Dysthymia

Definition

Dysthymia is a disturbance of mood. The essential feature is a chronic disturbance of mood of at least two years duration, involving either depressed mood or loss of interest or pleasure in all or almost all usual activities and pastimes.

Associated symptoms occur but not all of sufficient severity to meet the criteria for a major depressive episode. It is also called neurotic depression.

Description

Dysthymia (or dysthymic disorder) is a chronic state of mild depression that lasts for years. It is believed to affect about 3 percent of the population at any time and thus is the most common form of depression.

In dysthymia, the mood never seems to quit for more than a day or two, draining all pleasure from life. Every couple of years it may vanish for a month or two, but it almost always returns.

Some people grow so used to being depressed that they think it is part and parcel of who they are rather than an illness that can be treated. Because symptoms are not as severe as in major depression, sufferers are better able to function in the short run. In the long run, however, because their symptoms are chronic, their relationships and work suffer.

In addition to the mood, which is sad, blue, or down in the dumps, individuals with the disorder can suffer many of the same symptoms as in major depression (except the psychotic symptoms) but in a less intense or acutely life-disruptive way: sleep and appetite changes, fatigue or reduced energy, low self-esteem, indecisiveness and trouble concentrating, and feelings of hopelessness. In double depression, however, major depression and dysthymia coexist, so that the chronic state periodically is interrupted by intense, more severe episodes.

Some researchers believe that in some people, especially those who develop the disorder in adulthood, dysthymia results from an episode of major depression suffered years before from which they never fully recovered.

People who suffer from this chronic depressive disorder are at high risk for other mental difficulties as well, notably disorders of anxiety, eating, and personality, and substance abuse.

About half the time, problems with dysthymia (and other forms of depression) are compounded by alcohol dependency or abuse. Alcoholism and dysthymia are often seen together and typically each has such a long history that it is difficult to disentangle one from the other.

Causes and Risk Factors

Although it can occur at any age, dysthymia often begins earlier than major depression, in childhood, adolescence, or early adult life, Because of its usually early occurrence and its chronic nature, dysthymia seems to become embedded in a person's personality and to appear like a personality trait. People who have dysthymia have been thought to have a "depressive personality" or "depressive neurosis."

Symptoms

Low self-worth coupled with reliance on others for self-esteem, exaggerated disappointment reactions, feelings of helplessness, a tendency to blame others, and an angry, unhappy attitude often characterize people with this disorder. It is unclear, however, whether these personality factors predispose a person to dysthymia or whether they are a consequence of having it.

Diagnosis

The diagnosis of dysthymia is made from the pattern of mental and physical conditions observed.

Treatment

Only one in five who have dysthymia or other forms of depression ever seeks help. Yet dysthymia is a very treatable disorder. With the right kind of treatment, nearly every patient can experience significant relief in 12 to 14 weeks. Untreated, many dysthymics eventually develop major depression.

Often, psychotherapy is recommended first for three months, followed by antidepressants if therapy alone is not effective. Sometimes, a combination of psychotherapy and antidepressants is used early on. Newer SSRI antidepressants such as Prozac, Zoloft and Paxil are of variable helpfulness with this disorder.

Other forms of therapy used are:

• Cognitive-behavioral therapy, which shows patients how to change self-defeating and disturbed thought patterns into more positive and productive ways of thinking. The behavioral aspect of therapy includes training in asserting oneself, practicing relaxation techniques, and increasing pleasurable activities

• Interpersonal therapy, which focuses on developing better relationships

• Cultural analysis, which points out unrealistic societal messages that contribute to low self-esteem and a sense of powerlessness, especially for women

• Group therapy and self-help, which provide a source of emotional support and vital social connections

Questions to Ask Your Doctor

Is it major depression or dysthymia?

What is the essential difference between these two forms of depression?

What is the probable cause?

Can this be treated?

Would psychotherapy help?

Do you recommend use of antidepressants?

Is this condition curable?