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Mathias L, Quagliato LA, Carta MG, Nardi AE, Cheniaux E. Challenges in the treatment of dysthymia: a narrative review. Expert Rev Neurother 2024; 24:633-642. [PMID: 38805342 DOI: 10.1080/14737175.2024.2360671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
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.
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Affiliation(s)
- Livia Mathias
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Laiana A Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mauro G Carta
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Elie Cheniaux
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Panic and Respiration, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Wang W, Wang Y, Wang F, Chen H, Qin X, Yang L, Yang X, Yang L. Notable dysthymia: evolving trends of major depressive disorders and dysthymia in China from 1990 to 2019, and projections until 2030. BMC Public Health 2024; 24:1585. [PMID: 38872130 PMCID: PMC11170895 DOI: 10.1186/s12889-024-18943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Depressive disorders have been identified as a significant contributor to non-fatal health loss in China. Among the various subtypes of depressive disorders, dysthymia is gaining attention due to its similarity in clinical severity and disability to major depressive disorders (MDD). However, national epidemiological data on the burden of disease and risk factors of MDD and dysthymia in China are scarce. METHODS This study aimed to evaluate and compare the incidence, prevalence, and disability-adjusted life-years (DALYs) caused by MDD and dysthymia in China between 1990 and 2019. The temporal trends of the depressive disorder burden were evaluated using the average annual percentage change. The comparative risk assessment framework was used to estimate the proportion of DALYs attributed to risk factors, and a Bayesian age-period-cohort model was applied to project the burden of depressive disorders. RESULTS From 1990 to 2019, the overall age-standardized estimates of dysthymia in China remained stable, while MDD showed a decreasing trend. Since 2006, the raw prevalence of dysthymia exceeded that of MDD for the first time, and increased alternately with MDD in recent years. Moreover, while the prevalence and burden of MDD decreased in younger age groups, it increased in the aged population. In contrast, the prevalence and burden of dysthymia remained stable across different ages. In females, 11.34% of the DALYs attributable to depressive disorders in 2019 in China were caused by intimate partner violence, which has increasingly become prominent among older women. From 2020 to 2030, the age-standardized incidence, prevalence, and DALYs of dysthymia in China are projected to remain stable, while MDD is expected to continue declining. CONCLUSIONS To reduce the burden of depressive disorders in China, more attention and targeted strategies are needed for dysthymia. It's also urgent to control potential risk factors like intimate partner violence and develop intervention strategies for older women. These efforts are crucial for improving mental health outcomes in China.
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Affiliation(s)
- Wei Wang
- Department of Psychology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Yihe Wang
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
| | - Feng Wang
- Department of Education, Guangxi Normal University, Guilin, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaqing Qin
- Department of Psychology, Shandong Normal University, Jinan, China
| | - Lexia Yang
- Nursing Department, The Third Hospital of Jinan, Jinan, Shandong, 250000, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Lejin Yang
- Department of Psychology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, 250012, China.
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Quagliato LA, Primavera D, Fornaro M, Preti A, Carta MG, Nardi AE. An update on the pharmacotherapeutic strategies for the treatment of dysthymic disorder: a systematic review. Expert Opin Pharmacother 2023; 24:2035-2040. [PMID: 37787056 DOI: 10.1080/14656566.2023.2265809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Longer treatment times, more comorbidity, more severe impairments in social, psychological, and emotional functioning, increased healthcare use, and more hospitalizations are all factors that are related to dysthymia. Given the significant prevalence of dysthymia (including persistent depressive disorder) worldwide, its comorbidity with several mental disorders, and the detrimental effects of these comorbidities, it is important to conduct a systematic review to compare the effects of pharmacological acute and maintenance treatments for dysthymia with placebo and standard care in the last 10 years, based on the publication of DSM5. AREAS COVERED This systematic review was performed according to PRISMA guidelines. Databases, including PubMed and Cochrane Central Register of Controlled Trials, were searched to assess the effects of pharmacological acute and maintenance treatments for dysthymia in comparison with placebo and treatment as usual. EXPERT OPINION Our review shows that SSRIs and SNRIs present efficacy for dysthymia treatment, and L-Acetylcarnitine should be investigated further for this condition in elderly patients. The comparison of antidepressant medication versus placebo showed coherent results based on three studies favoring pharmacotherapy as an effective treatment for participants with dysthymia. However, the scarcity of research on continuation and maintenance therapy in people with dysthymia highlights the need for more primary research.
