Dysthymic Disorder

Dysthymic Disorder

Dysthymic Disorder

Dysthymia, also known as persistent depressive disorder (PDD) or dysthymic disorder, is a mood disorder characterized by the same mental and physical symptoms as depression but they last longer. Dysthymia is chronic but less severe than major depressive disorder.

Prevalence

Dysthymia can occur in childhood and adulthood, and the average age onset of this condition is 31. In the US, the lifetime rate of dysthymia is 1.5 to 15%, depending on the study. Dysthymia is slightly more common in women than in men.

Dysthymia often coexists with other conditions such as anxiety disorder (up to half), personality disorders (up to 40%), and alcohol and substance abuse (up to half).

Symptoms of Dysthymic Disorder:

The symptoms of dysthymia are not constant and can disappear for a few weeks at a time but never for more than two months. About 95% of people with PDD will also have an episode of major depression with dysthymia — called double depression.

  • Low mood, gloominess, irritability, anger, called “no fun”
  • Less joy or interest in activities or friendships that were once pleasurable
  • Feelings of hopelessness, anxiety, pessimism, and guilt; empty feeling, low self-esteem
  • Feelings of hopelessness, anxiety, pessimism, and guilt; empty feeling, low self-esteem
  • Sadness
  • Less energy
  • Low motivation to perform, avoidance of participation in anything that might fail, feeling incapable or inadequate
  • Sleep disturbances like insomnia or sleeping a lot
  • Difficulty concentrating, difficulty making decisions or handling conflict
  • Weight changes – little appetite or overeating
  • Mental withdrawal

Diagnosing Dysthymia:

A doctor will perform a physical exam and possibly order bloodwork to rule out any underlying illness or disorder first, such as adrenal issues, before referring the person to a mental health specialist.

A psychological assessment looking at current and past thinking patterns and the associated behavior will help narrow down the diagnosis to the particular type of mood disorder experienced. An fMRI can indicate areas of the brain that display signs of PDD.


  • Feeling depressed or appearing depressed to others most of the time for two years or more in adults. Symptoms persist for at least one year in children and adolescents.
  • At least two or more depressive symptoms such as decreased or increased appetite; fatigue or low energy; and feelings of hopelessness, worthlessness, and guilt.
  • Depressive symptoms cannot be absent for greater than two consecutive months.
  • No manic, hypomanic, or mixed episodes experienced.
  • Symptoms might have caused profound impairment in functioning at home or in social settings, and/or with activities of daily living.

As dysthymia is a chronic disorder, people with this condition may believe it is part of their personality, so they can experience symptoms for several years before consulting a doctor and receiving a diagnosis.

The older one is when symptoms appear, the more likely it is that the PDD is caused by a medical condition or severe stress. The younger one is, the more likely it can be to find co-existing disorders present. PDD might show up more as irritability than depression in younger children.

Causes of Dysthymic Disorder:

The exact cause of dysthymia is unknown, but the following factors have been implicated:

  • Irregularities in brain chemistry or brain makeup
  • Genetics – having a first-degree relative with a depressive disorder increases the risk of developing PDD by as much as 50%.
  • Environmental or life events – such as loss of a parent during childhood, financial difficulty, stress, lack of support, and aloneness.
  • Personality traits such as negativity, having low self-esteem, being pessimistic, and having a self-critical attitude

Medications for Dysthymic Disorder can include:

Complications of dysthymia include self-harm, substance abuse, relational difficulties, work-related issues, and double depression — when a person with this condition develops a coexistent major depressive disorder.

Treatment of Dysthymic Disorder:

Treatment for dysthymia depends on the severity of the disorder and if any coexistent issues are present. Getting the right treatment can help prevent double depression, so it’s crucial to see a mental health professional as soon as early symptoms are noticed.

The main treatment options for dysthymia are a combination of medication and talk therapy.

  • Antidepressant medications – A psychiatrist will need to prescribe different medications until the person finds one that is the most effective and gives the fewest side effects.

    • Selective serotonin reuptake inhibitors (SSRIs) such as escitalopram or citalopram will take up to two months to become therapeutically effective.
    • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as mirtazapine or bupropion.
    • Tricyclic antidepressants (TCAs) and monoamine inhibitors can be prescribed if the newer medications are not effective.
  • Talk therapy (psychotherapy) – such as:

    • Cognitive behavioral therapy (CBT) – helps people recognize triggers and adopt healthy ways to respond, plus ways to change negative thought patterns for positive ones.
    • Cognitive behavioral analysis system of psychotherapy (CBASP) – helps people stop avoiding others in order to feel safe and teaches skills to stay mentally present and engaged in social settings rather than withdraw mentally.
    • Interpersonal psychotherapy – 3- to 4-month therapy that helps people stop letting life circumstances dictate their mood and teaches problem-solving skills and strategies to face and process them.

Also helpful in treating or preventing the severity of symptoms are:

  • Lifestyle changes – exercise, healthy diet, enough sleep, and quitting smoking and any drug or alcohol abuse can help significantly with reducing the causes and severity of symptoms.
  • Individual and family therapy
  • Social support groups
 

Symptoms of Dysthymic Disorder:

The symptoms of dysthymia are not constant and can disappear for a few weeks at a time but never for more than two months. About 95% of people with PDD will also have an episode of major depression with dysthymia — called double depression.

