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  • Dysthymia


    What is Dysthymia?
    Dysthymia is chronic form of depression, characterized by moods that are consistently low, but not as extreme as other types of depression.

    Causes, incidence, and risk factors

    The exact cause of dysthymia is unknown. Although the symptoms are not as severe as those of other forms of depression, affected people struggle nearly every day with low self-esteem, despair, and hopelessness.

    Like all forms of depression, dysthymia occurs more frequently in women than in men and affects up to 5% of the general population. Dysthymia can occur alone or in conjunction with more severe depression or other mood or psychiatric disorders.

    Symptoms
    The main symptom of dysthymia is low, dark, or sad mood nearly every day for at least 2 years. Other symptoms can include:

    • Poor appetite or overeating
    • Insomnia or hypersomnia
    • Low energy or fatigue
    • Low self-esteem
    • Poor concentration
    • Feelings of hopelessness
    • Signs and tests

    Dysthymia is evaluated by taking a careful history of mood and other mental health symptoms over the past several months.

    Treatment
    As with other forms of depression, there are a number of treatment options for people with dysthymia. Selective serotonin reuptake inhibitors like flouxetine (Prozac) are often used. Talk therapies, such as cognitive/behavioral therapy and interpersonal therapy, have also been shown to be effective. There is some evidence to suggest that the combination of both medication and psychotherapy treatments may yield the most improvement.

    Expectations (prognosis)
    By definition, dysthymia is a chronic condition lasting many years. Though some people completely recover, others continue to have some symptoms despite treatment. Maintenance medication and therapy may be required.

    Complications
    Antidepressant drugs have a number of side effects that can complicate treatment. For example, selective serotonin reuptake inhibitors may cause stomach upset, mild insomnia, and reduced sex drive. However, untreated dysthymia can progress into a major depressive episode, a phenomenon known as "double depression."

    Calling your health care provider
    Call for an appointment with your health care provider if you suffer from a persistently depressed mood.

    Information about therapy
    Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

    Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

    Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.