Current pharmacotherapeutic approaches for dysthymic disorder and persistent depressive disorder

ABSTRACT

Introduction: Persistent Depressive Disorder (PDD) is a nosological entity introduced with DSM–5, encompassing numerous different conditions including Dysthymia, recurrent Major Depressive Disorder, Double Depression and Chronic Major Depression. PDD is a particularly significant cause of disease burden in the general population.

Areas covered: In the present paper, the authors explore the controversies surrounding the definition of PDD, the current approach to its treatment endorsed by the major scientific bodies, along with the available evidence on the efficacy of said treatments.

Expert opinion: Clinicians need to be particularly vigilant and always gather a thorough history. In this diagnostic group, there is a relevant risk of having an undiagnosed Bipolar Disorder as affected individuals typically fail to recognize the pathological components of hypomanic episodes. In this setting, it is crucial to reconsider the diagnosis and to frequently verify compliance with the treatment plan. Numerous technological advances, particularly in the neuroimaging field, offer new insight and new challenges in defining the pathophysiological mechanisms of depressive syndromes. In the future, these advances may offer guidance towards an improved treatment approach and diagnostic process.

KEYWORDS:

• Chronic major depressive disorder
• dysthymia
• major depressive disorder
• non-major persistent depressive disorder
• persistent depressive disorder
• psychopharmacology

Article highlights

• Persistent Depressive Disorder (PDD) has a lifetime prevalence ranging from 3% to 6% of the general population in Western countries and is associated with a significant impairment in the Quality of life.

• Since its inception with DSM-III, Dysthymia (DST) has been widely criticized for the significant heterogeneity encountered with this diagnosis and the criticism surrounding DST continues with its successor PDD.

• Psychotherapy and pharmacotherapy appear at least equally effective as acute treatments for PDD symptoms, with combined therapy appearing more effective than any monotherapy in Major-PDD.

• Despite the growing body of evidence supporting the efficacy of acute treatments for PDD symptoms, it still unclear whether continuation or maintenance therapy leads to fewer recurrences and relapses.

• Considering the persistent nature of this condition, it is of the utmost importance to involve the patient early on in the clinical decision-making in order to improve the treatment adherence and the outcome.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.