Dysthymia
Video Further Describing Dysthymia

The Greek word dysthymia means “bad state of mind” or “ill humor.” As one of the two chief forms of [[#|clinical depression]], it usually has fewer or less serious symptoms than [[#|major depression]] but lasts longer.


Variety: Dysthymic Disorder

Dysthymia is a chronic type of [[#|depression]] in which a person's moods are regularly low. However, it is not as extreme as other types of depression. Some consider it like the constant blues.
It is a depressed mood held for the majority of a day, lasting for more days than not, as seen by a subjective account or observation by others, lasting for at least 2 years. One major difference between dysthymia and major depressive disorder is that while major depressive includes thoughts of suicide, dysthymia does not, which is why it is considered less severe than major depressive.




Symptoms:

DSM IV Classification:
A. Depressed feeling for most days for at least 2 years.
B. Two or more of the following symptoms with depressed feeling:
(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
C. The individual has not been without symptoms in criteria A and B for more than 2 months

D. No Major Depressive Episode has been present during the first 2 years of the disturbance and the disturbance isn't caused by Major Depressive Disorder. Note: There may have been a previous [[#|Major Depressive Episode]] provided there was a full remission before development of the Dysthymic Disorder. After the initial 2 years of Dysthymic Disorder, there may be episodes of [[#|Major Depressive Disorder]], in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.

E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.

F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder

G. The symptoms are not due to the direct effects of a substance

H. The symptoms cause clinically significant distress or impairment in functioning



NOTE: All above criteria for Dysthymic Disorder apply to adults, but for children and adolescents, the criteria is at least one year.




Causes: The exact cause of dysthymia is unknown.
  • It appears somewhat more often during transitional periods (e.g., puberty or during mid-life crises).
  • Though it is not exactly known what exactly causes dysthmic disorder, approximately 75% of cases are accompanied by physiologoical disorders. However, this disorder is generally diagnosed as being independent from any physical infirmity (http://web.mit.edu/braintrust/Neuro/Dysthymic.htm)
  • Dysthymic Disorder is more common in the first-degree biological relatives of individuals with [[#|Major Depressive Disorder]] (http://www.mentalhealth.com/dis/p20-md04.html)
  • Occurs in approximately 25-50% people with sleep abnormalities that include rapid eye movement and impaired sleep continuity
  • Thyroid hormonal imbalances
  • Serotonin neurotransmitter imbalances
  • Childhood neglectment
  • Heredity. If one's immediate family has [[#|major depression]], th individual is 3 times more likely to get dysthymia
  • The lifetime prevalence has been estimated to be 4.1% for women and 2.2% for men. In adults, dysthymic disorder is more common in women than in men and research suggests that the prevalence in the age group 25 to 64 years is 6% for women. In children, dysthymic disorder can occur equally among both genders. (http://www.minddisorders.com/Del-Fi/Dysthymic-disorder.html)
  • Trauma
  • Isolation or lack of social support
  • In old age, it's more likely to be the result of medical illness, cognitive decline, bereavement, and physical disability (http://www.psychologytoday.com/conditions/dysthymia?tab=Causes)
  • It tends to run in families and is found more common in women than men

As found in http://www.health.harvard.edu/newsweek/Dysthymia.htm
"Like major depression, dysthymia has roots in genetic susceptibility, neurochemical imbalances, childhood and adult stress and trauma, and social circumstances, especially isolation and the unavailability of help. Depression that begins as a mood fluctuation may deepen and persist when equilibrium cannot be restored because of poor internal regulation or external stress.
Dysthymia runs in families and probably has a hereditary component. The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder. There are few twin or adoption studies, so it’s uncertain how much of this family connection is genetic. Nearly half of people with dysthymia have a symptom that also occurs in major depression, shortened REM latency — that is, they start rapid eye movement (vivid dreaming) sleep unusually early in the night.
The stress that provokes dysthymia, at least the early-onset form, is usually chronic rather than acute. Studies show that it usually has a gradual onset and does not follow distinct upsetting events. In old age, dysthymia is more likely to be the result of physical disability, medical illness, cognitive decline, or bereavement. In some older men, low testosterone may also be a factor. Physical brain trauma — concussions and the like — can also have surprising long-term effects on mood that often take the form of dysthymia.
At least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism. In these cases, it is difficult to distinguish the original cause, especially when there is a vicious cycle in which, say, depression exacerbates alcoholism or heart disease exacerbates depression.
The same vicious cycle exists in many other situations. For a person who is vulnerable to depression, every problem seems more difficult to solve and every misfortune causes more suffering. Depressed people give discouraging interpretations to every event in their lives, and these interpretations make them still more depressed. Depression often alienates others, and the resulting isolation and low social support make the symptoms worse. The experience of chronic depression may sensitize the brain to stress, heightening its vulnerability to further depression."




