[Dysthymic disorder and its treatment]

Dysthymia is a new nosographic category in the latest American and international classification of mental disorders. Dysthymics were previously considered either as "neurotic depressive characters" or "characterologic depressives." Today it has been demonstrated that the personality and affective traits of these patients are in fact simply different expressions of a constitutive predisposition to clinical depression. Some studies have shown biological and neurophysiological relationships between dysthymia and major mood disorders. We therefore submit that dysthymia constitutes a subaffective expression of the major depression phenotype. Other studies have demonstrated the short-term efficacy (6 weeks to 3 months) of antidepressants in this disorder. In this article, we present a prospective 2-years study comparing the efficacy of fluoxetine with tricyclic antidepressants. The results show not only the efficacy of fluoxetine in dysthymia, but especially, if we consider the degree of social adaptation, a much better response qualitatively. These patients, who were previously sentenced to a life of suffering, may now benefit from new mood-regulating agents. The benefit afforded by drug treatment must be supported by various supportive psychotherapies, which are also discussed.