Patients suffering from dysthymic disorder have a poor outlook on life and are very pessimistic, with feelings of low self-wealth. They have less dramatic symptoms, when compared with major depressive disorder. The sleep disturbances and neurological symptoms are not as dramatic. Affected individuals may be restless and anxious. These patients also have poor relationships and tend to focus their time and energy to project and work. They have poor social lives and are distant from family members. Many practice substance abuse [7].

• Fatigue

  Individuals who complain of fatigue but do not have diagnosable depression are at a higher risk for developing MDD later in life than individuals who do not complain of fatigue. [ncbi.nlm.nih.gov]

  In addition to the depressive mood the patients suffer from symptoms such as decreased appetite or increased appetite, insomnia or excessive sleepiness, loss of energy or fatigue, low self-esteem, poor concentration, poor decision-making ability and a [dr-elze.com]

  Although all of these physical symptoms would have a debilitating affect on the sufferers life, fatigue appears to be the major cause of these problems. [dnet.org.au]

  During periods of depressed mood, at least 2 of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings [icd9data.com]

• Weight Gain

  Weight gain is a well known side effect of olanzapine; the average difference in weight gain compared to antidepressant treatment lay around 4 kg within eight weeks, reported by two short‐term studies. [doi.org]

  gain, and dizziness. 12 The most frequently reported side effects for selective serotonin reuptake inhibitors (SSRIs) were dry mouth, profuse sweating, sexual dysfunction, and weight gain. 12 Two recent reviews of research in this area concluded that [ncbi.nlm.nih.gov]

  Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder. [nimh.nih.gov]

  Common adverse effects included withdrawal effects (73.5%), sexual problems (71.8%), and weight gain (65.3%). Adverse emotional effects, such as feeling emotionally numb (64.5%) and addicted (43%), were also common. [dx.doi.org]

• Weakness

  Based on effective outcomes in previous studies using fluoxetine (a 5-HT reuptake inhibitor) and ritanserin (a 5-HT2A antagonist), it was hypothesized that nefazodone, which is both a serotonin (5-HT) reuptake inhibitor (rather weak) and a 5-HT2A receptor [ncbi.nlm.nih.gov]

  It can affect and disrupt eating, sleeping, or thinking patterns, and is not the same as being unhappy or in a "blue" mood, nor is it a sign of personal weakness or a condition that can be willed or wished away. [childrensnational.org]

  It will also help you understand that it’s not your fault or a sign of weakness that you struggle with depression. Find a type of exercise you enjoy and do it consistently, even if you don’t feel like it. [promisesbehavioralhealth.com]

• Weight Loss

  […] slowed down" Difficulty concentrating, remembering, making decisions Insomnia, early-morning awakening, or oversleeping Appetite and/or weight loss or overeating and weight gain Thoughts of death or suicide; suicide attempts Restlessness, irritability [alternativedepressiontherapy.com]

  loss or gain, eating problems Symptoms present for over two years Differences by Gender Dysthymia in Women Women are diagnosed with dysthymic disorder at two to three times the rate as men. [depressedtest.com]

  Common antidepressant side effects include sleep disturbance, weight loss or gain, problems with sexual performance or decreased libido, and dry mouth. [promisesbehavioralhealth.com]

• Fever

  When I was a child I had a FEVER. My hands felt just like two balloons. Now I've got that feeling once again I can't explain, you would not understand This is not how I am. I have become comfortably numb. [healthcentral.com]

  Patients with unstable medical conditions, such as acute hyperthyroidism, uncorrected hypothyroidism, undiagnosed fever, uncontrolled angina, or any other serious medical illness, including any cardiovascular, hepatic, respiratory, hematological, endocrinologic [clinicaltrials.gov]

• Dyspnea

  See Also: dysphonia dysphoria dysplasia dyspnea dyspnoea dyspraxia dysprosium dysrhythmia dysteleology dysthymia dysthymic disorder dystonia dystopia dystrophic dystrophication dystrophy dysuria Dyushambe DZ dz. [wordreference.com]

