Dysthymic disorder: Current status and future directions

Current Opinion in Psychiatry

Volumn 13, Issue 2, 2000, Pages 171-177

  Klein, Daniel N ^a   Hayden, Elizabeth P ^a  

^a STONY BROOK UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIDEPRESSANT AGENT; NEFAZODONE; THYROXINE;

CLINICAL FEATURE; DEPRESSION; DISEASE CLASSIFICATION; DISEASE COURSE; HUMAN; PSYCHOTHERAPY; REVIEW;

EID: 0034107365     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-200003000-00006     Document Type: Review

References (85)

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2. 2 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994.
3. 3 Keller MB, Shapiro RW. Double depression: superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry 1982; 139:438-442.
4. 4 World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
5. 5 Akiskal HS. Dysthymic disorder: psychopathology of proposed chronic depressive subtypes. Am J Psychiatry 1983; 140:11-20.
6. 6 Kocsis JH, Francis AJ. A critical discussion of DSM-III dysthymic disorder. Am J Psychiatry 1987; 144:1534-1542.
7. 7 Kelter MB, Klein DN, Hirschfeld RMA, Kocsis JH, McCullough JP, Miller I, et al. Results of the DSM-IV mood disorders field trial. Am J Psychiatry 1995; 152:843-849.
8. 8 Horwath E, Johnson J, Klerman GL, Weissman MM. Depressive symptoms as relative and attributable risk factors for first-onset major depression. Arch Gen Psychiatry 1992; 49:817-823.
9. 9 Kovacs M, Akiskal HS, Gatsonis C, Parrone PL. Childhood-onset dysthymic disorder: clinical features and prospective naturalistic outcome. Arch Gen Psychiatry 1994; 51:365-374.
10. 10 Klein DN, Norden KA, Ferro T, Leader JB, Kasch KL, Klein LM, et al. Thirty-month naturalistic follow-up study of early-onset dysthymic disorder: course, diagnostic stability, and prediction of outcome. J Abnorm Psychol 1998; 107:338-348. This is one of the few prospective, longitudinal studies of dysthymic disorder available. It provides important information about the naturalistic course of the disorder, and also addresses the issues of diagnostic stability, prognostic factors, and mental health services utilization.
11. 11 Klein DN, Kocsis JH, McCullough JP, Holzer CE, Hirschfeld RMA, Keller MB. Symptomatology in dysthymic and major depressive disorder. Psychiatr Clin North Am 1996; 19:41-53.
12. 12 Goodman DW, Goldstein RB, Adams PB, Horwath E, Sobin C, Wickramaratne P, Weissman MM. Relationship between dysthymia and major depression: an analysis of family study data. Depression 1994/95; 2:252-258.
13. 13 Klein DN, Riso LP, Donaldson SK, Schwartz JE, Anderson RL, Ouimette PC, et al. Family study of early-onset dysthymia: mood and personality disorders in relatives of outpatients with dysthymia and major episodic depression and normal controls. Arch Gen Psychiatry 1995; 52:487-496.
14. 14 Harrison WM, Stewart JW. Pharmacotherapy of dysthymic disorder. In: Diagnosis and treatment of chronic depression. Kocsis JH, Klein DN (editors). New York: Guilford Press; 1995. pp. 124-145.
15. 15 Garyfallos G, Adamopoulou A, Karastergiou A, Voikli M, Sotiropoulou A, Donias S, et al. Personality disorders in dysthymia and major depression. Acta Psychiatr Scand 1999; 99:332-340. This study, addressing the controversial issue of the relationship between dysthymia and Axis II disorders, is unique in its large sample size and its consideration of dysthymic subgroups (e.g. early versus late onset), with findings of both clinical and theoretical significance.
16. 16 Klein DN, Taylor EB, Dickstein S, Harding K. Primary early-onset dysthymia: comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental character-istics and short-term outcome. J Abnorm Psychol 1988; 97:387-398.
