# Dysthymia (Persistent Depressive Disorder) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541052. - Verified date: 2026-08 ## Verified against - LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) - SmPC section 4.2, https://www.medicines.org.uk/emc/product/11909/smpc - SmPC section 4.2, https://www.medicines.org.uk/emc/product/7069/smpc - Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541052. ## Treatment metadata - Sertraline — 50 mg — oral.solid - Escitalopram — 10 mg — oral.solid - Fluoxetine — 20 mg — oral.solid ## Complete treatment card ```text DYSTHYMIA (PERSISTENT DEPRESSIVE DISORDER) Sources: Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541052. Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Low mood for most of the day, on more days than not, lasting two years or longer [low mood] - Appetite is off: either poor or excessive - Sleep is disturbed: either too little or too much - Low energy or persistent tiredness [fatigue] - Poor opinion of oneself - Trouble concentrating, or difficulty reaching a decision [poor concentration] - A settled sense of hopelessness [low mood] - At least two of those six accompany the low mood [low mood] - Never free of the symptoms for more than two months at a stretch, and one year is enough in a child - There must never have been a manic or hypomanic episode - The symptoms have to be causing real distress or damage at home, at work or socially - It is easily missed, and the suicide risk is higher than average SIGNS - what you find (10) - Appearance may be unkempt, reflecting neglected self-care - Slowed movement, and behaviour ranging from cooperative to withdrawn [social withdrawal] - Note the rate and tone of speech - Mood is described as depressed or sad, and the affect can be narrowed - Check thought content for hallucinations and delusions, and whether thinking is clear and coherent [delusions · hallucinations] - Ask directly about suicidal thoughts and plans, access to weapons, self-injury and aggressive thoughts [suicidal thoughts] - Test orientation to person, place and date - Insight ranges from partial to absent, and judgement can be impaired enough to affect decisions - Blood pressure and pulse matter, since they point to physical illness underneath - Examine the nervous system, heart and lungs, and the skin for signs of drug use or infection TESTS (12) - No blood test or scan diagnoses it - Information from family or close contacts helps - Routine bloods add little in an otherwise healthy person, but are commonly sent to support decisions - Those usually are blood count, metabolic panel, pregnancy and toxicology urine tests - Plus HIV, a syphilis test, vitamin B12, folate and thyroid function - Ask about tobacco, alcohol, cannabis and other substances - Look for Parkinson disease, multiple sclerosis, syphilis or HIV behind the mood - Also brain lesions, heavy metal poisoning, delirium, and metabolic or hormonal disease - Trace the timeline of symptoms and what set them off and keeps them going - Ask whether acute depressive episodes come before or after stretches of low-grade depression - Drawing a life chart or timeline can bring the pattern of depressive symptoms into view - Conduct the physical examination with care where there is a history of trauma IF NOT THIS - what else fits (8) - Major depressive disorder, which should be diagnosed alongside if its criteria are also met - Depressive symptoms lasting over two years that fit neither this nor major depression - Any past manic or hypomanic episode rules it out and points to bipolar disorder - Cyclothymia, where hypomanic symptoms fall short of an episode alongside two years of low mood - A psychotic disorder, when the depressive symptoms occur only within it - Mood disorder caused by another illness, multiple sclerosis for instance - Mood disorder caused by a drug of abuse, a prescribed medicine or a toxin - Personality disorder, which frequently coexists, in which case both are diagnosed Source StatPearls "Persistent Depressive Disorder" - disease-level clinical article Status traced to the source above 1. SERTRALINE [1st line] Adult 50 mg once