• Overeating

  Nonetheless, the distinction between chronic and nonchronic forms of depression was relatively stable over the follow-up period. [ncbi.nlm.nih.gov]

  From Wikidata Jump to navigation Jump to search mood disorder that involves the presence of a low mood almost daily over a span of at least two years dysthymia persistent depressive disorder neurotic depression depressive neurosis persistent anxiety depression [wikidata.org]

• Increased Appetite

  In addition to the depressive mood the patients suffer from symptoms such as decreased appetite or increased appetite, insomnia or excessive sleepiness, loss of energy or fatigue, low self-esteem, poor concentration, poor decision-making ability and a [dr-elze.com]

  Sleeping problems (decreased or increased sleep). Eating problems decreased or increased appetite). Avoiding social activities or events. Diagnosing Dysthymic disorder (DSM-IV). A. [barendspsychology.com]

  When depressed, the patient has two or more of: decreased or increased appetite decreased or increased sleep (insomnia or hypersomnia) Fatigue or low energy Reduced self-esteem Decreased concentration or problems making decisions Feelings of hopelessness [en.wikipedia.org]

• Nausea

  As expected, in the amisulpride group endocrine-like adverse events in female patients were the most common, while nausea, dyspepsia, anorexia and insomnia occurred more frequently with fluoxetine. [ncbi.nlm.nih.gov]

  Some of the common symptoms of drug and alcohol withdrawal include: Agitation and panic Heavy sweating Inability to focus and concentrate Sleeplessness Racing heart rate High blood pressure Pounding headaches Nausea and vomiting Muscle aches and spasms [altamirarecovery.com]

  […] discontinuation syndrome, also called antidepressant withdrawal syndrome, is a condition that can occur following the interruption, reduction, or discontinuation of antidepressant medication.[97] The symptoms may include flu-like symptoms, trouble sleeping, nausea [en.wikipedia.org]

• Loss of Appetite

  Changes in Physical Well-being Chronic fatigue, loss of appetite, slowing down and aches and pains are all extremely common physical aspects of Dysthymic Disorder. [dnet.org.au]

  (E.g.,Hard time concentrating, Hard time in making decisions) Loss of appetite or overeating. Low levels of energy or fatigue. Low self-esteem. Problems with sleep.(E.g.,Insomnia,Hypersomnia) 3. [psyweb.com]

  There is a marked drop in mood accompanied by severe symptoms that may include: Hopelessness Insomnia or sleeping too much Thoughts of suicide or death Low self-esteem Loss of appetite or overeating Poor concentration Loss of interest in things that the [webmd.com]

  In major depression, mood drops markedly, and is usually accompanied by poor sleep, loss of appetite, weight loss, hopelessness, and often with suicidal ideas. [depressionny.com]

• Constipation

  […] period. 12 The researchers used a 12-item shortened version of the Antidepressant Side-Effect Checklist that included insomnia, sleepiness during the day, restlessness, muscle spasms/twitching, dry mouth, profuse sweating, sexual disorders, nausea, constipation [ncbi.nlm.nih.gov]

• Low Self-Esteem

  In addition to the depressive mood the patients suffer from symptoms such as decreased appetite or increased appetite, insomnia or excessive sleepiness, loss of energy or fatigue, low self-esteem, poor concentration, poor decision-making ability and a [dr-elze.com]

  Associated symptoms include poor appetite or overeating, insomnia or hypersomnia, poor concentration or difficulty making decisions, low energy, low self-esteem and feelings of hopelessness. [ncbi.nlm.nih.gov]

  You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. [mayoclinic.org]

  During periods of depressed mood, at least 2 of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings [icd9data.com]

• Anxiety Disorder

  The estimated recovery rate from anxiety disorders was 53.8%. Only five of the comorbid patients recovered from both dysthymic disorder and all anxiety disorders during follow-up. [ncbi.nlm.nih.gov]

• Anhedonia

  Adolescents showed more suicidal thoughts and anhedonia than children. [ncbi.nlm.nih.gov]

