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• For diagnostic, research, and treatment reasons, a distinction should always be made between the milder dysthymias, atypical and hysteroid depressions, and the more serious major depressive illnesses, with and without melancholic (vegetative) and psychotic features.
• A decade ago most psychiatrists would have been puzzled to find a chapter on dysthymia in a book about severe depressive disorders. They would have characterized this chronic form of depression as mild, "minor," or "syndromal."[...]In recent years, research has demonstrated the severity, prevalence, and importance of vogorous antidepressant treatment of dysthymia, justifying its inclusion here among serious mood disorders.
• In other patients, the dysthymia may co-occur with but not be causally related to the ADHD (Adler and Cohen 2004).[...]Early studies of adults with ADHD found rates of dysthymia as high as 67%–81% (Wender et al. 1985).
• Dysthymia in childhood or adulthood also significantly increases the risk of developing a subsequent major depressive episode.
• Involutive depression or bipolar dysthymias must be ruled out.[...]Two characteristics of bipolar dysthymias are distinguishable: first, the bipolar disorders are cyclical in character and develop over several days to several weeks, which is quite different from the sudden and sometimes multiple changes of chronic depression; second, the productive phases of dysthymias are accompanied by a considerable decrease in the duration of sleep, to less than 6 hours per day.