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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 Dysthymia is a type of low-grade depression. Harvard Health Publications states that, “the Greek word dysthymia means ‘bad state of mind’ or ‘ill humor’. As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer.” Harvard Health Publications says, “at least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism”. The Primary Care Journal says that dysthymia “affects approximately 3% of the population and is associated with significant functional impairment”. Dysthymia “is twice as common in women as it is in men, although this may be because women are more likely to report their symptoms” .² Harvard health Publications says, “The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder.” Dysthymia is a “milder but more persistent depressed mood… accompanied by at least two cognitive or somatic symptoms” .³ For some people the depression of dysthymia “is usually mild or moderate, rather than severe. Most people with dysthymia can't tell for sure when they first became depressed” .⁴

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 (not all patients feel this effect). 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 negative self-image. The symptoms can grow into a full blown episode of major depression. This situation is sometimes called "double depression"⁵ 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. Others describe being under chronic stress. When treating diagnosed individuals, it is often difficult to tell whether they are under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.

Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders⁶ (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

Treatments

There are many types of medications for depression. The hard part is finding one that helps and has the least side effects. Henny H. Kim says, “The success rate for all antidepressants ranges from 60 to 80 percent… for another, not everyone can tolerate the side effects” .²Most doctors “[prescribe] an antidepressant known as an SSRI -- a selective serotonin reuptake inhibitor …because the side effects of the medications in the SSRI class of antidepressants are generally more tolerable than are those of other types of antidepressants.⁷ Some of the most commonly prescribed SSRI’s are “fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro)” (Mayoclinic.com). Medication is used very frequently with depressed patients.

Side Effects

Some side effects for SSRI’s are “sexual dysfunction, nausea…diarrhea, sleepiness or insomnia, short-term memory loss and tremors” .⁸ Sometimes antidepressants don’t work for patients. It does not work for everyone because, “some brains are more resistant to antidepressants than others… if you’re not responding in three to five weeks, you may be offered an older antidepressant, such as a tricyclic antidepressant or an MAOI” .⁹ “Every brain has different chemistry and therefore requires different dosages” .⁸. Tricyclic antidepressants are more effective but have worse side effects. Side effects for tricyclic antidepressants are “weight gain, dry mouth, blurry vision, sexual dysfunction, and low blood pressure” .⁸For many antidepressants, “it can take as long as eight to 12 weeks to gain the full benefits … although you may notice some improvements in your mood before that” .⁷

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. Attachment to relatives other than parents.
   6. Concentration and decisiveness decreased or increased
   7. 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).

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.¹⁰. Other new anti-depressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), and duloxetine (Cymbalta).

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 a doctor may prescribe a mood stabilizer or anti-anxiety medication in combination 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.

See also

• Anhedonia, a similar disorder characterized by a decreased or absent ability to enjoy a sense of pleasure. This may also be a symptom of schizophrenia and/or clinical depression. In addition, this disorder can be caused by excessive use of amphetamines.
• Blunted affect, a symptom of PTSD, schizophrenia, and ASPD involving decreased or absent emotional response
• Atypical depression
• Clinical depression

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. ^ Cite error: Invalid <ref> tag; no text was provided for refs named Kim
3. ^ Cite error: Invalid <ref> tag; no text was provided for refs named Pennington
4. ^ Cite error: Invalid <ref> tag; no text was provided for refs named Familydoctor.org
5. ^ Double Depression: Hopelessness Key Component Of Mood Disorder retrieved July 17, 2008
6. ^ (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. 
7. ^ Cite error: Invalid <ref> tag; no text was provided for refs named Mayoclinic
8. ^ Cite error: Invalid <ref> tag; no text was provided for refs named Rosenthal
9. ^ Cite error: Invalid <ref> tag; no text was provided for refs named rosenthal
10. ^ National Institute of Mental Health

• “What are the different forms of depression?” (2008). In National Institute of Mental Health. Retrieved 2008-02-26 from (http://www.nihm.nih.gov)
• “Diagnosis”. (2008). In Encyclopedia Britannica. Retrieved 2008-02-26, from Encyclopedia Britannica Online: http://www.britannica.com/eb/article-24621
• Dysthymia. (2008). Retrieved 2008-02-27, from http://www.intelhealth.com
• Gray, Peter. Psychology. New York: Worth Publishers, 2007
• The Facts. (2008). In U.S Department of Health and Human Services. Retrieved 2008-02-26; from SAMSHA (http://www.allmentalhealth.samsha.gov)