THE UNDERTREATMENT OF DYSTHYMIA

Background: Dysthymia is a chronic depressive condition that is quite prevalent. This condition can exact a significant toll on the general health and quality of life in the affected individual. Despite the fre quency and consequences of dysthymia, however, the condition is often not diagnosed or treated. We present data on prior treatment from 410 patients with DSM-III-R dysthymia, primary type, early onset without c oncurrent major depression. Method: Axis I and II diagnoses were made by using the Structured Clinical Interviews for DSM-III-R, Patient Ver sion (SCID-P) and SCID II for Personality Disorders. The Hamilton Rati ng Scale for Depression and the Clinical Global Impressions scale were also completed. Prior treatment was assessed, with special attention paid to previous antidepressant drug therapy and psychotherapy. Result s: Although the mean duration of dysthymia was about 30 years and almo st half of the patients had previous episodes of major depression, onl y 41.3% had been treated with antidepressants and 56.1% with psychothe rapy. A past history of major depression increased the frequency of pr ior antidepressant pharmacotherapy (45.7%) and psychotherapy (59.4%) c ompared with no history of major depression (36.8% and 40.9%, respecti vely). Comorbid personality disorder increased the likelihood of prior psychotherapy (70.7% vs. 49.6%) while having no effect on past pharma cotherapy. A history of substance abuse did not affect the history of antidepressant or psychotherapy treatment. In this study, dysthymia an d psychosocial outcomes improved with sertraline and imipramine treatm ent.Conclusion: Dysthymic patients in this sample were significantly u ndertreated. Newer antidepressant agents may alter the potential for p harmacotherapy interventions in this vulnerable population.