Dysthymia

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**Dysthymia**
*Classification & external resources*
ICD-10	F34.1
ICD-9	300.4

Dysthymia (pronunciation in IPA: [dɪsˈθaɪmɪə or dɪsˈθɪmeə (chiefly British)]) or dysthymic disorder is a form of the mood disorder of depression characterized by a lack of enjoyment/pleasure in life that continues for at least two years. It differs from clinical depression in the severity of the symptoms. Dysthymia can, though it does not always, prevent a person from functioning or affect sleep patterns and daily activities.

Dysthymia may seem a paradoxical disorder in that sufferers exhibit fairly mild symptoms on a day-to-day basis; however, over a lifetime it can have severe effects, such as high rates of suicide, work impairment, and social isolation. The symptoms of patients with dysthymic disorder are not as severe as those associated with major depression, but the duration of these symptoms is much longer. When a major depressive episode occurs on top of dysthymia, clinicians may refer to the resultant condition as double depression.

1 Diagnostic criteria
2 Treatment
3 Classical use of the term
4 Dysthymia in history
5 References
6 Bibliography
7 See also
8 External links

[edit] Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, characterizes Dysthymic disorder as a chronic depression, but with less severity than a major depression. The essential symptom involves the individual feeling depressed almost daily for at least two years, but without the criteria necessary for a major depression. Low energy, disturbances in sleep or in appetite, and low self-esteem typically contribute to the clinical picture as well. Sufferers have often experienced dysthymia for many years before it is diagnosed. People around them come to believe that the sufferer is 'just a moody person.' Note the following diagnostic criteria:

On the majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.
When depressed, the patient has 2 or more of:
1. Appetite decreased or increased
2. Sleep decreased or increased
3. Fatigue or low energy
4. Poor self-image
5. Reduced concentration or indecisiveness
6. Feels hopeless
During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
The patient has had no Manic, Hypomanic or Mixed Episodes.
The patient has never fulfilled criteria for Cyclothymic Disorder.
The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
The symptoms are not directly caused by a general medical condition or the use of substances, including prescription medications.
The symptoms cause clinically important distress or impair work, social or personal functioning.

[edit] Treatment

As with other forms of depression, a number of treatments exist for dysthymia. Doctors most commonly use psychotherapy, including cognitive therapy, to help change the mind-set of the individual affected. Additionally doctors may prescribe a variety of antidepressant medications^[1], with most individuals with dysthymia responding to fluoxetine and imipramine in a positive manner. For mild or moderate depression, the American Psychiatric Association in its 2000 Treatment Guidelines for Patients with Major Depressive Disorder advises psychotherapy alone or in combination with an antidepressant as possibly appropriate.

Evidence is currently inconclusive as to whether St John's wort extract might also prove effective in treating mild to moderate forms of depression such as dysthymia. A 2002 study involving 375 patients with mild to moderate major depression found it effective with side-effects similar to placebo ^[2]. However, a 2006 study involving 150 patients with moderately severe depression found St. John's Wort extract ineffective for the patients for dysthymic individuals.

[edit] Classical use of the term

The term dysthymia originally referred to a sub-clinical psychotic condition, and the Greek roots of the term dysthymia (dys- (abnormal) and thymia) suggest the interpretation: "abnormal or disordered feelings". Classical dysthymia refers to "feeling" something as a reality which is not a reality (for example "feeling" that one knows what others think) - or to "understanding" an underlying social dynamic which is not real. This definition of dysthymia used to cover a broad band of disorders, many of which may very likely result in anti-social behaviors. In ancient times, it was believed that the thymus "gland" was the heart of all emotions, and if one were to be depressed, said person had a "dysfunctional thymus" or "Dysthymia". Dysthymia was not considered a specific disorder, but this name was given to any type of depression in general.

[edit] Dysthymia in history

Dysthymia dates back at least as far as ancient Greek and Roman civilization as recorded in the works of Sophocles and Virgil. Many societal occurrences of dysthymia occur within groups of individuals leading stressful lives. Clinical descriptions of dysthymia date from 1881, when Jean de Caseet-Maneut, a leading physician at that time, investigated the phenomenon in Paris. Records also appear sporadically in medical and psychological journals.

[edit] References

↑ Lima MS, Moncrieff J. "Drugs versus placebo for dysthymia". Cochrane Database Syst Rev. 2000;(4):CD001130. PMID 11034701
↑ Lecrubier et al. "Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial." Am J Psychiatry. 2002 Aug;159(8):1361-6.
↑ C. Randløv, J. Mehlsen, C.F. Thomsen, C. Hedman, H. von Fircks and K. Winther. "The efficacy of St. John's Wort in patients with minor depressive symptoms or dysthymia - a double-blind placebo-controlled study" Phytomedicine. 2006 March;13(4):215-221