Fast Five Quiz: Are You Familiar With These Conditions Associated With Depression?

Stephen Soreff, MD

Disclosures

December 16, 2019

In the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), persistent depressive disorder (dysthymia) represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder. Persistent depressive disorder is a depressive mood disorder characterized by a chronic course and an early and insidious onset (ie, in childhood, adolescence, or early adulthood). Early onset (ie, before age 21) is associated with higher risk for comorbid personality disorders and substance use disorders.

The primary feature of persistent depressive disorder is the presence of depressed mood on most days for at least 2 years for adults (at least 1 year for children and adolescents). During this period, individuals are depression-free for no longer than 2 months at a time.

Although not as severe as those of major depression, symptoms of persistent depressive disorder also include the presence of two (or more) of the following:

  • Feelings of hopelessness

  • Low self-esteem

  • Low energy or fatigue

  • Poor appetite or overeating

  • Difficulty with concentration and decision-making

  • Difficulty falling/staying asleep (insomnia) or sleeping too much (hypersomnia)

Individuals with persistent depressive disorder often maintain a negative view of themselves, their future, others around them, and general life events.

Success in solving interpersonal conflicts through IPT is associated with improved symptoms of dysthymia. IPT is a structured, time-limited treatment, focusing on a patient's current problems and issues in the interpersonal context in which they occur.

Because of the chronic nature of dysthymia, long-term pharmacologic treatment is also often advisable. In cases wherein an antidepressant loses its effectiveness, another agent should be considered. Although the older antidepressants, such as MAOIs and TCAs, are effective, SSRIs are the medications most commonly used for dysthymia. Given that dysthymia is a chronic condition, tolerability is an important factor in achieving long-term patient adherence.

Psychotherapy and medication management are effective treatment modalities for dysthymia, and combination treatment is common. Regarding efficacy of combination psychotherapy and pharmacotherapy, minimal data are available; however, combined medication and IPT have been associated with positive results compared with IPT, brief supportive psychotherapy, or sertraline treatment alone.

For more on the treatment of dysthymia, read here.

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