September 1, 2011

Dysthymic disorder is a chronic mood disorder characterized by depressed mood (extreme irritability in children and teenagers) almost every day for most of the day for at least 2 years in adults and 1 year for children and teenagers. Most individuals with these disorders complain that they have been depressed for as long as they can recall. Other symptoms that accompany these feelings are at least two of the following: appetite abnormalities, changes in sleep patterns, excessive tiredness, poor self-esteem, difficulties with memory and concentration, and feelings of hopelessness and helplessness. Although the term “dysthymia” was first used in 1980 in order to bring a clearer understanding of depressive disorders that did not meet the criteria for major depression, were more chronic and less severe, and implied a temperamental dysphoria, the term is often imprecise. Perhaps a good definition is that of a chronic, low-grade depression that lasts more than 2 years.

Using the best definition possible, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, this is a common condition affecting about 3% of the population in the United States. Women have about 1.5-3 times more such conditions than men from adolescence through menopause. They occur more often in unmarried persons, those with low income and more health and other psychiatric illnesses. In fact about 75% of those with dysthymic disorder have another psychiatric diagnosis, the most common of which is major depressive disorder. Other common disturbances that exist with dysthymia are anxiety disorders such as panic and substance abuse, attention deficit disorder, conduct disorders, and personality disorders.

Causes of dysthymia are not clearly known, but some of the same factors that cause major depression have been implicated so that biological, psychological, and social factors are most likely involved. Some of the biological factors seen in major depression also occur in dysthymia such as rapid eye movement (REM) latency and decreased REM density. Those with dysthymia are much less likely to have positive results on tests of the adrenal axis (abnormal levels of hormones in the blood) such as the dexamethasone-suppression test (DST). Psychological theories relate to early developmental problems while cognitive theories revolve around diminished self-esteem and sense of helplessness. In helping make the diagnosis one must take care to be sure that the person does not have major depression, and if one does, it is known as double depression. Also, it is important to note that there is no mania or hypomania. About half of those with dysthymia have gradual onset prior to age 25. They are at increased risk for major depression or for bipolar I or II. Women with dysthymia are also at risk for premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and pregnancy-related depressions.

While the outlook for those with this disorder used to be quite dismal with only about 15% achieving a complete remission, newer treatments have raised this to about 75%. Newer treatments include some of the medications that raise serotonin levels of the neurotransmitters such as the antidepressants Prozac, Zoloft, Celexa, and others. Psychotherapies also have proven effective with and without medications. These include cognitive-behavioral, interpersonal, insight-oriented, family, and group therapies. Hospitalization is not usually indicated.

SEE ALSO: Anxiety disorders, Depression

Suggested Reading

  • Sadock, J. B., & Sadock, V. S. (2000). Comprehensive textbook of psychiatry (7th ed.). Philadelphia: Lippincott, Williams & Wilkins.

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