DYSTHYMIC DISORDER - THE DEPRESSION THAT NEVER QUITS

Dysthymic disorder, an insidious and chronic depressive mood disorder that waxes and wanes in intensity over several years,is fairly prevale nt in healthcare settings, Although the explicit etiology is unknown, serotonergic dysfunction may be involved, Dysthymia appears to have a high rate of comorbidity, including; both psychiatric and medical diso rders, The primary care physician should maintain an awareness of this mood disorder, be able to screen efficiently for signs and symptoms, and be able to differentiate major depression from dysthymia. The foun dation of treatment is pharmacotherapy, in particular with serotonergi c antidepressants, although response is moderate at best, Antidepressa nts are initiated at low doses and drug trials are conducted for 3-mon th periods if not precluded by side effects, When reasonably effective , antidepressants should be continued for 2 to 3 years or more. Adjunc tive interventions in the treatment of dysthymia are based on comorbid psychiatric or medical conditions. Although dysthymia is an insidious , difficult-to-treat disorder, intervention is worthwhile, Further res earch may elucidate more effective interventions for this challenging disorder.