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ErkkiIsometsä

Chronic Depression (Dysthymia)

Dysthymia is a form of mild but chronic (> 2 years) depressive disorder.
Treatment of dysthymia helps to prevent long-term decrease in functional ability and later actual depressive episodes (F32-33) Treatment of Depression in Association with other Psychiatric Disorders, which are common in these patients.
Psychotherapy and antidepressive medication are useful in the treatment of dysthymia.

Dysthymia often precedes actual depressive episodes that manifest later, after several years.
The prevalence of chronic depressive disorder is about 2%. Women have a higher prevalence than men.
Comorbidity is very often seen with dysthymia and anxiety disorder, personality disorders, substance abuse and, in young female patients, also eating disorders (see also Treatment of Depression in Association with other Psychiatric Disorders) are often seen.

Half of the patients have their first symptoms before the age of 25.
When the symptoms begin at a young age, the patient may consider them as a natural part of life and may not seek help for years.
Try to distinguish dysthymia from a situation where the patient has previously had one or several depressive episodes from which he/she has recovered only partially and the sequelae have become chronic.

Depressive mood most of the time for at least 2 years so that symptomless episodes have lasted at most a few weeks.
In addition to a depressed mood, the patient has at least 3 of the following symptoms:
- reduced activity and resources
- insomnia
- reduced self-esteem, or feelings of insufficiency
- difficulty in concentrating
- frequent tearfulness
- ability to enjoy sex or other activities that give pleasure has reduced, or interest in them is missing
- feeling of hopelessness
- feeling that coping with daily life is too much
- pessimistic thoughts about the past or continued grieving over the past
- avoidance of social contacts
- taciturnity compared to normal.

In distinction from depression (F32-F33) the symptoms of dysthymia are present most of the time and clear separate periods of disease do not exist. Actual depressive episodes may appear during later follow-up.
Dysthymia often causes deterioration of functional ability because of its long-lasting nature. Working capacity is often decreased.

See also Planning the Treatment of Patients with Depression.
Around half of the patients benefit from long-term (> 6 months) treatment with antidepressive medication. If drug therapy is clearly beneficial, long-term medication lasting up to years is usually worthwhile. Short-term medication usually only leads to recurrence of symptoms after the treatment period.
Most of the patients need a stable, supportive treatment relationship.
Psychotherapies that are commonly used in the treatment of depression have proved to be beneficial to dysthymia patients.
- The benefit of very short interventions may, however, remain minor, because the symptoms have continued for years and psychotherapeutic work requires more time. The chronicity of symptoms should be taken into account in the treatment.
- CBASP (Cognitive Behavioral Analysis System of Psychotherapy), a form of cognitive therapy tailored for chronic depression, is also suitable for treating dysthymia.

Schramm E, Klein DN, Elsaesser M et al. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry 2020;7(9):801-812. [PubMed]