Dysthymia Depression

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What is Dysthymia depression? Read on to understand this depression and learn more about recent diagnostic changes. If these changes are unimportant to you skip down to learn about this diagnosis and it's treatment. 

First, this page will discuss a bit of the controversy about Dysthymia depression and then a little about what you need to know if you or someone you love has been diagnosed with it. . 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), published by the American Psychiatric Association (2013) includes changes in this diagnosis. In the DSM -5, Dysthymia has been changed to be called called Persistent Depressive Disorder (PDD). Historically, dysthymia depression is also known as low-grade depression, and has been considered less severe than major depression but more chronic. 

Why did this change in the name happen? The validity of dysthymic depression being separated as a different diagnosis from major depressive disorder has been discussed over time. Studies showed that most people who had been diagnosed with dysthymic depression later went on to be diagnosed with a major depressive episode. Although the DSM divides mental illness into discrete categories there is evidence that it is really more dimensional. What that means is how we diagnose and conceive of mental
illness is really inaccurate. 

Chronic depression (major depressive disorder with a specifier which describes that it is chronic) and dysthymic depression, or dysthymia, were merged into PDD in DSM-5. This new division of depressive disorders pays more attention to how LONG depression lasts rather than how severe the symptoms are. 

This new diagnosis is still disputed and its conceptualization is new. In fact, it is still difficult to find any research on PDD. Almost all the research you will find is on dysthymia. What we will talk about, on this page is how to help you if you are suffering from a long period of depression. 

Criteria for Dysthymia or PDD

The clinical criteria for what we think of Dysthymia disorder and what is now called PDD is as follows:

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 year
. B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


Although we often think of Dysthymia depression as less severe, it's chronicity or the length of time a person suffers from it, can have even more damaging effects than a person with a single or multiple episodes of major depression with recovery periods in between. Long term or chronic, persistent depression, seems to be associated with worse outcomes.

Facts about Dysthymia Depression

  • According to research on dysthymic depression, most cases occur before the age of 21.
  • Struggling with depression at a young age can be a predictor of having a struggle with the illness in later life. This suggests it's important to get into therapy and develop healthy coping mechanisms early and tools to combat your depression. 
  • Risk factors include early trauma, a family history of depression, and ADHD.
  • It appears to have a genetic component. It is common in people who have first degree relatives with major depression. If you have parents who have depression, you are more likely to be diagnosed with this. 
  • Dysthymic depression relates to higher risk of substance abuse in later life.
  • Dysthymic depression is more common in females than males.
  • There is a high degree of impairment in the quality of life functioning and social support as well as struggles in marriage among people who have dysthymia depression. 
  • Some of people diagnosed with dysthymia that will convert to bipolar disorder
  • It negatively affects workplace performance, salary, and close relationships with friends.
  • Chronic depression has been shown to reduce the effectiveness of your immune system and is related to inflammation, it has been shown to cause neurological changes in the brain, and cognitive distortions, which can further exacerbate these risks.

  • People with chronic depression are at a higher risk of developing diabetes and arthritis. Also, other mental health illnesses and suicidality. 


Despite all these facts, people with dysthymia depression can function and often are unaware that they have a serious illness because they are flying under the radar with their mental illness. A major depressive episode can be a serious dramatic departure from functioning, but dysthymic depression is so chronic that it can seem like a personality. In fact, much has been written about difficulty distinguishing between Dysthymia and depressive personality disorder. It is difficult, depressive personality
disorder consists of a negative outlook on life, being self critical and pessimistic. 

Further, complicating all of these diagnostic issues, especially for children is the issue of the symptom of apathy. Apathy often appears as no motivation and goal directed activity. In children and adolescents, this event often looks like laziness. So often I have parents come in and they are treating their depressed child with punishment because they are perceiving them as lazy, when in fact they are experiencing the symptom of apathy as a result of their depression. 


Therapy and Treatment

Dysthymia Depression is one of the most important diagnoses to get therapy for, because of the seriousness of it and the long term impact on a person's sense of self worth and quality of life. Early identification and treatment are associated with the best outcome.

Therapy for Dysthymic depression consists of :

  • Improving the symptoms that you are presenting with,
  • Helping you or your child to connect with a social network,
  • Improving your workplace relationships, friendships, and marriage, Improving your functioning and overall quality of life.
  • Your therapist should help you to focus on improving your sense of hopelessness, and identify false beliefs and unfriendly views of people and the world and how that influences the way you think act and feel.
  • Therapy  should help you identify how you or your depression is interfering with you or your child's ability to engage in the things that are valuable to you.
  • Treatment  will also often include an antidepressant, as research has shown dysthymia disorder responds best to therapy and antidepressants in combination.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Johnson, D., Dupuis, G., Piche, J., Clayborne, Z., & Colman, I. (2018). Adult mental health outcomes of adolescent depression: A systematic review. Depression and Anxiety, 35(8), 700-716. doi:10.1002/da.22777

Junko Ishizaki and Masaru Mimura, “Dysthymia and Apathy: Diagnosis and Treatment,” Depression Research and Treatment, vol. 2011, Article ID 893905, 7 pages, 2011. https://doi.org/10.1155/2011/893905.


More at the National Institute of Mental Health

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