Differential Diagnosis of Dysthymic Disorder

A. Major Depressive Disorder. Dysthymia leads to chronic less severe depressive symptoms compared to Major Depression which usually has one of more discrete episodes.

B. Substance-Induced Mood Disorder. Alcohol, benzodiazepines and other sedative-hypnotics can mimic dysthymia symptoms, as can chronic use of amphetamines or cocaine. Anabolic steroids, oral contraceptives, methyldopa, beta adrenergic blockers and isotretinoin (Accutane) have also been linked to depressive symptoms. Rule out with careful history of drugs of abuse and medications.

C. Mood Disorder Due to a General Medical Condition. Depressive symptoms consistent with dysthymia occur in a variety of medical conditions. These disorders include: stroke, Parkinson's disease, multiple sclerosis, Huntington's disease, vitamin B12 deficiency, hypothyroidism, Cushing's disease, pancreatic carcinoma, HIV and others. Rule out with history, physical exam and labs as indicated.

D. Psychotic Disorders. Depressive symptoms are common in chronic psychotic disorders and dysthymia should not be diagnosed if symptoms occur only during psychosis, including residual phases.

E. Personality Disorders. Personality disorders frequently coexist with dysthymic disorder.

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