What is the difference between dysthymia and dysphoria

Although the term is new, dysthymia is based on several older clinical concepts, such as neurotic depression, depressive personality and chronic depression.

It is more common among females than among males and can begin at any age, although onsets in childhood and adolescence are particularly common, especially among patients seeking treatment. We do know that it runs in families, although it is unclear whether this linkage is due to genetic or environmental factors, or both. Dysthymia seems to be closely related to major depression, which is the more severe and episodic form of depression.

In other words, most people who have dysthymia do experience exacerbations that meet the criteria for major depression at some point in their lives, and there is a high rate of occurrence of major depression in the families of people with dysthymia.

There is also suggestive evidence that dysthymia responds to some of the focused, short-term psychotherapies that have been developed for major depression, such as cognitive therapy and interpersonal therapy. There have not been enough studies on psychotherapy treatment of dysthymia to draw any definitive conclusions at this point, however.

Newsletter Get smart. Sign up for our email newsletter. Already a subscriber? Sign in. Thanks for reading Scientific American. However, some patients who are treated for dysthymia only present with loss of interest and do not have a depressed mood. This condition should be regarded as apathy. Marin [ 27 ] defined the apathy syndrome as a syndrome of primary lack of motivation, that is, loss of motivation that is not attributable to emotional distress, intellectual impairment, or diminished consciousness.

Starkstein [ 28 ] described the features of apathy as lack of motivation characterized by diminished goal-oriented behavior and cognition, and a diminished emotional connection to goal-directed behavior. Levy and Dubois [ 29 ] proposed that apathy could be defined as the quantitative reduction of self-generated voluntary and purposeful behavior. At present, apathy is treated symptomatically.

There is no decision tree for apathy in DSM-IV-TR, but there is a possibility that apathy will come to be managed independently from mood disorders if the mechanisms involved or treatment strategy is more fully established in the future. Marin [ 27 ] and Starkstein [ 30 ] have suggested diagnostic criteria for this condition. As the basis of specific diagnostic criteria for apathy, abnormalities in aspects of emotion, cognition, motor function, and motivation have been suggested.

Marin has also developed an apathy rating scale [ 31 ], while diagnostic criteria for apathy have been proposed by Starkstein et al. Table 1. Apathy has received increasing attention because of its effects on emotion, behavior, and cognitive function. It seems likely that apathy in persons with depression results from alterations of the emotional and affective processing, but it may typically occur in the absence of a depressed mood Figure 1.

Marin et al. Elevated apathy scores were associated with low depression in Alzheimer's disease, high depression in major depression, and intermediate scores for depression in right hemispheric stroke. They found that the level of apathy and depression varied among diagnostic groups although apathy and depression were significantly correlated within each group. Thus, apathy is most often seen clinically within the setting of depression, dementia, or stroke, and problems related to apathy tend to be important because of its frequency, increasing prevalence, impact on daily life, poorer rehabilitation outcomes after stroke, and burden on caregivers.

Levy et al. Apathy, but not depression, was correlated with lower cognitive function as measured by the mini mental state examination [ 48 ]. These results imply that apathy might be a specific neuropsychiatric syndrome that is distinct from depression but is associated with both depression and dementia.

Symptomatologically, it is important to understand that apathy can occur concomitantly with depression, but is usually different from it. Starkstein et al. The apathetic patients were older, had a higher frequency of major but not minor depression, had more severe physical and cognitive impairment, and had lesions involving the posterior limb of the internal capsule.

In their study, there was a significantly higher frequency of apathy among the patients with major depression but not those with minor depression or no depression. These findings indicate that although major depression and apathy occur independently, apathy remains significantly associated with major depression but not with minor depression.

This is consistent with the results of previous studies that have differentiated between major and minor depression, including differences of cognitive function and cortisol suppression after dexamethasone administration [ 49 , 50 ], which were seen in patients with major depression but not minor depression.

Apathy is often seen in patients with lesions of the prefrontal cortex [ 51 , 52 ] and is also frequent after focal lesions of specific structures in the basal ganglia such as the caudate nucleus, the internal pallidum, and the medial dorsal thalamic nuclei [ 53 — 56 ]. Apathy is, therefore, one of the clinical sequelae of disruption of the prefrontal cortex-basal ganglia axis, which is one of the functional systems involved in the origin and control of self-generated purposeful behavior.

