Dysmia (Dysthymic disorder): Symptoms, Causes, Treatments

The dysthymia or dysthymic disorder  is characterized by a persistently depressed state of mind. 

It is distinguished from a major depressive episode in severity, chronicity and the number of symptoms, which are milder and less numerous in this disorder, although they last longer.

With dysthymia, you may lose interest in daily activities, feel hopeless, lack productivity, and have low self-esteem.

Dysthymic disorder

People with this disorder can complain constantly, be critical and are unable to have fun.

Dysthymic disorder

Main symptoms of dysthymia

Dysthymic disorder in adults can include the following symptoms:

  • Sadness.
  • Despair
  • Lack of energy.
  • Irritability.
  • Loss of interest for daily activities.
  • Lack of productivity
  • Self-criticism, loss of self-esteem.
  • Avoidance of social activities.
  • Feelings of guilt or worries about the past.
  • Poor appetite or overeating
  • Problems to reconcile or maintain sleep.
  • Suicidal behavior.

In children, dysthymia can occur along with attention deficit disorder, behavioral or dependent disorders, or anxiety disorders . Examples of their symptoms in children are:

  • Irritability.
  • Behavioral problems
  • Poor school performance.
  • Pessimistic attitude
  • Poor social skills.
  • Low self-esteem.

Normally the symptoms vary in intensity over time, although they do not disappear for more than two months.

Diagnosis

Diagnostic criteria according to the DSM-IV

A) Chronically depressed mood most of the day of most days, manifested by the subject or observed by others, for at least 2 years.

Note: in children and adolescents the mood may be irritable and the duration must be at least one year.

B) Presence, while depressed, of two (or more) of the following symptoms:

  1. Loss or increase of appetite.
  2. Insomnia or hypersomnia.
  3. Lack of energy or fatigue.
  4. Low self-esteem.
  5. Difficulty concentrating or making decisions.
  6. Feelings of hopelessness

C) During the period of 2 years (one year in children and adolescents) of the alteration, the subject has not been without symptoms of Criteria A and B for more than 2 consecutive months.

D) There has not been any major depressive episode during the first 2 years of the alteration (one year for children and adolescents).

E) There has never been a manic episode, a mixed episode or a hypomanic episode and the criteria for cyclothymic disorder have never been met.

F) the alteration does not appear exclusively during the course of a chronic psychotic disorder, such as schizophrenia or delusional disorder.

G) The symptoms are not due to the direct physiological effects of a substance or medical illness.

H) Symptoms cause clinically significant discomfort or impairment in social, occupational or other important areas of the individual’s activity.

  • Early start: before 21 years old.
  • Late start: at 21 years of age or later.

Causes of dysthymia

There are no known biological causes that apply consistently to all cases of dysthymia, which suggests that their origin is diverse.

There are some indications that there is a genetic predisposition to the dysthymia: the rates of depression in the families of people with dysthymia are up to 50% for the early onset syndrome.

Other factors associated with distress are stress, social isolation and lack of social support.

Comorbidity

Conditions that commonly occur together with dysthymic disorder are major depression (75%), anxiety disorders (50%), personality disorders (40%), somatoform disorders (45%) and substance abuse (50%).

A 10-year study found that 95% of patients with dysthymia had an episode of major depression.

When an intense episode of major depression occurs next to the dysthymia, the state is called “double depression.” Usually, dysthymia first develops and then major depression occurs.


Before age 21, it is associated with these personality disorders: borderline, narcissistic, antisocial, avoidant and  dependent.

Pathophysiology

There is evidence indicating that there could be neurological indicators of early dysthymia. There are several brain structures ( corpus callosum and frontal lobe ) that are different between women with dysthymia and those who do not.

Another study found several brain structures that work differently in people with dysthymia. The amygdala was more activated (associated with fear) and there was more activity in the insula (associated with sad emotions). Finally, there was more activity in the cingulate gyrus (which serves as a bridge between attention and emotion).

When to see a doctor

It is normal to feel sad in stressful or traumatic situations in life. But with distress, these feelings persist for years and interfere with personal relationships, work and daily activities.

Although it is believed that these symptoms are part of “oneself”, it is necessary to seek professional help if they have lasted for more than 2 years. If not treated effectively, the dysthymia can progress to major depression.

Risk factor’s

Several risk factors seem to increase the risk of developing dysthymic disorder:

  • Having a close family member with dysthymia or major depression.
  • Stressful life events, such as loss of a loved one or financial problems.
  • Emotional dependence.

Prevention

Although there is no clear way to prevent the dysrhythmia, some suggestions have been made. Because it can occur for the first time in childhood, it is important to identify children who are at risk of developing it.

That way you can work with them to control stress, resilience, increase self-esteem and social skills.

Epidemiology

The dysthymia occurs globally in approximately 105 million people per year (1.5% of the population).

It is somewhat more common in women (1.8%) 9 than in men (1.3%).

Complications

Complications of dysthymia may include:

  • Lower quality of life.
  • Major depression
  • Substance abuse.
  • Problems in personal or family relationships.
  • Social isolation.
  • Problems in school or work.
  • Lower productivity
  • Anxiety.
  • Eating disorders.
  • Suicidal behavior.

Treatments

Often people with dysthymia do not seek treatment for depressive mood, but for their higher levels of stress or personal difficulties.

This is due to the chronic nature of the disorder and how the mood is seen as an individual characteristic of the person.

The treatment that the professional will choose depends on:

  • The severity of dysthymic symptoms.
  • Personal preferences of the patient.
  • Ability to tolerate medication.
  • The desire of the person to solve the problems that affect their life.
  • Other emotional problems

Psychotherapy

Psychotherapy is an effective treatment in dysthymia.

The cognitive-behavioral therapy has been shown that by proper treatment, symptoms may dissipate over time.

Other forms of therapy, such as psychodynamics or interpersonal therapy, have also been effective in treating this disorder.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are the first line of pharmacological treatment.

The SSRIs most commonly prescribed for the dysthymia are fluoxetine, paroxetine, setralin, and flovoxamine.

Studies have shown that the average response to this medication is 55%, compared to 31% of placebo.

It usually takes 6-8 weeks before the patient begins to feel the effects of this medication.

In some cases, children, adolescents and young adults under 25 years of age may have an increase in suicidal thoughts or behaviors after taking antidepressants, especially in the first weeks of starting treatment. Therefore, people in this age group should be especially observed by caregivers, family members or professionals.

Combination of therapy and medication

A combination of antidepressants and psychotherapy is the most effective treatment line.

Also Read: Atypical Depression: Symptoms, Diagnosis and Treatment

Noting several studies on treatments for dysthymia, 75% of people responded positively to a combination of cognitive-behavioral therapy and medication, while only 48% of people responded positively to the single use of therapy or medication.

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