been confined to
small, usually uncontrolled studies with varying methods and limited follow-up.
Cognitive approaches have been most frequently studied; the results have not
been dramatic but do suggest that some dysthymic patients respond to brief
cognitive therapies. Preliminary results of an ongoing study of interpersonal
psychotherapy are promising. CONCLUSIONS: Given the public health importance of
dysthymia and the availability of treatments, the time is ripe for clinical
trials of antidysthymic psychotherapy. The author proposes the following
guidelines for such trials: time-limited, manual-based psychotherapy,
interpersonal focus, serial design, continuation and maintenance treatment,
combined treatments, and follow-up assessments.
Publication Types:
Review
Review, Tutorial
PMID: 8037243 [PubMed - indexed for MEDLINE]
47: J Nerv Ment Dis. 1990 Sep;178(9):577-81.
Comparison of early and late onset dysthymia.
McCullough JP, Braith JA, Chapman RC, Kasnetz MD, Carr KF, Cones JH, Fielo J,
Shoemaker OS, Roberts WC.
Department of Psychology, Virginia Commonwealth University, Richmond 23284-2018.
The present investigation compares early and late onset community dysthymia
groups on insidious onset patterns, cognitive, coping, and symptom measures
testing the assumption implicit in DSM-III-R that the two groups are
qualitatively dissimilar. The results suggest that, regardless of age of onset,
the groups did not differ except on some features of coping style. Homogeneity,
not heterogeneity, was the predominant finding. The results call into question
the DSM-III-R procedure for classifying dysthymia by age of onset, but also
point to the need for additional research.
PMID: 2394977 [PubMed - indexed for MEDLINE]
48: Med Clin North Am. 2001 May;85(3):631-44.
Depression and dysthymia.
Moore JD, Bona JR.
Department of Psychiatry and Behavioral Sciences, Emory University School of
Medicine, Atlanta, Georgia, USA.
The advances made in the 1980s and 1990s have yielded many advances in the
diagnosis and treatment of depression and dysthymia. Skill of the clinician is
important in sorting out the diagnosis, taking care to consider the various
medical conditions that can cause depression or disguise themselves as
depression. Depressive disorders are highly treatable conditions. Clinicians
must overcome the stigma associated with these disorders to alleviate the pain
and suffering of those afflicted. The advances in treatment have been enormous
and continue to grow. The keys to these treatments lie in continuing to acquire
the knowledge to unlock all of the causes of depression. An appendix follows
listing medications commonly used in the treatment of depression or for other
conditions in patients under treatment for depression.
Publication Types:
Review
Review, Tutorial
PMID: 11349477 [PubMed - indexed for MEDLINE]
49: Gen Hosp Psychiatry. 2001 Nov-Dec;23(6):301-10.
Status of minor depression or dysthymia in primary care following a randomized
controlled treatment.
Oxman TE, Barrett JE, Sengupta A, Katon W, Williams JW Jr, Frank E, Hegel M.
Departments of Psychiatry and Community & Family Medicine, Dartmouth Medical
School, Lebanon, NH 03756, USA. thomas.oxman@dartmouth.edu
This report describes the rates of recovery and remission from minor depression
or dysthymia in primary care patients three months after completing a randomized
controlled treatment trial. The subjects were primary care patients who received
> or =4 treatment sessions with Problem-Solving Treatment, paroxetine, or
placebo and who completed an independent assessment 3 months after the study
(201 with minor depression, 229 with dysthymia). The 17-item Hamilton Rating
Scale for Depression (HAMD), semistructured questions about postintervention
depression treatments, and baseline medical comorbidity, neuroticism, and social
function were the primary measures. For minor depression 76% and for dysthymia
68% of subjects who were in remission at the end of the 11-week treatment trial
were recovered (HAMD < or =6) three months after the treatment trial. Of
patients who were not in remission at 11 weeks, for minor depression 37% and for
dysthymia 31% went on to achieve remission at 25 weeks. The majority of patients
chose not to use antidepressants or psychotherapy after the trial. Patients with
minor depression that had greater baseline social function and lower neuroticism
scores were more likely to be recovered. For patients with minor depression,
these findings suggest a need for some matching of continuation and maintenance
treatment to patient characteristics rather than uniform, automatic treatment
recommendations. Because of the chronic, relapsing nature of dysthymia,
practical improvements in encouraging effective continuation and maintenance
phases of treatment are indicated.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11738460 [PubMed - indexed for MEDLINE]
50: Acta Psychiatr Scand Suppl. 1994;383:35-41.
