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Dysthymic Disorder – Dysthymia (Dysthemia)

Dysthymic Disorder (otherwise known as Dysthymia or Dysthemia) is a form of depression, with symptoms similar to clinical or ‘major’ depression. But the symptoms of Dysthymic Disorder are milder and longer lasting. Typically, these symptoms do not disable a person. This is a chronic, mild depression that may develop in childhood, but more typically emerges in middle age. It is not uncommon for people with dysthymia to experience major depressive episodes. Sometimes referred to as neurotic depression, minor depression, or intermittent depression, the predominant characteristics of this disorder includes at least a two-year history of depressed moods, with episodes lasting two or more days.

Most people think of depression as a major disorder, which is usually severe, and last weeks or months. In major or clinical depression, the patient’s mood is noticeably low, they may have trouble sleeping, lose weight, lose interest in food, feel hopeless and suicidal. Whereas, Dysthymic Disorder is not as severe, has less impact on daily activities, but can last for years, or even decades.

Some patients suffer from ‘double depression’ – in other words, they have Dysthemia and major or clinical depression. Patients diagnosed with dysthymia often have family members who suffer from depression, or from bipolar disorder.

What are the symptoms?

While the symptoms of Dysthymic Disorder may mimic major or clinical depression, they are milder and last longer.

Symptoms can include:

• Increase or decrease in appetite
• Insomnia or excessive sleeping
• Fatigue and low energy, irritability
• Low self-esteem, pessimistic, easily discouraged
• Inability to focus or concentrate
• Socially withdrawn and shy
• Inability to make decisions, unproductive
• Feeling of hopelessness

How is it diagnosed and treated?

The guidelines for diagnosis of Dysthymic Disorder are quite specific:

• In adults: Signs of depressed mood for most, or all, of the day, on most days, as observed by others, persisting for at least 2 years. In children and adolescents: Persistent irritability for at least 1 year.
• Depression is accompanied by at least two of the symptoms described above.

Dysthemia symptoms can often be misdiagnosed by a general physician or attributed to some other physical problem. When it is diagnosed, dysthymia is somewhat difficult to treat.

It is imperative that the doctor rule out other conditions and evaluate the patient for the possibility of multiple disorders, like ‘double depression’ wherein the patient suffers from both Dysthemia and major, or clinical, depression. If both conditions exist, treating one without treating the other does not solve the long-term problem.

Treatment can include one or more of the following modalities:

• Psychosocial therapy
• Problem Solving therapy
• Vocational Rehabilitation
• Psychotherapy
• Cognitive and behavioral therapy
• Family Therapy
• Group therapy
• Medication like antidepressants (Prozac, Zoloft, Paxil, Effexor, Serzone), anti-anxiety medications

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