Dysthymia

“Dysthymia” is a Greek word that means “ill humor” or “bad state of mind.” Dysthymia is also a mood disorder known as “chronic depression.” Dysthymia affects as many as three percent of Americans each year. It’s estimated that 35 million people in the United States  have suffered from dysthymia at some point in their lives.

Dysthymia affects about twice as many women as men. It usually begins earlier in life and can be a precursor to a more serious depressive episode or personality disorder. At any given time, up to one third of patients participating in psychotherapy may be suffering from dysthymia. ??

Dysthymia is considered a “milder” form of depression than a major depressive disorder (MDD) because its symptoms usually last much longer than in MDD. However, it can often be the more debilitating of the two diseases.

Symptoms of Dysthymia

The American Psychiatric Association (APA) defines dysthymia as having “depressed mood most of the time for at least two years, along with at least two of the following symptoms:” 

  • poor appetite or overeating
  • insomnia or hypersomnia
  • fatigue or low energy
  • poor concentration
  • indecisiveness
  • low self-esteem
  • feelings of hopelessness

Dysthymia may be intermittent, with patients feeling better for a period of time. Typically, however, these bursts of “normalcy” last no more than two months. Because it usually comes on slowly, often at a younger age, many people with dysthymia believe “this is just who I am.”

It is, however, a highly treatable condition and, therefore, shouldn’t be ignored. A recent New Zealand study found that, left untreated, dysthymia may develop into major depression. It’s estimated that around ten percent of patients with dysthymia also suffer from recurrent episodes of MDD—a condition known as “double depression.”

Additional symptoms of dysthymia may include:

  • irritability
  • lack of interest in once-pleasurable activities
  • feelings of guilt
  • ?low sexual desire
  • unexplained physical symptoms

Causes

Dysthymia, like other forms of depression, is related to neurotransmitters in the brain—specifically those such as norepinephrine and serotonin that affect mood. In addition, several medical conditions and neurological disorders are related to dysthymia. They include hypothyroidism, fibromyalgia, multiple sclerosis, stroke, and chronic fatigue syndrome.

Researchers believe that dysthymia is a biological effect of these disorders rather than a psychological reaction to the illness. Certain conditions as well as the medications used to treat them—including corticosteroids and beta blockers—may interfere with neurotransmitters, thus triggering dysthymia.

In addition, dysthymia may follow a severe psychological stress such as the death of a spouse, job loss, or divorce.

Diagnosis and Treatment

It’s important to remember that in addition to being a psychological condition, dysthymia is a physical illness. It’s usually not possible for a person to “think their way out of it” or to “cheer up” on their own. To diagnose dysthymia, a clinician or mental health provider will usually ask the patient about their symptoms and any alcohol or drug use. Additionally, lab tests may be performed to rule out an underlying medical problem such as a hormone imbalance.

The most effective treatment for dysthymia is selective serotonin re-uptake inhibitor (SSRI)-type antidepressants, such as paroxetine (Paxil) and fluoxetine (Prozac). A doctor will work with the patient to carefully select the best antidepressant for them. It typically takes between three to six weeks before a patient will receive the full benefits of an antidepressant. Most people will experience the greatest benefits after six months.

Psychotherapy—including cognitive behavioral therapy—has been found to be effective in treating patients with dysthymia, especially in combination with drug treatments.

Other “complimentary” treatments may also help reduce the symptoms of dysthymia including:

  • adding omega-3 fatty acids to one’s diet
  • taking St. John’s wort (an herbal remedy that has shown some effectiveness in treating dysthymia. However, it can have serious side effects when combined with certain medications, so a patient should consult their physician before taking St. John’s wort)
  • ?exercise

More on Exercise

Thirty minutes of exercise three times a week can be just as effective as antidepressants for many patients with dysthymia.

Exercise (such as bicycling, jogging, or brisk walking) is believed to work in much the same way antidepressants do—by regulating the neurotransmitters norepinephrine and serotonin. The increased body temperature that accompanies exercise also appears to have calming effects. Additional benefits of exercise include:

  • It works immediately—as little as 30 minutes of exercise can provide a mood boost.
  • It helps to build confidence.
  • It’s a healthy distraction from other problems.
  • It can lead to social interactions which are proven to help people with dysthymia.
  • It’s a positive coping strategy as opposed to other choices such as alcohol or drugs.

Maintaining a healthy lifestyle, which includes a healthy diet and getting enough sleep in addition to exercise, is a proven way to help prevent dysthymia in the future. Other preventative measures include:

  • spending time with family and friends
  • participating in enjoyable activities
  • learning stress-relieving exercises such as deep breathing
  • avoiding caffeine