Dysthymia

"Disthymia" redirects here. The moth genus Disthymia is nowadays considered a junior synonym of Ethmia.

Dysthymic disorder
Classification and external resources
ICD-10	F34.1
ICD-9	300.4
MeSH	D019263

Dysthymia (English pronunciation: /dɪs.ˈθaɪ.miː.ə/, dis-theye-mee-ə, from Ancient Greek δυσθυμία, "melancholy") is a mood disorder consisting of chronic depression, with less severe symptoms than major depressive disorder.^[1] The concept was coined by Dr Robert Spitzer (an editor of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III)) as a replacement for the term "depressive personality" in the late 1970s.^[2]

According to the DSM's definition of dysthymia, it is a type of chronic mild depression.^[3] As dysthymia is a chronic disorder, sufferers may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all. As a result, they may believe that depression is a part of their character, so they may not even discuss their symptoms with doctors, family members, or friends.

Signs and symptoms

Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, characterizes dysthymic disorder.^[4] The essential symptom involves the individual feeling depressed for the majority of days and parts of the day for at least two years. 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:^[1][5]

1. During a majority of days for two years or more, the adult patient reports depressed mood or appears depressed to others for most of the day.
2. When depressed, the patient has two or more of:
   1. decreased or increased appetite
   2. decreased or increased sleep (insomnia or hypersomnia)
   3. Fatigue or low energy
   4. Reduced self-esteem
   5. Decreased concentration or problems making decisions
   6. Feels hopeless or pessimistic
3. During this two-year period, the above symptoms are never absent longer than two consecutive months.
4. During the first two years of this syndrome, the patient has not had a major depressive episode.
5. The patient has not had any manic, hypomanic, or mixed episodes.
6. The patient has never fulfilled criteria for cyclothymic disorder.
7. The depression does not exist only as part of a chronic psychosis (such as schizophrenia or delusional disorder).
8. The symptoms are often not directly caused by a medical illness or by substances, including drug abuse, or other medications.
9. The symptoms may cause significant problems or distress in social, work, academic, or other major areas of life functioning.^[4]

Pediatric symptoms

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.

Differences between major depressive disorder and cyclothymic disorder

Prevalence

The prevalence estimate for dysthymia of "clinical significance" among the adult US population is 1.7 percent (CI: 1.5–1.9) based on the Epidemiologic Catchment Area Program and 1.8 percent (CI: 1.4–2.2) based on the National Comorbidity Survey.^[6]

Risk factors

Harvard Health Publications says: "The rate of depression in the families of people with dysthymia is as high as fifty percent for the early-onset form of the disorder. [...] Most people with dysthymia can't tell for sure when they first became depressed".^[3] Dysthymia, like major depression, tends to run in families. 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 the dysthymia is causing them to be more psychologically stressed in a standard environment.

Co-occurring conditions

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, cyclothymia, drug addiction, or alcoholism".^[3] People with dysthymia have a higher-than-average chance of developing major depression.^{[citation needed]} When an intense episode of depression occurs on top of dysthymia the state is called "double depression."^[7]

Treatments

Often times, people with dysthymia will seek out treatment not necessarily because of depressed mood, but rather due to increasing levels of stress or because of personal difficulties that may be situationally-related. ^[8] This is hypothesized to be because of the chronic nature of the disorder, and how depressed mood is often times thought to be a characterological pattern for the individual with the condition. ^[9] It is usually through the administration of the Structured Clinical Interview for DSM-IV that dysthymia is first diagnosed. ^[8] At this point, with the help of a trained professional, a certain line of treatment is often discussed and then selected. It is important to consider all factors in the person's life that may be affected when deciding on a particular course of treatment. Additionally, if one method of treatment does not particularly work for a certain individual, it may be helpful to try something else.

Therapy

Psychotherapy is often effective in treating dysthymia. Different modalities have been shown to be beneficial. Empirically-based treatments, such as cognitive-behavioral therapy, have been researched to show that through the proper course of treatment, symptoms can dissipate over time. ^[8] Other forms of talk-therapy (e.g. psychodynamic psychotherapy, interpersonal psychotherapy) have also been said to be effective in treating the disorder. ^[10] It may be helpful for people diagnosed with dysthymia to develop better coping skills, search for the root cause of symptoms, and work on changing faulty beliefs (e.g. I am worthless). ^[8]

In addition to individual psychotherapy, both group psychotherapy and self-help, or support groups, can be an effective line of treatment for dysthymia as well. ^[8] Through these treatment modalities, issues such as self-esteem, self-confidence, relationship issues/patterns, assertiveness skills, cognitive restructuring, etc., can be worked through and strengthened. ^[8]

