Dysthymia / Dysthymic Disorder or Chronic Depression
What Is Dysthymia?
Dysthymia (sometimes misspelled as "disthymia"; chronic depression) is a chronic (long-lasting), mild form of depression. For many people, dysthymia (pronounced, dis-thi-me-a) begins in childhood or early adulthood. However, calling it "mild" is misleading; because it can last for years, it can be just as debilitating as a more acute episode of major depression (clinical depression). People who develop dysthymia when they are young often do not realize that they are ill; they think: "this is just the way I am." This belief can create a negative view of the world and of life that is difficult to change and that can lead to thoughts of, or attempts at, suicide. The good news is that dysthymia is a treatable illness. Life does not have to seem like a long stretch of pain and suffering. There's hope.
Symptoms of Dysthymia
Many of the symptoms of dysthymia are the same as those of major depression; however, they may be less severe or intense. Dysthymia also has some symptoms that may not occur with major depression. The hallmark of dysthymia is the length of time that it persists. In adults, dysthymia is diagnosed when the symptoms continue for two or more years; in children or teens, the symptoms last for a year or more. You probably won't have the symptoms every day. You may feel good for a few days or even a month at a stretch, but the symptoms always come back. This particular characteristic of dysthymia contributes to the perception that this is "just the way I am." It also tends to wear us down and lead to thoughts of suicide. Although you may not hear much about dysthymia in the popular press, it is a serious condition that needs to be treated.
You may have dysthymia if you have the following symptoms for at least two years (adults; one year in children or teens):
Who Gets Dysthymia?
Dysthymia can affect men or women; but, like major depression, is more common in women. Dysthymia can begin in childhood or adolescence. As with many illnesses, dysthymia doesn't discriminate. However, some groups of people may be less likely to seek treatment than others. For more about dysthymia in children and adolescents, see the Children & Teens section.
How Is Dysthymia Treated?
Because dysthymia is a chronic depression, it can require longer treatment times than major depression. Both medications for depression (antidepressants) and talk therapy are used to treat dysthymia. Until a few years ago, talk therapy was the preferred treatment course for dysthymia. Now, more and more studies are showing that antidepressant medications can be very helpful in treating dysthymia. Caveat: Because dysthymia can create thought, belief and behavior patterns that can lead to recurring episodes, talk therapy is vital to overcoming this disorder. In other words, medication alone is not enough.
Medication for Dysthymia
When antidepressants are prescribed for dysthymia, the treatment lasts for up to five (5) years (range: 2 to 5 years). This is much longer than the treatment time for major depression (range: 6 to 18 months). Until the availability of the SSRI (selective serotonin reuptake inhibitor) medications, it was difficult to keep a dysthymic person on medication for the several years needed to treat the condition. SSRIs have fewer side effects than the older types of medications for depression, namely the MAOI (monoamine oxidase inhibitor) medications and the TCA (tricyclic antidepressant) medications. Although the SSRIs do have some side effects, usually they are not as bothersome as the side effects of the other types of medications.
If you are taking medication for your depression do not stop taking it without first talking with your doctor. One of the most common causes of relapse in any depressive disorder is stopping medication too soon. In this regard, antidepressant therapy is very similar to antibiotic therapy: We feel better before the illness is fully treated. But just as with antibiotic therapy, we need to finish the whole course of treatment before we are actually better. Also similar to antibiotic therapy, the illness can become harder to treat if we stop medication too soon.
Your primary care doctor can prescribe antidepressant medication; however, in many cases I believe it is best to see a psychiatrist (see below for more about psychiatrists) because they know the medications better than anyone. Finding the best medication for a particular person is a trial-and-error process. This process can be easy for some and very difficult for others. Especially with dysthymia, the process can seem hopeless at times. I believe this is where it is very helpful to be seeing a doctor who works with these medications on a daily basis, that is, a psychiatrist. (For more on how to talk to your doctor about depression, click here.)
Often there is a trigger or underlying cause to our dysthymia or clinical depression (sometimes there is not). We may have had a traumatic experience or be living in a situation that is emotionally difficult or abusive. When we're depressed, we often feel that there is no use trying to correct a bad situation. We may feel we're not worthy of being happy or having a "normal" life. These perceptions are usually caused by the dysthymia or clinical depression, and we need to talk with a mental health professional to overcome these misconceptions. Talk therapy is also vital in overcoming traumatic events or abuse in our past. Burying, ignoring, or "stuffing down" bad experiences never works. Never. You need to deal with the bad experiences. This process can be painful and emotionally draining, but the payoff is that you will feel better and these difficult experiences won't resurface every few years. Think of it as an infection: if you don't deal with it, it only gets worse and harder to treat. It does not go away on its own.
Dysthymia itself, because it often goes untreated, creates perceptions and beliefs that are not in line with reality. We may think people dislike us or are judging us, we are often sensitive to rejection, and we think we are not good at what we do. Beyond the help that medications for depression can give us, talking to a mental health professional can help us overcome these often long-standing ideas we have about ourselves and the world.
Talk therapy can take several different forms:
A mental health professional can be any one of these:
ECT (Electro-Convulsive Therapy)
Electro-convulsive therapy or ECT is considered a treatment of last resort. When all medication options have been exhausted, your doctor may talk with you about ECT. Things have changed quite a lot from the early days of ECT. Many of us remember scenes from movies where patients are given ECT -- the scenes are not pleasant to say the least. Today, ECT is administered under anesthesia and isn't the horrific experience portrayed in those films. For a number of people, it is the only treatment that gives them relief from their depressive symptoms.
Substance Abuse and Dysthymia
There are two schools of thought regarding the connection between clinical depression or dysthymia and substance abuse. One school holds that substance abuse causes the depression and dysthymia. Certainly, substance abuse will make existing major depression or dysthymia worse. The other school holds that substance abuse occurs when the person tries to self-medicate to feel better from the depression or dysthymia. This is particularly so with dysthymia or with either condition when it occurs early on in life.
In my experience, particularly with dysthymia, the illness leads to substance abuse in an effort to self-medicate. Think about it: If you've been dysthymic from childhood or teens, you don't even realize you have an illness -- thus, you're not likely to seek professional help or appropriate medication (if medication is necessary). You're likely to use legal (alcohol) or illegal (pot, amphetamines, hallucinogens, crack, cocaine etc.) substances to "feel better." Several of the symptoms of depression seem to be alleviated (at least temporarily) by alcohol or other substances; for example, anxiety and difficulty sleeping seem to get better. But in the long-term, the symptoms of depression or dysthymia only worsen with substance abuse. The upside is that once you're on the appropriate medication you'll feel better than you ever could by drinking or taking drugs. This may help ease the sobriety process.
Substance abuse complicates the treatment of depression. It's important to detoxify from any substance addiction in order to treat the depression. Many substances make depression worse (this is especially true of alcohol, which is a central nervous system depressant). Some people will require hospital detox and others will not. Regardless of how you become free of your addiction, you must seek the available help for that addiction. Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings are crucial to getting and staying clean and sober. I urge anyone with a substance abuse problem to get into a program such as AA, NA, or other type of addiction recovery program (there are others that are not 12-step based). If you are to beat depression, you must beat the addiction, too. I have found that taking the appropriate medication for my depression and dysthymia has virtually eliminated any desire to drink or take inappropriate drugs.
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