Depressive Disorders Health Article

Dysthymic disorder

Dysthymia commonly occurs in tandem with other psychiatric and physical conditions. Up to 70 percent of dysthymic patients have both dysthymic disorder and major depressive disorder, known as double depression. Substance abuse, panic disorders, personality disorders, social phobias, and other psychiatric conditions also are found in many dysthymic patients. Dysthymia is prevalent in patients with certain medical conditions, including multiple sclerosis, AIDS, hypothyroidism, chronic fatigue syndrome, diabetes, and post-cardiac transplantation. The connection between dysthymic disorder and these medical conditions is unclear, but it may be related to the way the medical condition and/or its pharmacological treatment affects neurotransmitters. Dysthymic disorder can lengthen or complicate the recovery of patients also suffering from medical conditions.

Along with an underlying feeling of depression, people with dysthymic disorder experience two or more of the following symptoms on an almost daily basis for a period for two or more years (most suffer for five years) or one year or more for children:

• under-eating or overeating
• insomnia or hypersomnia
• low energy or fatigue
• low self-esteem
• poor concentration or trouble making decisions
• feelings of hopelessness

When to call the doctor

Just like adults, children have days when they are feeling down. But if those blue or bad moods begin to interfere with schoolwork and daily living and start to increase in frequency, parents or caregivers need to seek help from their child's doctor. If a child or teen reveals at any time that they have had recent thoughts of self-injury or suicide, professional assistance from a mental healthcare provider or care facility should be sought immediately.

Diagnosis

In addition to an interview, a clinical inventory or scale such as the Child Depression Inventory (CDI) or the Child Depression Rating Scale (CDRS) may be used to assess a child's mental status and determine the presence of depressive symptoms. Tests may be administered in an outpatient or hospital setting by a pediatrician, general practitioner, social worker, psychiatrist, or psychologist.

Treatment

Major depressive and dysthymic disorders are typically treated with antidepressants or psychosocial therapy. Psychosocial therapy focuses on the personal and interpersonal issues behind depression, while antidepressant medication is prescribed to provide more immediate relief for the symptoms of the disorder. When used together correctly, therapy and antidepressants are a powerful treatment plan for the depressed child or adolescent.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) reduce depression by increasing levels of serotonin, a neurotransmitter. Some clinicians prefer SSRIs for treatment of dysthymic disorder. Anxiety, diarrhea, drowsiness, headache, sweating, nausea, and insomnia all are possible side effects of SSRIs. As of 2004, fluoxetine was the only SSRI (and the only antidepressant drug) approved by the U.S. Food and Drug Administration for use in children and adolescents with major depressive disorder. However, physicians may prescribe other SSRIs in younger patients in an off-label use of these drugs.

In 2004, fluoxetine and nine other antidepressant drugs came under scrutiny when the FDA issued a public health advisory and announced it was requesting the addition of a warning statement in drug labeling that outlined the possibility of worsening depression and increased suicide risk. These developments were the result of several clinical studies that found that some children taking these antidepressants had an increased risk of suicidal thoughts and actions. The FDA announced at the time that the agency would embark on a more extensive analysis of the data from these clinical trials and decide if further regulatory action was necessary.

Older classes of antidepressant drugs—(tricyclic antidepressants (TCAs), heterocyclics, and monoamine oxidase inhibitors (MAOIs)—do not have any substantial demonstrated effectiveness in pediatric populations and have potentially serious side effects that make them undesirable for child and adolescent use.

For severe depression that does not respond well to antidepressant, mood stabilizer drugs (e.g., lithium, carbamazepine, valproic acid) may be recommended.