Dysthymia in clinical practice :psychological therapies.
Paykel ES.
Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital,
United Kingdom.
Psychological therapies for depression may have several different targets:
symptom amelioration, relapse prevention, and improving social adaptation. For
cognitive therapy the targets are mainly the first two of these, for dynamic
psychotherapies particularly the third. In dysthymia, provision of a coping
repertoire for a long term illness may also be important. There have been few
controlled trials of psychological therapies in dysthymia, but one study has
found benefit from marital therapy, and uncontrolled studies, suggest some
benefit from cognitive therapy. Controlled trials in other forms of depression
of specific targeted psychotherapies, most commonly interpersonal psychotherapy,
but also group, marital and family therapy, and social work, show benefit on
social adjustment and some benefit on symptoms. Controlled trials of cognitive
therapy show symptom benefit in milder depression, and strongly suggestive
evidence of relapse reduction.
Publication Types:
Review
Review, Tutorial
PMID: 7942066 [PubMed - indexed for MEDLINE]
51: Acta Psychiatr Scand Suppl. 1995;386:36-9.
Studies of reversible and selective inhibitors of monoamine oxidase A in
dysthymia.
Petursson H.
Department of Psychiatry, Borgarspitalinn, University of Iceland, Reykjavik.
Dysthymia is a relatively common disorder and is frequently associated with
other mental conditions such as major depression and anxiety. A number of
controlled and uncontrolled studies have indicated that conventional as well as
more recent antidepressants such as moclobemide, a selective, reversible
inhibitor of monoamine oxidase (MAOI), may be effective in dysthymia and
dysthymia-like disorders. However, assessment of the results of previous studies
is confounded by the relative lack of standards in diagnostic criteria, outcome
measures, dosage and duration of treatment. Applying DSM-III-R criteria, the
efficacy of moclobemide in dysthymia has been confirmed in a significant study
from South America, and other comparable studies are under way. The potential
role of selective, reversible MAOIs such as moclobemide can be more firmly
established when results of additional investigations have become available.
PMID: 7717093 [PubMed - indexed for MEDLINE]
52: J Affect Disord. 1996 Sep 9;40(1-2):73-84.
Primary dysthymia: a study of several psychosocial, endocrine and immune
correlates.
Ravindran AV, Griffiths J, Merali Z, Anisman H.
Department of Psychiatry, Royal Ottawa Hospital, Ontario, Canada.
The relationship between primary dysthymia (chronic, low grade depression) and
indices of major and minor life stresses, uplifts and coping styles was
examined. Additionally, circulating lymphocyte subsets were assessed in
dysthymic patients to determine their relationship to stress/coping factors or
plasma levels of cortisol, ACTH or norepinephrine. Primary dysthymia was found
to be associated with increased minor stressors (daily hassles), reduced
uplifts, as well as particular reliance on emotion-focused rather than
problem-oriented coping strategies. Interestingly, among dysthymics, the early
onset group exhibited a greater degree of hassles and greater emotion-focused
coping compared to the late onset subgroup. Although hassles and coping styles
were correlated with depressed mood, only coping styles predicted severity of
depressed affect. It seems that although dysthymia is characterized by increased
hassles and reduced uplifts, these variables do not distinguish between the
severity of the depressive affect, whereas the coping styles employed in the
face of the increased hassles and reduced uplifts are more closely aligned with
depression severity. Dysthymia was associated with elevated levels of
circulating natural killer (NK) cells. Since levels of plasma cortisol, ACTH or
norepinephrine were not increased in the dysthymic subjects, it is likely that
the elevated NK cell number was unrelated to these neuroendorcrine measures. In
control subjects circulating NK cells were inversely related to the severity of
hassles recently encountered, while in dysthymic patients stress and coping
factors were unrelated to NK cell numbers. Thus, it appears that the altered NK
cells in dysthymic patients were not related to the increased stress perception
and altered coping which characterize these patients.
PMID: 8882917 [PubMed - indexed for MEDLINE]
53: Prog Neuropsychopharmacol Biol Psychiatry. 1995 Jul;19(4):637-53.
Stressful life events and coping styles in relation to dysthymia and major
depressive disorder: variations associated with alleviation of symptoms
following pharmacotherapy.
