Dysthymia in Psychology - What is it?

Dysthymia is a mood disorder characterized by symptoms of depression. But unlike depression, dysthymia is a chronic disease with less profound manifestations. That is, depression has a shorter course, but more expressive symptoms than dysthymia.

What is dysthymia?

Dysthymia is a disorder related to depression and is considered a milder form of depression. It is sometimes also referred to as chronic depression. The disease is diagnosed when depressed mood is present for most of the day for 2 years with a break of no more than 2 months.

Dysthymia is a disorder in which, in addition to depression, at least 2 of the following symptoms are present:

• loss of appetite or overeating;
• sleep disorders (insomnia or excessive sleepiness);
• weakness, fatigue;
• decreased self-confidence;
• impaired concentration;
• problems with decision making;
• feeling of hopelessness.

These symptoms lead to social, work, and school problems. This disorder is a chronic, long-term illness.

Dysthymia is a depressive disorder in psychiatry, classified depending on its origin into:

• endogenous disease, i.e. having internal causes (imbalance of neurotransmitters);
• an exogenous disease arising from external causes (crisis events in personal life, changes in social and work conditions, catastrophic events...).

Types of dysthymia

Somatized (cathesthetic) dysthymia

Somatized dysthymia - what is it? This is a disorder with a predominance of physical manifestations of depression. Actually, the depressed mood is little expressed here. More pronounced:

• poor health (in general),
• tearfulness,
• poor sleep with frequent awakenings,
• constipation,
• dyspnea,
• heartbeat.

Often physical sensations are combined with mood disorders and form common symptoms. The sadness and depression characteristic of depression are transformed into bodily sensations: “coldness” in the chest or solar plexus area, burning sensation in the throat and intestines.

As the disease progresses, events in the external world reduce their influence on the dynamics of clinical manifestations. The following become more significant:

asthenia - anxiety and restlessness are replaced by loss of strength and decreased activity, tension is replaced by lethargy.

Or the number of strange somatic sensations increases. This can be combined with excessive attention to well-being.

Characterological (characterogenic) dysthymia

Characteristic dysthymia: what is it? This is a constitutional-depressive personality type according to P. B. Gannushkin. This type is characterized by persistent, lifelong disorders in the form of:

• pessimism
• inability to experience pleasure (anhedonia)
• "blues", pessimism,
• "why live?" - thoughts about the meaninglessness of life.

With age, a depressive worldview increases and a “loser complex” forms at the center of it.

Gannushkin himself P.B. gave a very detailed description of this type of personality:

Currently, the view that the tendency to depression is a property or character of a person or the specificity of his temperament is disputed. It is now assumed that the roots of chronic depressive (dysthymic) disorders are laid in childhood under the influence of external factors.

External manifestations of dysthymia can be confused with the clinical picture of hypothyroidism, thyroid disease. Watch - “Hypothyroidism (psychosomatics).”

I hope that the article “Dysthymia - what is it” was interesting and useful for you.

Causes and risk factors of dysthymia

A multifactorial disorder is how dysthymia can be characterized. What kind of disease is this? Genetics (congenital predisposition), external factors such as poor family relationships, upbringing, physical and mental abuse, and long-term illnesses play a role in its development.

Some people with dysthymia have experienced a major loss in childhood, such as the death of a parent. Others report being exposed to constant stress as children.

Risk factors are cyclothymia, alcohol, drugs.

Dysthymia and cyclothymia

Cyclothymia and dysthymia - what is it? What is the difference between these disorders? Depression lasting more than 2 years, characterized by shallow depressed mood, is called dysthymia. This is a stable state, typical of a number of manifestations, in particular:

• decreased vital energy, activity, interests, decreased self-confidence;
• feeling of hopelessness;
• lack of interest in communication;
• pessimistic views.

Dysthymia is a mood disorder with symptoms similar to depressive syndrome, but with less episode intensity. In the international statistical classification of diseases, it belongs to persistent affective disorders.

The development of dysthymia is often unnoticeable. The person seems sad, complains about negative events, for example, increasing the cost of gas, electricity, etc. He is prone to pessimism, looks at the world with significant skepticism.