  Anhedonia and physical symptoms are not part of the definition, but this personality disorder otherwise has a great deal in common with dysthymia. [health.harvard.edu]

• Indecisiveness

  […] sadness or unexplained crying spells Significant changes in appetite and sleep patterns Irritability, anger, worry, agitation, anxiety Pessimism, indifference Loss of energy, persistent lethargy Feelings of guilt, worthlessness Inability to concentrate, indecisiveness [dbsalliance.org]

  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 [psychnet-uk.com]

  These symptoms include: persistent feelings of sadness and hopelessness sleep problems low energy a change in appetite difficulty concentrating indecisiveness a lack of interest in daily activities decreased productivity poor self-esteem a negative attitude [healthline.com]

  People suffering from dysthymic disorder may describe to their doctor feelings of hopelessness, lowered self-esteem, poor concentration, indecisiveness, decreased motivation, sleeping too much or too little, or eating too much or too little. [minddisorders.com]

• Suicidal Ideation

  The purpose of the current study was to examine differences in suicidal ideation, clinician-rated suicide risk, suicide attempts, and family history of suicide in a sample of outpatients diagnosed with various forms of depressive illness. [ncbi.nlm.nih.gov]

  Treatment for Dysthymia Because the symptoms of dysthymia may be less pronounced than the overwhelming depression and suicidal ideation that often characterizes major depression, the condition can sometimes progress significantly before treatment is sought [goodtherapy.org]

  When major depressive disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer somatic health, worse interpersonal and work functioning, and an increased risk for persistent [pro.psychcentral.com]

  Before psychotherapy beings, a mental health professional will conduct a thorough evaluation to evaluate the individual’s current state of functioning, to assess mood type and severity, check for suicidal ideation and plan, etc. [psychcentral.com]

• Irritability

  In children, dysthymia may present as irritable mood, and a duration of symptoms of only one year is required to make the diagnosis. By definition, there is no history of a major depressive disorder. [ncbi.nlm.nih.gov]

  […] years and cannot be without symptoms >2 months at a time.3 Also, the patient cannot have met criteria for a major depressive episode during the first 2 years or have ever met criteria for a manic, mixed, or hypo manic episode.3 In children, mood may be irritable [mdedge.com]

  This can present itself as lack of motivation, irritability, anhedonia, insomnia, hypersomnia etc. The most important distinction I want to make today is that when this occurs in children, it may look more like ADD or ADHD. [youtube.com]

  PDD: What to Look For A child with persistent depressive disorder appears to be irritable, moody, sad or pessimistic over a long period of time. [childmind.org]

  NOTE: In children and adolescents, mood can be irritable and duration must be at least 1 year. The individual must have been depressed for at least 22 months during the past 2 years. [courses.lumenlearning.com]

• Insomnia

  In addition to the depressive mood the patients suffer from symptoms such as decreased appetite or increased appetite, insomnia or excessive sleepiness, loss of energy or fatigue, low self-esteem, poor concentration, poor decision-making ability and a [dr-elze.com]

  Associated symptoms include poor appetite or overeating, insomnia or hypersomnia, poor concentration or difficulty making decisions, low energy, low self-esteem and feelings of hopelessness. [ncbi.nlm.nih.gov]

  During periods of depressed mood, at least 2 of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings [icd9data.com]

  In addition, the individual must experience at least two of the following six depressive symptoms: (1) low self‐esteem, (2) feelings of hopelessness, (3) low energy or fatigue, (4) difficulty concentrating or making decisions, (5) sleep disturbance (insomnia [onlinelibrary.wiley.com]

• Headache

  Side effects were reported by eight subjects (38.1%), and the most frequently reported effects were headache, decreased appetite, insomnia, gastrointestinal problems, restlessness, and tremulousness. [ncbi.nlm.nih.gov]

  Symptoms can include Feeling sad or "empty" Loss of interest in favorite activities Overeating, or not wanting to eat at all Not being able to sleep, or sleeping too much Feeling very tired Feeling hopeless, irritable, anxious, or guilty Aches or pains, headaches [icdlist.com]