Ravindran AV, Griffiths J, Waddell C, Anisman H.
Royal Ottawa Hospital, University of Ottawa, Ontario, Canada.
1. Both major depression and dysthymia (chronic, low grade depression) were
associated with increased reports of minor stressors (daily hassles), and
feelings of loneliness, reduced uplifts, as well as the use of inappropriate
coping strategies (i.e., emotion-focussed rather than problem-oriented coping).
2. Although major depressive and dysthymic patients shared several features with
respect to symptomatology, dysthymics tended to report a greater number of
hassles than major depressives. 3. Treatment with serotonin reuptake inhibitors
over an 8-week period resulted in a marked alleviation of the depressive
symptoms in both patient groups, although the clinical effectiveness of the
drugs appeared somewhat later in dysthymics. 4. The attenuation of the
depressive symptoms was accompanied by a modest, but significant diminution in
reports of minor stressors, while the perception of uplifts remained unchanged.
Moreover, recovery from depression was associated with changes in coping style,
such that patients relied less on inappropriate emotion-focussed coping
strategies.
Publication Types:
Clinical Trial
PMID: 8588062 [PubMed - indexed for MEDLINE]
54: Biol Psychiatry. 1999 Jan 15;45(2):229-33.
Treatment of refractory chronic depression and dysthymia with high-dose
thyroxine.
Rudas S, Schmitz M, Pichler P, Baumgartner A.
Community Mental Health Service of Vienna, Austria.
BACKGROUND: An 8-week open trial was conducted to investigate whether patients
with treatment-resistant, chronic depression and/or dysthymia could profit from
high-dose thyroxine (T4) augmentation. METHODS: Nine patients whose current
depressive episode had lasted for a mean of 15.5 +/- 8.6 months (range: 2-30
months) received T4 in addition to their current medication. RESULTS: Two
patients dropped out of the study owing to side effects. The remaining 7
patients received a final mean dose of T4 of 235 +/- 58 micrograms/day (range:
150-300 micrograms/day). Their scores on the Hamilton Depression Rating Scale
had fallen from a mean of 21.1 +/- 4.1 before inclusion in the study to a mean
of 8.0 +/- 2.8 at the end of the 8th week. Five patients were full responders, 1
a partial responder, and 1 a nonresponder. CONCLUSIONS: Augmentation with
high-dose T4 proved to have an antidepressant effect in more than 50% of the
previously treatment-resistant patients with chronic depression and/or
dysthymia.
Publication Types:
Clinical Trial
PMID: 9951571 [PubMed - indexed for MEDLINE]
55: J Personal Disord. 2001 Feb;15(1):84-93.
Chronic, low-grade depression in a nonclinical sample: depressive personality or
dysthymia?
Ryder AG, Bagby RM, Dion KL.
Department of Psychology, University of British Columbia, Vancouver.
agryder@interchange.ubc.ca
Depressive personality disorder (DPD) is being considered for inclusion in
future editions of the Diagnostic and Statistical Manual of Mental Disorders
(DSM). However, there is substantial conceptual and empirical overlap between
DPD and dysthymic disorder (Dysthymia) criteria, suggesting that these two
constructs may not be distinct. Confirmatory factor analysis of the DPD traits
and dysthymia symptoms in a large, nonclinical sample (N = 368) indicated that a
two-factor model was a better fit than a one-factor model. However, binary
diagnostic analysis revealed that over half of the individuals meeting criteria
for DPD also met criteria for dysthymia and that the best-fitting model allowed
the psychological symptoms of dysthymia to load on both DPD and dysthymia latent
factors. All of the individuals with DPD alone failed to meet criteria for
dysthymia because they did not report chronic depressed mood. Our results
suggest that although DPD is not synonymous with Dysthymia, it may be a milder
subtype.
PMID: 11236817 [PubMed - indexed for MEDLINE]
56: J Affect Disord. 1999 Nov;56(1):17-25.
Delineating psychopathologic clusters within dysthymia: a study of 512
out-patients without major depression.
Serretti A, Jori MC, Casadei G, Ravizza L, Smeraldi E, Akiskal H.