Cyclothymia is a long-term depression lasting at least 2 years, alternating with mild over-cheerful mood (elevated mood, the opposite of depressive episodes, but not reaching the intensity of mania). The frequency of fluctuations is usually higher than in bipolar affective disorder. Although both phases do not reach the necessary intensity or duration to diagnose mania or mild depressive phase, they cause discomfort in the patient. Moreover, mood swings last for years (sometimes longer).

To diagnose dysthymia, it must last for at least 2 years and be felt by the patient as a subjective burden. It is necessary to distinguish it from pessimism itself as a personality trait. With pessimism there is no sadness.

To diagnose cyclothymia, it is important that the patient's mood swings are not caused by life events. But it is difficult to make this diagnosis without long-term observation. It should also be confirmed that individual mood swings do not meet the criteria for any of the categories of manic, depressive phase.

Dysthymia and cyclothymia

Many people confuse these two conditions. But there are serious differences between them. Cyclothymia is a disorder characterized by sudden mood swings, alternating between mild depression and joy. It develops more often in young people. Over time, it can become chronic. With cyclothymia, a good mood sometimes lasts for several months, which makes diagnosis difficult.

Mood swings are not typical for dysthymia. At some moments it seems to a person that everything is fine with him. But he will still feel tired, apathetic and lacking vital energy. It's a long way from being in a good mood here.

Symptoms, signs of dysthymia

The disorder usually begins slowly. Most often, the first symptoms appear in early adulthood. The disease has a chronic course. In childhood dysthymia, symptoms and signs include inability to learn and interpersonal relationships. Common in children and adolescents:

• irritability;
• touchiness;
• low self-esteem;
• pessimistic mood;
• sometimes eccentric.

Before the development of these signs, a person is exposed to greater stress and traumatic life events. Fluctuations between mild depression and periods of relatively normal mood vary.

Dysthymia significantly affects a person’s quality of life - it disrupts adaptation at work and in personal life, it can lead to avoidance of society, and make it difficult to enjoy free time. The quality of life of patients with this disease is worse than that of people with arterial hypertension, diabetes, and arthritis.

Manifestations typical of dysthymia:

• increase or decrease in appetite, weight;
• lack of sleep or excessive sleepiness;
• frequent fatigue;
• weakness;
• decreased self-confidence;
• disturbances in concentration;
• indecision;
• hopelessness;
• pessimism.

The symptoms of dysthymia are similar to those of depression, but are less severe. Both diseases are characterized by a bad or irritable mood, lack of interest in pleasant, joyful things, and loss of energy. Symptoms may worsen to the point of developing classic depression.

Dysthymia is a stable, long-term disorder and is therefore perceived as part of a person’s character. A sick person does not even discuss his problems with his doctor, family, or friends.

It is impossible to say whether people with this disorder are under more pressure than others, or whether they are more susceptible and less able to cope with various difficulties.

Symptoms

Symptoms of dysthymia can appear in early childhood. The child becomes irritable, touchy, and constantly nervous. A pessimistic mood always prevails in him.

Over time, the number of manifestations increases:

1. Sleep disturbances, in particular insomnia, waking up early, drowsiness during the day.
2. Eating disorders. A person either refuses food or overeats.
3. Excessive fatigue, constant fatigue, lack of vital energy.
4. Low self-esteem, feelings of worthlessness, excessive self-criticism, self-flagellation.
5. Reluctance to think about something, feeling empty inside.
6. Inability to concentrate, slow reaction, inability to navigate a difficult situation and make a decision.
7. Lack of interest in activities that previously brought joy and pleasure.
8. Headache, heart and blood vessel diseases, joint pain.
9. Pessimism, strong doubts about the future.

And the last, most terrible symptom is thoughts of suicide.

Dysthymia can be judged if there are at least two of the listed signs of the disease.

Why can dysthymia be a background, what accompanies it?

This form of depression significantly reduces the patient's quality of life and is often associated with other disorders:

• 70–80% of patients also have personality disorders;
• 11–30% are dependent on alcohol, drugs, medications;
• Most patients suffer from eating disorders, depression, and anxiety disorders.

The most common pathology accompanying dysthymia is a personality disorder. This comorbidity can be explained in several ways:

1. If a personality disorder precedes depression, it is perceived as secondary, that is, caused by the person’s vulnerability. People with evasive, borderline, and hysterical disorders are most prone to developing a depressive disorder.
2. A personality disorder can arise as a result of a depressive state that affects a person’s attitude towards himself and the environment. A patient with chronic depression is so susceptible to changes in his life and behavior that pessimism becomes a permanent component of his personality.

