Things Everyone Should Know About Dysthymic Disorder

Mental illness is the leading cause of disability in the United States. Since 2012, there has been a sharp spike in the number of diagnoses and prescriptions written for mental health disorders, especially amongst teenagers. It is imperative to learn about symptoms and treatment options and dispel the silence and stigma traditionally associated with even the most common psychological issues. Dysthymic disorder, also known as persistent depressive disorder, is a form of depression that, being less severe, can easily go undiagnosed and put sufferers at risk.

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Why Mental Health Matters

Recent studies have confirmed rising rates of depression and suicide among teens as well as adults, coupled with a decrease in access to mental health services and psychiatric treatment. Currently, about forty-three million adults in the United States have a mental health condition, and up to fifty-seven percent may go without treatment, increasing the risk of comorbidity, substance abuse, financial and relational problems, self-mutilation, and even loss of life. The suicide rate among teens spiked drastically between 2007 and 2015 and is still on the rise, with over half of youth aged eleven to seventeen years old reporting weekly thoughts of suicide or self-harm over a five-year period.

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Dysthymia Prevalence

Up to five percent of the general population, which equals to about three million Americans, are affected by dysthymic disorder. Women are three times more likely to be diagnosed than men, but men with dysthymia are at a higher risk of death. The average age of diagnosis is thirty-one years old. However, it is also common in teens and young adults, as well as older generations, with early-onset defined as occurring before the age of twenty-one, and late-onset if diagnosed at or over twenty-one years old. Individuals in the mid-forty to mid-fifty age range are twice as likely to be diagnosed than those aged eighteen to twenty-nine years old, and nearly three times as likely as individuals sixty years old or older, but most often begins early in childhood, adolescence, or young adulthood.

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Causes

It is most likely that a myriad of factors is at play in a given case of dysthymia. Some of these factors include, but are not limited to, chronic stress or medical illness; maladaptive coping strategies, such as rumination; changes or abnormalities in the neurotransmitters responsible for mood stability and emotional processing; hereditary factors, such as having a relative with any kind of depressive disorder; and psychosocial factors, such as isolation, loss, or other traumatic life events. Other risk factors for dysthymic disorder include borderline or antisocial tendencies, as well as personality traits, such as codependency, pessimism, low self-esteem, self-criticism, and social anxiety.

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Can Be Caused By Brain Chemistry

Though there isn't an exact cause known for dysthymic disorder, scientists have linked multiple potential factors to the condition. Studies indicate dysthymic disorder can be caused by brain chemistry. The brain naturally makes chemicals called neurotransmitters, which are essential for healthy overall brain function, and they also play a big role in regulating mood. When the brain doesn't make enough of certain neurotransmitters or makes too much, it can lead to mood disorders like depression, anxiety, and bipolar disorder. When there are changes in the way neurotransmitters interact with the neurocircuits in the brain, individuals may develop depression or other mood disorders as a result.

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Can Be Inherited

There may be a genetic and hereditary component to the condition. Individuals with persistent depression often have family members who also have problems with depression, and if they do indeed have family members with persistent depression or other mood disorders, their risk of developing dysthymic disorder may be higher than those without affected relatives. Right now, researchers are conducting studies to try to isolate genes related to depression. However, there haven't been any conclusive studies that have found gene mutations linked to depression. Over the coming years, as more genetic research comes to light, there may be enough information to do genetic tests for an individual's depression risk.

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Can Be Triggered By Life Events

There's research indicating dysthymic disorder can be triggered by life events. The same is true of major depression. Persistent depression, major depression, and generalized anxiety can be brought on by life events. In some cases, they may resolve as life circumstances resolve. For example, if the depression is brought on by financial problems, individuals may find their symptoms lessening when they're in a better financial place. Similarly, if depression is brought on due to the death of a loved one, individuals may find that their symptoms abate as they work through their grief, process the loss, and move on. But in other cases, the depression will continue long after the life event has resolved itself. Research also shows high stress can trigger dysthymic disorder.

