Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T08:38:40.489Z Has data issue: false hasContentIssue false
  • English
  • Français

Dysthymia as a temperamental variant of affective disorder

Published online by Cambridge University Press:  16 April 2020

HS Akiskal
HS Akiskal*
Affiliation:
International Mood Clinic, Department of Psychiatry, University of California at San Diego, La Jolla, CA 92093-0603, USA
Get access

Summary

Dysthymia is estimated to afflict at least 3% of the population worldwide. Because it is a chronic disorder, its prevalence is high in psychiatric and general medical settings. The mystery of this incapacitating depressive subtype — long recognized but only recently sanctioned in the DSM-IV and ICD-10 — is that, in their habitual condition, those suffering from dysthymia lack the classical ‘objective’ or ‘major’ signs of acute clinical depression, such as profound changes in psychomotor and vegetative functions. Instead, patients consult their doctors for more fluctuating complaints consisting of gloominess, lethargy, self-doubt, malaise, and lack of joie de vivre. They typically work hard, but do not enjoy their work. If married, they are deadlocked in bitter and unhappy marriages which lead neither to reconciliation nor separation. For them, their entire existence is a burden: they are satisfied with nothing, complain of everything, and brood about the uselessness of existence. As a result, in the past they were labeled ‘existential depressives’ or ‘depressive characters’ and condemned to the couch, often on a chronic basis. Several lines of research over the past fifteen years have shed new light on the biological origins of this disorder. Sleep neurophysiologic findings have shown that many parameters of paradoxical sleep in dysthymia (such as REM percentage, REM latency, and circadian distribution of REM) are similar to those observed in major affective illness. Furthermore, family studies of dysthymia have demonstrated a significant excess of mood disorders. Indeed, dysthymia has been identified in childhood, and prospective follow-up has demonstrated major affective breakdowns including bipolar switches in up to 20%. Coupled with sleep findings, these family and follow-up data suggest that dysthymia is best considered as ‘trait depression’, a constitutional variant of major affective illness. As expected from the early onset chronic nature of the disturbance, in both clinical and epidemiological studies, the social and health burden of dysthymia has been found to be considerable and comparable to that of major medical disorders. The foregoing clinical and biological data have provided the impetus for well-designed pharmacological trials in dysthymia, and a new therapeutic optimism.

