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Dysthymic disorder in the elderly population

Published online by Cambridge University Press:  23 October 2013

D. P. Devanand
D. P. Devanand*
Affiliation:
Division of Geriatric Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
*
Correspondence should be addressed to: D. P. Devanand, MD, Division of Geriatric Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 126 New York, NY 10032, USA. Phone: +1-212-543-5612; Fax: +1-212-543-5854. Email: [email protected].
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Abstract

The diagnosis of dysthymic disorder was created in DSM-III and maintained in DSM-IV to describe a depressive syndrome of mild to moderate severity of at least two years’ duration that did not meet criteria for major depressive disorder. The prevalence of dysthymic disorder is approximately 2% in the elderly population where subsyndromal depressions of lesser severity are more common. Dysthymic disorder was replaced in DSM-V by the diagnosis of “persistent depressive disorder” that includes chronic major depression and dysthymic disorder. In older adults, epidemiological and clinical evidence supports the use of the term “dysthymic disorder.” In contrast to young adults with dysthymic disorder, older adults with dysthymic disorder commonly present with late age of onset, without major depression and other psychiatric disorders, and with a low rate of family history of mood disorders. They often have stressors such as loss of social support and bereavement, and some have cerebrovascular or neurodegenerative pathology. A minority has chronic depression dating from youth with psychiatric comorbidity similar to young adults with dysthymic disorder. In older adults, both dysthymic disorder and subsyndromal depression increase disability and lead to poor medical outcomes. Elderly patients with dysthymic disorder are seen mainly in primary care where identification and treatment are often inadequate. Treatment with antidepressant medication shows marginal superiority over placebo in controlled trials, and problem-solving therapy shows similar efficacy. Combined treatment and collaborative care models show slightly better results, but cost effectiveness is a concern. Further work is needed to clarify optimal approaches to the treatment of dysthymic disorder in elderly patients.

Keywords

dysthymic disorderchronic depressionsubsyndromal depressionlate lifepsychosocialantidepressant treatmentcerebrovascularneurodegenerative
Type
Review Article
Information
International Psychogeriatrics , Volume 26 , Issue 1 , January 2014 , pp. 39 - 48
Copyright
Copyright © International Psychogeriatric Association 2013 

