Dysthymic disorder: the chronic depression.

Dysthymic disorder is defined as chronic depression of a mild to moderate degree for at least two years' duration. The disorder tends to be underdiagnosed despite a prevalence of 5 to 15 percent in primary care settings. Both the diagnosis and treatment of dysthymic disorder may be complicated by a variety of comorbid psychiatric and medical conditions as well as chronic stressors. Treatment may be determined by the accompanying comorbid condition. Antidepressant drugs are moderately efficacious in the treatment of dysthymia, with selective serotonin reuptake inhibitors preferred over tricyclic antidepressants. However, patients may report oversensitivity to antidepressants, experience only partial remission with treatment and suffer relapses. Adjunctive support or psychodynamic psychotherapy should also be considered.