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Certain Personality Traits Heighten The Risk

Certain personality traits can heighten an individual's risk of developing dysthymic disorder. These traits may also make the disorder harder to treat. In many cases, talk therapy and cognitive behavioral therapy can help lessen negative thoughts and behaviors that cause distress. The main personality traits that heighten an individual's risk are ones involving negativity. If individuals have low self-esteem, they're more likely to feel bad about themselves, their life circumstances, and their future. If they're very dependent on others and insecure about their ability to function on their own, they're more likely to feel anxious and depressed. Perfectionists and those with high levels of self-criticism are also more likely to develop depression. A pessimistic outlook also increases depression risk. It's best to actively look for positive things along with negative things. Individuals should engage in activities they enjoy and take time to acknowledge their good traits.

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Symptoms

Because dysthymia is a subtle form of mood disorder, it can be hard to detect, and symptoms may seem unrelated to one another. In those with undiagnosed, early-onset dysthymic disorder, some symptoms could be confused with typical adolescent behavior, such as teen angst, and therefore go unnoticed. Teens may then grow up believing it is merely part of their character and never seek treatment. Common symptoms to be aware of include withdrawal from social situations and activities; feeling blue, dark, or angry moods over sustained periods; experiencing a lack of motivation or pleasure in ordinary activities; avoiding opportunities to avoid the chance stress or failure; and, in more severe cases, suicidal ideation (thinking or talking about suicide).

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Long-Term Effects

If untreated, dysthymia can lead to an increased risk of self-harm and suicidal thoughts or actions. However, dysthymia patients are more likely than those with depression to make nonfatal attempts to receive treatment. Adolescents are especially at risk for decreased academic performance, drug and alcohol abuse, unwanted sexual encounters, as well as increased levels of relational dysfunction (at home, with friends, or with romantic partners). Furthermore, dysthymic disorder is associated with high rates of unemployment, chronic pain, sleeping disorders, health complications, mental or physical disability. In one long-term study, seventy-six percent of children with dysthymic disorder developed major depression, while thirteen percent developed bipolar disorder over twelve years.

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The Difference Between Dysthymia And Depression

Despite its characterization as a milder form of depression, recent studies have concluded dysthymia can have severe consequences. Dysthymic disorder is characterized by earlier onset, greater withdrawal and stronger feelings of pessimism or inadequacy than major depressive disorder, but fewer changes in sleep patterns, and less drastic weight loss or gain. While some causes of dysthymic disorder and major depressive disorder overlap, severe depression is more likely to be the product of a sudden or violent loss; domestic, childhood, or sexual abuse; or experiencing war or another intensely traumatic event or series of events. As a result, depressed individuals have more severe and noticeable symptoms when compared to those with dysthymic disorder.

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Dual Diagnosis

Dysthymia is known for high instances of comorbidity, meaning it often co-occurs with other mental disorders such as anxiety disorders, schizotypal disorders, bipolar disorder, and major depressive disorder. In fact, about forty percent of dysthymic adults also meet the criteria for major depression or bipolar disorder, and approximately half will have problems with substance abuse over their lifetimes. Double depression occurs when an individual with dysthymic disorder also suffers from recurrent but temporary episodes of major depressive disorder. Individuals with co-occurring mental health or substance abuse issues have lower chances of recovery or remission than those who do not have an additional mental illness.

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Related Disorders

Co-occurring symptoms can be indicative of more serious problems, such as when depressive or dysthymia episodes alternate with periods of hypomania. Cyclothymic disorder is a mild form of bipolar disorder characterized by these alternating states. Because the periods of hypomania do not progress into the hyper-mania exhibited by bipolar disorder patients, cyclothymic disorder patients are sometimes misdiagnosed with dysthymia. Depressive episodes are not as severe as with bipolar or dysthymic disorder, and generally, do not last more than two weeks. Manic episodes are characterized by a decreased sense of control or productivity, rather than unnerving bouts of energy or feelings of invincibility.