  Insomnia, early-morning awakening, or oversleeping Appetite and/or weight loss or overeating and weight gain Thoughts of death or suicide; suicide attempts Restlessness, irritability Persistent physical symptoms that do not respond to treatment, such as headaches [alternativedepressiontherapy.com]

  […] insomnia or hypersomnia) Changes in appetite or weight Decreased energy Difficulty concentrating Irritability, hostility, aggression A decrease in the ability to make decisions Suicidal thoughts or attempts Frequent physical complaints (for example, headache [childrensnational.org]

• Sleep Disturbance

  They have less dramatic symptoms such as mild sleep disturbance as compared to major depression. They are also at risk of suicide. [symptoma.com]

  To save this word, you'll need to log in. dys·thy·mia | \ dis-ˈthī-mē-ə \ : a mood disorder characterized by chronic mildly depressed or irritable mood often accompanied by other symptoms (such as eating and sleeping disturbances, fatigue, and poor self-esteem [merriam-webster.com]

  […] or sleeping too much), and (6) appetite disturbance (poor appetite or overeating). [onlinelibrary.wiley.com]

  I began to treat the sleep disturbance component in the late 1970s. [orthomolecular.org]

  Symptoms may include: Persistent feelings of sadness Feeling hopeless or helpless Having low self-esteem Feeling inadequate Excessive guilt Feelings of wanting to die Difficulty with relationships Sleep disturbances (for example, insomnia or hypersomnia [childrensnational.org]

• Difficulty Concentrating

  In addition, the individual must experience at least two of the following six depressive symptoms: (1) low self‐esteem, (2) feelings of hopelessness, (3) low energy or fatigue, (4) difficulty concentrating or making decisions, (5) sleep disturbance (insomnia [onlinelibrary.wiley.com]

  These symptoms included: Either poor appetite or eating too much Sleep difficulties Fatigue Low self-esteem Difficulty concentrating or making decisions Feelings of hopelessness Diagnosis There was and still is no laboratory test available for diagnosing [depression.about.com]

  Besides the time criteria, the patient must also exhibit at least two of the following symptoms regularly: poor appetite or overeating, low energy or fatigue, difficulty concentrating, impairments in both judgment and decision making, feelings of hopelessness [healthguidance.org]

  anxious, or "empty" mood Feelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessness Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex Decreased energy, fatigue, being "slowed down" Difficulty [alternativedepressiontherapy.com]

  Changes in appetite or weight Decreased energy Difficulty concentrating Irritability, hostility, aggression A decrease in the ability to make decisions Suicidal thoughts or attempts Frequent physical complaints (for example, headache, stomachache, or [childrensnational.org]

It is important to rule out organic and possible medical causes, such as thyroid disorders and nutrient deficiencies such as vitamin B12 or folate. Other conditions such as chronic diseases have to be addressed. There are some experimental imaging studies with functional magnetic resonance imaging, but this is not routine.

First of all, treatment goals have to be made. The major being to put the patient into remission, and prevent relapse. A combination of psychotherapy and medication is usually an effective treatment.

Medications include second generation antidepressants, these include:

• Serotonin modulators
• Serotonin-norepinephrine reuptake inhibitors
• Selective serotonin reuptake inhibitors

Other drugs such as

• Tricyclic antidepressants
• Monoamine oxidase inhibitors (MAOIs)

may also be used. Other modalities such as exercise 4 to 6 times a week is helpful. Those deemed dangerous to themselves (suicidal) or others will require inpatient care until they are deemed safe [8] [9] [10].

The chance of remission is dependent on a number of factors, such as associated risk factors; genetic, social and so forth. It has been noted that patients with certain traits have a poorer prognosis, such as chronic stress and anxiety disorders. There is a risk that some patients may worsen into a major depressive state which has a worse prognosis. These patients are also at increased risk of employment and relationship issues. There is a significant risk of suicide as compared to the rest of the population [5] [6].

