Dysthymic disorder is a mild, chronic form of major depression.

Epidemiology
The lifetime prevalence is 6%.

Etiology
Because dysthymia is often conceptualized as a milder, chronic form of major depression, similar etiologies are generally attributed to dysthymia.

Clinical Manifestations
History and Mental Status Examination
Dysthymic disorder is a chronic and less severe form of major depression. The diagnosis of dysthymia requires a minimum of 2 years of chronically depressed mood most of the time (Fig. 2-1 B). Associated symptoms and complaints may include change in appetite and sleep, fatigue, decreased concentration, and hopelessness. Dysthymia can be chronic and difficult to treat. At times, major depressive episodes may co-occur, giving rise to the term double depression.

Differential Diagnosis
Major depression and etiologic mood disorders are the major differential diagnostic considerations.

Management
Treatment is similar to major depression except that psychotherapy may playa larger role and the course of treatment may be more protracted.