Istituto Scientifico Ospedale San Raffaele, Department of Neurospychiatric
Sciences, University of Milan School of Medicine, Italy.
serretti.alessandro@hsr.it
BACKGROUND: The literature indicates that emotional-cognitive symptoms are much
more characteristic of dysthymia than the vegetative and psychomotor symptoms of
major depression, yet this is insufficiently emphasized in the official criteria
listed in the criteria of the American Psychiatric Association. Furthermore, as
previous studies have examined these symptoms more in relation to prevalence
than to possible symptom aggregation, in the present analyses we address both
aspects. METHODS: In two multicenter collaborative trials, 512 out-patients
meeting the symptom criteria of DSM-III-R dysthymia but without major depression
were recruited. In this respect they conformed to the conceptual framework of
ICD-10 which tends to restrict dysthymia to a subthreshold depression without
excursion into severe depressive episodes. The Montgomery Asberg Depression
Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (HAM-A) were used to
assess depressive and anxiety symptoms. RESULTS: Symptoms most frequently
observed, besides depressed mood (100% by definition), were 'low energy or
fatigue' (96%) and 'poor concentration or indecisiveness' (88%), followed by
'low self-esteem' (80%), 'insomnia or hypersomnia' (77%), 'poor appetite or
overeating' (69%) and 'feeling of hopelessness' (42%). Interestingly, in the
subjects with fewer than five symptoms, the most frequent were low energy or
fatigue (93%), poor concentration or indecisiveness (79%) and low self-esteem
(77%), the other symptoms being present in no more than half the sample. MADRS
factor analysis identified two main factors: the first consisting of apparent
and reported sadness, and the second concentration difficulties and lassitude.
HAM-A factor analysis identified two factors clearly differentiating somatic and
psychic symptoms. LIMITATIONS: Because suicidal patients were excluded on the
ground of human subject concerns, our sample is representative of the milder
range of symptomatology within the spectrum of dysthymia. This may in part
explain the low prevalence of neurovegetative symptoms. CONCLUSION: Despite
this, the present study involves the largest sample of pure dysthymia ever
studied. Our results indicate that dysthymic disorder appears to primarily
involve psychologic symptoms. The psychological symptoms themselves seem to
cluster into sadness versus mental fatigue; as for anxiety symptoms, they appear
divisible into somatic and psychic clusters, with the latter prevailing in
dysthymia. Dysthymia proper, dominated by negative affectivity, might be
distinguishable from a 'neurasthenic' subform dominated by low energy or
'deficit' symptoms at mental and physical levels.
PMID: 10626776 [PubMed - indexed for MEDLINE]
57: Acta Psychiatr Scand. 1997 Apr;95(4):324-8.
The prevalence of current major depression and dysthymia in a Norwegian general
practice.
Vaeroy H, Merskey H.
Oppland Psychiatric Hospital, Reinsvoll, Norway.
Existing studies suggest that depression is underdiagnosed and undertreated in
general practice, and that the known prevalence of this mood disorder in a
primary care population may represent only the "tip of the iceberg'. A total of
100 consecutive patients in an average Norwegian general practice were tested,
of whom 31 patients were diagnosed as having a depressive illness in this study;
28 patients were diagnosed as having current major depression and three as
having dysthymia. In total, 21 of the 28 patients with current major depression
presented with other symptoms as their major complaints at the consultation in
which they were tested. Twelve of these 21 patients had some kind of pain
problem.
PMID: 9150827 [PubMed - indexed for MEDLINE]
58: Int Clin Psychopharmacol. 1997 Jul;12(4):183-93.
Moclobemide and imipramine in chronic depression (dysthymia): an international
double-blind, placebo-controlled trial. International Collaborative Study Group.
Versiani M, Amrein R, Stabl M.
Federal University of Rio de Janeiro, Brazil.
An international, multicenter, placebo-controlled study was undertaken to
determine the safety and antidepressant efficacy of moclobemide, a new
reversible inhibitor of monoamine oxidase A, and imipramine in the treatment of
dysthymia (DSM-III-R). A total of 315 patients were enrolled and randomly
assigned to an 8-week treatment in one of three groups (moclobemide, imipramine
and placebo). Patients were male or female outpatients aged between 18 and 65
years meeting DSM-III-R criteria for dysthymia, primary type, with late or early
onset. Of the patients in each group 85% completed the 8-week treatment period.