Both comorbid disorders are related by the term “depressive personality disorder.” But it is not used in the ICD-10 Diagnostic Manual.

General information

Dysthymia is a mental disorder that has a chronic course and is manifested by such signs as a depressed emotional state without the presence of pronounced behavioral disorders and somatic pathologies. This is a mild form of depression.

With this pathology, patients feel sadness, reluctance to engage in everyday activities, do not feel pleasure, and are often angry and gloomy. However, due to the absence of physical illnesses, people with dysthymia can work and function relatively normally in society. Dysthymia is determined by specialists based on symptoms such as low mood and apathy, which have been present in the patient for two years. Psychiatrists also pay attention to the presence of insomnia, appetite disturbances, increased fatigue, a feeling of weakness and decreased concentration. Such phenomena allow the doctor to diagnose dysthymia. This means that when a disease is identified, you need to choose the right treatment tactics. For this pathology, treatment must be comprehensive. It is advisable to apply an individual approach to each patient depending on the conditions in which he lives.

Diagnostics

To be diagnosed with dysthymia, a patient must have at least 3 of the following symptoms:

• decreased energy, activity, fatigue;
• sleep disorders, insomnia;
• low self-confidence;
• problems with concentration;
• decreased interest in sex and other pleasant things;
• hopelessness, despair;
• problems solving everyday problems;
• pessimism;
• social isolation;
• decreased productivity;
• crying, regret.

Patients also often suffer from physical symptoms. The disorder worsens in the simultaneous presence of chronic physical illness.

Prevention of pathology

Unfortunately, the answer to the question of whether dysthymia is completely curable is negative. Therapy is usually long-term, and recovery is rarely one hundred percent. The disease provokes many difficulties in work and personal life. Patients are often prone to suicidal thoughts and suicide attempts. Is it possible to prevent the occurrence of such a mental disorder? The answer to this question is positive, provided that the person follows the following recommendations:

1. You need to have hobbies and devote enough time to them.
2. You should follow a sleep schedule and get proper rest.
3. It is important to try to establish contact with family and friends and maintain social connections.
4. You need to lead a healthy lifestyle, give up addictions, and not neglect sports.
5. You should eat well and regularly.
6. You need to develop positive thinking in yourself.
7. You should discuss your problems with family, friends or a therapist.

   

Compliance with such preventive measures will allow a person to protect himself from the occurrence of mental disorders such as dysthymia.

Treatment of pathology

Unlike depression, dysthymia is less successfully treated with medication. Therefore, drug therapy is recommended only if other methods and procedures are ineffective.

Pharmacological treatment

Drug therapy consists of prescribing antidepressants aimed at capturing serotonin at receptors. According to the doctor's decision, drugs from the group of anxiolytics (medicines for relieving anxiety) and mood stabilizers are also used.

Medicines may have side effects. SSRIs can cause nausea, sexual dysfunction, increase anxiety at the beginning of treatment, and lead to long-term apathy. Concerns about the increased risk of suicide have led the US Drug Administration (FDA) to recommend warnings on these drugs. The increased risk of suicide has not been scientifically proven, but a small percentage of people taking the medications feel surprisingly worse than before starting treatment. All problematic changes must be reported to the doctor and the dates of visits must be observed. The risk of untreated depression is much higher than the risk of taking antidepressants.

It takes 2–6 weeks for antidepressants to take effect. It is important to adhere to the dosage prescribed by your doctor. It may take several months to achieve the full effect.

Psychotherapy

Psychotherapy is used as the first choice treatment approach, focusing on acquiring skills to combat melancholy, understanding its essence, and therefore preventing the duration and intensity of the symptoms of the disorder.

What is important is the patient’s ability to learn to cope with stressful situations, communicate with family and loved ones, who play a significant role in alleviating dysthymia. Treatment also consists of education, providing information about the nature of the disease, depression, eliminating self-critical thoughts, strengthening interpersonal relationships, self-confidence, and increasing self-esteem.

