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Depression Research and Treatment
Volume 2011, Article ID 893905, 7 pages
http://dx.doi.org/10.1155/2011/893905
Review Article

Dysthymia and Apathy: Diagnosis and Treatment

1Department of Psychiatry, Nagata Hospital, 5173 Goji-cho, Miyakonojo-shi, Miyazaki 885-0084, Japan
2Department of Neuropsychiatry, Showa University School of Medicine, 6-11-11 Kita-Karasuyama, Setagaya-ku, Tokyo 157-8577, Japan
3Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

Received 6 December 2010; Accepted 24 April 2011

Academic Editor: Mathias Berger

Copyright © 2011 Junko Ishizaki and Masaru Mimura. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. It is often difficult to be distinguished from major depression, specifically in its partially remitted state because “loss of interest” or “apathy” tends to prevail both in dysthymia, and remitted depression. Apathy may also occur in various psychiatric and neurological disorders, including schizophrenia, stroke, Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia. It is symptomatologically important that apathy is related to, but different from, major depression from the viewpoint of its causes and treatment. Antidepressants, especially noradrenergic agents, are useful for depression-related apathy. However, selective serotonin reuptake inhibitors (SSRIs) may be less effective for apathy in depressed elderly patients and have even been reported to worsen apathy. Dopaminergic agonists seem to be effective for apathy. Acetylcholine esterase inhibitors, methylphenidate, atypical antipsychotics, nicergoline, and cilostazol are another choice. Medication choice should be determined according to the background and underlying etiology of the targeting disease.