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References

Abrams, R. C., Spielman, L. A., Alexopoulos, G. S. and Klausner, E. (1998). Personality disorder symptoms and functioning in elderly depressed patients. American Journal of Geriatric Psychiatry, 6, 24–30.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Hull, J., Sirey, J. A. and Kakuma, T. (2000). Executive dysfunction and risk for relapse and recurrence of geriatric depression. Archives of General Psychiatry, 57, 285–290.CrossRefGoogle Scholar
Areán, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C. and Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry, 167, 1391–1398.CrossRefGoogle ScholarPubMed
Barcelos-Ferreira, R., Izbikci, R., Steffens, D. C. and Bottino, C. M. (2010). Depressive morbidity and gender in community-dwelling Brazilian elderly: systematic review and meta-analysis. International Psychogeriatrics, 22, 712–726.CrossRefGoogle ScholarPubMed
Bersani, G.et al. (2013). l-Acetylcarnitine in dysthymic disorder in elderly patients: a double-blind, multicenter, controlled randomized study vs. fluoxetine. European Neuropsychopharmacology, 23, 1219–1225.CrossRefGoogle ScholarPubMed
Blanco, C., Okuda, M., Markowitz, J. C., Liu, S. M., Grant, B. F. and Hasin, D. S. (2010). The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 71, 1645–1656.CrossRefGoogle ScholarPubMed
Blazer, D., Hughes, D. C. and George, L. K. (1987). The epidemiology of depression in an elderly community population. The Gerontologist, 27, 281–287.CrossRefGoogle Scholar
Brockow, T.et al. (2004). Identifying the concepts contained in outcome measures of clinical trials on depressive disorders using the International Classification of Functioning, Disability and Health as a reference. Journal of Rehabilitation Medicine, 44 (Suppl), 49–55.CrossRefGoogle Scholar
Brown, P. J., Devanand, D. P., Liu, X. and Caccappolo, E.for the Alzheimer's Disease Neuroimaging Initiative (2011). Functional impairment in elderly patients with mild cognitive impairment and mild Alzheimer disease. Archives of General Psychiatry, 68, 617–626.CrossRefGoogle ScholarPubMed
Byers, A. L., Covinsky, K. E., Barnes, D. E. and Yaffe, K. (2012a). Dysthymia and depression increase risk of dementia and mortality among older veterans. American Journal of Geriatric Psychiatry, 20, 664–672.CrossRefGoogle ScholarPubMed
Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B. and Bruce, M. L. (2012b). High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Archives of General Psychiatry, 67, 489–496.CrossRefGoogle Scholar
Carta, M. G., Carpiniello, B., Kovess, V., Porcedda, R., Zedda, A. and Rudas, N. (1995). Lifetime prevalence of major depression and dysthymia: results of a community survey in Sardinia. European Neuropsychopharmacology, 5 (Suppl), 103–107.CrossRefGoogle ScholarPubMed
Castilla-Puentes, R. C. and Habeych, M. E. (2010). Subtypes of depression among patients with Alzheimer's disease and other dementias. Alzheimer's and Dementia, 6, 63–69.CrossRefGoogle ScholarPubMed
Chen, C. Y., Liu, C. Y. and Liang, H. Y. (2009). Comparison of patient and caregiver assessments of depressive symptoms in elderly patients with depression. Psychiatry Research, 166, 69–75.CrossRefGoogle ScholarPubMed
Chou, K. L., Liang, K. and Sareen, J. (2011). The association between social isolation and DSM-IV mood, anxiety, and substance use disorders: wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 72, 1468–1476.CrossRefGoogle ScholarPubMed
Cooper, C.et al. (2011). A systematic review of treatments for refractory depression in older people. American Journal of Psychiatry, 168, 681–688.CrossRefGoogle ScholarPubMed
DeCarli, C. (2013). Clinically asymptomatic vascular brain injury: a potent cause of cognitive impairment among older individuals. Journal of Alzheimer's Disease, 33 (Suppl 1), S417–426.CrossRefGoogle ScholarPubMed
Devanand, D. P.et al. (1994). Is dysthymia a different disorder in the elderly? American Journal of Psychiatry, 151, 1592–1599.Google ScholarPubMed
Devanand, D. P.et al. (1996). Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Archives of General Psychiatry, 53, 175–182.CrossRefGoogle ScholarPubMed