Keywords

dysthymiadepressive temperamentconstitutional depression
Type
Research Article
Information
European Psychiatry , Volume 11 , Issue S3 , 1996 , pp. 117s - 122s
Copyright
Copyright © Elsevier paris 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, HSDysthymic disorder: psychopathology of proposed chronic depressive sybtypes. Am J Psychiatry 1983; 140:11–20Google Scholar
Akiskal, HSLa dysthymie et son traitement. Encéphale 1993; 19:375–8Google Scholar
Akiskal, HSDysthymia: clinical and external validity. Acta PsychiatrScand 1994; 89(suppl 383):19–2310.1111/j.1600-0447.1994.tb05879.xCrossRefGoogle Scholar
Akiskal, HSToward a temperament-based approach to depression: Implications for neurobiologic research. Adv Biochem Psycho-Pharmacol 1995; 52:114–23Google Scholar
Akiskal, HSBitar, AHPuzantian, VRRosenthal, TLWalker, PWThe nosological stuatus of neurotic depression: a prospective three-to-four year examination in light of the primary-secondary and unipolar-bipolar dichotomies. Arch Gen Psychiatry 1978; 35:756–6610.1001/archpsyc.1978.01770300098011CrossRefGoogle ScholarPubMed
Akiskal, HSDowns, JJordan, PWatson, SDaugherty, DPruitt, DBAffective disorders in the referred children and younger siblings of manic-depressives: mode of onset and prospective course. Arch Gen Psychiatry 1985; 42:996–100310.1001/archpsyc.1985.01790330076009CrossRefGoogle ScholarPubMed
Akiskal, HSLemmi, HDickson, HKing, DYerevanian, Bvan Valkenberg, CChronic depressions. Part 2. Sleep EEG differentiation of primary dysthymic disorders from anxious depressions. J Affective Disord 1984; 6:287–9510.1016/S0165-0327(84)80007-5CrossRefGoogle ScholarPubMed
Akiskal, HSRosenthal, TLHaykal, RFLemmi, HRosenthal, RHScott-Strauss, ACharacterologic depressions: Clinical and sleep EEG findings separating “subaffective dysthymias” from “character spectrum disorders”. Arch Gen Psychiatry 1980; 37:777–8310.1001/archpsyc.1980.01780200055006CrossRefGoogle Scholar
Akiskal, HSWeise, REThe clinical spectrum of so-called “minor” depression. Am J Psychother 1992; 46:9–2210.1176/appi.psychotherapy.1992.46.1.9CrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Eds. 3 and 4. Washington, DC: American Psychiatric Press, 1980, 1994Google Scholar
Angst, JWicki, WThe Zurich Study. XI. Is dysthymia a separate form of depression? Results of the Zurich Cohort Study. Eur Arch Psychiatry Clin Neurosci 1991; 240:349–4510.1007/BF02279765CrossRefGoogle ScholarPubMed
Arieti, SBemporad, JSevere and mild depression. New York: Basic Books, 1978Google Scholar
Burton, SWAkiskal, HSDysthymic disorder. London: Gaskell, 1990Google Scholar
Cassano, GBSavino, MChronic major depressive episode and dysthymia: comparison of demographic and clinical characteristics. Eur Psychiatry 1993; 8:277–910.1017/S0924933800000353CrossRefGoogle Scholar
Cooper, AMWill neurobiology influence psychoanalysis?. Am J Psychiatry 1985; 142:1395–402Google ScholarPubMed
Furukawa, TNakazato, HSumita, YCharacteristics of chronic outpatients with unipolar depression. Acta Psychiatr Scand 1993; 88:273–710.1111/j.1600-0447.1993.tb03456.xCrossRefGoogle ScholarPubMed
Horwath, EJohnson, JKlerman, GLWeissman, MMDepressive symptoms as relative and attributable risk factors for first-onset major depression. Arch Gen Psychiatry 1992; 49:817–23CrossRefGoogle ScholarPubMed
Howland, RHThase, MEBiological studies of dysthymia. Biol Psychiatry 1991; 30:283–30410.1016/0006-3223(91)90112-YCrossRefGoogle ScholarPubMed
Keller, MBCourse, outcome and impact on the community. Acta Psychiatr Scand 89suppl 3831994 24–3410.1111/j.1600-0447.1994.tb05880.xCrossRefGoogle Scholar
Keller, MBKlein, DNHirschfeld, RMA, et al. Results of the DSM-IV Mood Disorders Field Trial. Am J Psychiatry 1995; 152:843–9Google ScholarPubMed
Klein, DNClark, DCDansky, LMargolis, ETDysthymia in the offspring of parents with primary unipolar affective disorder. J Abnorm Psychol 1988; 97:265–7410.1037/0021-843X.97.3.265CrossRefGoogle ScholarPubMed
