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Ask the Mental Health Expert Archives 2001-2004

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Occurrence of Dysthymia

Q. Is dysthymia more common in any particular populations? Among teens? Children of divorce? Twins, especially female? What treatment protocols are recommended and how do they differ from treatment of major depression?

A. Dysthymic Disorder (DD) is a chronic form of depression that has a good deal of symptomatic overlap with major depressive disorder. While DD is often thought of as less severe than major depression, it can actually result in greater social and vocational impairment--perhaps because people are less likely to get appropriate treatment for DD than for major depression. Many individuals have superimposed DD and major depression-so-called "double depression".

DD may have either early or late onset. In children, DD occurs about equally in both sexes; in adulthood, women are two to three times more likely to develop DD than are men. Studies of adolescents find rates of DD around 5% (lifetime prevalence by age 17) vs. about 8% in the general population (Whitaker et al, 1990; Renouf & Kovacs, 1995). DD appears to be more common in first-degree relatives of people with major depression than among the general population.

The evidence from twin studies is still preliminary, but there may be a slight increase in the risk of one identical twin to develop DD if his/her co-twin has it. The issue of family discord, divorce, etc. has not been well-studied either, but some older evidence (Akiskal et al, 1981) suggested that chronic depression in young people may be partly related to family discord, divorce, parental separation, etc. (These subjects also had characterological or personality dysfunction, however, and so may not fully represent the DSM-IV diagnosis of DD).

Treatment of DD is still being investigated. For many years, DD was regarded as neurotic in nature, and long-term psychotherapy was regarded as the best treatment-not on the basis of any controlled studies, to my knowledge. In recent years, DD has been shown to respond to antidepressant medication such as fluoxetine (Prozac) or sertraline (Zoloft). Surprisingly, some DD patients will respond to short-term, cognitive or interpersonal forms of psychotherapy, which may be combined with medication in more severe cases.

I think it's too early to say what the best protocol is for DD, but for a very thorough review of DD and chronic depression, I recommend the book Diagnosis and Treatment of Chronic Depression, edited by James Kocsis and Daniel Kline (Guilford, 1995).

March 2001

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