Dysthymia and Dysthymic States

Dysthymia and Dysthymic States
In the latter years of the eighties dysthymic disorders have stimulated increasing research.

The DSM-111 category of depressive neurosis has become dysthymia in the DSM-111-R.

This is however, regarded as distinct from mild major depression. Dysthymia (or depression neurosis) includes depressed mood for most days at least two years plus two of the following:

• Poor appetite or overeating
• Insomnia or hyposomnia
• Low energy or fatigue
• Low self esteem
• Poor concentration of difficulty making decisions
• Feeling of hopelessness

The criteria of; insidious onset with origin often in childhood or adolescence; persistent or intermittent course; concurrent “character” pathology; ambulatory disorder compatible with “stable” social functioning.

The idea that there are cycles in neurasthenia has been for some centuries. There are suggestion three forms of cyclical disorder.

These are

• Hyperthymic disorder, where the individual cycles in and out of hypomanic episodes many of whom may nor present for treatment
• Cyclothymic disorder, where the individual cycles into both hypomania and depression
• Subaffective dysthymic disorder where the cycle is only into depression, although tricyclic anti depressants may trigger hypomania.

Dysthymia and Dysthymic States

DSM-111-R Criteria for Melancholia

DSM-111-R Criteria for Melancholia The presence of at least five of the following:

1. Loss of the interest or pleasure in all or almost all activities.
2. Lack of reactivity to usually pleasurable stimuli (does not feel much better even temporarily, when something good happens).
3. Depression regularly worse in the morning.
4. Early morning awaking (at least two hours before usually time).
5. Psychomotor retardation or agitation (not merely subjective complaints).
6. Significant anorexia or weight lost (e.g., more than 5% of body weight in a month).
7. No significant personally disturbance before fist major depressive episode.
8. One or more previous major depressives episodes followed by a complete, or early complete recovery.
9. Previous good response to specific and adequate somatic antidepressant therapy.

DSM-111-R Criteria for Melancholia

Endogenous/Melancholic Depression

Endogenous/Melancholic Depression
Within the heterogenous profile of depression, it has always been assumed that endogenous depression was likely to be closest to a disease entity.

Consequently, the investigation of endogenous/melancholic depression and its distinction from other sub-types have been a main focus for studies of symptom variation.

While neurotic depressions are often regarded as milder states of heterogenous nature and course, it has been assumed that endogenous depression is somehow one thing or (core) entity and that careful description associated with a variety of statistical and other techniques will illuminate it.

An early set of criteria for identifying endogenous depression was developed by the Newcastle group and other research criteria.

The Newcastle scale assigns various weights to different symptoms due to the idea that these symptoms were associated with good outcome.

Since the advent of the Newcastle scale, other classifications have appeared. The most well known being the DSM-111-R criteria for melancholia.

Unlike the Newcastle endogenous depression scale, symptoms of melancholia (DSM-111-R) are not given weights.

Thus the idea of a hierarchy of symptoms (i.e. some symptoms are more keys or core) is not found here.
Endogenous/Melancholic Depression

Types of Depression

Anyone coming to study depression and trying to make sense of the differences can be easily overwhelmed by the different terms and descriptions given to depression.

The Diagnostic and Statistical Manual (DSM) the American system provide criteria for the diagnosis of:

Major depression
Major depressive disorder (single episode or recurrent)
Major depression melancholic type

Bipolar disorder
Mixed
Depressed
Seasonal pattern
Cyclothymia

Dysthymia
Depressive neurosis

Depressive disorder not otherwise specified
Types of Depression

Symptoms of a Major Depressive Episode

Symptoms of a Major Depressive Episode
Major depressive episode can be defined by the criteria listed below. At least five of the symptoms, including one or the other of the first two, must be present during the same two-week period for major depression to be diagnosed.

• Depressed mood (or can be irritable mood in children and adolescents) most of the day, nearly every day, as indicated either by the subjective account or observation by others.

• Markedly diminished interest or pleasure in all day, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by others of apathy most of the time)

• Significant weight loss or weight gain when no dieting (e.g. more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gains).

• Insomnia or hypersomnia nearly every day

• Psychomotor agitation or retardation nearly every day (observation by others, not merely subjective feelings of restlessness or being showed down)

• Fatigue or loss of energy nearly every day

• Feelings of worthlessness or excessive of inappropriate guilt which may be delusional nearly every day (not merely self reproach or guilt about being sick)

• Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Symptoms of a Major Depressive Episode