DDysthymic Disorder: Who Cares?
Dysthymic disorder, or low-grade chronic
depression, is a paradoxical condition. It is common, seen among
3 to 5% of the general population. On a day to day basis it is a mild
condition, but in the words of one researcher, on a long-term basis,
"it is severe." When followed over time, people with dysthymic
disorder actually have higher risks of suicide attempts, psychiatric
hospitalizations, and other poor outcomes than individuals who present
with episodes of more severe 'major' depression. Not only that, a
person who has dysthymic disorder is at very high risk of developing
more severe episodes of depression: in one study, over 3/4 of
dysthymics developed major depression within five years.
Dysthymic disorder has been in general
neglected; in the entire world literature there are fewer than 20
published double-blind placebo controlled studies of treatment for
DD. Nevertheless, a number of medication and psychotherapy
approaches have been found to be successful, at least in short-term
treatment. There is a need for more research in order to better
understand how to treat dysthymic disorder, why it occurs, and how to
prevent the progression to major depression. Beyond that there is a
need for significant progress in basic neurobiological studies to
understand the causes of this disorder.
Of
note, the DSM-5 has recategorized dysthymic disorder within a new
category of Persistent Depressive Disorder (PDD), which also includes
chronic major depression and other forms of chronic depression. The
reason for this recategorization is that studies have indicated that the
different forms of chronic depression have much in common, in their
effects on people's lives, in their genetics and neurobiology and
response to treatment. All forms of PDD are associated with significant
impairment in quality of life, work productivity, and a wide range of
health outcomes.
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