Dysthymia

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Dysthymia
Classification and external resources
ICD-10 F34.1
ICD-9 300.4
MeSH D019263

Dysthymia (pronounced /dɪsˈθaɪmiə/) is a chronic mood disorder that falls within the depression spectrum. It is considered a chronic depression, but with less severity than major depressive disorder. This disorder tends to be a chronic, long-lasting illness.[1]

Dysthymia is a type of low-grade depression. Harvard Health Publications states that, “the Greek word dysthymia means ‘bad state of mind’ or ‘ill humor’. As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer.” Harvard Health Publications says, “at least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism”. The Primary Care Journal says that dysthymia “affects approximately 3% of the population and is associated with significant functional impairment”. Harvard health Publications says: "The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder." "Most people with dysthymia can't tell for sure when they first became depressed".[citation needed]

Contents

[edit] Symptoms

The symptoms of dysthymia are similar to those of major bipolar depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood (which can change rapidly for no apparent reason), lack of interest in things most people find enjoyable, but also experience an overenthusiastic interest in a certain activity, and a loss of energy that can be followed by a period of excessive energy (not all patients feel this effect). Appetite and weight can be increased or decreased. The person may suffer from insomnia or hypersomnia. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a negative self-image. Note that people suffering from dysthymia experience all the symptoms and effects all the time, as depressive episodes can be followed by episodes of hypomania. Furthermore, depressive and hypomanic episodes can be both short- (a matter of few minutes) and long-lasting (up to a few months) and vary in intensity. For a third person, someone suffering from dysthymia can appear to be "extremely moody", shy and, often, shows the tendency to "hide" emotional feelings from others (except in major episodes when stored-up emotions suddenly erupt).

The symptoms can grow into a full blown episode of major depression. This situation is sometimes called "double depression"[2] because the intense episode exists with the usual feelings of low mood. People with dysthymia have a greater-than-average chance of developing major depression. While major depression often occurs in episodes, dysthymia is a constantly present minor bipolar depression, where depressive and hypomanic episodes lasting anything from minutes to months constantly follow each other (often interrupted by episodes of seemingly normality), sometimes beginning in childhood. As a result a person with dysthymia tends to believe that depression is a part of his or her character. The person with dysthymia may often not be self-aware of the condition and, subsequently, may not even think to talk about this depression with doctors, family members or friends. Dysthymia, like major depression, tends to run in families. It is two to three times more common in women than in men. Some sufferers describe being under chronic stress. When treating diagnosed individuals, it is often difficult to tell whether they are under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.

[edit] Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders[3] (DSM), published by the American Psychiatric Association, characterizes Dysthymic disorder. The essential symptom involves the individual feeling depressed almost daily for at least two years, but without the criteria necessary for a major depression. Low energy, disturbances in sleep or in appetite, and low self-esteem typically contribute to the clinical picture as well. Sufferers have often experienced dysthymia for many years before it is diagnosed. People around them come to believe that the sufferer is 'just a moody person'. Note the following diagnostic criteria:[1]

  1. During a majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.
  2. When depressed, the patient has 2 or more of:
    1. Appetite decreased or increased
    2. Sleep decreased or increased
    3. Fatigue or low energy
    4. Poor self-image
    5. Decreased concentration and decisiveness
    6. Feels hopeless or pessimistic
  3. During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
  4. During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
  5. The patient has not had any Manic Hypomanic or Mixed Episodes.
  6. The patient has never fulfilled criteria for Cyclothymic Disorder.
  7. The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
  8. The symptoms are often not directly caused by a general medical condition or the use of substances, including prescription medications.
  9. In contrast to major depression, these symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000). People suffering from dysthymia are usually well capable of coping with their everyday lives (usually by following particular routines that provide certainty) (www.aware.ie).

In children and adolescents, mood can be irritable and duration must be at least 1 year, in contrast to 2 years needed for diagnosis in adults.

[edit] Treatments

[edit] Medications

In contrast to major depression, medication should only be the last resort. Instead, treatment should be primarily based on psychotherapy involving a. o. the patient learning to cope with dysthymia by understanding its nature.

If medication is deemed necessary, the most commonly prescribed anti-depressants for this disorder are the selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).[citation needed]. SSRIs are easy to take and relatively safe compared with older forms of anti-depressants.[4]. Other new anti-depressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), and duloxetine (Cymbalta).

Sometimes two different anti-depressant medications are prescribed together, or a doctor may prescribe a mood stabilizer or anti-anxiety medication in combination with an anti-depressant.

[edit] Side Effects of Medications

Some side effects for SSRI’s are "sexual dysfunction, nausea…diarrhea, sleepiness or insomnia, short-term memory loss and tremors".[citation needed] Sometimes antidepressants don’t work for patients. Older antidepressants, such as a tricyclic antidepressant or an MAOI can be tried in such cases. Tricyclic antidepressants are more effective but have worse side effects. Side effects for tricyclic antidepressants are "weight gain, dry mouth, blurry vision, sexual dysfunction, and low blood pressure".[citation needed]

[edit] Psychotherapy

Some evidence suggests the combination of medication and psychotherapy may result in the greatest improvement. The type of psychotherapy that will help depends on a number of factors, including the nature of any stressful events, the availability of family and other social support, and personal preference. Therapy should include education about depression. Support is essential. Cognitive behavioral therapy is designed to examine and help correct faulty, self-critical thought patterns and correct the cognitive distortions that persons with mood disorders commonly experience. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms.[citation needed]

[edit] See also

[edit] References

  1. ^ a b Hersen, M., Turner, S. M., & Beidel, D. C. (Eds.). (2007). Adult Psychopathology and Diagnosis (5th ed.). Hoboken, New Jersey: John Wiley & Sons, Inc.
  2. ^ Double Depression: Hopelessness Key Component Of Mood Disorder retrieved July 17, 2008
  3. ^ American Psychiatric Association, ed (June 2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.). American Psychiatric Publishing, Inc.. p. 943 pages. ISBN 978-0890420249. http://www.dsmivtr.org/. 
  4. ^ National Institute of Mental Health
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Bipolar disorder
History
Symptoms
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