Dysthymic disorder: definition and symptoms

Dysthymic disorder or dysthymia is a type of low-grade depression that lasts for at least two years. Dysthymia is less severe than major depression, but the chronic symptoms often have negative effects on work, relationships, and family and social interactions. Typically, having dysthymia means feeling mildly or moderately depressed more often than not.

Dysthymia frequently remains unrecognized and un-diagnosed for years. Co-morbid major depression, anxiety, personality, somatoform and substance abuse disorders are common. Symptoms center on sad mood, pessimism and hopelessness. Sufferers experience significant functional impairment and are at risk of death by suicide. Those most at risk are female, unmarried, and live in high income countries and have family histories of depression.

Dysthymia is not preventable, and symptoms may occur in childhood and continue throughout adult-hood. Experiencing a major loss during childhood, such as the death of a parent, is associated with an increased risk of later-developing dysthymia.

Approximately one in every 20 people encounters dysthymia in their life time with lifetime prevalence rate of 3–6%. The lifetime prevalence of major depressive disorder is more (5–17%; average: 12%) than that of dysthymia. Among all psychiatric illnesses, depression is the most commonly encountered with an overall prevalence of 9–20%.

In addition to a depressed mood for most ofthe day and most days for at least two years,people who suffer from dysthymia exhibit atleast two of the following symptoms:
•Low energy levels or fatigue;
•Low self-esteem;
•Trouble concentrating or making decisions;
•Feelings of hopelessness;
•Appetite problems (poor appetite or overeating);
•Sleep problems (insomnia or hypersomnia).

Dysthymic disorder: definition and symptoms

What is dysthymia?

Dysthymia is a low grade chronic depression, formerly viewed as a character trait that was difficult to treat, but is now known to be responsive to antidepressant pharmacotherapy. It is being depressed most days, for most of the day, for at least two years and not without symptoms for more than two months at a time.

The DSM-IV defined dysthymia in adult requires at least two of the following:
*Poor appetite or overeating
*Insomnia or hyper-insomnia
*Low energy or fatique
*Low self esteem
*Poor concentration
*Feelings of hopelessness

The symptoms are required to cause clinically significant distress or impairment in social, occupational or other important areas of functioning and not to be cause by the direct physiological effects of a substance.

Dysthymia is more common in women less than 65 years of age, unmarried person, and young persons with low income.

In children and adolescent, dysthymia may be characterized by irritability (instead of sadness) and has to persist only for at least one year.
What is dysthymia?

Symptoms of double depression

Double depression, the concurrent presence of dysthymia and major depression appears it be an important course modifier. By definition, patients with this disorder have a chronic course.

Persons with double depression who recover from major depressive episode are likely to return to being dysthymic, but ongoing dysthymia after a major depressive episode presents a high risk for relapse into major depression as well as portending a faster time to relapse.

Dysthymia is characterized by a down mood that is relatively mild quite persistence lasting for at least two years. During that period, symptoms tend to wax and wane.

At times, they may become intense and numerous enough to qualify as a full-blow episode of major depression superimposed on the dysthymia.  Children and adolescents with double depression have more severe and longer major depressive episodes, a higher incidence of co-morbid disorders, increased suicidality, a more pronounced social impairment in contrast with children with single major depression.

About half of patients with double depression eventually recovered, after a median of 10 months, with a combination of mediation and psychotherapy.
Symptoms of double depression

What is double depression?

Double depression is the concurrent presence of dysthymia and major depression, in which acute major depressive episodes appear to be ‘superimposed’ upon the underlying chronic depression.

Double depression is distinct from chronic major depression, in which an individual experiences the symptoms of a major depressive episode continuously for at least 2 years.

This type of depression has a poorer prognosis than either condition alone, and recurrences of major depressive episodes are common.

Patients with double depression seem to recover more rapidly from episodes of major depression than do patients with major depression alone.
What is double depression?

Dysthymic disorder

Dysthymic disorder is distinguished from major depressive disorder by the fact that patients complain that they have always been depressed.

It is a chronic unipolar depressive disorder with depressive symptom present most of the day, more days than not, for 2 years. Dysthymic disorder is different from major depression in that the symptoms are not as severe.

Until 1980 most chronically depressed patients were considered to have a character disorder: depressive neurosis.

Dysthymic disorder is common among the general population and affects 5 to 6 percent of all persons.

The disorder is more common in women younger than 64 years of age than in men of any age and is more common among unmarried and young persons and in those with low incomes.

More than 75% of adults with dysthymia had other psychiatric disorders, particularly major depression, anxiety disorders and substance abuse.

Symptoms of dysthymic disorder among children and adolescents include irritability, pessimism, depression, low self-esteem, poor social skills, impairment of school performance and social interaction, changes in appetite, sleep problems, fatigue, problems with making decision, and feelings of hopelessness.

In dysthymic disorder, cognitive and social or motivational symptoms, not neuro-vegetative symptoms, were common.

Dysthymic disorder in the elderly does not appear to be a continuation of early adult dysthymic disorder. Instead, it is more often associated with health problems and loses, such as the loss of a role in retirement, the delta of family members or lost contact with old friends.

Younger patents were more likely to have symptoms of worthlessness, guilt, feeling trapped, feeling blue, feeling lonely, blaming the self, decreased sexual interest, and overeating.

Dysthymic disorder runs in families, along with major depression. Persons with dysthymia have increased rates of both dysthymia and major depression in their first degree relatives.

There also appears to be higher rate of some personality disorders in the families of person with dysthymia.
Dysthymic disorder

Sub-affective Dysthymia

Sub-affective Dysthymia sometimes also called characteristics depressive if the patient have suffered depression since their adolescence.

Some unfortunate people seem to have long histories of intermittent depression.

They represent low grade depression involving low self esteem and slef0critical attitudes, passivity, pessimism and inter personal dependency which appears to follow rather than precede a well defined depressive episode from which there is incomplete recovery.

The depression may not be serious enough to be diagnosed as a ‘major depression’ but studies indicate that those who suffer with this type of depression also have diminished functioning in their lives in terms of social, occupational and intimate relationship.

Patients with sub-affective dysthymia display several pathognomomic features of major depression, including reduced REM latency and favorable response to antidepressant pharmacotherapy.

Such people may present as quiet, passive, gloomy, self-critical and conscientious. Patients often present with melancholic symptoms, report a family history of affective illness and posses many depressive personality traits.

The research shows that sub-affective dysthymia is related mainly to bipolar disorder. An equivalent rate of familial bipolar disorder and of tricyclic-induced hypomania has been observed among probands with sub-affective dysthymia, cyclothymia and bipolar disorder. 

Sub-affective Dysthymia

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