Dysthymic Disorder (previously known as Dysthymia) can be
diagnosed when a person has had a variety of depressive symptoms
for at least two years, and these symptoms are not numerous
or severe enough to qualify for Major Depressive Disorder.
It can be difficult to distinguish from
, since it is similar in terms of the types
of symptoms present, and their onset and
duration historically. In both disorders,
individuals may have changes in their sleep
patterns or appetite, low energy or fatigue,
low self-esteem, poor concentration or difficulty
making decisions, or hopelessness during
periods of depressed mood. However, individuals
with Dysthymic Disorder may have more prominent
cognitive or interpersonal symptoms, such
as pessimism, feelings of inadequacy, and
social withdrawal.
Dysthymic Disorder often has its onset
during teen years or early adulthood. When
this occurs, it may negatively affect personality
development, since the feelings of inadequacy
and social withdrawal can interfere with
achieving the important social goals of
that time. As a consequence, persons with
Dysthymic Disorder may be more likely to
remain single and those with early onset
(before age 21) more likely to develop personality
disorders than those with later onset.
When there is this early onset, individuals
may feel that the depression is “just
the way life is,” since they have
never known a period of better mood and
pleasure as teens or adults. As a result,
many do not seek treatment until, for some
reason, the depression becomes more severe.
This happens fairly often, as, each year,
about 10% of those with Dysthymic Disorder
develop Major Depressive Disorder. Many
persons with Dysthymic Disorder report that
they have been depressed for decades before
they finally seek treatment. Like Major
Depressive Disorder, Dysthymic Disorder
can cause significant impairments in occupational,
academic, social, or recreational functioning.
Treatment choices are also fairly similar to those used
for Major Depressive Disorder, though this has not been as
well studied. There is some evidence that psychotherapy, in
the forms of cognitive-behavioral
therapy or interpersonal
therapy, may be helpful. However, many believe that anti-depressant
medications are the preferred treatment, especially for those
individuals who, as is often the case in this disorder, have
had one or more prior unsuccessful trials of psychotherapy.
There is reason to believe that treatment with a combination
of psychotherapy and medication may be better for some patients,
such as those with significant psychosocial stressors, marital
problems, residual symptoms, or other maladaptive cognitive
or behavioral habits.
It must be said that it is not clear that
Dysthymic Disorder is really separate from
Major Depressive Disorder. It may only differ
in terms of severity and the course of the
illness. Several factors suggest that the
two disorders may, in fact, share some biological
basis. These include 1) a similar sex ratio
(women are diagnosed with these disorders
about twice as often as men), 2) the fact
that Dysthymic Disorder is more common among
close relatives of persons with Major Depressive
Disorder than in the general population,
3) the high frequency with which those with
Dysthymic Disorder go on to develop Major
Depressive Disorder (10% per year, as mentioned
above), 4) the presence in some patients
in both groups of certain abnormalities
in their sleep EEGs, and 5) the similarities
in methods of effective treatment.
Finally, it is important to know that
Dysthymic Disorder can be successfully treated
in most individuals. Because of the risk
of depressive symptoms returning, it may
be advisable to continue maintenance medications
to prevent relapse.
