A 39-year-old woman has experienced depressed mood on most days for the past 3 years. She describes her baseline as 'always feeling down' but is still able to work and maintain relationships. She has never had a full major depressive episode, manic episode, or hypomanic episode. She denies vegetative symptoms meeting MDD criteria. What is the most likely diagnosis?

• A Major depressive disorder, in partial remission
• B Bipolar II disorder, depressive phase
• C Cyclothymic disorder
• D Persistent depressive disorder (dysthymia) ✓

Explanation

Persistent depressive disorder (formerly dysthymia) is diagnosed when depressed mood is present for at least 2 years (in adults) on most days, with at least two associated symptoms, and the individual has never been symptom-free for more than 2 months at a time during that period. It differs from MDD in duration rather than severity and from cyclothymia which requires alternating hypomanic and depressive periods. The absence of any manic or hypomanic history rules out bipolar spectrum diagnoses.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.