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Affiliation(s)
- Laiana A Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michele Fornaro
- Neuroscience, Reproductive Science and Dentistry, Federico II University of Naples, Naples, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Mauro G Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Krzystanek M, Martyniak E, Pałasz A, Skałacka K, Chwalba A, Wierzbiński P. Amantadine in Treatment of Dysthymia-The Pilot Case Series Study. Pharmaceuticals (Basel) 2023; 16:897. [PMID: 37375844 DOI: 10.3390/ph16060897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/28/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Dysthymia is a common chronic mood disorder in which isolated symptoms of depression persist for at least 2 years. Despite the many medications recommended for the treatment of dysthymia, no recommendations have yet been made for the treatment of patients who fail to achieve clinical improvement. This justifies attempts to identify second-line drugs for the treatment of dysthymia. In an open and naturalistic case study, five patients diagnosed with dysthymia in whom at least one antidepressant treatment was ineffective were treated with amantadine. In the age- and gender-matched external control group, patients were treated with sertraline at 100 mg/day. Depressive symptoms were assessed using HDRS-17. Two men and three women were treated with 100 mg amantadine for 3 months with 3-5 months follow-up. After 1 month of treatment with amantadine, a significant reduction in the intensity of depressive symptoms was achieved in all patients, and the clinical improvement increased over the next 2 months of treatment. No deterioration in well-being was observed in any patient after discontinuation of amantadine. The effect of amantadine treatment was comparable to that of sertraline treatment in patients with dysthymia who improved with this drug. The present study indicates that amantadine is an effective and well-tolerated drug in the treatment of dysthymia. Amantadine may be associated with a quick improvement in symptoms in the treatment of dysthymia. Treatment with this drug seems to be associated with good tolerability and persistency of the therapeutic effect after the discontinuation of the treatment.
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Affiliation(s)
- Marek Krzystanek
- Department and Clinic of Psychiatric Rehabilitation, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Ewa Martyniak
- Department and Clinic of Psychiatric Rehabilitation, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Artur Pałasz
- Department of Histology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | | | - Artur Chwalba
- Pharmacology Department, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-808 Zabrze Rokitnica, Poland
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Matsuzaka Y, Urashima K, Sakai S, Morimoto Y, Kanegae S, Kinoshita H, Imamura A, Ozawa H. The effectiveness of lamotrigine for persistent depressive disorder: A case report. Neuropsychopharmacol Rep 2022; 42:120-123. [PMID: 34989158 PMCID: PMC8919124 DOI: 10.1002/npr2.12228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aim Persistent depressive disorder (PDD) was first introduced in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM‐5), which encompasses numerous different conditions, including dysthymia, recurrent major depressive disorder, double depression, and chronic major depression. SSRIs are the first‐line drugs for treatment of PDD; however, not all patients respond to SSRI treatment. Case presentation We describe a woman who was diagnosed with PDD. At the age of 38, the patient presented with anxiety, reduced energy, marked tiredness, and sleep disturbances. She was prescribed with three antidepressants (paroxetine, duloxetine, and mirtazapine), which were not effective in relieving her symptoms. She was also prescribed bromazepam, which was also not effective. Subsequently, she was switched to lamotrigine, which resulted in a marked improvement in symptoms. The antidepressants and bromazepam were gradually tapered and discontinued. Conclusion This case demonstrates that lamotrigine may be effective for treating patients with antidepressant resistant PDD and suggests that it may be a promising alternative to combination therapy of antidepressants and benzodiazepines in the treatment of PDD. The patient's depressive and anxiety symptoms remitted and relapsed repeatedly during taking combination therapy. After switching to lamotrigine monotherapy, the symptoms have improved and continued remission for a long time.![]()
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Affiliation(s)
- Yusuke Matsuzaka
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan.,Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kayoko Urashima
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan.,Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shintaro Sakai
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshiro Morimoto
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan.,Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinji Kanegae
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan
| | - Hirohisa Kinoshita
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan.,Health Center, Nagasaki University, Nagasaki, Japan
| | - Akira Imamura
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan.,Child and Adolescent Psychiatry Community Partnership Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroki Ozawa
- Department of Neuropsychiatry, Nagasaki University Hospital, Nagasaki, Japan.,Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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The prevalence of depression in adult onset idiopathic dystonia: Systematic review and metaanalysis. Neurosci Biobehav Rev 2021; 125:221-230. [PMID: 33662441 DOI: 10.1016/j.neubiorev.2021.02.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Adult onset idiopathic dystonia (AOID) is the third most common movement disorder in adults. Co-existing depressive symptoms and disorders represent major contributors of disability and quality of life in these patients, but their prevalence remains unclear. We investigated the point prevalence of supra-clinical threshold depressive symptoms/depressive disorders in AOID in a systematic review with qualitative synthesis and meta-analysis. Our search identified 60 articles suitable for qualitative synthesis and 54 for meta-analysis. The overall pooled prevalence of either supra-clinical threshold depressive symptoms or depressive disorders was 31.5 % for cervical dystonia, 29.2 % for cranial dystonia, and 33.6 % for clinical samples with mixed forms of AOID. Major depressive disorder was more prevalent than dysthymia in cervical dystonia, whereas dysthymia was more prevalent in cranial dystonia. In cervical dystonia, the prevalence of supra-clinical threshold depressive symptoms screened by rating scales was higher than that of depressive disorders diagnosed with structured interviews. Prevalence studies using rating scales yielded higher heterogeneity. More research is warranted to standardize screening methodology and characterization of mood disorders in AOID.