The percentage of patients who no longer fulfilled DSM-III-R symptom criteria at
treatment endpoint was significantly higher in the moclobemide (60%) and
imipramine (49%) treatment groups than in the placebo group (22%). Differences
to placebo were also statistically significant both for moclobemide and for
imipramine on the other efficacy variables (i.e. Hamilton Rating Scale for
Depression, final overall efficacy assessment, Clinical Global Impression and
symptom check list self-rating). A significant superiority of moclobemide and
imipramine over placebo was found in pure dysthymia and in double-depression, as
well as in early and late onset subgroups. In early onset cases, moclobemide was
significantly more effective than was imipramine on the Hamilton Rating Scale
for Depression. Anticholinergic symptoms and sleepiness were significantly more
frequent side effects on imipramine than on moclobemide or on placebo, and the
investigators' final overall assessment of tolerability significantly favoured
moclobemide over imipramine. This study demonstrates the efficacy of high dose
moclobemide (mean dose 675 mg/day) and high dose imipramine (220 mg/day) against
placebo in the treatment of dysthymia. Moclobemide was better tolerated than was
imipramine.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 9347378 [PubMed - indexed for MEDLINE]
59: Am J Psychiatry. 1988 Jul;145(7):815-9.
The epidemiology of dysthymia in five communities: rates, risks, comorbidity,
and treatment.
Weissman MM, Leaf PJ, Bruce ML, Florio L.
Department of Epidemiology, College of Physicians and Surgeons, Columbia
University, New York, NY 10032.
Data from a survey of five U.S. communities showed that dysthymia affected
approximately 3% of the adult population. It was more common in women under age
65, unmarried persons, and young persons with low income and was associated with
greater use of general health and psychiatric services and psychotropic drugs.
Dysthymia had a high comorbidity with other psychiatric disorders, particularly
major depression; only about 25%-30% of cases occur over a lifetime in the
absence of other psychiatric disorders. The findings suggest that although the
onset and highest risk periods of major depression and bipolar disorder are in
young adulthood, a residual state of dysthymia occurs in middle and old age.
PMID: 3381924 [PubMed - indexed for MEDLINE]
60: Am J Addict. 1997 Winter;6(1):48-53.
Clinical epidemiology of comorbid dysthymia and substance disorder.
Westermeyer J, Eames SE.
Minneapolis VA Medical Center, Department of Psychiatry, Minneapolis 55417, USA.
The authors sought to determine the 1-year-period prevalence and demographic
characteristics of comorbid substance-related disorder (SRD) and dysthymia, as
well as the demographic characteristics of SRD-dysthymia patients as compared
with SRD-only patients. Patients being treated at two university medical centers
and abstinent less than 2 years were followed prospectively for 6 months to
establish the diagnosis of dysthymia. A total of 642 patients were assessed, of
whom 39 had SRD-dysthymia and 308 had SRD only. Data collection instruments
included a demographic questionnaire and assessment of DSM Axis I psychiatric
diagnoses. The 1-year prevalence rate was lower than noted in previous studies
where there were less stringent criteria for dysthymia. The rate of dysthymia
among these SRD patients closely resembled that observed in a general population
study. SRD-dysthymia patients and SRD-only patients did not differ on most
demographic characteristics. SRD-dysthymia is not easily detected among
recovering SRD patients because of the need for lengthy observation and the
absence of special demographic characteristics.
PMID: 9097871 [PubMed - indexed for MEDLINE]
61: Br J Psychiatry. 1995 Feb;166(2):174-83.
Comment in:
Br J Psychiatry. 1995 May;166(5):678.
Dysthymia in clinical practice. The WPA Dysthymia Working Group.
[No authors listed]
BACKGROUND. Dysthymia has been reconceptualised in recent years from a
personality disorder to a chronic affective disorder. It is incorporated into
both the DSM and ICD diagnostic systems. METHOD. The members of the WPA
Dysthymia Working Group combined the results of their manual literature searches
with a search using Medline. RESULTS. Available data are summarised under the
headings of classification, epidemiology, validity, comorbidity, course and
outcome, pharmacotherapy and psychotherapy. The coexistence of major depressive
disorder, constituting 'double depression' is of particular importance.
CONCLUSIONS. Improved knowledge of this disorder has led to a more positive
approach to treatment, in which antidepressants can usefully be complemented by
psychosocial measures. A high proportion of cases remain unrecognised in most
populations, leading to prolonged morbidity and distress, much of which is now
treatable.
Publication Types:
Review
Review, Tutorial
PMID: 7728360 [PubMed - indexed for MEDLINE]
Revised 7/26/03