17. 17 Klein DN, Schatzberg AF, McCullough JP, Keller MB, Dowling F, Goodman D, et al. Early versus late-onset dysthymic disorder: comparison in outpatients with superimposed major depressive episodes. J Affect Disord 1999; 52:187-196. Validating the distinction between early and late-onset dysthymia, group differences were found in rates of substance abuse, personality disorders, and family history of affective disorders. These findings suggest that the early-onset type may be a qualitatively distinct or quantitatively more severe subgroup.
18. 18 Brunnello N, Akiskal H, Boyer P, Gessa GL, Howland RH, Langer SZ, et al. Dysthymia: clinical picture, extent of overlap with chronic fatigue syndrome, neuropharmacological considerations, and new therapeutic vistas. J Affect Disord 1999; 52:275-290. This is an interesting review of clinical, psychobiological, and neuropharmacological data and theory in dysthymic disorder. The authors also discuss the difficult question of the relationship between dysthymia and chronic fatigue syndrome.
19. 19 Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998; 55:694-700. This study is an important contribution to the literature, examining the fluctuations in subclinical depressive symptomatology between episodes, and increasing our understanding of the complexity of the long-term course of major depression.
20. 20 Thase ME, Fava M, Halbreich U, Kocsis JH, Koran L, Davidson J, et al. A placebo-controlled, randomized clinical trial comparing sertraline and imipramine for the treatment of dysthymia. Arch Gen Psychiatry 1996; 53:777-784.
21. 21 McCullough JP, Klein DN, Keller MB, Holzer CE, Davis SM, Kornstein SG, et al. Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): a study of the validity and value of differential diagnosis. J Abnorm Psychol 1999; (in press).
22. 22 Markowitz JC, Moran ME, Kocsis JH, Frances AJ. Prevalence and comorbidity of dysthymic disorder among psychiatric outpatients. J Affect Disord 1992; 24:63-71.
23. 23 Eames SL, Westermeyer J, Crosby RD. Substance use and abuse among patients with comorbid dysthymia and substance disorder. Am J Drug Alcohol Abuse 1998; 24:541-550. An intriguing look at the selectivity of substance use and patterns of usage in a sample of substance abusers with comorbid dysthymia.
24. 24 Westermeyer J, Eames SL, Nugent S. Comorbid dysthymia and substance disorder: treatment history and cost. Am J Psychiatry 1998; 155:1556-1560. This paper compares the treatment history and costs of a relatively understudied group - dysthymics with comorbid substance abuse - to non-dysthymic substance abusers.
25. 25 Pepper CM, Klein DN, Anderson RL, Riso LP, Ouimette PC, Lizardi H. DSM-III-R Axis II comorbidity in dysthymia and major depression. Am J Psychiatry 1995; 152:239-247.
26. 26 Sansone RA, Wiederman MW, Sansone LA, Touchet B. Early-onset dysthymia and personality disturbance among patients in a primary care setting. J Nerv Ment Dis 1998; 186:57-59. The authors examine the association between dysthymia and personality disorders in a primary care setting, providing an interesting extension of earlier research conducted in mental health venues.
27. 27 Riso LP, Klein DN, Ferro T, Kasch KL, Pepper CM, Schwartz JE, Aronson TA. Understanding the comorbidity between early-onset dysthymia and cluster B personality disorders: a family study. Am J Psychiatry 1996; 153:900-906.
28. 28 Ryder AG, Bagby RM. Diagnostic viability of depressive personality disorder: theoretical and conceptual issues. J Personal Disorders 1999; 13:99-117. The authors review the history of the construct of depressive personality and critically evaluate the theoretical and empirical evidence for this disorder as an entity that is distinct from Axis I mood disorders.
