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Dysthymic Disorder - Causes, Symptoms, and Treatment

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Dysthymic disorder is a behavioral mental disorder and is defined as a mild form of chronic depression. Chronic depression refers to long-term depression.

Written by

Dr. Kirti Maan

Medically reviewed by

Dr. Vishal Anilkumar Gandhi

Published At September 23, 2022
Reviewed AtSeptember 23, 2022

Introduction:

Dysthymic disorder is also known as persistent depressive disorder (PDD) and dysthymia. In the late 1970s, there were many misconceptions about the term depression and depressive personality, and so Robert Spitzer coined the term dysthymia, which later on was also recognized as the term persistent depressive disorder. To officially diagnose someone with dysthymia, the symptoms of depression must last a minimum of two years for adults and one year for minors (children and adolescents).

What Are Persistent Depressive Disorder and Dysthymic Disorder?

Persistent depressive disorder (PDD) is a form of depression that is chronic in nature. The affected individual experiences mood changes and swings for about two years (one year of symptomatic behavior is sufficient for classification as PDD in children and adolescents). The depression experienced is rarely severe and typically falls in the mild to moderate spectrum. Affected patients cannot usually recall when they first became depressed.

PDD is quite common. This disorder can affect children and adults and can occur at any age. There does not seem to be an explainable reason for PDD. Women are more commonly affected by PDD. PDD was previously termed dysthymic disorder or dysthymia. Depression and dysthymic disorder are often misconstrued as similar disorders with overlapping symptoms; however, mild the symptoms of dysthymia are, they last longer and affect an individual's mood more.

In the fourth edition of the diagnostic and statistical manual of mental disorders (DSM-IV), dysthymia has been defined as a consequential form of chronic depression. In the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-V), the term dysthymia was replaced by persistent depressive disorder (PDD). However, persistent depressive disorder includes both major depressive disorder (chronic) and dysthymic disorder, as there was no documented difference between the two.

What Is Dysthymic Disorder?

  • Due to the early onset of symptoms, individuals suffering might not be self-aware and might even consider their low mood and depressive symptoms as a part of their personality and everyday life.

  • The diagnosis is often late, and it is hard for the individual suffering to recognize and accept their condition, let alone seek professional help.

  • Dysthymic disorder can be a stand-alone mental illness or can be due to complications of other mental illnesses (except for mania and hypomania).

  • The symptoms of dysthymic disorder are similar to that of depression; it affects the cognitive ability of an individual, which includes thinking capabilities, the way an individual reacts, and reasoning abilities.

  • Along with cognitive abilities, the physical health of an individual is compromised, with an added characteristic feature of long-lasting symptoms and their repercussions.

Earlier, to the inclusion of dysthymic disorder and major depressive disorder and forming persistent depressive disorder, if an individual were to suffer from both dysthymic disorder and major depressive disorder, the official diagnosis was double depression.

What Are the Causes of Dysthymic Disorder?

With similarity to depression and other mental illnesses, the cause of the dysthymic disorder is still unknown. However, with progression in the field of psychology and psychiatry, many probable causes of dysthymic disorder have been put forward in order for them to either be corrected or avoided.

Some of the probable causes of the dysthymic disorder are:

  • Changes in the chemical levels of the brain (progression of depression has been closely related to low levels of serotonin). Serotonin is a hormone and a neurotransmitter that regulates the emotional center of the brain and helps an individual feel happy, sad, angry, irritable, and euphoric. It also plays a significant role in decision-making.

  • Stress.

  • Sex (women are at a greater risk of developing the dysthymic disorder in comparison to men).

  • Positive familial history.

  • Trauma that is experienced at an early age in life.

  • Post-traumatic stress disorder (PTSD).

  • Chronic illnesses.

  • Side effects of medicines.

What Are the Symptoms of Dysthymic Disorder?

Dysthymia is a long-term mild episode of depression. With the characteristic symptom being depression episodes lasting for more than two years, dysthymia is more than that. Some of the common symptoms of dysthymia include:

  1. Poor appetite.

  2. Overeating or binge eating.

  3. Low self-esteem.

  4. Difficulty concentrating.

  5. Fatigue.

  6. Feelings of worthlessness and hopelessness.

  7. Sleeping disorders (hypersomnia or insomnia).

  8. Comorbid illnesses (such as diabetes and hypertension).

  9. Panic disorders.

  10. Generalized anxiety disorder.

  11. Substance abuse disorder.

  12. Personality disorder (multiple personality disorder and borderline personality disorder).

  13. Suicidal tendencies and behavior.

  14. Feeling of emptiness.

  15. Socially isolated or in seclusion.

  16. Continuous feelings of guilt, remorse, and worry.

  17. Anger management issues.

  18. Constant feeling of anxiousness.

What Is the Treatment Protocol for Someone Suffering From Dysthymic Disorder?

