Dysthymia, a term coined in the 1980s for minor depression, was previously known in the 1950s as depressive neurosis and in the 1970s as depressive personality. It is a mild but persistent form of depression that afflicts at least 2 to 3 million people. According to the DSM-IV criteria, a diagnosis of dysthymia requires a patient to have been depressed most of the time for at least two years (one year for children and adolescents). In addition, at least three of the following symptoms must be present:

* low self-esteem or lack of confidence

* pessimism, hopelessness, or despair

* lack of interest in ordinary pleasures and activities

* withdrawal from social activities

* guilt or ruminating about the past

* irritability or excessive anger

* lessened productivity

* difficulty concentrating or making decisions.

Because the symptoms of dysthymia are less severe than those of major depression, dysthymia is not always recognized and is sometimes misdiagnosed as a personality disorder. The importance of the diagnosis cannot be underestimated because diagnosis determines treatment. Yet in psychiatry, diagnosis can be imprecise. Psychotic hallucinations, for instance, can be a symptom of schizophrenia, which is notoriously difficult to treat, or of severe manic depression, which can be controlled with lithium. Unhappiness and feelings of emptiness can be characteristic of borderline personality disorder or of dysthymia. The difference is major. If the diagnosis is dysthymia, medications such as Prozac may help. We have treatments. If the diagnosis is a personality disorder, the treatment involves many years of therapy, and the prognosis is guarded. Thus, if a patient is diagnosed as having a disease which he or she does not have, or for which there is no cure, then nothing will be done to help the patient. In this sense, whether you get well or not is determined by the diagnosis. The importance of finding an experienced doctor is critical because the diagnosis—along with the doctor’s knowledge of which drug to choose and in what dosage—can determine the person’s fate.

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