The etiology is not clear but most it is likely to be a multifactorial. These factors may include a family history, with genetic factors, underlying medical problems (particularly chronic medical conditions) and social/economic stressors. Underlying personality disorders may also contribute such as antisocial, dependent and depressive traits.

Lifetime risks of this order may reach as high as 25%. Over 35% of mental health patients have this diagnosis [3]. There is a female predominance with women being twice more likely to suffer from this disorder.

There are a number of theories, but the prevailing one states that there are abnormalities in the noradrenergic and serotonin neurotransmitters. This has been suggested due to the response to treatment with serotonin/norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitor and tricyclic antidepressants.

It has been noted that in a subset of depressed and dysthymic patients shows elevated levels of cortisol associated with increased production of corticotrophin-releasing factor from the hypothalamus and perhaps other brain regions. This chronic levels cause damage to the hippocampal regions with loss of their inhibitory effect on the hypothalamic-pituitary-adrenal axis, with more production of cortisol.

Genetic factors have been found, but not yet confirmed, hence the family history being contributory [4].

Good social support systems and a healthy life style are protective, but there is little date to show this.

Dysthymic disorder, also called dysthymia or neurotic depression, is a common mood disorder. By definition the condition has to have been present for a minimum of two years in adults and one year in children. For the diagnosis to be made the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria have to be meet.

The DSM-V requires:

• Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least two years (In children it one year).
• Presence of two or more of the following while depressed:

1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness

• During the two year period the patient must have not gone for more than two months without the symptoms.
• There has never been a manic episode. 
• The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
• The symptoms are not attributable to the physiological effects of a substance (a drug of abuse, a medication) or another medical condition.
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning [1] [2].

• Definition: Dysthymic disorder is a medical condition that causes psychological symptoms. This condition may considered as a milder form of major depression, as it has less dramatic symptoms. The condition has to be there for a minimum of two years in adults and one year in children.
• Cause: There are many suggested causes of this disorder with chronic stress and chronic medical conditions putting your at risk. Also poor coping mechanisms may also be a significant factor. There also appear to be a strong familial links, which may be related to genetics, but no gene has been implicated to date.
• Symptoms: Patients tend to be gloomy and have a negative outlook on the future. They tend to be withdrawn and focus their time and energy to work rather than relationships and family. They have less dramatic symptoms such as mild sleep disturbance as compared to major depression. They are also at risk of suicide.
• Diagnosis: The doctor has to rule out medical conditions such as thyroid disorders, but the diagnosis is made on the basis of clinical grounds. There are specific criteria that has to be meet. Other test for medical conditions may have to be done.
• Treatment: This will include psychotherapy and antidepressant medications. The psychotherapy will include cognitive behavioural therapy and coping techniques. Exercise and a healthy living have been noted to be beneficial.

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013
2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197.
3. Eaton WW, Shao H, Nestadt G, et al. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry 2008; 65:513.
4. Wallace RJ Jr, Griffith DE. Antimycobacterial agents. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012:946
5. Shankman SA, Klein DN. The impact of comorbid anxiety disorders on the course of dysthymic disorder: a 5-year prospective longitudinal study. J Affect Disord. Jul 2002;70(2):211-7
6. Hermens ML, van Hout HP, Terluin B, van der Windt DA, Beekman AT, et al. The prognosis of minor depression in the general population: a systematic review. Gen Hosp Psychiatry. Nov-Dec 2004;26(6):453-62.
7. Casement MD, Shestyuk AY, Best JL, Casas BR, Glezer A, Segundo MA, et al. Anticipation of affect in dysthymia: behavioral and neurophysiological indicators. Biol Psychol. Feb 2008;77(2):197-204
8. Markowitz JC, Kocsis JH, Bleiberg KL, Christos PJ, Sacks M. A comparative trial of psychotherapy and pharmacotherapy for "pure" dysthymic patients. J Affect Disord. Dec 2005;89
9. American Psychiatric Association: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition, 2010. 
10. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, third edition. Am J Psychiatry 2010; 167 (supplement):1.