Dysthymic disorder (also known as persistent depressive disorder) is a mood disorder that is part of the depressive spectrum. The World Health Organisation (WHO) estimates that major depressive mood disorders are the 11th greatest cause of disability worldwide.
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 .
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:
Other drugs such as
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   .
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  .
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 . 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 .
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: