Dysthymia and Cyclothymia

A 38-year-old woman from Delhi presents with a 6-year history of persistent low mood, lack of energy, and poor concentration. She reports feeling "down most days" but denies any periods of elevated mood or decreased need for sleep. She has never had a manic or hypomanic episode. She functions adequately at work and maintains relationships, though she finds little pleasure in activities. She has tried no psychiatric medications. Mental status examination shows depressed affect, psychomotor retardation, and intact cognition. What is the most likely diagnosis?

Which of the following mood patterns is characteristic of Cyclothymia?

A 32-year-old man from Bangalore attends the psychiatry clinic with a 3-year history of mood instability. His wife reports that he cycles between periods (lasting 1–3 weeks each) of elevated mood, increased talkativeness, and excessive spending on hobbies, alternating with periods of low mood, anhedonia, and social withdrawal. He denies any psychotic symptoms, and his elevated periods do not require hospitalization or cause severe occupational disruption. His baseline functioning remains intact, and he has never had a full manic or major depressive episode. Routine investigations including thyroid function and metabolic panel are normal. What is the most likely diagnosis?

A 38-year-old woman from Delhi presents to the psychiatry outpatient department with a 6-year history of persistent low mood, poor concentration, and chronic fatigue. She reports that her mood has never been normal for more than a few weeks at a time. She denies any periods of elevated mood, racing thoughts, or decreased need for sleep. Her symptoms have caused significant occupational impairment—she has changed jobs three times due to poor performance. She denies suicidal ideation. Mental status examination reveals depressed affect, psychomotor retardation, and negative cognitions. There is no evidence of psychotic features. What is the most likely diagnosis?

A 32-year-old male software engineer from Bangalore presents with a lifelong pattern of mood instability. He describes alternating periods of 2–3 weeks of elevated mood, increased energy, decreased need for sleep (5 hours/night feeling rested), increased talkativeness, and ambitious goal-setting, followed by 3–4 weeks of depressed mood, anhedonia, and low energy. He denies any psychotic features, suicidal ideation, or hospitalization. His relationships and job performance have been chronically affected by these mood swings, though he has never lost employment. He has never sought treatment. What is the most likely diagnosis?