What is Dysthymia
Dysthymia (or mild depression) is a chronic depressive disorder, mild, lasts for a long period of time, symptoms are expressed for two or more years. The concept was coined by Robert Spitzer, this term is now used instead of the pre-existing terms “neurasthenia” and “psychasthenia”.
According to statistics, about 20% of people over 18 years old suffered from dysthymia at least once. This disease does not completely paralyze psychic, mental, motor abilities, unlike clinical depression or major depression. However, dysthymia has a significant impact on the psychological and physical conditions of the individual and limits some person’s functions.
Dysthymic disorder often occurs in childhood or adolescence and is more common in women. Often, dysthymia is diagnosed after a long period of time after its development, since most patients consider the most common symptom among all types of depression – low mood – as the peculiarities of their characters, and do not tell their doctors. The simultaneous manifestation of dysthymia with other mental disorders also hampers diagnosis of dysthymic disorder because the symptoms of other diseases are expressed more intensely and clearly. The disease lasting more than 3 years without treatment increases the risk of developing more severe forms of depression because stressful events may trigger them. The development of mild depression in people at the age of 21 is fraught with frequent relapses and a large number of symptoms.
People suffering from depression look tired and weak, and they have no energy. They are described as incorrigible pessimists; people with dysthymia are believed to be irritable, morose, dull and grouchy. Patients with dysthymia consider the difficulties as something natural, they do not try to overcome or resist them. For example:
- loss of interest in everything,
- anhedonia (the inability to experience pleasure).
It has been found that over 75% of people with dysthymia have a history of another chronic disease or other mental pathologies. Such disorders often combine with dysthymia:
- anxiety and phobia (frequent panic attacks, generalized anxiety disorder);
- somatic diseases;
- drug addiction;
- alcohol abuse.
Types of Dysthymia
A person experiences typical symptoms such as malaise, palpitation, shortness of breath without physical activity, constipation, tearfulness, and sleep problems. Low mood, as a rule, is slightly expressed; the patient has the feeling of irrational anxiety. Often, sadness and emptiness may be experienced as a burning feeling in the chest, cold in the heart. Other signs take place, such as low activity, weakness or abnormal bodily sensations.
This type of dysthymia occurs in constitutional-depressive personality types. The clinical picture of the disease is characterized by stable, unchanging for individual conditions and feelings:
- a tendency to “blues”,
- innate pessimism,
- thoughts about the meaninglessness of existence,
- the expectation of problems and misfortune in the future
- remorse over made mistakes, usually imaginary,
- increased sensitivity to minor negative stimuli.
The apathetic condition gradually forms depressive outlook which makes a person act as a “loser”. Patients are considered eternally morose, gloomy, taciturn and unhappy individuals. Such people unconsciously stay away from not only little-known people but also close friends. You can notice external symptoms of depression in the movements and facial expressions: drooping mouth corners, slow movements, poor gestures. Whatever work they do, it will be unpleasant, uninteresting and tiring. People with a dysthymic disorder are not able to make long-willed efforts, they hesitate too much and are not able to take the initiative. Any mental activity causes immense stress and leads to fatigue.
What Causes Dysthymia
There is no clear understanding what the factors trigger this chronic depression. The most promising hypothesis suggests a direct relationship between the occurrence of dysthymia and changes in the chemical composition of substances that regulate brain functions. Lack of serotonin as a main neurotransmitter is a leading factor of developing a depressive disorder.
What can trigger the development of dysthymia:
- External stress factors;
- Chronic somatic diseases;
- Particular personal characteristics;
- Problems come from “childhood”: poor nurture, high demands from parents, loss of loved ones, social isolation;
- Unbalanced nutrition;
- Violation of the regime “work-rest”.
Symptoms of Dysthymia
The common symptomatic signs of this disease last for two years at least or the person notices low mood and other signs of depression for a long period of time.
According to the DSM-IV guidelines for making a diagnosis “dysthymic disorder” the patient must have two or more criteria, such as:
- Loss of appetite or excessive desire to eat;
- Sleeping problems: insomnia at night or sleepiness during the day;
- Fatigue and lack of energy;
- Low self-esteem, the feeling of worthlessness, self-criticism, and self-blame;
- The feeling of emptiness;
- Slow mental activity, loss of the ability to concentrate, difficulty to make decision;
- Loss of interest, loss of ability to enjoy life;
- The negative assessment of the past and the present, confidence in the meaningless and hopeless future;
- Headaches, “tension”, joint pain, disorders of the digestive tract;
- Suicidal thought.
As a rule, manifestations mentioned above have a negative impact on a person’s life: social, professional and personal. Many people have to change usual way of living: they do not want to communicate with others, avoid social activities, change their jobs, and break up with someone they love.
It is important to distinguish dysthymia symptoms from symptoms of other depressive disorders such as:
- major depressive disorder,
- episodes of mania,
- delusional disorder,
- hormonal imbalance.
It is necessary to exclude the likelihood of depressive symptoms as a result of the use of narcotic or psychotropic drugs, alcohol, as the side effects of any medication.
Treatment of Dysthymia
Although the dysthymic disorder is relatively severe disease, it is well treated. An important role in achieving remission plays: timely diagnosis, determining the severity and subtype of depression, treatment including pharmacological medicine and methods of psychotherapy. An adequate combination helps beat the symptoms of dysthymia, reduce the risk of further development, allows a person return to any social activity.
Psychotherapeutic techniques, which are used in the treatment of mood disorders, teach how you should respond and prevent the negative effects of daily stressors. The person should maintain the healthy lifestyle and learn about ways how to have a rest, and most importantly, treatment helps to find out and to rethink the root causes of dysthymia. Cognitive therapy which proved to be effective is one of the important methods of treatment. Group therapy allows the individual to master the skills of positive interpersonal communication, helps to improve self-esteem and build confidence.
There are many different antidepressants. Taking into account the individual characteristics of mental and physical condition of the particular patient, the doctor selects the most suitable drugs with minimal side effects. Medication consists of the use of different groups of antidepressants: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), moclobemide (RIMA).
The therapeutic effect of antidepressants shows up after 2-3 weeks after starting treatment. It is recommended to take prescribed medication for six to nine months. It is necessary to inform the patient that to stop taking antidepressants is the gradual process and takes over 2-3 weeks. Also, the patient needs to be aware of side effects.