Dysthymia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dysthymia is a mood disorder that falls on the depression spectrum. It is typically characterized by a lack of enjoyment or pleasure, clinically referred to as anhedonia, that continues for an extended period. Dysthymia differs from major depression in that it is both longer-lasting and less disabling. Dysthymia can prevent a person from functioning effectively, disrupt sleep patterns, and interfere with activities of daily living (ADLs). Many dysthymia sufferers have a more specific subtype called Atypical depression. Dysthymia sufferers exhibit fairly mild symptoms on a day-to-day basis. Over a lifetime the disorder may have more severe effects, such as a high rate of suicide, work impairment, and social isolation. The psychiatric term describing a personality with opposite characteristics to dysthymia is hyperthymia.

Symptoms

The symptoms of dysthymia are similar to those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, lack of interest in things most people find enjoyable, and a loss of energy (not all patients feel this effect). Appetite and weight can be increased or decreased. The person may sleep too much or have trouble sleeping. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a negative self-image.

The symptoms can grow into a full blown episode of major depression. This situation is sometimes called "double depression" 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 more constant, lasting for long periods, 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 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.

Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, characterizes Dysthymic disorder as a chronic depression, but with less severity than a major depression. 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. On the 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. Reduced concentration or indecisiveness
   6. Feels hopeless
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 had no 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 not directly caused by a general medical condition or the use of substances, including prescription medications.
9. The symptoms cause clinically important distress or impair work, social or personal functioning.

Treatments

Medications

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). SSRIs are easy to take and relatively safe compared with older forms of anti-depressants.. 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.

Side Effects of Medications

Some side effects for SSRI’s are "sexual dysfunction, nausea…diarrhea, sleepiness or insomnia, short-term memory loss and tremors". 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".

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.

See also

• Anhedonia, a similar symptom of schizophrenia and clinical depression involved absence of or decreased sense of pleasure
• Blunted affect, a symptom of PTSD, schizophrenia, and ASPD involving decreased or absent emotional response
• Atypical depression
• Clinical depression

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