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  1. #1

    Understanding Dysthymia

    Understanding Dysthymia
    By Laura Greenstein, NAMI: National Alliance on Mental Illness
    Jan. 17, 2018

    If someone mentioned that they have depression, most people would likely have some idea of what that means. They might imagine a person feeling tired, gloomy or empty. They might even know some of the accompanying symptoms such as changes in weight or sleep patterns. But what many people don’t know is that there are actually different types of depression.

    The most common form is major depressive disorder, which affects about 16 million adults in the U.S. This is what most people associate with the term “depression.” Other forms include depression with a seasonal pattern, which usually occurs in late fall and winter; postpartum depression, affecting women after childbirth; and dysthymia, which is a long-term form of depression that lasts for years.

    All forms of depression have similar symptoms: issues with sleep, low energy, low self-esteem, poor concentration, difficulty making decisions, feelings of hopelessness. What distinguishes them is timing and consistency of symptoms. And the primary distinction with dysthymia (also known as persistent depressive disorder) is that it’s the only depressive disorder where symptoms are present for at least two years, and typically longer.

    What is Dysthymia Like?
    While someone with major depressive disorder will typically “cycle” through episodes of feeling severely depressed and then be symptom-free for periods of time, dysthymia presents with persistent symptoms for years.

    An episode of depression usually represents a break from someone’s normal life and outlook, while dysthymia is often embedded into a person’s life and outlook because they experience symptoms for such prolonged periods of time. In fact, an adult must experience depression for at least a two-year period to receive a diagnosis (one year for children and teenagers).

    Dysthymia often has an early and subtle onset during childhood, adolescence or early adulthood. However, it can be challenging to detect because its less severe and lingering nature can make the condition feel “normal” for that person.

    Also making it a challenge to diagnose is the fact that about 75% of people with dysthymia will also experience a major depressive episode. This is referred to as “double depression.” After the major episode ends, most people will return to their usual dysthymia symptoms and feelings, rather than feel symptom-free.

    What Can I Do?
    If you think you may have dysthymia, it’s essential to seek help. Seeing a mental health professional is the first step to recovery. Taking the time to go to therapy is an investment in your health and well-being; the condition will not go away on its own. Typically, a combination of both psychotherapy and medication leads to the best outcomes.

    Further, according to a study that followed people experiencing dysthymia for nine years, one of the most important factors of recovery is having confidence in your health care providers. This may mean trying out different therapists and psychiatrists until you find one that best fits your needs.

    The study also notes that participants who recovered felt like they gained “tools to handle life,” including understanding themselves and their condition, having self-acceptance and self-compassion and focusing on solving problems that create distress.

    Learning these tools and preparing yourself to handle difficult symptoms requires patience. It can be challenging to have hope for recovery when depression is your norm—when feeling good seems more like a memory than a possibility. But recovery is possible. It takes effort and commitment, but you deserve to feel better.

  2. #2

    Re: Understanding Dysthymia

    David, can you help me understand more about the distinctions between dysthymia/MDD?

    IF I understand the description from this article, having been in a pretty much constant depressed state for years now with episodes of major depression would that be considered my condition being dysthymia with episodes of MD?

    I thought MDD was being in a pretty constant depressed state. This seems to describe MD as episodal rather than a prolonged depressed state.

    I know I should talk to my doctor about it but his focus is on keeping me alive more than figuring out what labels to put on my disorders and the psychiatrist I saw about a year ago doesn't seem to have the competency to properly diagnose anything else than calling everything a personality disorder. The only half decent info he had was from a previous psychiatrist that I saw years back but who has long since retired. And the others I have seen blame my depression and symptoms on being medication side effects.

    Trying to understand and grasp the reason for being in this state is depressing in itself.
    Maybe I just have to learn to simply accept things as they are and not add extra pressure and stress on myself by trying to figure out what the heck is wrong with me...

    Thanks,
    Gary

  3. #3

    Re: Understanding Dysthymia

    No.

    Dysthymia is basically low level depression that doesn't meet the criteria for Major Depressive Episode:

    Emotional depression that persists for years, usually with no more than moderate intensity, characterizes this depressive disorder.