Anatomical localization of regional dysfunction associated with apathy and depression appears to overlap considerably. Depression has been reported to be more frequent when focal lesions are anterior and left-sided [ 57 ]. Taking into consideration the facts that apathy is related to cognitive function and disruption of the prefrontal cortex-basal ganglia axis, apathy can be considered to resemble subcortical dementia and to be treatable using dopaminergic agents in central nervous system.

A growing number of reports have documented the treatment of apathy with a variety of psychoactive agents. Various small studies have indicated that psychostimulants, dopaminergics, and cholinesterase inhibitors might be of benefit for this syndrome. However, there is no current consensus about treatment for apathy, and information on pharmacotherapy for this condition mainly depends upon underlying etiology and background disease.

Therefore, the treatment of apathy should be selected according to its etiology. Depressed patients with apathy should be given antidepressants, which may also alleviate other symptoms. However, caution has been raised about using SSRIs for depressed elderly persons because it may worsen apathy [ 58 ]. Since frontal lobe dysfunction is considered to be one of the causes of apathy, patients with primary apathy may respond to psychostimulants such as methylphenidate or dextroamphetamine.

There have also been reports about improvement of apathy and cognitive function after stroke by treatment with cilostazol [ 59 ]. Apathy syndrome is associated with many diseases, but whether medications are applicable across this spectrum of background diseases remains unknown. These issues should be examined in future studies. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues. Academic Editor: Mathias Berger. Received 06 Dec Accepted 24 Apr Published 27 Jun Abstract Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression.

Treatment for Dysthymia The best treatment for dysthymia appears to be a combination of psychotherapy and medication. Apathy Dysthymia is essentially defined by the existence of depressive symptoms at some level.

Presence, with lack of motivation, of at least one symptom belonging to each of the following three domains. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to a diminished level of consciousness or the direct physiological effects of a substance e.

Adapted from Starkstein [ 30 ]. Figure 1. Table 2. References M. Weissman, P. Leaf, M. Bruce, and L. View at: Google Scholar R.

Kessler, K. McGonagle, S. Zhao et al. View at: Google Scholar J. Markowitz, M. Moran, J. Kocsis, and A. Broadhead, D. Blazer, L. George, and C. Brunello, H. Akiskal, P. Boyer et al. Kovacs, H. Akiskal, C. Gatsonis, and P. View at: Google Scholar M. Keller, D. Klein, R. Hirschfeld et al. View at: Google Scholar D. Klein, J. Schwartz, S. Rose, and J. Klein, S. Shankman, and S. Kwon, Y. Kim, C.

Chang et al. Dysthymia and depression can both result in feelings of deep sadness and hopelessness. However, these two conditions vary in the severity and consistency of their symptoms. While some people may use the terms above, the medical classifications for dysthymia and depression are persistent depressive disorder PDD and major depressive disorder MDD , respectively. Understanding these differences can be an important first step toward getting the right treatment.

Read on to learn more about how the conditions differ in their symptoms, how medical professionals can diagnose them, and what treatment options are available to you.

Both conditions are relatively common. According to estimates, over 7 percent of all adults in the United States will have experienced a major depressive episode in the last year, while around 2. It can significantly affect your:. MDD is a common medical illness that negatively affects the way you think, feel, and act. This may lead to emotional and physical problems that can interfere with your ability to function at home and work.

Medical professionals typically use PDD to describe a person who experiences clinically significant depression over a long period. As a result, the most significant difference between the two conditions is how long a person may experience symptoms. For a diagnosis of MDD, symptoms must last at least 2 weeks , and for a diagnosis of PDD, symptoms must have been present for at least 2 years.

While people with PDD will typically experience depression for longer than someone with clinical depression, their symptoms may not be severe enough for an MDD diagnosis. However, people with PDD can still experience major depressive episodes. Between these episodes, people with PDD will return to feelings of general, less severe depression. In contrast, people who exclusively have MDD may return to a regular mood baseline between major episodes. During this time, they may not experience any symptoms of depression at all.

While medical professionals will individually tailor treatment programs for any type of depression, the treatments for PDD and MDD are similar. The main routes of treatment are programs of short- and long-term medications and therapy sessions. Combining these two methods of treatment is more effective than either treatment by itself. Alongside medication programs to treat PDD and MDD, a doctor may recommend you participate in psychotherapy , which people also refer to as talk therapy.

Psychotherapy involves one-on-one sessions with a mental health professional.