What is Dysthymia?
Dysthymia is a form of depression in which a person's mood is chronically low, though symptoms are not as severe as Major Depressive Disorder. Dysthymia is a chronic mental health disorder that is persistent in nature, which makes it particularly likely to affect normal lifestyles and behaviors. As this disorder is a chronic, long-lasting disorder, many people are depressed so often and for so long that they do not recognize these feelings as abnormal, and may not complain of feeling depressed — it has become their new “normal.”
Causes of Dysthymia:
The cause of dysthymia, like many mental health issues, is unknown; however, researchers speculate that there are biochemical changes in the brain that cause depression and dysthymia. Genetics combined with environmental situations (loss of a loved one, financial struggles, stress) may play a part in who develops dysthymia.
Who Gets Dysthymia?
Anyone can get dysthymia, but it does tend to run in families. Women are twice as likely to be diagnosed with dysthymia than men. It is also more likely to affect the elderly due to risk factors such as difficulty caring for themselves, social and physical isolation, mental decline, and medical illnesses.
Dysthymia may affect up to 5% of the general population.
People with dysthymia are more likely to have other mental health disorders such as anxiety or struggles with addiction. Approximately 50% of people with dysthymia will also have one or more episodes of major depression.
Symptoms of Dysthymia:
The main symptom of dysthymia is a lower-than-normal or sad mood on most - if not all - days for at least two years. Friends and family members may notice that an individual with dysthymia is pessimistic, critical, and does not seem to enjoy themselves. In children and adolescence, irritability rather than depression can be considered for one year.
Other symptoms may include:
- Feelings of sadness or guilt
- Changes in sleeping patterns
- Low self-esteem (self-criticism)
- Changes in appetite
- Difficulty concentrating, problem-solving, and making decisions
- Loss of interest in hobbies
- Feelings of anger
- Social isolation
- Gloomy, pessimistic or negative outlook
This list is by no means all-inclusive or meant to diagnose dysthymia. If you suspect you may have dysthymia, call your doctor or a mental health practitioner.
How Is Dysthymia Different From Major Depressive Disorder?
While major depressive disorder and dysthymia are both mood disorders with very similar symptom sets, they are different disorders and should be treated as such. Differentiating dysthymia from major depression may be difficult, such as in cases of major depression with a partial response to treatment.
To be diagnosed with major depressive disorder, an individual must experience at least five of the nine symptoms of depression within a two-week period. To diagnose dysthymia, only two of the characteristic symptoms of depression must be evident.
The symptoms of dysthymia must occur over a longer period of time - two years of chronic depressive symptoms - but are of a lesser intensity than major depressive disorder. According to the American Psychiatric Association, the depressed mood of a person with dysthymia must be present more often than not, rather than close to every day as is the case with major depressive disorder.
What is Double Depression?
Double depression occurs when a person diagnosed with dysthymia experiences an episode of major depression. This episode of major depression on top of dysthymia may be the impetus for the person who has long-since been suffering dysthymia to seek treatment.
Double depression is treated almost identically to major depression and fine-tuned for each individual: medications and psychotherapy are almost always utilized. Treatment goals focus upon treating the dysthymia as well as the major depression.
Diagnosis of Dysthymia:
Physicians or mental health practitioners will take a mental health history and discuss your mood as well as other symptoms with you. Health care providers may perform a physical exam and request blood or urine tests to rule out any physical/medical causes of depression.
Diagnostic Criteria for Dysthymia:
The Diagnostic and Statistical Manual of Mental Disorders uses the following diagnostic criteria for dysthymia:
- During a majority of days for two years or more, patient reports depressed mood or appears depressed to others for most of the day.
- When depressed, the patient has two or more of:
- Decreased or increased appetite
- Decreased or increased sleep (insomnia or hypersomnia)
- Fatigue or low energy
- Reduced self-esteem
- Decreased concentration or problems 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 depression does not exist only as part of a chronic psychosis (such as schizophrenia or delusional disorder).
- The symptoms are often not directly caused by a medical illness or by substances, including drug abuse, or other medications.
- The symptoms may cause significant problems or distress in social, work, academic, or other major areas of life function
Treatment for Dysthymia:
The treatment approach for for dysthymia is the same as for major depression and includes antidepressants and therapy. Therapy seems to be one of the more effective treatments for dysthymia, particularly cognitive-behavioral therapy, psychodynamic therapy, and group therapy.
Additional Dysthymia Resources:
Mental Health America - Mental Health America (formerly known as the National Mental Health Association) is the country’s leading nonprofit dedicated to helping ALL people live mentally healthier lives.
National Institute of Mental Health (NIMH) - A part of the National Institutes of Health (NIH), a division of the US Department of Health and Human Services, the mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. Its comprehensive website provides information for patients, families, healthcare professionals, and the public about mental health and mental illnesses.
The Mayo Clinic provides an excellent resource with tips on getting support and how to cope with dysthymia.
Canadian Psychiatric Association - The national voluntary professional association of Canadian psychiatrists. Its website provides resources and links for professionals and the public in order to advocate for and promote mental health education and well-being in Canada.
Mood Disorder Association of Ontario - This organization offers free support and recovery programs to people across Ontario living with depression, anxiety or bipolar disorder. It provides a wealth of services and information, including online tools focused on wellness and recovery.