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Dysthymic Disorder

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Dysthymic disorder is a form of depression with milder but long-lasting symptoms. It is also known as dysthymia or persistent depressive disorder (PDD).

What Is Dysthymic Disorder? (Dysthymia)

Dysthymic disorder is a behavioral and mood disorder characterized by chronic but mild depressive symptoms. Dysthymia is a chronic and long-term variation of depression and should not be considered less severe than major depression.

It can lead to low self-esteem, feelings of worthlessness and hopelessness, decreased productivity, and loss of interest in daily activities. The symptoms can last for several years and can adversely affect one’s ability to pursue education, career, and relationships.

According to a 2009 study 1, 6(5), 46–51. )), persistent depressive disorder (PDD) “is a smoldering mood disturbance characterized by a long duration (at least two years in adults) as well as transient periods of normal mood.”

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Understanding Dysthymic Disorder

Dysthymic Disorder Facts
Dysthymic Disorder

People suffering from dysthymia experience low depressive moods and hypomanic episodes for at least 2 years. Two of the undeniable markers of dysthymia are apathy and anhedonia (or a loss of interest in activities). Sufferers may also experience –

  • Rapid mood swings
  • Constant hopelessness
  • Poor self-esteem
  • Low self-confidence
  • Anger
  • Irritability and frustration

Most of the time, people with dysthymic disorder symptoms harbor extreme negativity, guilt, and self-criticism—because of which, they resort to socially withdrawn destructive conduct. They also experience cognitive impairment.

This makes them irritable and lacking in concentration and, most of the time, they end up with poorly made decisions or poorly handled conflicts. This harms their personal, professional, and social functioning.

Nonetheless, the depressive symptoms experienced in dysthymia are mild. In fact, according to one 2011 study 2, “patients with dysthymia tend to have more subjective symptoms and less dramatic psychomotor disturbance or neurovegetative symptoms including abnormalities of sleep, appetite, and energy levels.” This makes the disorder easily manageable, even though it persists throughout a person’s lifetime.

One 2021 study 3 states, “depression, in general, has a substantial impact on both morbidity and mortality and is a common cause of global disease burden and disability worldwide.” As per dysthymic disorder facts, persistent depressive disorder affects 12% 3 of the global population. It is also associated with a very low prognosis rate, greater severity of depression & anxiety, and complex somatic symptoms in comparison to major depression. Nonetheless, despite its life-long prevalence, it can be effectively managed with therapy, medication, and self-help strategies.

Read More About Anxiety Here

Dysthymic Disorder In The DSM

The conceptual origin of dysthymic disorder in psychiatry can be traced back to C.F. Fleming, an American psychiatrist, around 1844. But the term would not gain popularity till the 1970s, thanks to another American psychiatrist, Robert Spitzer.

One of the creators of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Spitzer borrowed the term “dysthymia” from the Greek roots: dys meaning “ill/bad” and thymia meaning “mind/emotions”. He used the term “dysthymic disorder” in the DSM to replace the term “depressive personality” and elaborately ‘label’ all types of chronic depression.

However, years later, the revised versions of the DSM brought together dysthymic and cyclothymic depressive disorders into an affective category called “persistent depressive disorder” (PDD). Today, PDD is clinically distinguished from major depressive disorder (MDD) and is used to denote a mild, chronic state of depression.

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Symptoms Of Dysthymic Disorder

Symptoms Of Dysthymic Disorder
Dysthymic Disorder

The symptoms of dysthymic disorder vary from one person to another. Because of its close resemblance to major depressive disorder (MDD), it is often confused with it. However, as research 3 and medical practice show, dysthymia has fewer but long-lasting symptoms than MDD. For instance, the symptoms of persistent depressive disorder have to last for at least 2 years to qualify the patient for diagnosis.

According to research 3, the common dysthymic disorder symptoms include:

  1. Low moods
  2. Hopelessness
  3. Fatigue
  4. Low self-esteem
  5. Irritability
  6. Lack of concentration
  7. Poor decision-making
  8. Amnesia
  9. Hyperactivity
  10. Decreased productivity
  11. Social isolation
  12. Harboring extreme negativity, guilt, or self-criticism
  13. Anger
  14. Frustration
  15. Poor appetite
  16. Disrupted sleep
  17. Anhedonia (or loss of interest/pleasure in activities)
  18. Apathy
  19. Mental disorders (such as anxiety disorders, panic disorders, personality disorders, substance use disorders, etc.)