  • Low mood, gloominess, irritability, anger, called “no fun”
  • Less joy or interest in activities or friendships that were once pleasurable
  • Feelings of hopelessness, anxiety, pessimism, and guilt; empty feeling, low self-esteem
  • Feelings of hopelessness, anxiety, pessimism, and guilt; empty feeling, low self-esteem
  • Sadness
  • Less energy
  • Low motivation to perform, avoidance of participation in anything that might fail, feeling incapable or inadequate
  • Sleep disturbances like insomnia or sleeping a lot
  • Difficulty concentrating, difficulty making decisions or handling conflict
  • Weight changes – little appetite or overeating
  • Mental withdrawal
 

Diagnosing Dysthymic Disorder:

A doctor will perform a physical exam and possibly order bloodwork to rule out any underlying illness or disorder first, such as adrenal issues, before referring the person to a mental health specialist.

A psychological assessment looking at current and past thinking patterns and the associated behavior will help narrow down the diagnosis to the particular type of mood disorder experienced. An fMRI can indicate areas of the brain that display signs of PDD.


  • Feeling depressed or appearing depressed to others most of the time for two years or more in adults. Symptoms persist for at least one year in children and adolescents.
  • At least two or more depressive symptoms such as decreased or increased appetite; fatigue or low energy; and feelings of hopelessness, worthlessness, and guilt.
  • Depressive symptoms cannot be absent for greater than two consecutive months.
  • No manic, hypomanic, or mixed episodes experienced.
  • Symptoms might have caused profound impairment in functioning at home or in social settings, and/or with activities of daily living.

As dysthymia is a chronic disorder, people with this condition may believe it is part of their personality, so they can experience symptoms for several years before consulting a doctor and receiving a diagnosis.

The older one is when symptoms appear, the more likely it is that the PDD is caused by a medical condition or severe stress. The younger one is, the more likely it can be to find co-existing disorders present. PDD might show up more as irritability than depression in younger children.

 

Causes of Dysthymic Disorder:

The exact cause of dysthymia is unknown, but the following factors have been implicated:

  • Irregularities in brain chemistry or brain makeup
  • Genetics – having a first-degree relative with a depressive disorder increases the risk of developing PDD by as much as 50%.
  • Environmental or life events – such as loss of a parent during childhood, financial difficulty, stress, lack of support, and aloneness.
  • Personality traits such as negativity, having low self-esteem, being pessimistic, and having a self-critical attitude
 

Dysthymic Disorder complications:

Complications of dysthymia include self-harm, substance abuse, relational difficulties, work-related issues, and double depression — when a person with this condition develops a coexistent major depressive disorder.

 

Treatment of Dysthymic Disorder:

Treatment for dysthymia depends on the severity of the disorder and if any coexistent issues are present. Getting the right treatment can help prevent double depression, so it’s crucial to see a mental health professional as soon as early symptoms are noticed.

The main treatment options for dysthymia are a combination of medication and talk therapy.

  • Antidepressant medications – A psychiatrist will need to prescribe different medications until the person finds one that is the most effective and gives the fewest side effects.

    • Selective serotonin reuptake inhibitors (SSRIs) such as escitalopram or citalopram will take up to two months to become therapeutically effective.
    • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as mirtazapine or bupropion.
    • Tricyclic antidepressants (TCAs) and monoamine inhibitors can be prescribed if the newer medications are not effective.
  • Talk therapy (psychotherapy) – such as:

    • Cognitive behavioral therapy (CBT) – helps people recognize triggers and adopt healthy ways to respond, plus ways to change negative thought patterns for positive ones.
    • Cognitive behavioral analysis system of psychotherapy (CBASP) – helps people stop avoiding others in order to feel safe and teaches skills to stay mentally present and engaged in social settings rather than withdraw mentally.
    • Interpersonal psychotherapy – 3- to 4-month therapy that helps people stop letting life circumstances dictate their mood and teaches problem-solving skills and strategies to face and process them.

Also helpful in treating or preventing the severity of symptoms are:

  • Lifestyle changes – exercise, healthy diet, enough sleep, and quitting smoking and any drug or alcohol abuse can help significantly with reducing the causes and severity of symptoms.
  • Individual and family therapy
  • Social support groups
Source MAYO CLINIC | WIKIPEDIA – Mood Disorder | WIKIPEDIA – Major Depressive Disorder | MAYO CLINIC – Persistent depressive disorder (dysthymia) | DRUGS.com – Dysthymia | NIH – Depression | AMERICAN PSYCHIATRIC ASSOCIATION – What Is Depression | HARVARD – Dysthymia | NIH – Dysthymic Disorder, Forlorn and Overlooked | SCIENCE DAILY – Double Depression | Ravindran, A. V., Smith, A. Cameron, C., Bhatal, R., Cameron, I., Georgescu, T. M., Hogan, M. J. (2009). “Toward a Functional Neuroanatomy of Dysthymia: A Functional Magnetic Resonance Imaging Study”. Journal of Affective Disorders. 119 (1–3): 9–15. | Baldwin, Rudge S.; Thomas S. (1995). “Dysthymia: Options in Pharmacotherapy”. Practical Therpeutics. 4 (6): 422 to 430. | Bellino, S.; Patria, L.; Ziero, S.; Rocca, G.; Bogetto, F. (2001). “Clinical Features of Dysthymia and Age: a Clinical Investigation”. Psychiatry Review. 103 (2–3): 219–228.