Common Mental Disorders Depression - New Zealand Doctor

Dysthymia
Dysthymia is a chronic lowering of mood that does not fulfil the criteria for recurrent
depressive disorder in terms of either severity or duration of individual episodes. There
are variable phases of minor depression and comparative normality. Despite tiredness,
feeling down and not enjoying very much, people with dysthymia are usually able to
cope with everyday life. 65 DSM criteria for dysthymia in adults require a duration of at
least 2 years. 255
The management of dysthymia is discussed briefly in the Royal Australian and
New Zealand College of Psychiatrists’ clinical practice guidelines for depression,
at: http://www.ranzcp.org/pdffiles/cpgs/Depression%20Clinican%20Full.pdf
Further information given below is derived from the relevant sections of two guidelines
and a Cochrane systematic review.
No guidelines were found specifically on the management of dysthymia. The information
below derives from the relevant sections of two guidelines and a Cochrane systematic
review.
beyondblue Guideline
Treat dysthymia as for moderate depression with an antidepressant or one of the brief
psychological therapies. Monitor for side effects (at least twice a week by telephone)
and encourage compliance with the selected treatment. If after 6–8 weeks symptoms
still persist, consider changing to a second- or third-line treatment option. 529
National Guidelines for Seniors’ Mental Health, Canada –
applies to older adults
People with dysthymic disorder should be treated with pharmacological therapy,
with or without psychotherapy, with periodic reassessment to measure response. [B] 510
In specific clinical situations, for example where patients do not wish to take
antidepressants, psychotherapy may be used alone with periodic reassessment
to measure response. 510
Lima 2005
A Cochrane review of pharmacotherapy for dysthymia 579 found that antidepressants
are effective in the treatment of dysthymia with no differences between and within drug
classes. Tricyclic antidepressants are more likely to cause adverse events and dropouts.
There is little information on quality of life and medium- or long-term outcome.
146
Identification of Common Mental Disorders and Management of Depression in Primary Care