Medications

SSRIs are usually the first line of treatment via pharmacotherapy due to its more tolerable nature and reduced side effects. ^[8] Studies have found that the mean response to antidepressant medications for people with dysthymia is 55% compared with a 31% response rate to a placebo. ^[10] The most commonly prescribed antidepressants/SSRIs for dysthymia are fluoxetine, paroxetine, sertraline, and fluvoxamine. These medications will often take an average of 6-8 weeks before the patient will begin to feel its therapeutic effects. ^[8] Additionally, STAR*D, a multi-clinic governmental study, found that people with overall depression will generally need to try different brands of medication before finding one that works specifically for them. ^[8] Of those who switch medications, about 1 in 4 have been found to get better regardless of whether or not the second medication is an SSRI or some other type of antidepressant. ^[8]

Below is a list of particular antidepressant medications that are recommended by staff at the Mayo Clinic as listed online:^[11]

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Tetracyclic antidepressants (TeCAs)

Tricyclic antidepressants (TCAs)

Monoamine oxidase inhibitors (MAOIs)

Combination of therapy and medication

A combination of antidepressant medication and psychotherapy has consistently been shown to be the most effective line of treatment for people diagnosed with dysthymia. ^[8] Working with a psychotherapist to address the causes and effects of the disorder, in addition to taking antidepressants to help eliminate the symptoms, can be extremely beneficial. This combination is often the preferred method of treatment for those who have dysthymia. Looking at various studies involving treatment for dysthymia, 75% of people responded positively to a combination of cognitive behavioral therapy (CBT) and pharmacotherapy, whereas only 48% of people responded positively to just CBT or medication alone. ^[8]

Treatment Resistance

Because of dysthymia's chronic nature, treatment resistance can be somewhat common in dysthymic patients. ^[10] In such a case, augmentation is often recommended. Such treatment augmentations can include lithium pharmacology, thyroid hormone augmentation, buspirone, bupropion, stimulants, and mirtazapine. Additionally, if the personal also suffers from seasonal affective disorder, light therapy can be useful in helping augment therapeutic effects. ^[10]

See also

• Anhedonia, a symptom of dysthymia characterized by a decreased or absent ability to enjoy a sense of pleasure. This may also be a symptom of schizophrenia and/or clinical depression. In addition, this disorder can be caused by excessive use of amphetamines.
• Blunted affect, a symptom of PTSD, schizophrenia, and ASPD involving decreased or absent emotional response
• Atypical depression

References

1. ^ ^{a b} Turner, Samuel M.; Hersen, Michel; Beidel, Deborah C., eds (2007). Adult Psychopathology and Diagnosis (5th ed.). Hoboken, New Jersey: John Wiley. ISBN 9780471745846. OCLC 427516745. 
2. ^ Brody, Jane (30 January 1995), "Help awaits those who live with sadness", The News-Journal (Daytona Beach, Florida): 54, http://news.google.com/newspapers?id=NeopAAAAIBAJ&sjid=YdMEAAAAIBAJ&dq=dr-james-kocsis&pg=2251%2C6530609 
3. ^ ^{a b c} "Dysthymia", Harvard Health Publications (Harvard University), February 2005, archived from the original on 6 January 2010, http://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/Dysthymia.htm, retrieved 12 December 2009 
4. ^ ^{a b} American Psychiatric Association, ed (June 2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (4th ed.). American Psychiatric Publishing. ISBN 978-0890420249. http://www.dsmivtr.org/. 
5. ^ 300.4, ICD9, Accessed 2009 May 2
6. ^ Narrow WE, Rae DS, Robins LN, Regier DA (February 2002). "Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates". Arch Gen Psychiatry 59 (2): 115–123. doi:10.1001/archpsyc.59.2.115. PMID 11825131. http://archpsyc.ama-assn.org/cgi/pmidlookup?view=long&pmid=11825131. 
7. ^ Double Depression: Hopelessness Key Component Of Mood Disorder, Science Daily, 26 July 2007, archived from the original on 7 September 2008, http://web.archive.org/web/20080907155216/http://www.sciencedaily.com/releases/2007/07/070723160142.htm, retrieved 17 July 2008 
8. ^ ^{a b c d e f g h i j k l} [1].
9. ^ [2], Thus, it is only when the person experiences increasing stress that he or she thinks to go to some sort of trained professional for symptom relief.
10. ^ ^{a b c d} [3]
11. ^ Mayo Clinic Staff (26 August 2010), Treatment and drugs, "Dysthymia", Health Information (Mayo Clinic), archived from the original on 29 December 2010, http://web.archive.org/web/20101229143445/http://www.mayoclinic.com/health/dysthymia/DS01111/DSECTION=treatments-and-drugs, retrieved 3 October 2011 

Further reading

• Davidson JR, Abraham K, Connor KM, McLeod MN (February 2003). "Effectiveness of chromium in atypical depression: a placebo-controlled trial". Biol. Psychiatry 53 (3): 261–4. doi:10.1016/S0006-3223(02)01500-7. PMID 12559660. 

External links

• Depression patients helping community
• Video: How to Identify and Treat Depression