Diagnosis:
  • DSM-IVTR criteria must be established through extensive psychological interview and evaluations
  • The diagnosis cannot be made if depression occurs during an active course of psychosis, [[about:../Br-Del/Delusions.html|delusions ]], schizophrenia, or [[about:../Py-Z/Schizoaffective-disorder.html|schizoaffective disorder]]
  • Further psychological tests that can be administered to help in the diagnostic process include the Beck Depression Inventory and the Hamilton Depression Scale
  • Clinician must rule out any possbile medical consitions that can cause depressed affect (Affect meaning the expression of emotion displayed to others through facial expressions, hand gestures, tone of voice, etc)
(http://www.minddisorders.com/Del-Fi/Dysthymic-disorder.html)



Treatments:


Psychotherapy: Before therapy beings, a mental health professional will evaluate the individual’s current state of functioning, to assess mood type and severity, check for suicidal ideation and plan, etc. No matter which specific type of psychotherapeutic approach is utilized, a cognitive-behavioral therapy should generally be considered, as it offers a therapy environment tailored to the patient’s need for unconditional acceptance and support. Therapy should be generally conducted with respect to the client’s pace and level of functioning. Attempts to focus on change too early in therapy could lead to early termination of therapy because the patient feels the therapist didn’t respect or care enough about him or her to move at their rate.
  • level of functioning. This level, however, may be markedly less than what is expected in the average person since a person who suffers from dysthymic disorder has generally learned to live with a fair amount of chronic unhappiness in their lives. Realistic goals should be established early-on and the focus of therapy, instead of focusing on the person’s mood state.
  • Your health care provider will take history of your mood and other mental health symptoms.
  • Group therapy has been shown to be an effective modality for individuals suffering from this disorder. A group can be more supportive an individual than any one therapist can and help point out inconsistencies in the patient’s thinking and behavior. It should be considered, if not initially, then later on in treatment as the client regains his or her own self-confidence and can interact in a social context. Issues of self-esteem often accompany individuals who have dysthymic disorder, so care must be employed not to place the person into a group situation (where failure may be imminent) too soon.
  • Family therapy may also be helpful for some individuals. Couples therapy can bring the individual’s spouse or significant other into the therapeutic relationship to create a therapeutic (and more powerful) triad.

Goals will vary according to type of therapy.
  • Cognitive therapy emphasizes changes in one’s faulty or distorted way of thinking and perceiving the world.
  • Interpersonal therapy focuses on an individual’s relationships with others and how to improve and strengthen existing relationships while finding new ones.
  • Solution-focused therapy looks at specific problems plaguing an individual’s life in the present and examines how to best go about changing the person’s behavior to solve these difficulties.
  • Social skills training focuses on teaching the client new skills on how to become more effective in social and work relationships.
  • Usually, psychoanalytic and other insight-oriented approaches will be less effective because of their focus on the past and emphasis on lengthy therapy. While incorporation of therapy into a person’s chronic condition might be quite financially lucrative for the therapist, it is not the most change-effective and timely approach to help this dysthymic individual overcome his or her difficulties.

Because the clinician must move at the client’s pace, progress with any type of therapy can be slow. Therapists should resist the temptation to try and “speed up” the process or force the client in a direction he or she is not yet ready to try. Closely related to this issue of the pace of therapy is being aware of the clinician’s frustration with lack of progress or boredom within the therapy session. It can be an emotionally draining experience for some therapists.

Medications: People with dysthymia often take an antidepressant medication, one that they find helps keep their energy levels up and keep them from reaching the lowest depressive moods.
  • A class of antidepressants called selective serotonin re-uptake inhibitors (SSRIs) are the most commonly prescribed medication for chronic depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Luvox (fluvoxamine) are the most commonly prescribed brand names.
  • The large-scale, multi-clinic government research study called STAR*D found that people with depression and who take a medication often need to try different brands and be patient before they find one that works for them.
  • If a first treatment with one SSRI fails, about one in four people who choose to switch to another medication will get better, regardless of whether the second medication is another SSRI or a medication of a different class.
  • If people choose to add a new medication to the existing SSRI, about one in three people will get better.
  • The most commonly prescribed antidepressants generally take 6 to 8 weeks before a person will start feeling their therapeutic effects.

Self-Help: Adjunctive community support groups in concurrence with psychotherapy is usually beneficial to most people who suffer from dysthymic disorder. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings
  • Caution should be utilized if the person also suffers from social anxiety.
  • A group like A.A. or N.A. may also be appropriate, if the underlying cause of the dysthymia is a substance abuse problem.
  • Patients can be encouraged to try out new coping skills, assertiveness skills, cognitive restructuring, etc. within such a support group. They can be an important part of expanding the individual’s skill set and develop new, healthier social relationships.

Since this is a chronic disorder, your mental health professional should be sensitive to not using previous treatment approaches (especially medication) which have proven ineffective in the past. A careful and thorough history should be conducted at the onset of treatment to ensure this is evaluated. Specific attention should also be given to diagnostic issues, such as the existence of an alcohol or substance abuse problem, or social anxiety or other phobia, underlying or causing the dysthymic condition.
(http://psychcentral.com/lib/2008/dysthymia-treatment/)


Prognosis:
  • Dysthymia is a chronic (long-term) disorder and often lasts patients whole lives, causing them to be unhappy almost every day in their future
  • Dysthymic disorder often begins in late childhood or adolescensce, more than half the time causing the development of major depressive disorder among children with dysthymic disorder
  • Patients with this disorder usually have impaired emotional, social, and physical functioning.
  • Significant financial and occupational losses
  • Isolation
  • Restricting daily activities and spending days in bed
  • Patients often complain of poor health and incur more disability days when compared to the general population

In general, the clinical course of dysthymic disorder is not promising. Causes of a poorer outcome include not completing treatment, noncompliance with medication intake, and lack of willingness to change behaviors that promote a depressed state. However, patients can do very well with a short course of medications if they have a desire to follow treatment recommendations.
(http://www.minddisorders.com/Del-Fi/Dysthymic-disorder.html)
(http://www.iampanicked.com/anxiety-articles/dysthymia-treatment.htm)