Persistent depressive disorder

Dysthymia or dysthymic disorder is a form of the mood disorder of depression characterized by a lack of enjoyment/pleasure in life that continues for at least two years. It differs from clinical depression in the severity of the symptoms. While dysthymia usually does not prevent a person from functioning, it prevents full enjoyment of life.

Dysthymia can be considered a paradoxical disorder in that its symptoms are fairly mild on a day-to-day basis, however, over a life time it can be a sever disorder with high rates of suicide, work impairment, and social isolation. Dysthymia typically lasts much longer than an episode of major depression, and outsiders often perceive dysthymic individuals as 'dour' and humorless. When a major depressive episode occurs on top of dysthymia, clinicians may refer to the resultant condition as double depression.

Diagnostic criteria
The DSM-IV-TR characterizes Dysthymic Disorder as a chronic depression, but with less severity than a major depression. The essential symptom is that the individual is depressed almost daily for at least two years, but with out the criteria necessary for a major depression. Low energy, sleep or appetite disturbances and low self-esteem are typically parts of the clinical picture as well. The diagnostic criteria are as follows:


 * 1) On the majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.
 * 2) When depressed, the patient has 2 or more of:
 * 3) Appetite decreased or increased
 * 4) Sleep decreased or increased
 * 5) Fatigue or low energy
 * 6) Poor self-image
 * 7) Reduced concentration or indecisiveness
 * 8) Feels hopeless
 * 9) During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
 * 10) During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
 * 11) The patient has had no Manic, Hypomanic or Mixed Episodes.
 * 12) The patient has never fulfilled criteria for Cyclothymic Disorder.
 * 13) The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
 * 14) The symptoms are not directly caused by a general medical condition or the use of substances, including prescription medications.
 * 15) The symptoms cause clinically important distress or impair work, social or personal functioning.

Treatment
Some people with dysthymia respond to treatment with antidepressant medications. For mild or moderate depression, the American Psychiatric Association in its 2000 Treatment Guidelines for Patients with Major Depressive Disorder advises that psychotherapy alone or in combination with an antidepressant may be appropriate. A 2002 study involving 375 patients found a St John's wort extract effective for treating mild to moderate depression.

Approximately 6% of the population of the United States has dysthymia.

Classical use of the term
The term dysthymia originally referred to a sub-clinical psychotic condition. The Greek roots of the term dysthymia suggest the interpretation: "abnormal or disordered feelings".

Classical dysthymia refers to "feeling" something as a reality which is not a reality, for example "feeling" that one knows what others think - or "understanding" an underlying social dynamic which is not real. This thinking pattern would lead sufferers to see themselves as "prophets" or as "highly intuitive healers". Such people may imagine that they can "feel" underlying hostilities which do not exist.

These people often endure social estrangement because they continually inject disordered judgments, which result from their abnormal "feelings". These disordered feelings and the way that dysthymics may express them within social settings are usually considered intensely strange.

This definition of dysthymia used to cover a broad band of disorders, which may very likely result in anti-social behaviors.