Dysthymia

Persistent depressive disorder (dysthymia), is a continuous long-term form of depression.

This condition makes a person lose interest in normal daily activities, feel hopeless, lack productivity and to have low self-esteem and an overall feeling of inadequacy.

These feeling usually last for many years and may affect day-to-day life activities. Dysthymia is not as severe as depression. Patients may have mild, moderate or severe depressed mood.

A combination of psychotherapy and medications can help patients with this condition to manage symptoms.

The symptoms of the persistent depressive disorder (dysthymia) usually come and go over a period of years. However, symptoms do not disappear for more than two months at a time.

The intensity of symptoms tends to increase with time. Major depression episodes may occur before or during persistent depressive disorder, this is sometimes known as double depression.

Symptoms of persistent depressive disorder may include:

• Loss of interest in daily activities
• Sadness, emptiness or feeling down
• Hopelessness
• Low self-esteem, self-criticism or feeling incapable
• Trouble concentrating or making decisions
• Irritability or excessive anger
• Decreased activity, effectiveness and productivity
• Avoiding social activities
• Poor appetite or overeating
• Feelings of guilt and worries over the past
• Sleep problems

The exact cause of persistent depressive disorder (dysthymia) in not known.

The following may contribute to the development of this disorder:

• Physical changes in the brain.
• Changes in the function and effect of neurotransmitters that are involved in maintaining mood stability.
• Certain inherited genes that may be involved in causing depression.
• Traumatic events, such as loss of a loved one, financial problems or high level of stress.

The following may be used in the diagnosis of the persistent depressive disorder (dysthymia) include:

• A physical exam and medical history to determine the causing of depression. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests to rule out other medical conditions, such as hypothyroidism, that may cause depressive symptoms.
• A psychological evaluation in which a patient talks about his or her thoughts, feelings and behavior. It may include a questionnaire to help pinpoint a diagnosis.

To diagnose the persistent depressive disorder, many doctors use the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.

For a diagnosis of persistent depressive disorder, the main indication for an adult differs from that of a child:

• For an adult, depressed mood occurs most of the day for two or more years
• For a child, depressed mood or irritability occurs most of the day for at least one year

Symptoms caused by persistent depressive disorder can vary from person to person.

When persistent depressive disorder starts before age 21, it's called early-onset; if it starts at age 21 or older, it's called late-onset.

The treatment for persistent depressive disorder (dysthymia) depends on :    

• Severity of  symptoms                                                                                                                                                                                                                    
• A patient's desire to address emotional or situational issues                                                                                                                                                              
• Previous treatment methods                                                                                                                                                                                                        
• A patient’s ability to tolerate medications                                                                                                                                                                                        
• Presence of other emotional problems                                                                                                                                                                                    

Treatments include medications and psychotherapy. Psychotherapy may be the first recommendation for children and adolescents with the persistent depressive disorder, but that depends on the individual. Sometimes antidepressants are also needed.

The types of antidepressants most commonly used to treat persistent depressive disorder:

• Selective serotonin reuptake inhibitors (SSRIs)                                                                                                                                                                        
• Tricyclic antidepressants (TCAs)                                                                                                                                                                        
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)                                            

Most patients may  need to try several medications or a combination before they find one that works. This requires patience, as some medications take several weeks or longer for full effect and for side effects to ease as the body adjusts.

Long-term treatment with medications is usually required to help patients with the persistent depressive disorder to manage symptoms.

Pregnant or breastfeeding women should take antidepressants with caution as  some antidepressants may pose an increased health risk to an  unborn child.

Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the most serious warning for prescriptions.

Children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed help if suicidal behaviors occur.

Therefore, they must be closely watched. Psychotherapy, also known as talk therapy or psychological counseling a type of treatment in which a patient talks with a psychologist or counselor about his or her condition. Different types of psychotherapy, such as cognitive-behavioral therapy, can be effective for the persistent depressive disorder.                    

Different types of psychotherapy, such as cognitive-behavioral therapy, can be effective for the persistent depressive disorder.                    

There is no sure way to prevent persistent depressive disorder (dysthymia).

A few alternative remedies exist for persistent depressive disorder (dysthymia).

In addition to professional treatment, the persistent depressive disorder can be managed by:                                          

• Sticking to the treatment plan by not skipping medications or sessions with a psychotherapist.                                                                                                            
• Learning more about the condition and encouraging family members to do the same.                                                                                                                            
• Paying attention to warning signs which may indicate worsening of persistent depressive disorder.                                                                                                              
• Eating a healthy diet, exercising regularly and getting enough sleep.                                                                    
• Avoiding alcohol and recreational drugs which may worsen depression and make it harder to treat in the long run.

Individuals with persistent depressive disorder (Dysthymia) can cope with this condition by: 

• Setting goals and staying motivated by the goals in mind.  
• Simplifying life by cutting back on obligations when possible, structuring time by planning the day, making a list of tasks, using sticky notes as reminders or using a planner to stay organized.
• Journaling as part of treatment to improve mood. This allows an individual to express anger, pain, fear or other emotions.
• Reading reputable self-help books and websites.
• Trying to participate in social activities, getting together with family and friends and joining a support group.
• Learning ways to relax, such as meditation, to reduce stress.                                                                                         

There are several risks and complications associated with persistent depressive disorder (dysthymia).

Factors that may increase the risk of having persistent depression disorder include:

• Having a first-degree relative with depression.
• Traumatic or stressful life events, such as a loss of a loved one or financial problems.
• Personality traits that include negativity, such as low self-esteem, and being too dependent, self-critical, pessimistic
• Having a history of mental health disorders.

Complications associated with persistent depressive disorder include:

• Alcohol and drug abuse
• Major depression, anxiety disorders, and other mood disorders
• Academic difficulties
• Trouble maintaining relationships
• Chronic pain and general medical illnesses -Suicidal thoughts or behavior