Dysthymia is a mental disorder described as being the milder, longer-term form of depression. In some medical texts it is called persistent depressive disorder. People need to know the difference between dysthymia and depression, symptoms of those two mood disorders and the recommended treatment.
What is Dysthymia?
Dysthymia is originally a Greek word that means “bad state of mind”. The true basis of dysthymia is built on the parent mood disorder: depression. It is always defined as the chronic, less-severe form of depression. If it persists for too long, it can easily become part of an individual’s personality. It is also described as “depressed mood, all the time, for at least two years”.
Dysthymia affects women three times more than men. It runs in families and has hereditary susceptibility. Causes of dysthymia could also be biochemical or environmental. However, the exact cause remains unknown.
Dysthymia vs. Depression
People often confuse dysthymia with depression. While they both have their share of parallel symptoms, depression is more sudden and has a shorter duration, while dysthymia is milder and goes on for at least two years.
Symptoms of depression must last for at least two weeks. They include:
- Feelings of sadness and emptiness.
- Anhedonia (inability to feel pleasure).
- Lethargy and agitation.
- Difficulty getting out of bed.
- Loss of appetite.
- Excessive feelings of guilt.
- Low energy.
- Difficulty in concentration.
- Suicidal thoughts.
Dysthymia is often characterized by:
- Overeating or loss of appetite.
- Difficulty in concentration.
- Low self-esteem.
How Can a Patient with Dysthymia Get Better?
Coping with dysthymia starts with becoming educated on this serious mood disorder and learning how to deal with its consequences. Developing assertiveness skills, cognitive restructuring and stress management skills helps in expanding your social skills and building healthier relationships in your life.
You should also work on treating any underlying medical condition that precipitated to dysthymia. If it is a substance abuse problem, you should work on resolving it first.
Alternative treatment may work hand-in-hand with psychotherapy for treatment of dysthymia. Among the very famous mind-body techniques are:
- Yoga or Tai chi.
- Massage Therapy.
- Relaxation techniques.
- Music and art therapy.
- Dance Therapy.
- Guided Imagery Techniques.
- Autogenic Training.
How to Identify a Child with Dysthymia
Dysthymia often begins in childhood. However, children often do not realize they have a serious mood disorder. This is where the diagnostic problem stems from. Symptoms of a child suffering from dysthymia are:
- Child is irritable, moody and sad for a long period of time.
- Child suffers from erratic behavior, low-performance at school, low-self esteem and inability to socialize with kids of the same age.
- Difficulty in concentration or making decisions.
- Troubled sleep or insomnia.
- Lack of energy.
These symptoms must persist in your child everyday for at least one year.
What is the Recommended Treatment for Dysthymia?
The two main methods of treatment for adults include drug therapy and psychotherapy. The optimal treatment is a combination of both methods.
In children, psychotherapy is the only therapeutic method of choice.
Medications for treating dysthymia are typically going to be antidepressants:
- Selective serotonin reuptake inhibitors (SSRIs): This is the first line treatment. SSRIs are very effective and have tolerable side effects. They include fluoxetine, paroxetine, sertraline and fluvoxamine. Psychiatrists usually start with the lowest possible dose of SSRIs for 2-4 weeks and then increase it as treatment progresses. SSRIs cannot be stopped suddenly or you will experience withdrawal symptoms. When you start treatment for the first time, mild yet uncomfortable side effects like anxiousness, agitation, blurred vision, low sex drive and erectile dysfunction might occur. SSRIs are prohibited in case of pregnancy, breastfeeding or for teens under 18.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): They are called dual-action antidepressants. SNRIs include venlafaxine, milnacipran, and duloxetine. They are less recommended in case of dysthymia because of their extreme side effects including nausea if taken with a meal, hypertension, increased suicide risk, elevated liver enzymes and serotonin syndrome.
- Tricyclic antidepressants (TCAs): These are only prescribed when treatment with SSRIs or SNRIs fails due to their dangerous side effects and withdrawal symptoms.They include amitriptyline, amoxapine, impiramine, nortriptyline and others.
Psychotherapy for dysthymia should start with a mental health assessment test by a mental health professional for the following reasons:
- Evaluate your current state of functioning.
- Assess mood type and severity of disorder.
- Check for suicidal tendencies.
- Estimate presence or lack of underlying mental disorders.
There are different approaches to dealing with dysthymia in psychotherapy. Most psychoanalysts consider a well-structured cognitive-behavioral therapy (CBT) with the patient at its core. The therapist shouldn’t focus on change too fast so that the patient doesn’t find it difficult to adapt. Therapists also prefer short-term psychotherapy approaches because they ensure realistic, attainable changes in the patient’s life.
Group psychotherapy provides two benefits: support and gradual change in the patient’s life. It should be a later step in treatment, however, so that the therapist gives the patient time to regain confidence and develop positive social skills.
Some psychoanalysts prefer interpersonal psychotherapy (IPT) as an alternative method for managing dysthymia. IPT is rather time-limited and relies on role-transition as the ultimate therapeutic method for patients to improve their poor social and interpersonal skills. Unfortunately, this approach fails to work on its own and always requires a combination therapy with medications.