29. 29 Klein DN. Comment on Ryder and Bagby's 'Diagnostic viability of depressive personality disorder: theoretical and conceptual issues'. J Personal Disorders 1999; 13:118-127. The author critiques and extends several of Ryder and Bagby's [28•] conclusions and recommendations regarding the classification of depressive personality disorder.
30. 30 Widiger TA. Depressive personality traits and dysthymia: a commentary on Ryder and Bagby. J Personal Disorders 1999; 13:135-141. In response to Ryder and Bagby [28•], the author provides a trenchant discussion of the complexities involved in drawing nosological boundaries between conceptually overlapping conditions such as depressive personality disorder and dysthymic disorder.
31. 31 Klein DN, Vocisano C. Depressive and self-defeating (masochistic) personality disorders. In: Oxford textbook of psychopathology. Millon T, Blaney PH, Davis RD (editors). New York: Oxford University Press; 1999. pp. 653-673. A comprehensive review of the historical development and empirical data on the construct of depressive personality disorder and its relationship to other disorders, such as the mood and personality disorders.
32. 32 Klein DN, Shih JH. Depressive personality: associations with DSM-III-R mood and personality disorders and negative and positive affectivity, 30-month stability, and prediction of course of Axis I depressive disorders. J Abnorm Psychol 1998; 52:319-327. The authors provide evidence for the discriminant validity and stability of depressive personality disorder.
33. 33 Phillips KA, Gunderson JG, Triebwasser J, Kimble CR, Faedda G, Lyoo IK, Renn J. Reliability and validity of depressive personality disorder. Am J Psychiatry 1998; 155:1044-1048. This careful study presents data addressing whether depressive personality disorder can be distinguished from Axis I and Axis II disorders.
34. 34 Akiskal HS. Overview of chronic depressions and their clinical management. In: Dysthymia and the spectrum of chronic depressions. Akiskal HS, Cassano GB (editors). New York: Guilford; 1997. pp. 1-34.
35. 35 Klein DN. Depressive personality in the relatives of outpatients with dysthymic disorder and episodic major depressive disorder and normal controls. J Affect Disord 1999; 55:19-27. This study attempts to clarify the relationship between depressive personality disorder and Axis I disorders by examining patterns of familial aggregation. The study finds strong familial links between depressive personality disorder and chronic, but not episodic, depressive disorders.
36. 36 Akiskal HS, Placidi GF, Maremmani I, Signoretta S, Liguori A, Gervasi R, et al. TEMPS-I: delineating the most discriminant traits of the cyclothymic, depressive, hyperthymic and irritable temperaments in a nonpatient population. J Affect Disord 1998; 51:7-19. Using a large non-clinical sample, the authors present the results of factor analyses of temperamental traits thought to be linked to the major mood disorders.
37. 37 Gunderson JG, Phillips KA, Triebwasser JT, Hirschfeld RMA. The diagnostic interview for depressive personality. Am J Psychiatry 1994; 151:1300-1304.
38. 38 Placidi GF, Maremmani I, Signoretta S, Liguori A, Akiskal HS. A prospective study of stability and change over 2 years of affective temperaments in 14-18 year-old Italian high school students. J Affect Disord 1998; 51:199-208. An important study of the stability of affective temperamental traits in a large non-clinical sample of adolescents and young adults.
39. 39 Renouf AG, Kovacs M. Dysthymic disorder during childhood and adolescence. In: Treatment of chronic depression. Kocsis JH, Klein DN (editors). New York: Guilford Press; 1995. pp. 20-40.
40. 40 Angst J. Dysthymia and personality. Eur Psychiatry 1998; 13:188-197. This study provides important information on the developmental progression and early precursors of dysthymia in a longitudinal study of a large community sample.
41. 41 Devanand DP, Nobler MS, Singer T, Kiersky JE, Turret N, Roose SP, Sackeim HA. Is dysthymia a different disorder in the elderly? Am J Psychiatry 1994; 151:1592-1599.
