Dysthymia

Definition

Dysthymia is a chronic type of depression in which a person's moods are regularly low. However, symptoms are not as severe as with major depression.

Alternative Names

Neurotic depression (dysthymia); Dysthymic disorder; Chronic depression; Depression - chronic

Causes, incidence, and risk factors

The exact cause of dysthymia is unknown. It tends to run in families. Dysthymia occurs more often in women than in men and affects up to 5% of the general population.

Many people with dysthymia have a long-term medical problem or another mental health disorder, such as anxiety, alcohol abuse, or drug addiction. About half of people with dysthymia will also have an episode of major depression at some point in their lives.

Dysthymia in the elderly is often caused by:

• Difficulty caring for themselves
• Isolation
• Mental decline
• Medical illnesses

Symptoms

The main symptom of dysthymia is a low, dark, or sad mood on most days for at least 2 years. In children and adolescents, the mood can be irritable instead of depressed and may last for at least 1 year.

In addition, two or more of the following symptoms will be present almost all of the time that the person has dysthymia:

• Feelings of hopelessness
• Too little or too much sleep
• Low energy or fatigue
• Low self-esteem
• Poor appetite or overeating
• Poor concentration

People with dysthymia will often take a negative or discouraging view of themselves, their future, other people, and life events. Problems often seem more difficult to solve.

Signs and tests

Your health care provider will take a history of your mood and other mental health symptoms. The health care provider may also check your blood and urine to rule out medical causes of depression.

Treatment

Treatment for dysthymia includes antidepressant drug therapy, along with some type of talk therapy.

Medications often do not work as well for dysthymia as they do for major depression. It also may take longer after starting medication for you to feel better.

The following medications are used to treat dysthymia:

• Selective serotonin reuptake inhibitors (SSRIs) are the drugs most commonly used for dysthymia. They include: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
• Other antidepressants used to treat dysthymia include: serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion (Wellbutrin), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).

People with dysthymia often benefit from some type of talk therapy. Talk therapy is a good place to talk about feelings and thoughts, and most importantly, to learn ways to deal with them. Types of talk therapy include:

• Cognitive behavioral therapy (CBT) teaches depressed people ways of correcting negative thoughts. People can learn to be more aware of their symptoms, learn what seems to make depression worse, and learn problem-solving skills.
• Insight-oriented or psychodynamic psychotherapy can help someone with depression understand the psychological factors that may be behind their depressive behaviors, thoughts, and feelings.
• Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or health care provider for a recommendation.

Support Groups

Expectations (prognosis)

Dysthymia is a chronic condition that lasts many years. Though some people completely recover, others continue to have some symptoms, even with treatment.

Although it is not as severe as major depression, dysthymia symptoms can affect a person's ability to function in their family, and at work.

Dysthymia also increases the risk for suicide.

Complications

If it is not treated, dysthymia can turn into a major depressive episode. This is known as "double depression."

Calling your health care provider

Call for an appointment with your health care provider if:

• You regularly feel depressed or low
• Your symptoms are getting worse

Call for help immediately if you or someone you know develops these symptoms, which are signs of a suicide risk:

• Giving away belongings, or talking about going away and the need to get "affairs in order"
• Performing self-destructive behaviors, such as injuring themselves
• Suddenly changing behaviors, especially being calm after a period of anxiety
• Talking about death or suicide, or even stating the desire to harm themselves
• Withdrawing from friends or being unwilling to go out anywhere

Prevention

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References

Institute for Clinical Systems Improvement. Health Care Guidelines: Major Depression in Adults in Primary Care. 11th ed. 2008.

Stewart JW. Treating depression with atypical features. J Clin Psychiatry. 2007;68:25-29.