Treatment resistance

Treatment-resistant depression is a cause of decreased ability to work in patients. About 50% of people suffering from depressive disorder do not achieve remission after using antidepressants. They are classified as treatment resistant. Current pharmacological and psychotherapeutic strategies for treating this disorder have limited effectiveness, and new treatment options must be sought. The most commonly used therapeutic modalities are drug combinations or substitutions.

The reasons for the lack of effectiveness of treatment vary. These include:

• incorrect diagnosis (eg, lack of concomitant pathology);
• insufficient dose of antidepressants;
• short duration of drug use;
• low patient cooperation (about 50% of patients stop treatment prematurely or do not use the recommended dose of medication for various reasons);
• anxiety, stress associated with stigmatization;
• insufficient medicinal effectiveness;
• unpleasant side effects (sedation, poor health, weight gain, sexual dysfunction).

Here we are talking about pseudo-stability. Considering the above-mentioned factors, the European multicenter study also identified other clinical factors associated with treatment resistance. These include:

• comorbid personality disorder;
• comorbid anxiety disorder;
• early age of onset of the disease;
• insufficient response to the first antidepressant.

Alternative Treatments for Traumatic Rape Syndrome Relaxation

The disease is very difficult to treat, since there is a strong resistance to it, which is characterized by the constant presence of signs of mood disorders, but not leading to a depressive state.

It happens that depressive manifestations within the framework of dysthymia become more complicated and a clinical picture of severe depression is noted. This condition is called double depression.

There are reviews from patients that this disease responds well to treatment with Sertraline at a therapeutic dose of 50 mg per day. Patients often make mistakes when taking antidepressants from different groups or when unsystematic treatment was carried out in the early phases of treatment.

Dysthymia includes the following antidepressants in treatment: Amelipramine, Imipramine, Amitriptyline, Anafranil, Clomipramine.

Such drugs as Sulpiride and Amisulpriide give good results. Sulpiride is an atypical antipsychotic that has a moderate antipsychotic effect with a weak antidepressant and psychostimulant effect. It is necessary, under the supervision of doctors, to carry out consistent and correct treatment according to specially selected regimens.

Amisulpriide is an antipsychotic that belongs to the atypical antipsychotics. The antipsychotic effect is combined with a calming (sedative) effect.

Cognitive psychotherapy is of great importance in the treatment of dysthymia. Individual psychotherapy, group therapy, as well as support groups have successfully proven themselves, allowing the patient to develop interpersonal communication and assertiveness (open, direct behavior), increasing self-confidence.

https://www.youtube.com/watch?v=ytdev

Prevention of dysthymia includes timely detection of signs of this disease and increasing a person’s level of self-esteem.

In addition to any therapy, the patient should learn deep muscle relaxation or progressive relaxation. These techniques can help the victim overcome anxiety attacks, help him cope with sleep disturbances, and reduce the likelihood of outbursts of tearfulness and headaches (Rosenhan et al., 1989).

Prevention

Based on the information reviewed about what dysthymia is, it is clear that there are no real ways to prevent it. But there are some steps you can take. Because the disease often first appears in childhood, it is important to identify children at risk. It is useful to work with children, help them cope with stress, increase resilience, self-esteem, and create social support networks.

For adults, proper rest and relaxation are recommended (for both preventive and therapeutic purposes). Social activities, yoga, meditation, and physical exercise work well.

Factors provoking the disease

Pathology occurs as a result of various reasons - both external and internal. The main factors that trigger the development of the disease include the following:

1. Genetic predisposition. In families where cases of the disease have occurred, it can even occur in children. However, parents often confuse dysthymia with manifestations of the personal characteristics of their son or daughter.
2. Brain dysfunction (insufficient production of the hormone serotonin).
3. Nervous stress, troubles at work, difficulties in personal relationships.
4. Lack of sleep.

   

5. Unbalanced diet.
6. Unfavorable family environment, lack of parental attention or lack thereof (in minors).
7. Personal characteristics (increased anxiety, vulnerability).
8. Constant physical and emotional stress (for example, in military personnel).

So, dysthymia is a mental disorder that occurs under the influence of various factors. Therefore, each case must be considered individually.

Bottom line

Dysthymia is a chronic condition characterized by both isolated and recurrent episodes. Treatment of the disorder is one of the most pressing problems of modern medicine. In the world, this disease causes a high percentage of cases of decreased ability to work. The use of antidepressants in practice has revolutionized not only the treatment of dysthymia, but also the perception of it.