42. 42 Kirby M, Bruce I, Coakley D, Lawlor BA. Dysthymia among the community-dwelling elderly. Int J Geriatr Psychiatry 1999; 14:440-450. A well conducted study of the clinical features of dysthymia in a geriatric sample.
43. 43 Kocsis JH. Geriatric dysthymia. J Clin Psychiatry 1998; 59:13-15. A concise review of the special characteristics of dysthymia in the elderly.
44. 44 Weissman MM, Leaf PJ, Bruce ML, Florio L. The epidemiology of dysthymia in five communities: rates, risks, comorbidity, and treatment. Am J Psychiatry 1988; 145:815-819.
45. 45 Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:8-19.
46. 46 Prescott CA, McArdle JJ, Hishinuma ES, Johnson RC, Miyamoto RH. Andrade NN, et al. Prediction of major depression and dysthymia from CES-D scores among ethnic minority adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37:495-503.
47. 47 Szadoczky E, Papps ZS, Vitrai J, Rihmer Z, Furedi J. The prevalence of major depressive and bipolar episodes in Hungary. Results from a national epidemiological survey. J Affect Disord 1998; 50:153-162. This ambitious study presents the results of the first large-scale epidemiological assessment of affective and anxiety disorders in Hungary.
48. 48 Takeuchi DT, Chi-Ying Chung R, Lin K, Shen H, Kurasaki K, Chun C, Sue S. Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. Am J Psychiatry 1998; 155:1407-1414. The authors report data from the Chinese-American Psychiatric Epidemiological Study, and report some interesting differences compared with previous epidemiological studies in the United States with predominantly non-Chinese samples.
49. 49 Browne G, Steiner M, Roberts J, Gafni A, Byrne C, Bell B, et al. Prevalence of dysthymic disorder in primary care. J Affect Disord 1999; 54:303-308. This is an important study of the prevalence and comorbidity of dysthymic disorder in a primary care setting.
50. 50 Klein DN, Dickstein S, Taylor EB, Harding K. Identifying chronic affective disorders in outpatients: validation of the General Behavior inventory. J Consult Clin Psychol 1989; 57:106-111.
51. 51 Friedman RA, Markowitz JC, Parides M, Kocsis JH. Acute response of social functioning in dysthymic patients to desipramine. J Affect Disord 1995; 34:85-88.
52. 52 Leader JB, Klein DN. Social adjustment in dysthymia, double depression, and episodic major depression. J Affect Disord 1996; 37:91-101.
53. 53 Miller IW, Keitner GI, Schatzberg AF, Klein DN, Thase ME, Rush AJ, et al. The treatment of chronic depression, part 3: psychosocial functioning before and after treatment with sertraline or imipramine. J Clin Psychiatry 1998; 59:608-619. This study provides compelling evidence that antidepressant treatment can produce significant improvements in social functioning in chronic depressive patients.
54. 54 Agosti V. Residual symptoms and social functioning over six months in recovered outpatients with chronic depression. J Affect Disord 1999; 52:251-255. An informative look at the social functioning of patients who had recovered from chronic depression.
55. 55 Friedman RA, Markowitz JC, Parides M, Gniwesch L, Kocsis JH. Six months of desipramine for dysthymia: can dysthymic patients achieve normal social functioning? J Affect Disord 1999; 54:283-286. The authors provide evidence that whereas antidepressant medication may lead to improvements in social functioning, dysthymic patients do not typically reach normative levels even after 6 months of treatment.
56. 56 Howland RH. General health, health care utilization, and medical comorbidity in dysthymia. Int J Psychiatry Med 1993; 23:211-238.
57. 57 Gupta S, Kulhara P, Verma SK. Quality of life in schizophrenia and dysthymia. Acta Psychiatrica Scand 1998; 97:290-296. The authors compare various quality of life indices between dysthymic and schizophrenic patients. Their findings illustrate the adverse impact of dysthymia on subjective assessments of the quality of life.