    DSM IV-TR Criteria

    A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note:In children and adolescents, mood can be irritable and duration must be at least 1 year.

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

    (1) poor appetite or overeating
    (2) Insomnia or Hypersomnia
    (3) low energy or fatigue
    (4) low self-esteem
    (5) poor concentration or difficulty making decisions
    (6) feelings of hopelessness

    C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.

    D. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
    Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.

    E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.

    F. The disturbance does not occur 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(e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

    H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    If you experience at least one Major Depressive Episode, you can still have periods where you don't meet the criteria for MDD. Once you experience a second Major Depressive Epiosode, your diagnosis wiuld be Major Depressive Disorder, Recurrent.



    DSM IV-TR Criteria

    A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either

    (1) depressed mood or
    (2) loss of interest or pleasure.

    Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

    (1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
    (2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
    (3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
    (4) Insomnia or Hypersomnia nearly every day
    (5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    (6) fatigue or loss of energy nearly every day
    (7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
    (8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
    (9) recurrent thoughts of death (not just fear of dying), recurrentsuicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

    B. The symptoms do not meet criteria for a Mixed Episode (see p. 335).

    C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    D. The symptoms are not due to the direct physiological effects of a substance(e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

    E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

  4. #4

    Re: Understanding Dysthymia

    l would like to know if this is Heriditary?? My Mother had MDD and my sister has MDD as well as Bi - polar, so is there a chance my children might suffer from Depression also?? l know after the loss of my child, l did suffer a Mdd but l have since been diagnosed with Dysthemia. lt is my son, that has always worried me as he always seemed sad and was bullied at school. l did mention to the Dr. l was worried he might have anxiety but also looked depressed and she told me, he would grow out of it.. That is why l wanted to know if any forms of Depression could be passed to children. Thanks
    Never be a Prisoner of your Past,
    lt was just a Life Lesson,
    Not a Life Sentence......

  5. #5

    Re: Understanding Dysthymia

    The answer is yes, there is a genetic basis to almost any mental disorder so vulnerability may be passed on to your children.

    But that doesn't mean that they will necessarily inherit any mental disorders.

    For one thing, they are not inheriting only your genetic material but also that of their father which may at least partially offset the risk they inherit from you.

    Additionally, whether someone exhibits the full symptoms of a disorder often seems to depend on an interaction between genes and experience in the world. For example, there have been numerous studies of schizophrenia using identical twins, who have the same genetic material. When one twin develops schizophrenia, this significantly increase the possibility that the other twin will also develop schizophrenia, confirming the genetic factor. But the risk for the non-schizophrenic does not jump to 100% but rather only to about 50%, so the twin without schizophrenia still has a 50% chance of NOT developing the illness.

    A similar risk picture applies to your children or siblings, except since they can have quite different genetic makeup the effect is even smaller.

  6. #6

    Re: Understanding Dysthymia

    Okay, l understand but there is mental illness on the Father's side as well as Alcoholism, so that would increase the mental illness up a bit and 50% for becoming alcoholics, especially if the Father was supplying them with Alcohol at 14 + years before the age of 25, when the brain is fully formed.
    The Father's family , as well as the Father were extremely Dysfunctional and it carried down to our family and the children were shutting me out of their lives as they were being rewarded with Alcohol and money.
    Never be a Prisoner of your Past,
    lt was just a Life Lesson,
    Not a Life Sentence......

  7. #7

    Re: Understanding Dysthymia

    As I said above, they may have inherited vulnerabilities but they are not doomed. Only time will tell.

  8. #8

    Re: Understanding Dysthymia

    lol, Thank you for the info....Good to know they may not continue on past behaviours of other family members..l had to giggle when you told me they were not "doomed". l did not realize how my messages were sounding, but l do really appreciate your quick response!
    Never be a Prisoner of your Past,
    lt was just a Life Lesson,
    Not a Life Sentence......

  9. #9

    Re: Understanding Dysthymia

    I couldn't think of another word in the moment. I just meant there is no guarantee one way or another.

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