Dystymi

Dystymi (often referred to as dysthymia or persistent depressive disorder) is a chronic mood disorder characterized by a long-lasting, low-grade depressive state. Unlike major depressive episodes, which are typically more severe and episodic, dysthymia involves a persistent depressed mood present for most of the day, more days than not, over an extended period (commonly defined as at least two years in adults). Symptoms are generally milder but more enduring and include decreased appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.

Etiology is multifactorial, involving genetic vulnerability, neurobiological factors, personality traits, and psychosocial stressors such as chronic interpersonal difficulties or prolonged life stress. Comorbidity with anxiety disorders, substance use disorders, and personality disorders is common and can complicate diagnosis and treatment.

Diagnosis is clinical, based on history and symptom duration, and requires exclusion of mood symptoms attributable to medical conditions, medication effects, or bipolar disorder. Treatment typically combines psychotherapy (for example, cognitive-behavioral therapy or interpersonal therapy) with pharmacotherapy when appropriate, especially selective serotonin reuptake inhibitors. Lifestyle measures and social support are adjunctive. Response may be slower than for episodic depression, and long-term management is often needed to prevent relapse or progression to major depressive episodes. Dysthymia is frequently underrecognized and can substantially impair functioning and quality of life.