58. 58 Durbin CE, Klein DN, Schwartz JE. The impact of childhood adversity and family history of psychopathology on the course of dysthymic disorder. J Consult Clin Psychol 1999; (in press).
59. 59 Agosti V. One year clinical and psychosocial outcomes of early-onset chronic depression. J Affect Disord 1999; 54:171-175. This is an important paper demonstrating the high risk of relapse in chronic depression.
60. 60 Lyons MJ, Eisen SA, Goldberg J, True W, Lin N, Meyer JM, et al. A registry-based twin study of depression in men. Arch Gen Psychiatry 1998; 55:468-472. An important, large-scale twin study of major depression in men that also includes a small subgroup with dysthymia. Similar to previous studies of female twins, the results indicate that both genetic and environmental factors play a significant role in the etiology of major depression.
61. 61 Lizardi H, Klein DN, Ouimette PC, Riso LP, Anderson RL, Donaldson SK. Reports of the childhood environment in early-onset dysthymia and episodic major depression. J Abnorm Psychol 1995; 104:132-139.
62. 62 Klein DN, Taylor DB, Dickstein S, Harding K. Primary early-onset dysthymia: comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome. J Abnorm Psychol 1988; 27:387-398.
63. 63 Brown GW, Harris TO, Hepworth C, Robinson R. Clinical and psychosocial origins of chronic depressive episodes II: a patient inquiry. Br J Psychiatry 1994; 165:457-465.
64. 64 McCullough JP, McCune KJ, Kaye AL, Braith JA, Friend R, Roberts C, et al. Comparison of a community dysthymia sample at screening with a matched group of nondepressed community controls. J Nerv Ment Dis 1994; 182:402-407.
65. 65 Hirschfeld RMA. Personality and dysthymia. In: Dysthymic disorder. Burton SW, Akiskal HS (editors). London: Gaskell; 1990. pp. 69-77.
66. 66 Howland RH, Thase ME. Biological studies of dysthymia. Biol Psychiatry 1991; 30:283-304.
67. 67 Boyer P, Lecrubier Y, Stalla-Bourdillon A, Fleurot O. Amisulpride versus amineptine and placebo for the treatment of dysthymia. Neuropsychology 1999; 39:25-32.
68. 68 Smeraldi E. Amisulpride versus fluoxetine in patients with dysthymia or major depression in partial remission: a double-blind, comparative study. J Affect Disord 1998; 48:47-56. This is a well conducted study comparing amisulpride to fluoxetine. Although both drugs were equally successful in reducing measures of depression, amisulpride was somewhat more effective in reducing anxiety.
69. 69 Tripodianakis J, Markianos M, Sarantidis D, Spyropoulou G, Taktikou V, Bistolaki E. Platelet MAO activity in patients with dysthymic disorder. Psychiatry Res 1998; 78:173-178. This study reports data indicating that levels of platelet MAO activity are significantly lower in women with dysthymia than female controls. No differences were evident for men.
70. 70 Shah PJ, Ebmeier KP, Glabus MF, Goodwin GM. Cortical grey matter reductions associated with treatment-resistant chronic unipolar depression. Br J Psychiatry 1998; 172:527-532. One of the few studies of structural brain abnormalities in chronic depressive patients, this paper reports significantly lower grey matter density in the left temporal cortex of patients with chronic major depression compared with patients who have recovered from major depression and normal controls.
71. 71 Anisman H, Ravindran AV, Griffiths J, Merali Z. Endocrine and cytokine correlates of major depression and dysthymia with typical or atypical features. Mol Psychiatry 1999; 4:182-188. An interesting examination of selected immunological parameters in depression, and their relationships to symptom patterns, age of onset, and chronicity.
72. 72 Ravindran AV, Griffiths J, Merali Z, Anisman H. Circulating lymphocyte subsets in major depression with typical or atypical features. Psychosomatic Med 1998; 60:283-289. The authors compare typical and atypical depressive patients on selected immunological measures.
