Dysthymia and Antidepressants

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Dysthymia is a chronic condition that lasts at least two years, characterized by depressed mood for more than half of the days a year, but does not meet the criteria for an episode of major depression.

Some patients have the so-called “double depression”, in which episodes of major depression occur against the background of constantly existing dysthymia. In this condition, there may be difficulties in assessing the effectiveness of treatment, because without aggravation, the level of mood corresponds to dysthymia, and not euthymia. Patients with dysthymia usually look sad and depressed. They find it difficult to answer the question when they last felt good. Since the invariably depressed mood becomes almost an integral part of their own self, such patients complain much less about bad mood than patients with major depression. In adulthood, dysthymia is 2 to 3 times more common in women than in men. Its prevalence is 3%, while during life it is detected in 6% of the population. Dysthymia debut usually occurs at children’s, youthful or young age.

Symptoms of dysthymia

Depressed mood (according to subjective feelings or observations of others) most of the day for more than half of the days in a year for at least 2 years.

Note: in children and adolescents, a change in mood may manifest as irritability, and the duration of symptoms must be at least 1 year.

During periods of depressed mood, 2 or more of the symptoms listed below are observed:

  • Poor appetite or overeating
  • Insomnia or Hypersomnia
  • Loss of energy or fatigue
  • Low self-foaming
  • Disturbed concentration or difficulty making decisions
  • Feeling hopeless

For 2 years (in children and adolescents – for 1 year) of the existence of the disorder, the symgtoms listed above were absent for no more than 2 months in a row.

In the first 2 years of the disorder (in children and adolescents in 1 year), there was not a single major depressive episode, i.e. symptoms cannot be better explained by the presence of the chronic form of major depression or major depression in a state of partial remission.

Note: the presence of a previous major depressive episode is allowed, provided that before the appearance of dysthymia there was complete remission (the absence of clinically significant symptoms for at least 2 months). In addition, after 2 years of dysthymia (in children and adolescents – after 1 year), episodes of major depression may occur in its background, and both diagnoses can be made if the symptoms meet the criteria of the Major Depressive Episode.

Manic, mixed or hypomania episodes have never been observed; symptoms do not meet the criteria for shilotymia

Disorder does not occur solely due to the development of a chronic psychotic disorder, such as schizophrenia or delusional disorder

Symptoms are not caused by the direct physiological action of exogenous substances (including addictive substances or drugs) or a general disease (for example, hypothyroidism).

Symptoms cause clinically significant discomfort or impairment of the patient’s life in social, professional or other important areas

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Treatment of dysthymia

Dysthymia is a chronic affective disorder that occurs in 3–6% of the US population. Patients with dysthymia constitute about a third of all patients in psychiatric clinics. In patients with dysthymia, comorbid conditions are often detected: anxiety disorders, dependence on psychotropic substances, major depression. Although only a small number of studies evaluating the effectiveness of pharmacotherapy for dysthymia were conducted, they showed that the drugs used for major depression appear to be effective in treating dysthymia. But an improvement in dysthymia may occur more slowly than with a major depression. Scientists conducted a double-blind, placebo-controlled study of the effectiveness of fluoxetine in dysthymia. After 3 months of treatment, improvement was noted in 58% (42 of 72) patients taking fluoxetine (20 mg / day) and only 36% (11 of 39) patients taking placebo. Among patients who did not initially respond to treatment, about half in the next 3 months after increasing the dose of fluoxetine to 40 mg / day improved. The effectiveness of sertraline and imipramine for dysthymia was confirmed in a large double-blind, placebo-controlled study that included 416 patients with early-onset dysthymia without concomitant major depression. Significant and pronounced improvement (assessed on a scale of total clinical impression of 1 or 2 points) was observed in 64% of patients taking imipramine, in 59% of patients taking sertraline and in 44% of patients taking placebo. There are fewer side effects with SSRIs than with TCAs.