From the Guidelines
Dysthymia, now officially called Persistent Depressive Disorder (PDD), should be treated with a combination of psychotherapy and medication, prioritizing selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) to improve symptoms and quality of life. The treatment approach for dysthymia can be characterized by three phases: acute, continuation, and maintenance, similar to major depressive disorder 1. Dysthymia is a chronic form of depression with symptoms lasting for at least two years in adults, affecting approximately 3-6% of the general population and causing significant functional impairment in daily activities, work performance, and relationships. Key treatment components include:
- Medications: SSRIs such as sertraline (50-200 mg daily), fluoxetine (20-80 mg daily), or escitalopram (10-20 mg daily) as first-line options
- Psychotherapy: CBT and interpersonal therapy as equally important components of treatment
- Lifestyle modifications: Regular exercise, adequate sleep, stress management techniques, and social connection to improve symptoms Unlike major depressive disorder, dysthymia symptoms are less severe but more persistent, often leading people to believe their chronic low mood is part of their personality. Treatment typically needs to be continued for at least 2-3 years after symptom remission to prevent relapse, as dysthymia has a high recurrence rate without adequate maintenance therapy, as suggested by the phases of treatment outlined in the guideline from the American College of Physicians 1.
From the Research
Definition and Characteristics of Dysthymia
- Dysthymia is a chronic mood disorder that persists for at least two years in adults, and one year in adolescents and children 2.
- It is characterized by very mild but continuous chronic depressive symptoms, with a quality of symptoms similar to episodic depressive disorders, but not fulfilling the severity criteria for major depression 3.
- Dysthymia can be classified into two subtypes: early-onset, when it begins before 21 years-old, and late onset Dysthymia, when it starts after this age 2.
Etiology and Risk Factors
- The etiology of Dysthymia is complex and multifactorial, involving biological, psychological, and social factors 2, 4.
- Genetic hypothesis and environmental factors, as well as an aminergic hypothesis suggesting a deficiency in serotonin, norepinephrine, and dopamine in the central nervous system, are proposed to explain the etiology of Dysthymia 2, 4.
- Chronic stressor experiences or stressors encountered early in life may lead to the development of the dysthymic state 4.
Treatment and Management
- Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), are proven to be effective in the treatment of dysthymia, with no significant difference in effectiveness between the two types of drugs 3, 5.
- Psychotherapy, such as behavior therapy, is also effective and should be prescribed in combination or alone, especially if a patient refuses to take drugs 3.
- A prophylactic treatment for 2 years is recommended, with the dose of antidepressants in the therapeutic range for treatment of major depression 3.
- A tailored, modular approach to treatment, accommodating the multifaceted nature of dysthymia, is proposed, including new developments in psychotherapy and pharmacotherapy 6.
Clinical Implications and Quality of Life
- Dysthymia is a distinct entity, characterized by a chronic depressive disorder that could persist throughout life, with important repercussions on the life quality of both patients and families 2.
- It can be difficult to detect in psychiatric and primary care settings until it intensifies in the form of a superimposed major depressive episode 6.
- The quality of life of patients with dysthymia can be severely impacted, with symptoms such as poor awareness of self-mood, negative thinking, low self-esteem, and low energy for social and family activities 2.