Dysthemic Disorder: Overview, Symptoms and Treatments

Overview

Dysthymia or dysthemic disorder is a condition of chronic depression that lasts for at least two years at a stretch in adults and one year in children and adolescents. This term was introduced by Dr. Robert Spitzer (of the American Psychiatric Association) after the early 1970’s, in replacement of the term depressive personality. Individuals suffering from this condition experience continuous depressive moods consisting of feelings of hopelessness, sadness and detachment. However, the symptoms are not as severe as in the case of the major depressive episode. In other words, a person suffering from dysthemic disorder would typically complain of feeling down, or having the blues for a long period.

An estimated 3% of adults are known to be suffering from dysthymia and the number of children experiencing the condition is also increasing in an alarming manner. Medical experts believe that this increase in depression among younger populations is likely to be due to the increased parental marital failures, technology, increase of cost of living and increase in the competition in academics and related activities. Lack of physical activity and improper diets are also contributors of depression. In addition, exposure to violence (violent computer games and television shows) is likely to increase the risk of depression among young children.

The cause of dysthymia among adults is most likely to be to dissatisfaction in life. Abused, violated, poor, helpless, sick and the socially stigmatized people are more likely to develop this long term condition of depression. Dysthemia, like many other mood disorders run in families but tend to get triggered only if the external components allow it. Young adults and people over the age of 65 are most vulnerable. In addition, single men and married women (in comparison to married men and single women), single parents, children with learning difficulties and adolescents who are bullied and pick on in school are more likely to develop the condition.

Symptoms and Types

An individual suffering from the dysthemic disorder is most likely to display the following symptoms;

• Insomnia or hypersomnia
• Loss of appetite or increased appetite (thus drastic weight loss or gain)
• Low self image
• Loss of interest in the future
• Loss of interest in pleasurable activities
• Low sex drive
• Feelings of detachment
• Difficulties in communicating
• Difficulties in attending to needs
• Problems in concentrating
• Poor problem solving and decision making skills
• Fatigue
• Passiveness
• Lack of empathy
• Display of inappropriate emotions
• Lack of sense of belonging
• Self harm including suicidal attempts in more severe cases

Children and adolescents suffering from this condition are more likely to display

• Temper tantrums
• Irritability
• Disinterest in social and recreational activities
• Difficulties in studies and other areas of academics
• Preferring to be isolated
• Crying or weeping
• Getting into arguments and fights often
• Drug use and inclination towards self harming activities

The symptoms of dysthemic disorder vary from those of major depressive episode. In the case of major depression the symptoms are acute and short term. Also, it is important to note that dysthymia varies from Anhedonia, Atypical depression and Blunted affect. Anhedonia is the lowering of interest in otherwise pleasurable activities due to the overuse of amphetamines. Atypical depression is a similar condition consisting of most of the above symptoms but the individual is able to experience pleasure to some degree with regard to positive events. Blunted effect is a term referred to the condition in which the sufferer is unable to invoke the appropriate emotional response and this condition is present mostly during PTSD (Post traumatic stress disorder) and ASPD (Antisocial personality disorder)

Diagnosis and Tests

According to the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic criteria for dysthymia are as follows;

• Depressed mood in most part of the day in most days continuously for a period of two years. In children this period is for one year or more. (note that an observer maybe able to note the changed mood of the dysthemic individual)
• Presence of at least two of the following observable symptoms when depressed
  • Loss of appetite or overeating
  • Insomnia or hypersonmia
  • Low energy levels and constant fatigue
  • Markedly reduced self esteem
  • Poor concentration
  • Difficulty in decision making and problem solving
  • Feeling hopeless and empty
• The above mentioned symptoms are only absent for a period less than two months during the course of dysthymia
• Absence of a diagnosable major depressive period before or during the onset of the disorder (please refer the relevant articles)
• Absence of manic or mixed episodes (please refer the relevant articles)
• The disturbance does not occur alongside schizophrenia or any other psychotic disorder
• The symptoms are not brought about due to medical or substance usage
• Causes marked impairments in daily lives (occupational, academic, social and self-care difficulties)

Treatment and Care

In addition to long term therapy, medication is necessary for this condition. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are the most effective medicines because they increase the extra cellular neurotransmitter levels ensuring that the nervous system is at its optimal levels of functioning.  Some of the most commonly prescribed SSRIs include paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and escitalopram (Lexapro). Other antidepressants such as bupropion, mirtazapine and duloxetine are also commonly used. Mood stabilizers like Valproic acid, Gabapentin, divalproex sodium, Carbamazepine and Oxcarbazepin are also prescribed by therapists. However, it is important to become knowledgeable about the possible side-effects of the long term usage of these medicines.

Psychotherapy consisting of cognitive, behavioral and group therapy during which the dysthemic individual is taught positive thinking, social skills, communication skills, behavioral monitoring, etc are rather promising in comparison to medication. Long term inpatient care is usually unnecessary but the person must be carefully screened for the presence of any other severe condition. Group therapy and family therapy are also two of the most effective treatment methods for people experiencing long term mild depression.

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Tagged as: acute stress disorder, Childhood Disintegrative Disorder, cognitive behavioral therapy, mood swings, Personality Disorder