Definition

Dysthymia is considered one of the depressive disorders and is thus classed as a Mood Disorder in the DSM-IV. It can be generally distinguished from major depressive disorder (or unipolar disorder) by the chronicity (long-term duration) and moderate severity of its symptoms, and by its early onset. Essentially, it can be considered more relenting and less consuming than major depression.

The central feature of this disorder is a chronic depressed mood that occupies much of a person's waking moments for at least two years (one year in the case of children and adolescents). Dysthymic individuals may have days or even weeks where they may feel well enough, but, for the most part, they feel exceedingly tired, unable to take pleasure in almost anything, sad and "down in the dumps," "in a constant cloud" or a "perpetual gloom." Children can also manifest these feelings as irritability or even anger. The disorder is further marked by disturbed appetite and sleep, lack of energy and low self-esteem, and poor concentration or decision-making ability. Despite such seemingly debilitating symptoms, individuals are usually able to cope with the demands of everyday life, unlike many of those who suffer from major depression. Diagnosis is contingent on there being no evidence of a major depressive episode occurring during this period, nor another mental disorder, organic condition or substance use.

Hospitalization for Dysthymia is rare; however, due to the chronic nature of the disorder, there can be significant impairment to social and occupational functioning. Sufferers may also be susceptible to substance abuse as a means of coping with the disorder. Dysthymia can impair the social interactions and school performance of children and adolescents. Youngsters may respond negatively or shyly to praise; they may have trouble forming relationships and may respond to positive relationships with negative behaviors. Current clinical evidence suggests that women are two-to-three times more likely to develop the disorder than men. In children, however, there is approximately equal incidence in both sexes.

Symptoms

Diagnosis of Dysthymia is contingent upon a number of diagnostic criteria; however, the essential symptoms include the following:

• Depressed mood for most of the day, most days, for at least 2 yrs. For children, the mood can be irritable and the duration must be at least 1 year.
• Presence, while depressed, of two (or more) of the following:
  • poor appetite or overeating
  • disturbed sleep
  • low energy or fatigue
  • low self-esteem
  • poor concentration or difficulty making decisions
  • feelings of hopelessness
• Individuals have not been without the depressive symptoms for more than 2 months at a time.
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Cause(s)

Depressive conditions may be precipitated by the interaction of a number of factors:

For example, research has indicated that individuals can inherit a predisposition to develop depressive conditions. Individuals who have family members who have suffered from depression may have an increased risk of contracting such disorders themselves.

Imbalances or impaired functioning in the brain's neurochemical systems associated with mood and activity can also have a striking effect on thoughts, emotions and behavior. A variety of drugs are presently available to correct such neurochemical abnormalities.

A host of environmental factors may also give rise to depressive conditions. Disappointment, stress and/or trauma resulting from such things as unemployment, personal failure or tragedies, and family breakdown, can all precipitate depression.

Certain psychological factors may also contribute to the development of depression. For example, behavioral explanations have suggested that depression may be a product of "learned helplessness" that arises from a repeated loss of positive reinforcement and a, perhaps, increased rate of negative life events among other things. More cognitive-oriented explanations suggest that depression can be exacerbated and maintained by negative and/or unrealistic beliefs and attitudes about the self, the world and the future.

Course

Dysthymia can affect children and adolescents as well as adults. Early onset is considered to be less than twenty-one years of age and late onset is from that age forward. Its onset is gradual and its course is chronic. Symptoms may fluctuate and even remit for a time, but if a diagnosis is to be valid, these periods of relatively normal mood can only last for up to two months.

Treatment

A combination of biologically and psychologically oriented therapies can be used to treat depression.

A range of "anti-depressant" mood stabilizing drugs have proved to have some efficacy in counter-acting many of the symptoms of depression. Three major classes of drugs are often prescribed for treatment of depression: heterocyclics, monoamine-oxidase inhibitors (MAOI's), selective serotonin reuptake inhibitors (SSRI's). The first two classes of drugs essentially act to prolong the effects of two key neurotransmitters associated with mood and activity, Norepinephrine and Serotonin. The last, SSRI's, target Serotonin specifically and act to prolong its effects along Serotonin pathways in the brain. If medication is warranted in the case of Dysthymia, MAOI's may be most typically prescribed. In many cases, these anti-depressant medications can have a positive mood elevating effect on many depressed individuals if they are able to stick to their treatment regimen.

In some treatment-resistant cases, Electroconvulsive Therapy (ECT) can also prove to be effective in eliminating symptoms associated with depression. ECT involves the application of a mild electric current sufficient to induce seizure to a region of the skull (typically in the right hemisphere near the temporal lobe) under carefully controlled conditions. The nightmare media depictions of ECT undertaken in past decades are by no means accurate today. Great steps are taken to ensure that no harm comes to those undergoing this type of therapy. ECT is usually considered as a later resort in difficult cases.

Depressed individuals are also encouraged to undertake counseling for their condition. This form of treatment has proved beneficial for helping individuals on a number of fronts: for example, they can learn more about their condition; feel supported; learn to cope more effectively with the disorder; learn to identify and avoid situations that may engender relapse; learn to extinguish the onset of episodes through early symptom recognition; learn to view the world and themselves more rationally and realistically; improve interpersonal relationships; as well as address the problems with which they are faced.

Some of the more common therapies include:

Interpersonal Therapy, an approach that focuses on resolving interpersonal difficulties.

Behavior Therapy, an approach that assumes that individuals are lacking sufficient positive reinforcement. It is thus focused on achieving positive behavior change by teaching individuals such things as how to maximize praise from self and others, avoid self-punishment, set realistic goals, improve social skills, and so forth.

Cognitive Therapy, an approach that views depression as a product of dysfunctional or maladaptive thoughts, feelings or behaviors. Therapy largely focuses on replacing these unproductive tendencies with more realistic thoughts, feelings and behaviors.

Group Therapy, an approach that provides a supportive community and essentially seeks to change maladaptive attitudes and behavior through group expectation and pressure.

Dealing with Relapse

During a period of stability and wellness, individuals should devise a relapse management plan with their mental health professional and family members or friends that will outline what steps may need to be taken should a relapse occur. The plan will need to identify symptoms that may constitute warning signs and, if they are evident, an agreement should be made by the individual and members of his or her immediate support network to contact the family physician, counselor, or other mental health professional. In addition, methods to reduce stress and stimulation should be established with a counselor so that they can be put into effect pending any relapse.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

Further Information and Support (Coming Soon)

References (Coming Soon)

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