Even with dysthymic disorder being a mild form of chronic depression, it still needs treatment as the chances of dysthymic disorder developing into clinical depression are very high and probable. The treatment plan for the dysthymic disorder has three major components:

1. Medicinal therapy.

2. Psychotherapy.

3. Combination therapy.

1. Medicinal Therapy: Episodes of the dysthymic disorder are salvageable by the use of tricyclic antidepressants (TCA), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs). SSRIs have proven to be effective in the case of major depressive disorder, and as discussed above, major depressive disorder and dysthymia are one disorder; hence they work effectively even in the case of dysthymic disorder. Commonly prescribed selective serotonin reuptake inhibitors are Fluoxetine and Sertraline. Tricyclic antidepressants, on the other hand, are more effective and do not stand the risk of developing a habit or addiction of them.

2. Psychotherapy: In the case of dysthymic disorders, psychotherapy is an essential component of the treatment plan. Psychotherapy has a significant effect on the treatment of dysthymia. An individual suffering from dysthymia has a constant feeling of anxiety and worthlessness. Psychotherapy is also known as talk therapy.

Different types of psychotherapies advised for an individual suffering from the dysthymic disorder are:

  • Cognitive-behavior therapy (CBT), wherein the individual is motivated to talk about their emotions, behaviors, and their feelings (especially of hopelessness and worthlessness). Cognitive-behavioral therapy has proven to be effective in both chronic and non-chronic episodes of depression.

  • In addition to CBT, the cognitive-behavioral analysis system of psychotherapy (CBASP) was specifically structured to treat a dysthymic disorder or persistent depressive disorder. Individuals undergoing a cognitive behavioral analysis system of psychotherapy have shown a significant amount of improvement.

Other therapies suggested for the treatment of dysthymic disorder are:

  • Schema therapy (a therapy that combines techniques of cognitive-behavioral therapy and experiential therapy)

  • Psychodynamic psychotherapy (the counselor takes deeper notice of the individual’s emotions and fears).

  • Interpersonal psychotherapy (as the name suggests, this therapy focuses on treating interpersonal relationships and amending any shortcomings caused due to the illness).

3. Combination Therapy: Combination therapy suggests combining both medicinal therapy and psychotherapy. Experiments have proven that medicinal therapy, when used in adjunction with psychotherapy, increases the chances of improvement and reduces the chance of recurrence. Continuing the therapy, even after a significant reduction in the severity of the symptoms or complete absence of the symptoms, has proven to be effective in reducing the chance of developing clinical depression.

What Are the Complications of Dysthymic Disorder?

In the case of an untreated long-term episode of dysthymic disorder, complications are bound to appear. Some of the complications or conditions arising due to the dysthymic disorder are:

  • Poor quality of life.

  • The dysthymic disorder may develop into major depressive disorder, anxiety disorder, and mood disorders.

  • Substance abuse disorder.

  • Occurrence of co-occurring disorder or dual-diagnosis.

  • Difficulty in both personal and professional relationships.

  • Reduced efforts and productivity in professional and personal life.

  • Chronic illnesses.

  • Suicidal tendencies and behaviors.

  • High risk of developing mental illnesses such as multiple personality disorder or borderline personality disorder.

What Are the Home Remedies for Dysthymic Disorder?

In the case of mild to moderate forms of dysthymic disorder, counselors advise individuals on self-help tricks in order to maintain regularity in an individual's life. Some of the self-help tips and advice are:

1. Maintaining a sleeping pattern.

2. Exercising a healthy diet.

3. Following a daily routine.

4. Avoiding the use of illicit drugs and alcohol.

5. Following the doctor's advice (including medicinal therapy).

6. Interacting with friends and family.

7. Talking about one’s fear and feelings.

8. Changing the environment by adding more positive people to one’s life.

9. Add yoga and exercise to your daily routine.

10. Understanding their situation.

11. Being there for themselves.

12. Practicing self-help.

Conclusion:

Dysthymic disorder, however mild it is, can make an individual feel blue. Feeling blue is a layman's term used to describe depression. Feeling blue includes feeling worthless, hopeless, and most often sad without a proper reason. Dysthymic disorder is a treatable condition. Treatment suggested for dysthymic order includes both medicinal therapy as well as psychotherapy. The chances of recurrence are high in the case of dysthymic disorder. The symptoms might become redundant, and then later in life, may flare up and, in severe cases, might even develop into clinical depression. Treatment is mandatory in the case of dysthymic disorder. Following up on therapy is required to ease the symptoms of dysthymic disorder even after recovering from the disorder.

