Dysthymia

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Dysthymia
Classification and external resources
ICD-10 F34.1
ICD-9 300.4

Dysthymia (pronounced /dɪsˈθaɪmiə/) is a mood disorder that falls within the depression spectrum. It is considered a chronic depression, but with less severity than a major depression. This disorder tends to be a chronic, long-lasting illness.[1]

Contents

[edit] Duration

Dysthymia can start early in life, even in childhood, and it is constant. Treatment can reduce how long it lasts and the intensity of the symptoms.[citation needed]

[edit] Symptoms

The symptoms of dysthymia are similar to those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, lack of interest in things most people find enjoyable, and a loss of energy. Appetite and weight can be increased or decreased. The person may sleep too much or have trouble sleeping. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a poor self-image. The symptoms can grow into a full blown episode of major depression. This situation is sometimes called "double depression"[citation needed] because the intense episode exists with the usual feelings of low mood. People with dysthymia have a greater-than-average chance of developing major depression. While major depression often occurs in episodes, dysthymia is more constant, lasting for long periods, sometimes beginning in childhood, as a result a person with dysthymia tends to believe that depression is a part of his or her character. The person with dysthymia may not even think to talk about this depression with doctors, family members or friends. Dysthymia, like major depression, tends to run in families. It is two to three times more common in women than in men. Some people with dysthymia experienced a major loss in childhood, such as death of a parent. Others describe being under chronic stress. It is often difficult to tell whether people with dysthymia are under more stress than other people or if the dysthymia causes them to perceive more stress than others.

[edit] Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders[2] (DSM), published by the American Psychiatric Association, characterizes Dysthymic disorder. The essential symptom involves the individual feeling depressed almost daily for at least two years, but without the criteria necessary for a major depression. 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]

  1. During a majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.
  2. When depressed, the patient has 2 or more of:
    1. Appetite decreased or increased
    2. Sleep decreased or increased
    3. Fatigue or low energy
    4. Poor self-image
    5. Reduced concentration or indecisiveness
    6. Feels hopeless or pessimistic
  3. During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
  4. During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
  5. The patient has had no Manic, Hypomanic or Mixed Episodes.
  6. The patient has never fulfilled criteria for Cyclothymic Disorder.
  7. The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
  8. The symptoms are not directly caused by a general medical condition or the use of substances, including prescription medications.
  9. These symptoms must result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000).

[edit] Treatment

As with other forms of depression, a number of treatments exist for Dysthymia. Doctors most commonly use psychotherapy, including cognitive-behavioral therapy, to help change the mind-set of the individual affected. Additionally doctors may prescribe a variety of antidepressant medications

[edit] Most effective treatments

Some evidence suggests the combination of medication and psychotherapy may result in the greatest improvement. The most commonly prescribed anti-depressants for this disorder are the selective serotonin reuptake inhibitors (SSRIs),which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).[citation needed]. SSRIs are easy to take and relatively safe compared with older forms of anti-depressants.[3]. Other new anti-depressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), and duloxetine (Cymbalta).

There may be side effects of medication. SSRIs can cause nausea and problems with sexual functioning.[citation needed] They can cause anxiety to increase in the early stages of treatment and lead to apathy in the long run. Concerns about the increased risk of suicide have led the U.S Food and drug administration to advise many anti-depressant manufacturers to put prominent warning labels on their products[citation needed]. The scientific community has not found that anti-depressants increase suicide risk, but a small number of people using the medications feel strikingly worse rather than better when they take them. You should immediately report all troubling changes to your doctor and keep all follow-up appointments. Remember the risk of leaving depression untreated is far greater than the risk of treatment with an anti-depressant.[citation needed]

It usually takes two to six weeks of anti-depressant use to see improvement. The dose may have to be adjusted. Often it will take up to a few months for the full positive effect to be seen. Sometimes two different anti-depressant medications are prescribed together, or your doctor may combine a mood stabilizer or anti-anxiety medication with an anti-depressant. The type of psychotherapy that will help depends on a number of factors, including the nature of any stressful events, the availability of family and other social support, and personal preference. Therapy should include education about depression. Support is essential. Cognitive behavioral therapy is designed to examine and help correct faulty, self-critical thought patterns and correct the cognitive distortions that persons with mood disorders commonly experience. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms.

[edit] See also

[edit] References

  1. ^ a b Hersen, M., Turner, S. M., & Beidel, D. C. (Eds.). (2007). Adult Psychopathology and Diagnosis (5th ed.). Hoboken, New Jersey: John Wiley & Sons, Inc.
  2. ^ (June 2000) in American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, Fourth Edition (Text Revision), American Psychiatric Publishing, Inc., 943 pages. ISBN 978-0890420249. 
  3. ^ National Institute of Mental Health