Despite a number of studies conducted to study the relationship between personality type and depression, the role of concomitant personality disorders in relation to the disease and its treatment remains a relatively little-studied problem.

IMPORTANT! Informational article! Before use, you should consult a specialist.

How to treat dysthymia?

To combat the symptoms of the pathology, doctors recommend drug therapy. As a rule, the patient is prescribed antidepressants that increase the production of serotonin. Most drugs used today do not cause serious side effects. In order to achieve tangible results, medications must be taken for about six months. To combat increased excitability and insomnia, sedatives are recommended. A visit to a psychotherapist plays an important role in the treatment of dysthymia. These can be individual, group or family sessions. Psychotherapeutic techniques allow the patient to better adapt to society, solve problems in relationships with others, and cope with stress.

Dysthymia - what is it and how does it differ from depression, treatment methods

Dysthymia is a type of depression that is characterized by persistent mood disturbances.
At one time or another, many people had to deal with its manifestation. The article describes the main symptoms that can help identify dysthymia. In addition, we suggest taking a test that will help determine whether you have been exposed to this disease.

So, what is dysthymia and is it possible to fight it?

Dysthymia: what is it?

What do psychologists say about the disease?

General information

Dysthymia is a chronic depressive disorder, also called minor depression. It occurs in a mild form, but is protracted - symptoms can appear over several years. The term was first used by psychiatrist R. Spitzer. Now this designation is being replaced by the terms psychasthenia and neurasthenia.

Who is at risk of getting sick?

It is believed that people with certain mental characteristics are more often predisposed to dysthymia. Sometimes the disorder occurs due to chemical disorders in the brain, due to insufficient production of serotonin, a hormone responsible for resistance to stressful situations.

Factors that provoke the disease

To date, there is no single expert theory about the factors that provoke this type of chronic depression.

The most likely hypothesis suggests a direct connection between the onset of the disease and changes in the chemical composition of substances that affect brain activity.

A key factor in the formation of depressive disorder is considered to be a deficiency of serotonin, which is the main neurotransmitter.

Factors that increase the chances of dysthymia

:

• Chronic somatic diseases.
• Regular exposure to stress factors.
• Individual properties of the nervous system and a number of personal characteristics.
• Difficult situations “from childhood” in the form of strict upbringing, loss of loved ones, social isolation.
• Incorrect rest and work schedule.
• Junk food, lack of diet.

Symptoms of dysthymia

The main symptom of the disease is considered to be chronically low mood. The situation with a general basement condition can be observed for two years or more.

Check out the list below. If you have two or more symptoms, you may have a disorder

:

• Sleep problems, manifested in the form of insomnia, early awakenings, obvious drowsiness during the day.
• Disturbed eating behavior caused by decreased appetite or excessive overeating.
• Constant lack of energy and fatigue.
• Low self-esteem, feelings of personal worthlessness, tendency to self-criticism, self-flagellation.
• A systematic feeling of emptiness, reluctance to think about anything.
• Slow reaction, distracted attention, inability to make quick decisions.
• Loss of interest in usual hobbies and reluctance to do what you once liked.
• Periodic headaches, cardiovascular diseases, joint pain, and other ailments that cannot be eliminated with medications.
• Pessimism, doubts about one's future.
• Thoughts about suicide.

Main types of dysthymia

Let's take a closer look at the two types of dysthymia:

Somatized dysthymia (cathesthetic)

This type of disorder is characterized by general poor health, rapid heartbeat, constipation, shortness of breath in the absence of physical activity, intermittent sleep, and tearfulness. The patient feels irrational anxiety.

Characterological dysthymia (characterogenic)

This type of illness is characteristic of a constitutionally depressive personality type. Feelings that an individual constantly experiences: a tendency to the blues, pronounced pessimism, constant thoughts and reasoning about the meaninglessness of life.

Dysthymia in a child

Diseases for which a child may be diagnosed with chronic dysthymia

:

• Social phobia.
• Severe chronic diseases.
• Manic-depressive disorder.
• Problems with the endocrine system.

In children, symptoms of dysthymia appear not only due to illness, but also after emotional or physical stress, as well as taking certain medications that were not approved by the doctor. The character of the child and his mental state can play a certain role.