daily, titrate up to max 200 mg daily if required - Long-term Peds Should not be used in the treatment of children and adolescents under the age of 18 years, except for patients with obsessive compulsive disorder aged 6-17 years old. Source LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) Why Standard SSRI starting dose, equally applicable to the chronic low-grade depression of dysthymia as to anxiety or major depression. Caution Onset of benefit takes 2-4 weeks; warn the patient in advance so they do not stop early. Monitor for worsening mood or suicidal ideation in the first 2-4 weeks, especially under age 25. Do not combine with MAO inhibitors; taper rather than stop abruptly. Refer to psychiatry if there is no response, risk features develop, or a superimposed major depressive episode ('double depression') occurs. RED FLAG - Suicidal ideation or self-harm risk, or psychotic features: refer to psychiatry urgently. Egypt OPIRALINE 50 MG 20 F.C. TABS. EL-OBOUR 29.00 EGP (1.45/unit) AGRELOCIT 50 MG 20 TAB. MEMPHIS > ATM... 34.80 EGP (1.74/unit) DEPR-STAT 50MG 10 CAPS. MEMPHIS 21.60 EGP (2.16/unit) SESERINE 50MG 30 TAB. ADWIA 75.00 EGP (2.50/unit) SERPASS 50MG 30 F.C.TAB. GLOBAL NAPI P... 102.00 EGP (3.40/unit) SIRTO 50MG 10 F.C. TABS. HI-PHARM 34.00 EGP (3.40/unit) MOODAPEX 50 MG 30 F.C.TAB. MULTI-APEX 111.00 EGP (3.70/unit) LUSTRAL 50 MG 20 F.C.TABS. VIATRIS 136.00 EGP (6.80/unit) 2. ESCITALOPRAM [2nd line] Adult 10 mg PO once daily, may increase to max 20 mg once daily. - Long-term (continue 6-12 months) Peds Contraindicated / not recommended in children and adolescents under 18 years. Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/7069/smpc Why Same standard SSRI starting dose used across the depressive/anxiety spectrum, appropriate for persistent depressive disorder. Caution Alternative first-line SSRI if sertraline is not tolerated or preferred. Onset of benefit takes 2-4 weeks. Escitalopram is contraindicated in patients with known QT interval prolongation or congenital long QT syndrome, and together with medicinal products that are known to prolong the QT interval. Egypt ESCTIKANA 10 MG 14 F.C.TABS. HOCHSTER PHAR... 17.00 EGP (1.21/unit) CITALOMEP 10 MG 14 F.C.TABS. MEPACO 26.00 EGP (1.86/unit) ECANOPRAM 10 MG 14 F.C. TABS. FUTURE PHARMA... 30.00 EGP (2.14/unit) MOODAMASH 10 MG 14 F.C. TABS. MASH PREMIERE 63.00 EGP (4.50/unit) EXCELSA 10 MG 14 F.C.TABS. PHAROPHARMA 66.00 EGP (4.71/unit) ESCITA 10 MG 14 F.C.TABS. GENESIS PHARM... 77.00 EGP (5.50/unit) CIPRAPRO 10 MG 30 F.C.TABS. MARCYRL PHARM... 237.00 EGP (7.90/unit) CIPRALEX 10 MG 28 F.C.TABS. LUNDBECK > MU... 392.00 EGP (14.00/unit) XYGAROT 5MG/5ML SYRUP 100ML MULTI-APEX 21.00 EGP -> ? strength differs, ? different route - not oral solid ESCITALOBORG 5 MG/5ML SYRUP 125 ML BORG 50.00 EGP -> ? strength differs, ? different route - not oral solid 3. FLUOXETINE [3rd line] Adult 20 mg PO once daily. - Long-term (continue 6 months post-remission) Peds 8 to under 18 years: Specialist supervised: start 10 mg (2.5 mL oral solution) once daily; may increase after 1 to 2 weeks to 20 mg once daily. (Age 8-17y (specialist supervised): start 10 mg (2.5 ml oral solution) once daily, may increase after 1-2 weeks to 20 mg once daily.) Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/11909/smpc Why The same SSRI dose used for major depressive disorder is appropriate for the chronic low-grade depression of dysthymia. Caution Alternative SSRI, useful if the patient has fatigue or low energy given its more activating profile. Monitor closely for suicidal ideation in young adults during initial weeks. Do not combine with MAO inhibitors or other serotonergic drugs. Egypt FLOROSIN 20MG 10 CAPS. UP PHARMA 11.00 EGP (1.10/unit) PHILOZAC 20MG 10 CAPS. AMOUN 11.00 EGP (1.10/unit) FLUOXETINE 20 MG 10 CAPS. MISR 18.60 EGP (1.86/unit) ELEVAMOOD 20 MG 28 CAPS. UNIPHARMA 56.00 EGP (2.00/unit) OCTOZAC 20MG 10 CAPS. OCTOBER PHARMA 21.60 EGP (2.16/unit) PHILOZAC 20MG 30 CAPS. AMOUN 75.00 EGP (2.50/unit) PROZAC 20MG 14 CAPS. ELI LILLY 118.00 EGP (8.43/unit) FLUOXETINE 20 MG H.G.CAPS. SIGMA 8.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)