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Causes Of Dysthymic Disorder

Causes Of Dysthymic Disorder
Dysthymic Disorder

Some of the most common factors that influence the onset of dysthymic disorder include:

1. Genetics

Dysthymia tends to run in families. In fact, a person with a family history of depression, bipolar disorder, or substance abuse is more vulnerable to PDD. According to a 2013 study 4, “four CRY2 (circadian clock) genetic variants are associated significantly with dysthymia”. This makes it a highly genetically transmitted disease.

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2. Biological causes

Research 2 shows that the onset of the dysthymic disorder can be caused by certain structural and functional changes in the brain, particularly in the:

  • Corpus callosum
  • Frontal lobe
  • Amygdala
  • Insula
  • Cingulate gyrus

Studies 3 also show that dysfunctional regulation of neurotransmitters like corticotropin-releasing hormone (CRH), arginine vasopressin (AVP), and forebrain serotonergic mechanisms can also make people vulnerable to persistent depressive disorder.

3. Environmental causes

Certain environmental and psychosocial factors 1, 6(5), 46–51. )) contribute to a person’s suffering from persistent depressive disorder symptoms. Some of these factors include:

  • Stress
  • Loss and grief
  • Parental neglect and abandonment
  • Abuse
  • Negative developmental experiences
  • Traumatic experiences
  • Financial hardships

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Risk Factors For Dysthymic Disorder

Certain factors 5 make people vulnerable to dysthymia and these can even induce symptoms of persistent depressive disorder.

The major risk factors for persistent depressive disorder include:

  • A neurotic and anxious personality type
  • Long-term physical illness
  • Brain injury
  • Hormonal imbalances
  • A history of violence, abuse, and trauma
  • A history of substance abuse
  • A family history of mental disorders like depression, bipolar disorders, eating disorders, mood disorders, anxiety disorders, etc.

Read More About Eating Disorders Here

How To Diagnose Dysthymic Disorder

The diagnosing criteria for dysthymic disorder have been laid out in DSM-5. Experts have long noted the variation in the symptoms and origins of dysthymic disorder across different age groups.

For instance, while adults experience apathy and low moods, children suffering from dysthymic disorder tend to experience irritability more than depressive symptoms. Because of this, the disorder is differently and differentially diagnosed based on the patient’s:

  • Age group
  • Signs and symptoms of the disorder
  • Severity of illness
  • Chronicity of illness
  • Comorbid conditions
  • Medical and family history
  • Causes of illness

According to the dysthymic disorder DSM-5 criteria, the first step of dysthymic disorder diagnosis usually involves a general medical professional examining the patient’s medical history, running a few laboratory tests, asking the patient to fill out psychiatric questionnaires, and outlining a working diagnosis.The screening scales 6 used for diagnosing persistent depressive disorder include:

  • Hamilton Depression Rating Scale (HDRS 7)
  • Eysenck Personality Questionnaire (EPQ 8)
  • Patient Health Questionnaire (PHQ 9)
  • Hospital Anxiety and Depression Scale (HADS 10)

The patient’s performance in the physical tests and psychiatric questionnaires is used to determine the nature of his/her dysthymic disorder. Accordingly, the patient is referred to a mental health professional (MHP) for his/her persistent depressive disorder treatment.

Read More About Major Depressive Disorder (Depression) Here

How To Treat Dysthymic Disorder

Dysthymia is a persistent and crippling mental disorder. However, its timely diagnosis and proper treatment can help you better manage the symptoms, take control over the course of the disorder, and lead a happier life. Thankfully, several dysthymic disorder treatment options are available, including:

1. Therapy

Psychotherapy is the cornerstone of treatment for PDD. It is the most studied form of therapy and has yielded promising treatment outcomes for patients with both chronic and acute depressive disorders. One 2011 study 2 elaborates that “its core procedure is called ‘situational analysis’ and is a highly structured technique that teaches chronically depressed patients how to handle problematic interpersonal encounters.” To treat the symptoms, correct the patient’s thought processes and emotional disturbances, and help him/her develop effective strategies for coping with dysthymia—a variety of long-term psychotherapies are used, including:

  • Cognitive-behavioral therapy (CBT 11)
  • Cognitive-behavioral analysis system of psychotherapy (CBASP 12)
  • Schema therapy 2
  • Psychodynamic psychotherapy 13
  • Interpersonal psychotherapy 14

