title: General health, health care utilization, and medical comorbidity in dysthymia.
abstract: OBJECTIVE
  This article reviews the literature on the general health, health care utilization, prevalence, medical comorbidity, and treatment of dysthymia in medical settings.
  
  
  METHODS
  The literature was searched by using MEDLINE and by reviewing the bibliographies of recent publications. Studies were selected that included health data on patients with dysthymia or chronic depression according to DSM-III, DSM-III-R, ICD-9, or RDC criteria, or patients who were described as having persistent depressive symptoms.
  
  
  RESULTS
  This review shows that dysthymic patients are at increased risk for poor general health and frequently use medical services. Compared to the general population, dysthymia is more prevalent in primary care and among patients with various medical and neurological conditions, sleep disorders, chronic fatigue, hypothyroidism, and somatoform disorders. Pharmacotherapy is effective, but has not been well studied. Non-tricyclic antidepressants might be especially useful. Psychotherapy studies are virtually non-existent.
  
  
  CONCLUSIONS
  Although dysthymia is considered a minor depressive condition, these findings show that it is a significant public health problem, comparable to major depression. Recent efforts to improve the recognition and treatment of major depression in medical settings, therefore, should be extended to include the entire spectrum of depressive disorders. Future studies should investigate the type and pattern of medical comorbidity and health care utilization, different antidepressant and psychosocial therapies, and the clinical and biological correlates of treatment response in different chronic depressive subtypes in medical settings and compare them to major depressive and subsyndromal depressive conditions.
authors.affiliation: University of Pittsburgh School of Medicine, Pennsylvania.
authors.forename: R H
authors.initials: RH
authors.lastname: Howland
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002908:Chronic Disease; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D015673:Fatigue Syndrome, Chronic / Q000150:complications / Q000523:psychology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000523:psychology; D008297:Male; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011613:Psychotherapy; D012893:Sleep Wake Disorders / Q000150:complications / Q000523:psychology; D013001:Somatoform Disorders / Q000150:complications
chemical_list: D000929:Antidepressive Agents, Tricyclic