Klein, DNTaylor, EBHarding, KDickstein, SDouble depression and episodic major depression: demographic, clinical, familial, personality, and socioenviromental characteristics and short-term outcome. Am J Psychiatry 1988; 145:1226–31Google ScholarPubMed
Klein, DNRiso, LPDonaldson, , et al.Family study of early-onset dysthymia. Arch Gen Psychiatry 1995; 52:487–9610.1001/archpsyc.1995.03950180073010CrossRefGoogle ScholarPubMed
Kocsis, JHFrances, AJA critical discussion of DSM-III dysthymic disorder. Am J Psychiatry 1987; 144:1534–42Google ScholarPubMed
Kocsis, JHFrances, AJVoss, CMason, BJMann, JJSweeney, JImipramine and social-vocational adjustment in chronic depression. Am J Psychiatry 1988; 145:997–9Google ScholarPubMed
Kocsis, JHVoss, CMann, JJFrances, AChronic depression: demon- graphic and clinical characteristics. Psychopharmacol Bull 1986; 22:192–5Google Scholar
Kovacs, MAkiskal, HSGatsonis, CPatrone, PLChildhood-onset dysthymic disorder: Clinical features and prospective naturalistic outcome. Arch Gen Psychiatry 1994; 51:365–7410.1001/archpsyc.1994.03950050025003CrossRefGoogle ScholarPubMed
Kraepelin, EBarclay, RMRobertson, GMManic-depressive insanity and paranoia. Edinburgh: ES Livingstone, 1921 10.1097/00005053-192104000-00057CrossRefGoogle Scholar
Liebowitz, MRKlein, DFHysteroid dysphoria. Psych Clin of North Am 1979; 2:555–75CrossRefGoogle Scholar
Montassut, MLa depression constitutionnelle: L’ancienne neurasthénie dans ses rapports avec la médecine générale; clinique, biologie, thérapeutique. Paris: Masson, 1938Google Scholar
Peron-Magnan, PTrouble dysthymique et personnalité dépressive. Encephale 1992; 18:51–54Google Scholar
Perugi, GAkiskal, HSMusetti, LSimonini, ECassano, GBSocial adjustment in panic-agoraphobic patients reconsidered. Br J Psychiatry 1994; 164:88–93CrossRefGoogle ScholarPubMed
Ravindran, AVBialik, RJLapierre, YDTherapeutic efficacy of specific serotonin reuptake inhibitors (SSRIs) in dysthymia, Can J Psychiatry 1994; 39:21–2610.1177/070674379403900106CrossRefGoogle Scholar
Rihmer, ZDysthymia: a clinician's perspective. In: Burton, SWAkiskal, HSDysthymic Disorder London, Gaskell: Royal College of Psychiatrists, 1990; 112–25Google Scholar
Rosenthal, TLAkiskal, HSScott-Strauss, ARosenthal, RHDavid, MFamilial and developmental factors in characterologic depressions. J Affect Disord 1981; 3:183–9210.1016/0165-0327(81)90043-4CrossRefGoogle Scholar
Stabl, MBiziere, KSchmid-Burgk, WAmrein, RReview of comparative clinical trials. Meclobomid vs tricyclic antidepressants and vs placebo in depressive states. J Neural Transm 1989; 28(suppl):77–89Google ScholarPubMed
Stewart, JWQuitkin, FMMcGrath, PJ, et al. Social functioning in chronic depression: effect of 6 weeks of antidepressant treatment. Psychiatry Res 1988; 25:213–2210.1016/0165-1781(88)90053-4CrossRefGoogle ScholarPubMed
Tyrer, PJSeivewright, NFerguson, B, et al. The general neurotic syndrome: a coaxial diagnosis of anxiety depression and personality disorder. Acta Psychiatr Scand 1992; 85:201–610.1111/j.1600-0447.1992.tb08595.xCrossRefGoogle ScholarPubMed
Weissman, MMLeaf, PJBruce, MLFlorio, LThe epidemiology of dysthymia in five communities: rates, risks, comorbidity, and treatment. Am J Psychiatry 1988; 145:815–19Google ScholarPubMed
Wells, KBBurnam, MARogers, WHays, RCamp, PThe course of depression in adult outpatients: Results from the Medical Outcomes Study. Arch Gen Psychiatry 1992; 49:788–9410.1001/archpsyc.1992.01820100032007CrossRefGoogle ScholarPubMed
Wells, KBStewart, AHays, RD, et al. The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. JAMA 1989; 262:914–19CrossRefGoogle ScholarPubMed
West, EDDally, PJEffects of iproniazid in depressive syndromes. Br Med J 1959; 1:1491–4CrossRefGoogle ScholarPubMed
World Health Organization. ICD-10 Classification of Mental and Behavioral Disorders. Geneva: WHO, 1992Google Scholar
WPA Dysthymia Working Party Dysthymia in clinical practice. Br J Psychiatry 1995; 166:174–8310.1192/bjp.166.2.174CrossRefGoogle Scholar
Yerevanian, BIAkiskal, HSNeurotic, characterological, and dysthymic depressions. Psych Clin North Am 1979; 2:595–61710.1016/S0193-953X(18)30998-5CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.