Devanand, D. P., Kim, M. K. and Nobler, M. S. (1997). Fluoxetine discontinuation in elderly dysthymic patients. American Journal of Geriatric Psychiatry, 5, 83–87.CrossRefGoogle ScholarPubMed
Devanand, D. P.et al. (2000). Personality disorders in elderly patients with dysthymic disorder. American Journal of Geriatric Psychiatry, 8, 188–195.CrossRefGoogle ScholarPubMed
Devanand, D. P.et al. (2003). Sertraline treatment of elderly patients with depression and cognitive impairment. International Journal of Geriatric Psychiatry, 18, 123–130.CrossRefGoogle ScholarPubMed
Devanand, D. P.et al. (2004). Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients. Journal of Affective Disorders, 78, 259–267.CrossRefGoogle ScholarPubMed
Devanand, D. P.et al. (2005). Randomized, double-blind, placebo-controlled trial of fluoxetine treatment for elderly patients with dysthymic disorder. American Journal of Geriatric Psychiatry, 13, 59–68.CrossRefGoogle ScholarPubMed
Edvardsen, J.et al. (2009). Unipolar depressive disorders have a common genotype. Journal of Affective Disorders, 117, 30–41.CrossRefGoogle ScholarPubMed
Elovainio, M.et al. (2009). Depression and C-reactive protein: population-based Health 2000 Study. Psychomatic Medicine, 71, 423–430.CrossRefGoogle ScholarPubMed
Fann, J. R., Fan, M. Y. and Unützer, J. (2009). Improving primary care for older adults with cancer and depression. Journal of General Internal Medicine, 24 (Suppl 2), S417–S424.CrossRefGoogle ScholarPubMed
Goveas, J. S.et al. (2011). Depressive symptoms, brain volumes and subclinical cerebrovascular disease in postmenopausal women: the Women's Health Initiative MRI Study. Journal of Affective Disorders, 132, 275–284.CrossRefGoogle ScholarPubMed
Hybels, C. F., Blazer, D. G. and Steffens, D. C. (2006). Partial remission: a common outcome in older adults treated for major depression. Geriatrics, 61, 22–26.Google ScholarPubMed
King-Kallimanis, B., Gum, A. M. and Kohn, R. (2009). Comorbidity of depressive and anxiety disorders for older Americans in the national comorbidity survey – replication. American Journal of Geriatric Psychiatry, 17, 782–792.CrossRefGoogle ScholarPubMed
Kirby, M., Bruce, L., Coakley, D. and Lawlor, B. A. (1999). Dysthymia among community-dwelling elderly. International Journal of Geriatric Psychiatry, 14, 440–445.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Klein, D. N.et al. (1998). Thirty-month naturalistic follow-up study of early-onset dysthymic disorder: course, diagnostic stability, and prediction of outcome. Journal of Abnormal Psychology, 107, 338–348.CrossRefGoogle ScholarPubMed
Kocsis, J. H., Frances, A. J., Voss, C., Mann, J. J., Mason, B. J. and Sweeney, J. (1988). Imipramine treatment for chronic depression. Archives of General Psychiatry, 45, 253–257.CrossRefGoogle ScholarPubMed
Kumar, A., Jin, Z., Bilker, W., Udupa, J. and Gottlieb, G. (1998). Late-onset minor and major depression: early evidence for common neuroanatomical substrates detected by using MRI. Proceedings of the National Academy of Sciences of the United States of America, 95, 7654–7658.CrossRefGoogle ScholarPubMed
Lu, P. H.et al. (2009). Donepezil delays progression to AD in MCI subjects with depressive symptoms. Neurology, 72, 2115–2121.CrossRefGoogle ScholarPubMed
Lyness, J. M., Yu, Q., Tang, W., Tu, X. and Conwell, Y. (2009). Risks for depression onset in primary care elderly patients: potential targets for preventive interventions. The American Journal of Psychiatry, 166, 1375–1383.CrossRefGoogle ScholarPubMed
Mackenzie, C. S., Reynolds, K., Cairney, J., Streiner, D. L. and Sareen, J. (2012). Disorder-specific mental health service use for mood and anxiety disorders: associations with age, sex, and psychiatric comorbidity. Depression and Anxiety, 29, 234–242.CrossRefGoogle ScholarPubMed
Maes, M., Kubera, M., Obuchowiczwa, E., Goehler, L. and Brzeszcz, J. (2011). Depression's multiple comorbidities explained by (neuro)inflammatory and oxidative and nitrosative stress pathways. Neuroendocrinology Letters, 32, 7–24.Google Scholar
Maia, A. C., Braga Ade, A., Brouwers, A., Nardi, A. E. and Oliveira e Silva, A. C. (2012). Prevalence of psychiatric disorders in patients with diabetes types 1 and 2. Comprehensive Psychiatry, 53, 1169–1173.CrossRefGoogle ScholarPubMed