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Ventriglio A, Bhugra D, Sampogna G, Luciano M, De Berardis D, Sani G, Fiorillo A. From dysthymia to treatment-resistant depression: evolution of a psychopathological construct. Int Rev Psychiatry 2020; 32:471-476. [PMID: 32436408 DOI: 10.1080/09540261.2020.1765517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Dysthymia is a psychopathological construct historically described and often reconsidered through the centuries. Its first description is dated back to 400 b.C., when Hippocrates proposed his theory about the 'black bile' and the melancholic temperament. The concept of dysthymia (dys-, 'ill', thymia-, 'emotions') has been largely elaborated in the XIX and XX centuries by Burton, Cullen, Schneider, Kretschmer, Akiskal and other authors, and recently re-formulated in the various editions of the modern Diagnostic and Statistical Manual of Mental Disorders under different diagnostic labels: neurotic depression, dysthymic disorder, persistent depressive disorder. Beyond the nosology, dysthymia issues some other challenges, including the need for further research to characterise the peculiar pathophysiological framework of this syndrome (compared with major depressive disorder) and to better define evidences about tailored-treatment options and their effectiveness.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Zhuo C, Ji F, Lin X, Tian H, Wang L, Xu Y, Wang W, Jiang D. Global functional connectivity density alterations in patients with bipolar disorder with auditory verbal hallucinations and modest short-term effects of transcranial direct current stimulation augmentation treatment-Baseline and follow-up study. Brain Behav 2020; 10:e01637. [PMID: 32304288 PMCID: PMC7303392 DOI: 10.1002/brb3.1637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the neuroimaging characteristics of auditory verbal hallucinations (AVHs) in patients with bipolar disorder (BP) experiencing depressive episodes with and without AVHs, and alterations in those characteristics after transcranial direct current stimulation (tDCS). METHODS For a baseline pilot study, we recruited 80 patients with BP and depressive status (40 with and 40 without AVHs), and 40 healthy controls (HCs). Their global functional connectivity density (gFCD) was screened by functional magnetic resonance imaging (fMRI). Voxel-wise one-way analysis of covariance (ANCOVA) was conducted to detect intergroup differences in gFCD. In a follow-up study, the effects of 5 weeks of tDCS augmentation treatment on clinical symptoms and gFCD were assessed in the 40 BP patients with AVHs. RESULTS Compared to HCs, BP patients with and without AVHs exhibited increased gFCD in the central parietal lobe, insular lobe, and middle cingulate cortex, with decreased gFCD in the posterior parietal cortex, lateral prefrontal cortex, and occipital lobe (all bilateral). Only patients with AVHs showed increased gFCD in the Broca and Wernicke regions, and decreased gFCD in the hippocampus (all bilateral). After 5 weeks of tDCS, AVHs were slightly alleviated and gFCD abnormalities in the hippocampus were mildly attenuated. CONCLUSIONS Patients with BP and AVHs showed disturbances in the brain's communication capacity mainly in the left frontoparietal network, control network, and memory circuitry. Five weeks of tDCS alleviated AVHs slightly, without improving depressive symptoms, and attenuated hippocampal gFCD alterations in these patients.
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Affiliation(s)
- Chuanjun Zhuo
- School of Mental Health, Jining Medical University, Jining, China.,Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China.,Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, China.,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen, China
| | - Feng Ji
- School of Mental Health, Jining Medical University, Jining, China
| | - Xiaodong Lin
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Hongjun Tian
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Lina Wang
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenqiang Wang
- Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen, China
| | - Deguo Jiang
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China
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