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Dysthymia

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.

Causes

The exact cause of dysthymia is unknown. It tends to run in families. Dysthymia occurs more often in women.

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

Dysthymia in the elderly is often associated with difficulty caring for oneself, isolation, or medical illness. 

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 lasts for at least 1 year.

In addition, two or more of the following symptoms will be present almost all of the time that a 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.

Exams 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

There are a number of things you can try to improve dysthymia:

  • Get enough sleep.
  • Follow a healthy, nutritious diet.
  • Take medicines correctly. Discuss any side effects with yourdoctor.
  • Learn to watch for early signs that your dysthymia is getting worse. Have a plan for how to respond if it does.
  • Try to exercise regularly.
  • Look for activities that make you happy.
  • Talk to someone you trust about how you are feeling.
  • Surround yourself with people who are caring and positive.
  • Avoid alcohol and illegal drugs. These can make your mood worse over time and impair your judgment.

Medications are often effective for dysthymia, though they sometimes do not work as well as they do for major depression, and may take longer to work.

Don’t stop taking your medicine on your own, even if you feel better or have side effects. Always call your doctor first.

When it is time to stop your medicine, you and your doctor will slowly reduce the dose instead of stopping suddenly.

People with dysthymia may also be helped by some type of talk therapy. Talk therapy is a good place to talk about feelings and thoughts, and to learn ways to deal with them. Types of talk therapy include:

  • Cognitive behavioral therapy (CBT), which helps you learn to be more aware of your symptoms and what makes them worse. You will be taught problem-solving skills.
  • Insight-oriented or psychotherapy, which can help people with dysthymia understand factors that may be behind their depressive thoughts and feelings.

Joining a support group for people who are having problems like yours can also help. Ask your therapist or health care provider to recommend a group.

 

Outlook (Prognosis)

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

Dysthymia also increases the risk for suicide.

When to Contact a Medical Professional

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

Alternative Names

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

References

Fava M, Cassano P. Mood disorders: major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.

Update Date: 9/17/2012

Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY.

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