Mason, B. J.et al. (1993). Measurement of severity and treatment response in dysthymia may have been limited by the structure and format of existing rating instruments. Psychiatric Annals, 23, 625–631.CrossRefGoogle Scholar
Meeks, T. W., Vahia, I. V., Lavretsky, H., Kulkarni, G. and Jeste, D. V. (2011). A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. Journal of Affective Disorders, 129, 126–142.CrossRefGoogle Scholar
Moore, M. T. and Brown, T. A. (2012). Are there meaningful differences between major depressive disorder, dysthymic disorder, and their subthreshold variants? The Journal of Nervous and Mental Disease, 200, 766–772.CrossRefGoogle ScholarPubMed
Murphy, J. A. and Byrne, G. J. (2012). Prevalence and correlates of the proposed DSM-5 diagnosis of chronic depressive disorder. Journal of Affective Disorders, 139, 172–180.CrossRefGoogle ScholarPubMed
Murray, G.et al. (2010). Relief of chronic or resistant depression (Re-ChORD): a pragmatic, randomized, open-treatment trial of an integrative program intervention for chronic depression. Journal of Affective Disorders, 123, 243–248.CrossRefGoogle ScholarPubMed
Naismith, S. L., Norrie, L. M., Mowszowski, L. and Hickie, I. B. (2012). The neurobiology of depression in later-life: clinical, neuropsychological, neuroimaging and pathophysiological features. Progress in Neurobiology, 98, 99–143.CrossRefGoogle ScholarPubMed
Olfson, M., Liu, S. M., Grant, B. F. and Blanco, C. (2012). Influence of comorbid mental disorders on time to seeking treatment for major depressive disorder. Medical Care, 50, 227–232.CrossRefGoogle ScholarPubMed
Orengo, C. A., Fullerton, L. and Kunik, M. E. (2005). Safety and efficacy of testosterone gel 1% augmentation in depressed men with partial response to antidepressant therapy. Journal of Geriatric Psychiatry and Neurology, 18, 20–24.CrossRefGoogle ScholarPubMed
Pelton, G. H.et al. (2008). Randomized double-blind placebo-controlled donepezil augmentation in antidepressant-treated elderly patients with depression and cognitive impairment: a pilot study. International Journal of Geriatric Psychiatry, 23, 670–676.CrossRefGoogle ScholarPubMed
Piek, E.et al. (2012). Determinants of (non-)recognition of depression by general practitioners: results of the Netherlands Study of Depression and Anxiety. Journal of Affective Disorders, 138, 397–404.CrossRefGoogle ScholarPubMed
Posner, J.et al. (2013). Antidepressants normalize the default mode network in patients with dysthymia. JAMA Psychiatry, 70, 373–382.CrossRefGoogle ScholarPubMed
Rafanelli, C., Milaneschi, Y., Roncuzzi, R. and Pancaldi, L. G. (2010). Dysthymia before myocardial infarction as a cardiac risk factor at 2.5-year follow-up. Psychosomatics, 51, 8–13.CrossRefGoogle Scholar
Ravindran, A. V.et al. (2009). Toward a functional neuroanatomy of dysthymia: a functional magnetic resonance imaging study. Journal of Affective Disorders, 119, 9–15.CrossRefGoogle Scholar
Reynolds, C. F. 3rd, et al. (2011). Maintenance treatment of depression in old age: a randomized, double-blind, placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy. Archives of General Psychiatry, 68, 51–60.CrossRefGoogle ScholarPubMed
Rhebergen, D.et al. (2010). Trajectories of recovery of social and physical functioning in major depression, dysthymic disorder and double depression: a 3-year follow-up. Journal of Affective Disorders, 124, 148–156.CrossRefGoogle ScholarPubMed
Seidman, S. N.et al. (2009). Effects of testosterone replacement in middle-aged men with dysthymia: a randomized, placebo-controlled clinical trial. Journal of Clinical Psychopharmacology, 29, 216–221.CrossRefGoogle ScholarPubMed
Stefansson, J. G., Lindal, E., Bjornsson, J. K. and Guomundsdottir, A. (1991). Lifetime prevalence of specific mental disorders among people born in Iceland in 1931. Acta Psychiatrica Scandinavica, 84, 142–149.CrossRefGoogle ScholarPubMed
Swan, A., Watson, H. J. and Nathan, P. R. (2009). Quality of life in depression: an important outcome measure in an outpatient cognitive-behavioural therapy group programme? Clinical Psychology and Psychotherapy, 16, 485–496.CrossRefGoogle Scholar
Williams, J. W. Jr.et al. (2000). Treatment of dysthymia and minor depression in primary care: A randomized controlled trial in older adults. JAMA, 284, 1519–1526.CrossRefGoogle ScholarPubMed