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Dysthymic and cyclothymic depressions: therapeutic considerations
1Department of Psychiatry, University of California at San Diego, La Jolla 92093-0603.
The Journal of Clinical Psychiatry
|April 1, 1994
Summary
This review distinguishes two major depressive illness patterns: double depression and cyclothymic depression. Both subtypes show responsiveness to specific pharmacotherapies and psychosocial interventions, challenging suboptimal treatment beliefs.
Area of Science:
- Psychiatry and Behavioral Sciences
- Pharmacology and Therapeutics
Background:
- Major depressive illness presents with diverse course patterns originating from distinct temperamental substrates.
- Two prevalent patterns identified are 'double depression' and 'cyclothymic depression'.
Purpose of the Study:
- To review current evidence on the course patterns and treatment of major depressive illness subtypes.
- To explore the efficacy of various pharmacotherapies and psychosocial interventions for these subtypes.
Main Methods:
- Review of recent evidence on the clinical course and treatment response of depressive illness subtypes.
- Analysis of pharmacotherapy (TCAs, MAOIs, SSRIs, bupropion, lithium, valproate) and psychotherapy effectiveness.
Main Results:
- Double depression responds to TCAs, MAOIs, and SSRIs (fluoxetine evidence strongest).
- Cyclothymic depression (Bipolar II, soft bipolar) benefits from bupropion, MAOIs, low-dose SSRIs with mood stabilizers (lithium, valproate), and thyroid augmentation.
- Depressions linked to 'personality' disorders do not respond suboptimally; temperamental dysregulation is responsive to thymoleptic agents.
Conclusions:
- Temperament-based classification of depressive illness is closely linked to effective clinical management strategies.
- Specific pharmacologic and psychotherapeutic approaches are indicated for double depression and cyclothymic depression.
- Interpersonal factors and rhythmopathy require attention in managing these affective subtypes.