Dysthymic disorder
It is characterized by a depressed mood for most of the day, almost every day, for at least two years. During the period of illness the patient is never in a normal mood for more than two consecutive months. In addition, at least two of the following symptoms must be present:
- hyporessia or hyperphagia;
- insomnia or hypersomnia;
- reduced energy and fatigue;
- low self-esteem;
- poor ability to concentrate or difficulty making decisions;
- feelings of despair.
There must not have been an episode of major depression during the first two years of the illness. There may have been, but it must have resolved completely before the onset of dysthymic disorder.
If, after the initial two-year period, major depressive episodes overlap with the dysthymic disorder (and this happens in 75% of patients), it is called double depression.
Symptoms cause significant distress and impairment in social, work and other important areas.
The term "dysthymia" was coined, in 1970, by Dr. Robert Spitzer and took the place of "depressive personality", used previously. Today, the disorder is also known as neurotic depression or dysthymic disorder, although recently the DSM-5 (2013) introduced the new term Persistent Depressive Disorder ( persistent depressive disorder ).
Depressive disorder not otherwise specified
It includes disorders with depressive manifestations that do not meet the criteria for major depressive and dysthymic disorders. The most frequent of the disorders belonging to this category is the premenstrual dysphoric disorder. In order to diagnose this disorder, there must be 5 or more symptoms in a series, which includes:
- markedly depressed mood, desperation, self-depreciation;
- anxiety and tension;
- emotional lability;
- anger or irritability;
- decreased interest in usual activities;
- difficulty concentrating;
- drowsiness and easy fatigability;
- marked changes in appetite, overeating and compulsive research of certain foods (especially carbohydrates and sweets);
- insomnia or hypersomnia;
- feeling about to lose control;
- physical symptoms: increased breast volume with pain, swelling, weight gain, joint pain.
At least one of the symptoms must be in the first four. Moreover, the same must have occurred during the week preceding menstruation in most menstrual cycles of the previous 12 months. These symptoms are always absent in the week following menstruation. The intensity, but not the duration, of the symptoms, are of a severity comparable to that of the major depressive disorder and must cause a clear and marked impairment of social and work functioning for the period in question (including quarrels with spouse, friends and family).
At least 75% of women experience isolated or premenstrual minor changes, 20-50% suffer from "premenstrual syndrome" while the disorder in question would affect 3-5% of women.
