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Dysthymia

DAug 13 04

 

What Is It?

Dysthymia, also called dysthymic disorder, is a form of depression. It is less severe than major depression, but usually lasts longer. Many people with this type of depression describe having been depressed as long as they can remember, or they feel they are going in and out of depression all the time.

The symptoms of dysthymia are similar to major depression, though they tend to be less intense. In both conditions, a person can have low or irritable mood, a lack of interest in things and a loss of energy. Appetite and weight can be increased or decreased, and the person may sleep too much or have trouble sleeping. He or she may have low energy and concentration. It also is common for the person to be indecisive and pessimistic, and have a poor self-image.

The symptoms can escalate into a full-blown episode of major depression, a situation sometimes called “double depression” because the acute, intense episode is superimposed on a background of chronic low mood. In fact, people with dysthymia have a greater-than-average chance of developing major depression.

While major depression often occurs in episodes, dysthymia is more constant, persisting for long periods of time, sometimes starting in childhood. As a result, a person with dysthymia will tend to believe that depression is a part of his or her character. He or she may not even think to report the depression to people in a position to help, such as health-care providers, family members or friends.

Dysthymia, like major depression, tends to run in families. It is very common, and is two to three times more common in women than men. Some people with dysthymia have experienced major losses in childhood, such as the death of a parent. Some describe being under chronic stress. It is often difficult to tell whether people with dysthymia are under more stress than is typical or if the dysthymia causes them to perceive more stress than others do.

Symptoms

The main symptom of dysthymia is a long-lasting low or sad mood. People with dysthymia also can be irritable. Other symptoms include:

  • Increased or decreased appetite or weight
  • Poor sleep or sleeping too much
  • Fatigue or low energy
  • Low self-esteem
  • Difficulty concentrating
  • Indecisiveness
  • Hopelessness or pessimism

Diagnosis

Primary-care physicians usually are prepared to recognize when a person has some form of depression. A specific diagnosis of dysthymia is usually made by a mental-health professional, after a full evaluation. Dysthymia is diagnosed when a person has had low mood, along with some of the symptoms described above, for two years or more. Someone who has symptoms for less than two years may not officially qualify for the label, but treatment should be considered for any persistent or distressing symptoms.

The symptoms of dysthymia are closely related to those of other mood disorders. So it may be hard to tell the difference between dysthymia and, for example, major depression (a more severe form of depression), bipolar disorder (in which a person may have both depressive episodes and periods of elevated mood, called mania) or cyclothymic disorder (a milder form of bipolar disorder).

Given the stigma still associated with depression, dysthymia goes unrecognized and untreated in many people. Dysthymia can be hard to recognize because the symptoms are so constant over time, and they blend into the background. There are no specific laboratory tests to help diagnose dysthymia. However, to make sure there is no medical condition or medication causing the symptoms, a general evaluation by a primary-care physician is important. The physician may order tests to investigate conditions such as thyroid disease or anemia.

Expected Duration

Dysthymia can start early in life, even in childhood, and it is chronic. Treatment can reduce the duration and intensity of the symptoms.

Prevention

There is no known way to prevent this disorder.

Treatment

The best treatment is a combination of psychotherapy and medication.

People with dysthymia who have integrated “feeling blue” into their self-image may be surprised to learn that antidepressant medication can be very helpful. The most commonly prescribed antidepressants for this disorder are the selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). SSRIs are fairly easy to take and relatively safe compared with previous generations of antidepressants. However, all medications have side effects. SSRIs are known to cause nausea and problems with sexual functioning. They also can cause anxiety to increase in the early stages of treatment and lead to apathy in the long run. Concerns about the increased risk of suicide have led the U.S. Food and Drug Administration to advise some antidepressant manufacturers to put prominent warning labels on their products. There is no scientific proof that antidepressants increase suicide risk, but a small number of patients feel strikingly worse rather than better when they take the medication. You should immediately report all troubling changes to your doctor, and make sure that you keep all follow up appointments. But remember that the risk of leaving any form of depression untreated is far greater than the risk of treatment with an antidepressant.

Other new and effective antidepressants include bupropion (Wellbutrin), venlafaxine (Effexor), and mirtazapine (Remeron). The older classes of antidepressants, tricyclic antidepressants and monoamine inhibitors, are still in use and can be very effective for those who do not respond to other treatments.

It usually takes at least two to six weeks of treatment with any antidepressant to see improvement. The dose may have to be adjusted, and often it will take up to a few months for the full positive effect to be seen.

Sometimes, two different antidepressant medications are prescribed together in order to enhance the positive effect. Or, a medication from the class called mood stabilizers is added. Sometimes, antianxiety medication also is used.

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 always include education about depression, and support is essential. Cognitive behavioral therapy is designed to examine and help correct faulty, self-critical thought patterns. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms.

When To Call A Professional

You should contact a health-care provider if you suspect that you or a loved one has this disorder.

Prognosis

Treatment has become quite sophisticated and effective. With treatment, the outlook for someone with this disorder is excellent. The duration and intensity of symptoms often is diminished significantly, and in many people, the symptoms go away completely. Without treatment, the person has an increased risk of developing the more severe form of depression called major depression.

When treatment is successful, it can be very important to continue seeing your doctor or therapist periodically, since maintenance treatment often is required to prevent symptoms from returning.

Johns Hopkins patient information

Last revised: December 7, 2007
by Sharon M. Smith, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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