DysthymiaWhat 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 those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, a lack of interest in things and a loss of energy. Appetite and weight can be increased or decreased. The person may sleep too much or have trouble sleeping. He or she may have low energy and difficulty concentrating. The person may be indecisive and pessimistic and have a poor 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 starting in childhood. As a result, a person with dysthymia tends to believe that depression is 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 people with dysthymia experienced a major loss in childhood, such as the death of a parent. Others describe being under chronic stress. It is often difficult to tell whether people with dysthymia are under more stress than other people 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
- Lack of sleep or sleeping too much
- Fatigue or low energy
- Low self-esteem
- Difficulty concentrating
- Indecisiveness
- Hopelessness or pessimism
Diagnosis
Many doctors can recognize when one of their patients has some form of depression. The specific diagnosis of dysthymia is usually made by a mental health professional after a full evaluation. Doctors diagnose the depression as dysthymia when a person has had low mood, along with some of the other symptoms, for two years or more. Someone who has symptoms for less than two years may still be treated for any persistent or distressing symptoms.
There are a number of hurdles to diagnosing dysthymia:
- The symptoms are related to symptoms of other mood disorders such as major depression, bipolar disorder (in which a person has depressive episodes and periods of elevated mood) and cyclothymic disorder (a milder form of bipolar disorder).
- The symptoms are constant over time.
- There are no laboratory tests to diagnose dysthymia. (However, a doctor may order tests to investigate conditions such as thyroid disease or anemia.)
- Many people are embarrassed or ashamed to be labeled "depressed."
Expected Duration
Dysthymia can start early in life, even in childhood, and it is constant. Treatment can reduce how long it lasts and the intensity of the symptoms.
Prevention
There is no known way to prevent dysthymia.
Treatment
The best treatment is a combination of psychotherapy and medication.
People with dysthymia who think that "feeling blue" is just part of their life 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), which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). SSRIs are easy to take and relatively safe compared with older forms of antidepressants. However, all medications have side effects. SSRIs can cause nausea and problems with sexual functioning. They 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 many antidepressant manufacturers to put prominent warning labels on their products. The scientific community has not found that antidepressants increase suicide risk, but a small number of people using the medications feel strikingly worse rather than better when they take them. You should immediately report all troubling changes to your doctor and keep all follow-up appointments. Remember: The risk of leaving depression untreated is far greater than the risk of treatment with an antidepressant.
Other new antidepressants include bupropion (Wellbutrin), venlafaxine (Effexor) mirtazapine (Remeron) and duloxetine (Cymbalta). Older types of antidepressants ? tricyclic antidepressants and monoamine inhibitors ? are still in use and can be very effective for those who do not respond to the newer treatments.
It usually takes two to six weeks of antidepressant use to see improvement. The dose may have to be adjusted. 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, or your doctor may combine a mood stabilizer or antianxiety medication with an antidepressant.
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. 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
Contact a health care professional if you suspect that you or a loved one has this disorder.
Prognosis
With treatment, the outlook for someone with this disorder is excellent. The duration and intensity of symptoms is often diminished significantly. In many people, the symptoms go away completely. Without treatment, the person has an increased risk of developing major depression.
Even when treatment is successful, maintenance treatment often is required to prevent symptoms from returning.
Additional Info
National Institute of Mental Health
Office of Communications
6001 Executive Blvd.
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
Toll-Free: 1-866-615-6464
TTY: 301-443-8431
Fax: 301-443-4279
Email: nimhinfo@nih.gov
http://www.nimh.nih.gov/
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd.
Suite 300
Arlington, VA 22201-3042
Phone: 703-524-7600
Toll-Free: 1-800-950-6264
TTY: 703-516-7227
Fax: 703-524-9094
http://www.nami.org/
National Mental Health Association
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
Phone: 703-684-7722
Toll-Free: 1-800-969-6642
TTY: 1-800-433-5959
Fax: 703-684-5968
http://www.nmha.org/
American Psychiatric Association
1000 Wilson Blvd.
Suite 1825
Arlington, VA 22209-3901
Phone: 703-907-7300
Toll-Free: 1-888-357-7924
Email: apa@psych.org
Web site: http://www.psych.org/Public information site: http://www.healthyminds.org/
American Psychological Association
750 First St., NE
Washington, DC 20002-4242
Phone: 202-336-5510
Toll-Free: 1-800-374-2721
TTY: 202-336-6123
http://www.apa.org/