Frequently Asked Questions

1.

What Do Dysthymic Behaviors Mean?

Dysthymia is a long-term mood disorder that can last for more than two years in an adult with few episodes of normal mood. It is common among the general population, and the condition has no known cause. It is a chronic form of depression, and the affected individuals experience persistent low mood, low energy, lack of pleasure or interest, fatigue, poor concentration, weight changes, sleep disturbances, and appetite loss.

2.

What Is the Difference Between Dysthymic and Cyclothymic Disorder?

 
A chronic form of depression with mild severity is called dysthymia, while cyclothymia is a milder form of bipolar disorder. In cyclothymia, there can be episodes of mild depression and mild mania. Both these conditions are associated with psychosocial, genetic, and physical causes. 

3.

How Are MDD and Dysthymic Disorder Differentiated?

 
MDD (major depressive disorder) is a very severe acute condition, but dysthymia refers to a milder form of depression where there can be chronic low mood. In a person with MDD, symptoms of depression will last up to two weeks. If the depressive symptoms are mild and last for over two years, it is called a dysthymic disorder.

4.

What Is a Cyclothymic Disorder Otherwise Called?

Cyclothymic disorder is also known as cyclothymia. They refer to the same medicine and are used interchangeably. This condition is considered a milder form of bipolar disorder characterized by cyclic episodes of elevated mood or hypomanic and depressive episodes.

5.

What Are the Various Types of Dysthymia?

Dysthymia, or PDD (persistent depressive disorder), is characterized by various symptoms and characteristics. The following are the types of dysthymia:
- Early Onset Dysthymic Disorder: Symptoms begin in childhood and continue until adulthood if the case is not treated.
- Late-Onset Dysthymic Disorder: Symptoms begin in adulthood due to various causes like stressors, life events, and biological changes.
- Episodic Dysthymic Disorder: Patients experience episodes of MDD, which superimpose the underlying dysthymia. 
- Double Depression: It is characterized by the presence of MDD and dysthymia, and there can be persistent dysthymia symptoms. 
- Chronic Dysthymic Disorder: Persistent and continuous form of dysthymia without underlying MDD. 

6.

Is Dysthymia Curable?

Dysthymia is treatable but not completely curable in a traditional sense. Psychotherapies such as CBT (cognitive behavioral therapy) or IPT (interpersonal therapy) will help affected individuals develop coping strategies. Antidepressants can be given; it can take up to six weeks to show full efficacy. 

7.

What Is the Prevalence of Dysthymia?

Dysthymia is seen twice as commonly in women compared to men. They can affect individuals of any age, and the disease can occur anywhere in the individual's lifespan. Dysthymia can coexist with severe mental health conditions like anxiety and MDD. Specific psychosocial stressors and traumatic incidents can also trigger dysthymia.

8.

What Is Directly Opposite to Dysthymia?

Optimal mental health with a state of well-being is a contrast state, unlike dysthymia. Hyperthermia is a depressive mood lasting for several years and is considered the opposite of dysthymia. In a typical health being, a balanced mood will be without persistent depressive symptoms.

9.

Can Dysthymia Exist Lifelong?

 
Dysthymia can last up to five years and can last for a lifetime. The symptoms of the disease can be treated, but it is not entirely curable. It is considered a long-term mild episode of depression. Antidepressants like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) that include Fluoxetine and Venlafaxine, respectively, can be used by the affected individual to reduce the symptom severity. 

10.

How Can Dysthymia Be Prevented?

Dystjmia can be prevented by maintaining and balancing a combination of biological and environmental factors. The following are specific preventive measures:
- Maintaining a healthy lifestyle.
- Coping strategy development.
- Building resilience.
- Monitor stress and management.
- Social support seeking.
- Addressing trauma and adversity.
- Recognize early warning signs..
Source Article IclonSourcesSource Article Arrow
Dr. Vishal Anilkumar Gandhi
Dr. Vishal Anilkumar Gandhi

Psychiatry

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