Dysthymia (Persistent Depressive Disorder)

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Dysthymia, or persistent depressive disorder, has fewer or less serious symptoms than major depression but lasts longer.  Dysthymia is sometimes referred to as chronic depression. With dysthymia, the depression symptoms last two years or more. Whereas, an episode of major depression needs to last only two weeks rather than two years. It is not uncommon for a person with dysthymia to also experience an episode of major depression at the same time. This is called double depression.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines dysthymia as depressed mood most of the time for at least two years, along with at least two of the following symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness (American Psychiatric Association, 2013). People with dysthymia may find it hard to be upbeat even on happy occasions—you may be described as having a gloomy personality, constantly complaining or incapable of having fun.

A guy burying his face in his hands due to depressed mood
Guy with depressed mood

Dysthymia is a serious disorder. Sometimes it is more disabling than major depression. It is about as common as major depression. About 6% of the population of the United States has had an episode of dysthymia at some time. It is more common in women than in men. Its onset is earlier in life than is the case with major depression. More than half of people with dysthymia eventually have an episode of major depression (Harvard Health Publishing, 2014).

Dysthymia Symptoms (Harvard Health Publishing, 2014)

Depressed mood, disturbed sleep, low energy, and poor concentration are common to dysthymia and major depression.

The symptoms of poor appetite, low self-esteem, and hopelessness in dysthymia are parallel to the more severe symptoms of weight change, excessive guilt, and thoughts of death or suicide in major depression.

Anhedonia (inability to feel pleasure) and psychomotor symptoms (chiefly lethargy or agitation) are present in major depression but they are not usually associated with dysthymia.

Diagnostic criteria of dysthymia include the following (American Psychiatric Association, 2013):

  • Sadness or depressed mood for most of the day, almost every day, for at least 2 years (at least 1 year in children and adolescents).
  • Presence, while depressed, of two (or more) of the following:
    1. Poor appetite or overeating.
    2. Insomnia or hypersomnia.
    3. Low energy or fatigue.
    4. Low self-esteem.
    5. Poor concentration or difficulty making decisions.
    6. Feelings of hopelessness.
  • During the 2-year period (1 year for children or adolescents), the individual has never been symptom-free for more than 2 months at a time.
  • Criteria for a major depressive disorder may be continuously present for 2 years.
  • There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
  • The disturbance is not better explained by a psychotic disorder, such as persistent schizoaffective disorder, schizophrenia, delusional disorder, etc.
  • The symptoms are not attributable to substance abuse, a medication, or another medical condition (e.g. hypothyroidism).
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Causes of Dysthymia

The exact cause of dysthymia is not known. The causes implicated are somewhat similar to the ones in major depression, which include:

  • Biological differences. There may be physical changes in the brains of people with dysthymia.
  • Neurochemical imbalances. Imbalance of neurotransmitters such as serotonin may play a role in dysthymia. Neurotransmitters are naturally occurring chemicals in the brain that facilitate signal transmission between nerve cells.
  • Genetics. Dysthymia runs in families and probably has a hereditary component.
  • Life events. Traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger dysthymia in some people.

Risk Factors for Dysthymia

Factors that can increase the risk of developing or triggering dysthymia include:

  • Having a first-degree relative with major depressive disorder or other depressive disorders
  • Trauma or stress, such as the loss of a loved one, financial problems, chronic illness, and relationship or work problems
  • Negative personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
  • History of other mental health disorders, such as a personality disorder

Treatment of Dysthymia

Most people with dysthymia are undertreated since their family doctors often fail to diagnose the problem. Also, the disorder would have become so much a part of them that they believe, that is simply how life is. In older people, dysthymia may be disguised as dementia, apathy, or irritability. The treatments for dysthymia are mainly medications or psychotherapy, or a combination of the two. You could also try lifestyle changes and alternative remedies.

Medications

The drugs most commonly used are selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft), or one of the dual-action antidepressants such as venlafaxine (Effexor). In some patients, a tricyclic antidepressant like imipramine (Tofranil) can be more effective.

Psychotherapy

Supportive therapy provides advice, reassurance, sympathy, and education about the disorder. Cognitive therapy identifies and corrects wrong thought patterns that promote self-defeating attitudes. Behavioral treatment improves social skills and teaches ways to manage stress and unlearn learned helplessness. Psychodynamic therapy helps patients resolve emotional conflicts, particularly those stemming from childhood experience. Interpersonal therapy helps patients cope with personal conflicts, loss or separation, and taking on new social roles (Harvard Health Publishing, 2014).

Lifestyle Changes and Alternative Remedies (Mayo Clinic Staff, 2018)

Exercise is one good option, as it leads to a sense of well-being by releasing endorphins.

Avoid alcohol and recreational drugs. Alcohol or drugs may seem to lessen depression-related symptoms, but in the long run they usually worsen depression and make it harder to treat.

Simplify and organize. Cut back on unnecessary obligations. Plan your day by making a list of daily tasks so that your time is well structured. Use sticky notes or a planner as reminders to stay organized.

Socialize. Do not go into isolation. Participate in social activities, and be in touch with family or friends regularly. Join a support group, if possible, because it can help you connect with others facing similar challenges and share your experiences.

Yoga and meditation. Learn how to relax and manage your stress. You could try yoga, meditation, progressive muscle relaxation, and tai chi.

Maintain a journal. Journaling may improve mood by allowing you to express your emotions, such as pain, anger, fear, etc.

Self-help books and websites. Read high-quality self-help books and visit websites dealing with coping mechanisms for depression. Ask your doctor or therapist for recommendations if you do not know what to read.

Do not make important decisions when you are feeling down. Avoid decision-making when you are feeling depressed, since your thinking may be impaired.

The herbal supplement called St. John’s wort may help improve mild or moderate depression, but the overall evidence is not conclusive. It is not approved by the Food and Drug Administration (FDA) to treat depression in the US. St. John’s wort can interfere with a number of medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John’s wort while taking antidepressants because the combination can cause serious side effects.

References

American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing.

Harvard Health Publishing, 2014. Dysthymia. [Online]
Available at: https://www.health.harvard.edu/newsletter_article/dysthymia
[Accessed 21 Nov 2019].

Mayo Clinic Staff, 2018. Persistent depressive disorder (dysthymia). [Online]
Available at: https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/diagnosis-treatment/drc-20350935
[Accessed 21 Nov 2019].

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Dysthymia (Persistent Depressive Disorder)
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Dysthymia (Persistent Depressive Disorder)
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Dysthymia, or persistent depressive disorder, has fewer or less serious symptoms than major depression but lasts longer - for 2 years or more.
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DepressionPedia.org
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