Challenges in the treatment of dysthymia: a narrative review

ABSTRACT

Introduction

Despite its milder severity, the chronic nature of dysthymia leads to significant impairments and functional limitations. The treatment of dysthymia has received considerably less research attention compared to major depressive disorder (MDD).

Areas Covered

The authors have conducted a comprehensive review on the treatment of dysthymia. Their primary objective was to identify therapeutic options that have demonstrated genuine efficacy. To do this, they searched the PubMed database, without any time restrictions, to retrieve original studies. The samples were exclusively comprised individuals diagnosed with dysthymia according to the diagnostic criteria outlined in DSM-III, DSM-III-R, DSM-IV, or DSM-IV-TR.

Expert opinion

Within the realm of dysthymia treatment, several antidepressants, including imipramine, sertraline, paroxetine, minaprine, moclobemide, and amineptine, in addition to the antipsychotic agent amisulpride, have demonstrated superiority over placebo. In certain studies, psychotherapeutic interventions did not distinguish themselves significantly from pharmacological treatments and failed to exhibit greater efficacy than a placebo. However, these findings remain inconclusive due to the limited number of studies and substantial methodological limitations prevalent in a significant proportion of them. Limitations include factors like small sample sizes, the absence of placebo comparisons, and a lack of study blinding.

KEYWORDS:

• Dysthymia
• chronic depression
• treatment
• pharmacotherapy
• psychotherapy

Article highlight

• The elimination of dysthymia as a diagnostic category in DSM5 is questionable since that was based on the chronic course, as the only characteristic shared with other forms of chronic depression, without taking severity into account.

• Despite some methodological difficulties, certain antidepressants, namely imipramine, sertraline, paroxetine, minaprine, moclobemide, amineptine, and the atypical antipsychotic amisulpride, were statistically superior to placebo.

• Augmentation of antidepressant with psychotherapy did not differ from antidepressant monotherapy.

• Psychotherapeutic treatment, Group Cognitive Behavioral Therapy, Interpersonal Psychotherapy and Brief Supportive Psychotherapy, did not distinguish itself from pharmacological treatment but failed to exhibit greater efficacy than placebo.

• There is a lack of guidance on how to proceed in the event of dysthymia treatment failure. Despite that, in practice the approach is basically the same as in major depressive disorder.

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 paper was not funded.