Dysthymia and Apathy: Diagnosis and Treatment

Abstract

Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. It is often difficult to be distinguished from major depression, specifically in its partially remitted state because “loss of interest” or “apathy” tends to prevail both in dysthymia, and remitted depression. Apathy may also occur in various psychiatric and neurological disorders, including schizophrenia, stroke, Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia. It is symptomatologically important that apathy is related to, but different from, major depression from the viewpoint of its causes and treatment. Antidepressants, especially noradrenergic agents, are useful for depression-related apathy. However, selective serotonin reuptake inhibitors (SSRIs) may be less effective for apathy in depressed elderly patients and have even been reported to worsen apathy. Dopaminergic agonists seem to be effective for apathy. Acetylcholine esterase inhibitors, methylphenidate, atypical antipsychotics, nicergoline, and cilostazol are another choice. Medication choice should be determined according to the background and underlying etiology of the targeting disease.

Persistent Depressive Disorder or Dysthymia: An Overview of Assessment and Treatment Approaches

“…Personality disorders, such as depressive personality disorder, which is characterized by self-critical tendencies, introversion and a gloomy, negative outlook can appear very similar to dysthymia (Ishizaki & Mimura, 2011). Similarly somataform disorders, which are characterized by physical symptoms that suggest a general medical condition, but are not fully explained by that condition, can overlap with dysthymia (Feder, n.d.).…”

“…Those with family histories of major depression, bipolar disorder, dysthymia and personality disorders are particularly susceptible (Ishizaki & Mimura, 2011;Lizardi & Klein, 2000).…”

“…PDD or dysthymia is a recurrent, prolonged depressive disorder with no clearly demarcated episodes. Dysthymia, from the Greek "ill humor" or "bad state of mind" is understudied, often undertreated and can lead to high rates of death by suicide (Cristancho, Kocsis & Thase, 2012;Ishizaki & Mimura, 2011;Niculescu & Akiskal, 2001). Existing research has focused on diagnosing dysthymia and evaluating treatment with antidepressant medication and psychotherapy.…”

Demonstrating the Role of Anticholinergic Activity in a Mood Disorder

“…Importantly, memory disturbances [23] and apathy [24], which are known to be related to ACh deficiency, can be partially ameliorated with ChEI therapy. In this patient, the SAA marker was 6.21 n M , suggesting that she was burdened by AA, regardless of her actual diagnosis.…”

Common and Different Features Between Depression and Apathy in Neurocognitive Disorders

“…In literature apathy has received less attention than depression, but is important distinguish these conditions from the viewpoint of its causes and treatment [7].…”