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Diagnostic Criteria Section_Index.

Refer to conditions of use

Dysthymic Disorder

Dysthymic Disorder is characterized by chronic depression, but with less severity than a major depression. The essential symptom for dysthymic disorder is an almost daily depressed mood for at least two years, but without the necessary criteria for a major depression. Low energy, sleep or appetite disturbances and low self-esteem are usually part of the clinical picture as well.  The diagnostic criteria is as follows:

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:

* Appetite decreased or increased
* Sleep decreased or increased
* Fatigue or low energy
* Poor self-image
* Reduced concentration or indecisiveness
* 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.

Specify whether

Early onset, if it begins by age 20

Late onset, if it begins at age 21 or later

The only specifier that can apply is With Atypical Features.

Associated Features 

Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Addiction
Anxious or Fearful or Dependent Personality
Dramatic or Erratic or Antisocial Personality

Differential Diagnosis 

Some disorders have similar or even overlapping symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Psychiatric:

Manic, Mixed, or Hypomanic Episode; Mood Disorder Due to a General Medical Condition; Substance-Induced Mood Disorder; Schizoaffective Disorder; Schizophrenia; Delusional Disorder; Psychotic Disorder Not Otherwise Specified; dementia; Major Depressive Disorder; chronic Psychotic Disorders; coexisting personality disturbance.

Medical:

Organic Mood Syndromes caused by: Acquired Immune Deficiency Syndrome (AIDS), Adrenal (Cushing's or Addison's Diseases), Cancer (especially pancreatic and other GI), Cardiopulmonary disease, Dementias (including Alzheimer's Disease); Epilepsy, Fahr's Syndrome, Huntington's Disease, Hydrocephalus, Hyperaldosteronism, Infections (including HIV and neurosyphilis), Migraines, Mononucleosis, Multiple Sclerosis, Narcolepsy, Neoplasms, Parathyroid Disorders (hyper- and hypo-), Parkinson's Disease, Pneumonia (viral and bacterial), Porphyria, Postpartum, Premenstrual Syndrome, Progressive Supranuclear Palsy, Rheumatoid Arthritis, Sjogren's Arteritis, Sleep Apnea, Stroke, Systemic Lupus Erythematosus, Temporal Arteritis, Trauma, Thyroid Disorders (hypothyroid and "apathetic" hyperthyroidism), Tuberculosis, Uremia (and other renal diseases), Vitamin Deficiencies (B12, C, folate, niacin, thiamine), Wilson's Disease.

Drugs:

Acetazolamine, Alphamethyldopa, Amantadine, Amphetamines, Ampicillin, Azathioprine (AZT), 6-Azauridine, Baclofen, Beta Blockers, Bethanidine, Bleomycin, Bromocriptine, C-Asparaginase, Carbamazepine, Choline, Cimetidine, Clonidine, Clycloserin, Cocaine, Corticosteroids (including ACTH), Cyproheptadine, Danazol, Digitalis, Diphenoxylate, Disulfiram, Ethionamide, Fenfluramine, Griseofulvin, Guanethidine, Hydralazine, Ibuprofen, Indomethacin, Lidocaine, Levodopa, Methoserpidine, Methysergide, Metronidazole, Nalidixic Acid, Neuroleptics (butyrophenones, phenothiazines, oxyindoles), Nitrofurantoin, Opiates, Oral Contraceptives, Phenacetin, Phenytoin, Prazosin, Prednisone, Procainamide, Procyclidine, Quanabenzacetate, Rescinnamine, Reserpine, Sedative/Hypnotics (barbiturates, benzodiazepines, chloral hydrate), Streptomycin, Sulfamethoxazole, Sulfonamides, Tetrabenazine, Tetracycline, Triamcinolone, Trimethoprim, Veratrum, Vincristine.

Mood Disorder Episodes:    |   Major  |  Manic Mixed Hypomanic  |

Cause:

Genetic factors appear to be causative in Cyclothymia as they do in the Bipolar Disorders. Many of those affected have a family history of major depression, bipolar disorder, suicide or alcohol/drug dependence.

Treatment:

Counseling and Psychotherapy [ See Therapy Section ]:

Psychotherapy ( both Group & Individual ) is the treatment for choice for this psychological problem. Often, antidepressant medication is also recommended because of the chronic nature of the depression in dysthymia. Family-centered approaches differ from individual methods in their direct focus on the "role of the sick member" in the family system rather than on the symptoms of the identified patient. Psychotherapy is used to treat this depression in several ways:

* First, supportive counseling can help to ease the pain, and can address the feelings of hopelessness.

* Second, cognitive therapy is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to learn how to accept the life problems that cannot be changed. 

* Third, problem solving therapy is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression. Behavioral therapy can help you to develop better coping skills, and interpersonal therapy can assist in resolving relationship conflicts. 

 

Pharmacotherapy [ See Psychopharmacology Section ] :

Some individuals with dysthymic disorder respond well to anti-depressant medication, in addition to psychotherapy, so an evaluation for medication may be appropriate.

Antidepressant Drugs:

fluoxetine
imipramine

Antianxiety Drugs

amphetamines
barbiturates
benzodiazepines

 

Coding Notes

In children, the abnormal mood may be one of irritability and the time required is only one year.

A Major Depressive Episode may precede Dysthymia if it has remitted for a full two months before Dysthymia begins. Also, Dysthymia may begin first, if it lasts at least two years before the major depression begins. In this case, the two diagnoses may be made together.

After the first two years, Major Depressive Episodes may also be diagnosed with Dysthymic Disorder, if the symptoms are met for both.

See our Mood Disorders Page for links