Dysthymia in children is treated only by qualified specialists. Talk to your doctor and come up with a dysthymia treatment plan together. He will tell you how to get rid of possible complications and what to do as a preventive measure.

Doctors who will help you cope with the problem: psychologist, pediatrician, toxicologist, psychiatrist. The doctor will be able to identify parameters that contribute to the appearance of signs of dysthymia. After this, a course of treatment will be prescribed. Depending on the severity of the disease, drug treatment, group or individual therapy may be chosen. Do not delay diagnosis and treatment.

Cyclothymia and dysthymia: differences

Some people confuse cyclothymia and dysthymia. What are their differences?

Cyclothymia

Chronic instability of mental state, in which mild depression alternates with high spirits. Young people are usually susceptible to this instability.

Subsequently, it becomes chronic, but at times the mood can be normal for several months.

It is difficult to make a diagnosis if the patient is not seen by a specialist for a long period, and because of this, many people do not even suspect that they have an illness.

Dysthymia

With dysthymia, there are no long periods of elation or normalization of mood.

At the same time, some patients may evaluate some periods as relatively good, but even during them they continue to feel tired and lack of energy.

That is, the main difference is that a person almost constantly feels oppressed. Of course, such a condition is much easier for doctors to identify than cyclothymia.

Seasonal dysthymia

Some people experience seasonal dysthymia without always noticing it. As the name implies, the disease comes with the change of season. Typically, during the autumn period, changes in mood, sleep patterns, appetite, and energy levels are observed. It is believed that about 2% of people are susceptible to deep seasonal depression. Milder forms are typical for 15% of people.

Signs of summer affective disorder (it is not so common): insomnia, anxiety, poor appetite.

Signs of winter affective disorder: overeating, drowsiness, cravings for foods high in carbohydrates, narrowing the circle of social contacts.

Treatment and prevention of pathology

Dysthymia is treated with psychotherapy and medication. Antidepressants are among the main group of medications that help combat the disorder. Many patients are wary of these drugs, but modern antidepressants for the most part do not carry the negative side effects that the drugs were characterized by before.

Shortly before the start of therapy, the doctor prepares the patient for the fact that the course will take a certain time - this is not a matter of two or three days. The main task is to eliminate the patient’s symptoms of the disease, as well as consolidate a positive result.

The doctor individually determines the dosage of the medicine and its immediate choice in each specific case. The specialist also determines the duration of treatment.

Dysthymia is a mental disorder that can be easily corrected. The sooner you decide to seek help, the faster you can achieve success in treatment.

Subsequent prevention of the disorder will also be determined by the doctor depending on the individual characteristics of the course of the disease. Usually it is aimed at a healthy lifestyle, increasing self-esteem, maintaining a sleep, work and rest schedule, and a balanced diet.

Dysthymia test

We suggest taking a fairly simple test that will help you determine whether you have dysthymia. So, read the questions and give yourself one point for each positive answer.

Questions

:

• Does it take a lot of effort to make you happy?
• Do you often notice that you are in a depressed mood?
• When you smile, don't you always actually feel happy?
• Do you find it difficult to switch off from all your worries and start having fun?
• Do your everyday life go by without expecting any joys from life?
• Do you tend to be pessimistic about your own life?
• Do you often think about something unpleasant?
• Do you think your life is very difficult?
• Do you consider your own life to be meaningless?
• Do you lose your temper easily and despair when you fail?
• Do you often feel guilty?
• Is your conscience tormenting you because of past mistakes?
• Can you be called an insecure person?
• When talking about your failures, do you feel ashamed and uncomfortable?
• Do you not really like to talk a lot and prefer to remain silent in conversations?
• Are you cool with telling jokes?
• Do you feel discomfort when being in the company of confident and happy people?
• Is sunny weather not having any positive effect on your overall mood?

Now count up all positive answers in points

:

• 0-11
  – you don’t have to worry about having dysthymia.
• 11-14
  – you are close to dysthymia or its initial stage.
• 15-18
  – you undoubtedly have dysthymia, which can turn into serious depression, so be sure to take action.