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Related Disorders Continued

A major component of dysthymia and other mood disorders is anhedonia, the decreased or complete inability to experience pleasure, whether from eating, playing games, exercise, hobbies, singing, sexual activities, or social interactions. It is believed to be caused by a disruption in the brain's pleasure response and poor regulation of dopamine levels. Anhedonia is prevalent in schizophrenia and has high rates of comorbidity with depression and social anxiety, as well as other mood disorders including dysthymia. It can be consummatory (a lack of pleasure in typically pleasurable experiences), or motivational (a lack of desire to engage in enjoyable activities).

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History

While traditionally considered a passive, less severe form of depression, dysthymia was originally measured solely by the level of enjoyment observed in patients. Later studies of the disorder concluded there were two categories of dysthymic patients: those with anxious dysthymia, characterized by pronounced restlessness, low self-esteem, and sensitivity to interpersonal rejection; and anergic dysthymia, which is characterized by symptoms like anhedonia, hypersomnia, and chronically low energy levels. The fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5) consolidated the definitions of dysthymic disorder and chronic major depressive disorder under a single classification: persistent depressive disorder.

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Diagnosis

Before making a diagnosis, doctors will likely perform a physical exam, bloodwork, and a psychological evaluation. For an adult to be diagnosed with dysthymia, their depressed mood must persist for two or more years, though children are diagnosed after only one year. Patients must also exhibit two or more of the following symptoms while depressed: poor appetite or overeating, insomnia or hypersomnia, poor concentration or indecisiveness, or feelings of hopelessness. Up to fifty percent of the population in the United States living with dysthymic disorder do not receive a diagnosis. In addition, approximately ten percent will go on to develop major depression in their lifetimes, making it vital for individuals experiencing these symptoms to seek appropriate treatment.

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Treatment

Treatment for dysthymic disorder can range from lifestyle changes, like exercise and stress management, to talk therapy and medication. Common forms of talk therapy used to treat dysthymia are cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and psychodynamic psychotherapy. CBT and IPT are both short-term treatments, but while cognitive behavioral therapy focuses on recognizing and learning to redirect negative thought patterns, interpersonal therapy addresses immediate issues and interpersonal conflicts. Psychodynamic therapy explores the underlying cause of depression.

Antidepressants are also an effective form of treatment. Selective-serotonin reuptake inhibitors (SSRIs) are most effective for individuals with anxious dysthymia; patients with anergic dysthymia are more likely to be prescribed DRIs or NDRIs, which regulate the chemicals dopamine and norepinephrine. In some cases, lithium therapy is also appropriate.

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Prevention

While there is no real way to prevent dysthymic disorder, early intervention and patient education are the best tools to prevent negative health outcomes and increase quality of life. Since the disorder often begins in childhood, it is especially important for parents to observe their children for psychosomatic symptoms of depression like trouble sleeping and interpersonal dysfunction. What could be perceived as shyness or trouble adjusting to a new bed could be indicative of the effects of stress on a child's developing brain. Fostering an environment of communication, and learning constructive forms of coping and problem solving, can also reduce rates of comorbidity and mortality.

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Complications Of Dysthymia

There are several potential complications linked to dysthymic disorder. Because affected individuals struggle to enjoy themselves or experience positivity, their overall quality of life is reduced. They may also stop taking care of themselves in terms of mental self-care, basic hygiene, and upkeep of relationships. Dysthymic disorder predisposes individuals to develop anxiety disorder, major depression, or other mood issues. Some individuals begin abusing substances like alcohol and drugs to cope with their feelings. The condition can lead to familial conflicts and difficulties in relationships. It can also make the ability to focus harder and cause individuals to feel less motivated, which leads to difficulties in work and school. Their productivity may decrease. There's a high comorbidity rate between dysthymic disorder and chronic pain. Any type of depression raises the risk of suicidal thoughts or actions.