Read More About Cognitive Behavioral Therapy (CBT) Here

2. Medication

People suffering from dysthymic disorder usually experience long-term depressive symptoms. Therefore, medical professionals often turn to long-term pharmacological therapy for its treatment. Medications used to treat the symptoms of persistent depressive disorder include:

  • Antidepressants 15 (like SSRIs, SNRIs, NaSSAs, DNRIs, tetracyclic and tricyclic antidepressants, etc.)
  • Dopamine stimulants 16 and agonists
  • Antipsychotic agents 17
  • Psychostimulants 18 (like dopaminergic agents)
  • Antidementia agents 19 (like cholinesterase inhibitors, pyrrolidone-type nootropic agents, etc.)
  • Cerebral circulation and metabolism stimulants 20 (like ergot alkaloid, etc.)
  • Antiplatelet drugs 21 (like phosphodiesterase inhibitors)

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3. Other forms of treatment

More often than not, combination treatment involving both therapy and medication are used to successfully treat dysthymia. Studies 22 show that 73.9% of patients showed recovery from dysthymic disorder due to combination treatment.

Because of the very persistent nature of the disorder, sometimes treatment augmentations are employed to aid the prognosis of a patient. Such augmentations include:

  • Lithium pharmacology
  • Thyroid hormone augmentation
  • Amisulpride, buspirone, and bupropion stimulants
  • Administration of mirtazapine
  • Light therapy 23
  • Group therapy 24

Coping With Dysthymia

Coping With Dysthymia
Dysthymic Disorder

Dysthymia is a chronic psychiatric illness that has long-term consequences on our lives. Apart from therapeutic and pharmacological treatment for dysthymic disorder, a large number of self-help strategies exist that can help you better manage the disorder in the long run. Try developing healthy coping mechanisms that help you manage stress, increase psychological resilience, and boost self-esteem.

Consider the following measures for coping with persistent depressive disorder:

  • Educate yourself about depression
  • Identify the triggers
  • Look for effective and healthy coping measures
  • Create a structured and disciplined routine
  • Exercise regularly
  • Eat a healthy and balanced diet
  • Follow a sound sleep hygiene regime
  • Avoid caffeine, alcohol, drugs, and other similar substances
  • Try mindfulness techniques like yoga, meditation, etc.
  • Pursue hobbies like cooking, gardening, hiking, etc.
  • Try journaling and expressive writing
  • Connect with your friends and family
  • Socialize more often, both online and offline
  • Revisit activities that you once liked
  • Try new activities that challenge your existing knowledge and help you learn more

Practice these coping skills alongside long-term therapy for a steady recovery. Most importantly, remember to be patient and kind to yourself during the entire process of diagnosis, treatment, and recovery from dysthymia.

Takeaway

Dysthymia is a chronic, long-term type of depression that persists throughout a person’s lifetime. The patient experiences intermittent periods of recovery and relapse. However, if the symptoms are not managed properly, dysthymic disorder can negatively impact one’s quality of life and social relationships.

Therefore, timely diagnosis and the right treatment options should be availed to address the negative consequences of this debilitating mental disorder.

Dysthymic Disorder At A Glance

  1. Dysthymic disorder is a chronic but mild depressive mood disorder.
  2. It is also known as dysthymia or persistent depressive disorder (PDD).
  3. The common dysthymic disorder symptoms include apathy, low moods, anhedonia, social isolation, low appetite, etc.
  4. The common dysthymic disorder causes include genetics, biological factors, and psychosocial development.
  5. If untreated, it can negatively impact one’s quality of life and social relationships.
  6. Treatment for dysthymic disorder involves therapy and/or medication, as well as self-help strategies.

Frequently Asked Questions (FAQs)

1. Is persistent depressive disorder a disability?

Persistent depressive disorder is a crippling psychiatric disability because it interferes with our daily functioning and quality of life.

2. What is the difference between major depressive disorder and dysthymic disorder?

Both types of depression differ in their duration and the number of symptoms. Dysthymic disorder has fewer symptoms, but it lasts longer—sometimes for up to 2 years. Major depressive disorder (MDD), on the other hand, has more symptoms and it doesn’t necessarily last as long as dysthymia, before or after diagnosis.

3. How am I supposed to get out of dysthymia?

Dysthymia does not go away on its own, because of which you should seek medical help and consider therapy, medication, and self-help strategies (like gardening, developing a hobby, journaling, etc.)

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