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Dysthymia in Clinical Practice

Published online by Cambridge University Press:  02 January 2018

Hagop S. Akiskal
Department of Psychiatry, University of California at San Diego, 9500 Gilman Dr., BSB-2072, La Jolla, California 92093-0603
Jorge Alberto Costa e Silva
Division of Mental Health, WHO, Geneva
Allen Frances
Department of Psychiatry, Duke University Medical Center, North Carolina 27710
Hugh L. Freeman*
21 Montagu Square, London
Martin B. Keller
Department of Psychiatry and Human Behaviour, Brown University, and Brown Affiliated Hospitals, 345 Blackstone Boulevard, Providence RI 029906
Yvon D. Lapierre
Department of Psychiatry, Royal Ottawa Hospital, 1145 Carling, Ottawa, Ontario K1Z 7K4
Juan José Lopez Ibor Jr
Psychiatric Unit, Hospital Clínico San Carlos, Martin Lagos s/n, 28040 Madrid
Eugene S. Paykel
Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ
Max Stabl
F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, CH-4002 Basel, Switzerland
Professor H. L. Freeman, 21 Montagu Square, London W1H 1RE



Dysthymia has been reconceptualised in recent years from a personality disorder to a chronic affective disorder. It is incorporated into both the DSM and ICD diagnostic systems. Method. The members of the WPA Dysthymia Working Group combined the results of their manual literature searches with a search using Medline.


Available data are summarised under the headings of classification, epidemiology, validity, comorbidity, course and outcome, pharmacotherapy and psychotherapy. The coexistence of major depressive disorder, constituting ‘double depression’ is of particular importance.


Improved knowledge of this disorder has led to a more positive approach to treatment, in which antidepressants can usefully be complemented by psychosocial measures. A high proportion of cases remain unrecognised in most populations, leading to prolonged morbidity and distress, much of which is now treatable.

Review Article
Copyright © 1995 The Royal College of Psychiatrists 

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Members of the WPA Dysthymia Working Group: Hagop S. Akiskal (USA), Jorge A. Costa e Silva (Chair) (Brazil), Allen Frances (USA), Hugh L. Freeman (UK), Martin B. Keller (USA), Yvon D. Lapierre (Canada), Juan José Lopez Ibor Jr (Spain), Eugene S. Paykel (UK), Max Stabl (Switzerland).


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