Anxiety, Depression, Stress

Dysthymia is a chronic mood disorder that falls within the depression spectrum, the opposite of hyperthymia. It is considered a chronic depression, but with less severity than major depressive disorder. This disorder tends to be a chronic, long-lasting illness.

Dysthymia is a type of low-grade depression. Harvard Health Publications states that, "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." Harvard Health Publications also says, "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". The Primary Care Journal says that dysthymia "affects approximately 3% of the population and is associated with significant functional impairment". Harvard Health Publications says: "The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder. Most people with dysthymia can't tell for sure when they first became depressed".

Symptoms
Dysthymia is a chronic long lasting form of depression sharing many characteristic symptoms of major depressive disorder (in the form of the melancholic depression subtype). However, these symptoms tend to be less severe but do fluctuate in intensity. To be diagnosed an adult must experience 2 or more of the following symptoms "for most of the day, more days than not, for at least 2 years"

Feelings of hopelessness
Insomnia or hypersomnia
Poor concentration or difficulty making decisions
Low energy or fatigue
Low self-esteem
Poor appetite or overeating.
Irritability
Symptoms exclude "Manic, Hypomanic or Mixed Episodes commonly associated with bipolar disorder". (If a person experience these episodes they may suffer from cyclothymia.)

People with dysthymia have a greater-than-average chance of developing major depression. Fluctuating symptoms intensity can trigger 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.

As dysthymia is a chronic disorder, a person may often experience symptoms for many years before it is diagnosed, if diagnosis occurs at all. As a result, they tend to believe that depression is a part of his or her character. This, subsequently, may lead sufferers to not even discuss their symptoms 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. 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:

During a majority of days for two years or more, the patient reports depressed mood or appears depressed to others for most of the day.

When depressed, the patient has two or more of:

Appetite decreased or increased
Sleep decreased or increased (insomnia or hypersomnia)
Fatigue or low energy
Low self-esteem
Decreased concentration or difficulty making decisions
Feels hopeless or pessimistic
During this two year period, the above symptoms are never absent longer than two consecutive months.
During the first two years of this syndrome, the patient has not had a Major Depressive Episode.
The patient has not had any Manic, Hypomanic or Mixed Episodes.
The patient has never fulfilled criteria for Cyclothymic Disorder.
The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
The symptoms are often not directly caused by a general medical condition or the use of substances, including prescription medications.
In contrast to major depression, these symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning.[8]
People suffering from dysthymia are usually well capable of coping with their everyday lives (usually by following particular routines that provide certainty).

In children and adolescents, mood can be irritable and duration must be at least one year, in contrast to two years needed for diagnosis in adults.

Treatments

Medications
If medication is deemed necessary, the most commonly prescribed anti-depressants for this disorder are the selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), 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 physician 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". SSRI's can also cause suicidality and aggression in some cases. Some antidepressants are ineffective in 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.

Friends and family
Anecdotal evidence indicates that the subject's awareness that he/she forms an important part in the lives of the people familiar to him/her both near and far holds great promise in helping the subject to cope. Reminders are to be given daily and support given freely when asked for. Depression is a condition hard to convey in lucid terms because there does not need to be a determinable vector or cause. Friends and family are encouraged to be aware and accept that they don't need to understand in order to care.

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