History and exam

Key diagnostic factors

common

chronic mood disorder lasting greater than 2 years

Mood disorder needs to be 2 years or longer (1 year or longer in children/adolescents).

depressive symptoms present for most of the day, most days

Mood disturbance needs to be present "more days than not".

no periods of euthymia in the past 2 years (1 year for children or adolescents)

Part of the DSM-5-TR criteria: during the 2-year period, the person has not been without the symptoms for 2 months or longer.[1]

symptoms of major depression may be continuously present for 2 or more years

 According to DSM-5-TR, criteria for a major depressive disorder may be continuously present for 2 years.[1]

Other diagnostic factors

common

no symptoms of mania/hypomania or schizophrenia

According to DSM-5-TR, this is necessary for the diagnosis.[1]

Persistent depressive disorder is a "unipolar" mood disorder. Presence of periods of elevated mood would result in a diagnosis of a bipolar mood disorder.

absence of underlying medical conditions, medication use, or substance abuse that could cause the mood disorder

Necessary for the diagnosis.

fatigue or low energy

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.

low self-esteem

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.

poor concentration or difficulty making decisions

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.

feelings of hopelessness

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.

uncommon

poor appetite or overeating

Patients with the dysthymia subtype of persistent depressive disorder are less likely to report appetite changes than patients with a chronic major depressive disorder.

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.

sleep disturbance

Includes insomnia or hypersomnia. Patients with the dysthymia subtype of persistent depressive disorder are less likely to report sleep changes than patients with a chronic major depressive disorder.

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.

Risk factors

weak

positive family history

One study showed an increase in forms of chronic depression in first-degree relatives of people with dysthymia,[25] but another study of male twins did not reveal an increase in rates of dysthymia in monozygotic versus dizygotic twins.[26]

female sex

The lifetime prevalence of dysthymia has been reported as about 2% in men and about 4% in women.[4] Both dysthymia and chronic major depression are about twice as frequent among women as among men.[8]

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