73. 73 Keller MB, Gelenberg AJ, Hirschfeld RMA, Rush AJ, Thase ME, Kocsis JH, et al. The treatment of chronic depression, part II: a double-blind, randomized trial of sertraline and imipramine. J Clin Psychiatry 1998; :598-607. This study compared sertraline to imipramine in a large sample of outpatients with double depression and chronic major depression.
74. 74 Ravindran AV, Charbonneau Y, Zaharia MD, Alto-Zaid K, Weins A, Anisman H. Efficacy and tolerability of venlafaxine in the treatment of primary dysthymia. J Psychiatry Neurosci 1998; 23:288-292.
75. 75 Versiani M. Pharmacotherapy of dysthymic disorder and chronic depressive disorders: overview with focus on moclobemide. J Affect Disord 1998; 51:323-332. The authors review the literature on the pharmacotherapy of dysthymic disorder, and summarize their recent work with MAO inhibitors.
76. 76 Hirschfeld RM, Russell JM, Delgado PL, Fawcett J, Friedman RA, Harrison WM, et al. Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine. J Clin Psychiatry 1998; 59:669-675. A comprehensive examination of clinical and psychosocial predictors of response to antidepressant medication in a large sample of chronically depressed patients.
77. 77 Kocsis JH, Mason BJ, Frances AJ, Sweeney J, Mann JJ, Marin D. Prediction of response of chronic depression to imipramine. J Affect Disord 1989; 17:255-260.
78. 78 Levitt AJ, Joffe RT, Sokolov ST. Does the chronological relationship between the onset of dysthymia and major depression influence subsequent response to antidepressants? J Affect Disord 1998; 47:169-175. The authors provide evidence that experiencing a major depressive episode before dysthymia predicts a relatively poor prognosis.
79. 79 Keller MB, McCullough JP, Rush AJ, Klein DN, Schaztberg A, Gelenberg AJ, Thase ME. Nefazodone HCI, CBASP, and combination therapy for the acute treatment of chronic depression. Washington DC: American Psychiatric Association; 1999. This study compared the efficacy of combined treatment with medication and psychotherapy to either treatment alone in a large sample of chronic depressive patients. Combination treatment was significantly more effective than either monotherapy, whereas the two monotherapies did not differ from each other.
80. 80 McCullough JP. Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP). New York: Guilford Press 2000.
81. 81 Rudas S, Schmitz M, Pichler P, Baumgartner A. Treatment of refractory chronic depression and dysthymia with high-dose thyroxine. Biol Psychiatry 1999; 45:229-233. In an uncontrolled study, the authors examined the utility of adjunctive thyroxine in the treatment of refractory chronic depression, with encouraging results.
82. 82 Kocsis JH, Friedman RA, Markowitz JC, Leon AC, Miller NL, Gniwesch L, Parides M. Maintenance therapy for chronic depression: a controlled clinical trial of desipramine. Arch Gen Psychiatry 1996; 53:769-774.
83. 83 Keller MB, Kocsis JH, Thase ME, Gelenberg AJ, Rush AJ, Koran L, et al. Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial. JAMA 1998; 280:1665-1672. The authors compared the efficacy of sertraline with placebo in preventing recurrence in chronic depression.
84. 84 Baldessarini RJ, Yiguera AC. Relapse of depressive symptoms after discontinuing sertraline. JAMA 1999; 282:323-. The authors critique me study by Keller et al. [83••], and raise important issues regarding the design and interpretation of maintenance studies of depression more generally.
85. 85 Keller MB, Kocsis JH, Thase ME, Gelenberg AJ, Rush AJ, Koran L, et al. Relapse of depressive symptoms after discontinuing sertraline. JAMA 1999; 282:323-324. The authors address the criticisms raised by Baldessarini and Viguera [84•], and elaborate upon some of the methodological decisions and interpretation of results in their study [83••].