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Source: https://PsyLogik.ru/96-distimija.html

Dysthymia

Dysthymia is characterized by chronic nonpsychotic signs and symptoms of depression that meet specific diagnostic criteria but do not meet criteria for major depressive disorder. Dysthymia means “bad mood,” and these patients are characterized by introversion, moodiness, and low self-esteem. Patients who experience mild episodes of depression occasionally rather than constantly are not considered to have dysthymic disorder. Disorders such as recurrent dysthymia are classified as depressive disorders not otherwise specified (NDD) or unspecified according to the DSM-III-R.

Dysthymia has had a number of other names in the past. Although each term had its own meaning and history, they all described mixed groups of patients. Dysthymia defines temperament-dependent dysphoria, an innate tendency to be in a bad mood. In contrast, neurotic depression (also called depressive neurosis) involves a disorder of adaptation, persistent thinking and behavior that results in depression. Patients believed to suffer from depressive neurosis are often anxious, obsessive, and somatizing. Characterological depression implies that dysphoric mood is a character trait. The term "hypochondriacal depression" is sometimes used to emphasize that a feature of this condition is a variety of somatic complaints. It is more correct to say that such patients suffer from a disorder in the form of somatization or dysthymia.

Epidemiology

Because the DSM-III1-R diagnostic definition for dysthymia is relatively new, epidemiological data for this disorder are lacking. However, both clinical impressions and research data suggest that dysthymia is a relatively common disorder. It is believed to occur in the population with a frequency of 45 per 1000, and its incidence in mentally ill patients is approximately 10%. This disorder occurs more often in women than in men.

Etiology

Biological factors. Some patients with dysthymia who have a family history of mood disorders report decreased FBS latency and a positive response to antidepressant treatment. They really look like patients with a subaffective syndrome, which has a common genetic and pathophysiological basis with severe depressive syndrome. One study, however, reported that the dexamethasone suppression test and thyrotropin-releasing hormone test were not impaired in dysthymic patients as a group as a whole. However, a patient with dysthymia who has abnormal neuroendocrine tests is a candidate for antidepressant treatment.

Psychosocial factors . DSM-III1-R identifies a subtype of dysthymia with onset before age 21 years. In contrast to theories that the early onset of dysthymia is a manifestation of innate temperament, psychodynamic theories view dysthymia as the result of personality imperfections and ego-dependence, the culmination of which occurs when faced with difficulties of adaptation to the conditions of adolescence and young adulthood. Karl Abraham suggested that depressive conflicts center around oral- and anal-sadistic tendencies. Anal tendencies manifest themselves in excessive subservience, guilt, and concern for others; they are believed to be a defense against anal predominance, disorganization, hostility and self-absorption. The strongest defense occurs in the reactive formation. Low self-esteem, anhedonia and introversion are often combined with a depressive personality.

Sorrows and melancholy . Freud believed that vulnerability to depression could be caused by disappointments in interpersonal relationships in early childhood, leading to ambivalence in love when the patient became an adult, and that real or perceived losses in adulthood then caused depression. Subjects prone to depression are oral dependent and require constant narcissistic pleasure. If they are deprived of such love, recognition, care, they show clinical signs of depression. When such subjects experience a real loss, they internalize or project onto themselves the lost object and direct their anger towards it and thus against themselves.

According to the cognitive theory of depression, there is a discrepancy between the actual situation and the situation imagined by the subject, which leads to decreased self-esteem and a feeling of helplessness. A recent report found that patients with dysthymia experience increased neuroticism, self-harm, and torturing others, as well as decreased self-esteem.

Clinical signs and symptoms

Here are the clinical signs and symptoms of dysthymia as defined in DSM-III-R. A. Depressed mood (or irritable mood in children and adolescents) most of the day, on more days than self-reported or observed as non-depressed, for at least 2 years (1 year for children and adolescents).

B. The presence of at least two of the following factors while the patient is depressed:

1. poor appetite or overeating;
2. insomnia or excessive sleepiness;
3. low energy or fatigue;
4. low self-esteem;
5. decreased ability to concentrate or difficulty making decisions;
6. feeling of hopelessness.

B. During a 2-year period (1 year for children and adolescents) of the presence of the disorder, there is no absence of the symptoms listed in point A for more than 2 consecutive months.

D. Absence of an obvious attack of major depressive disorder during the first 2 years (1 year for children and adolescents) from the onset of the disease.

Note: It is possible to have a history of episodes of major depressive disorder followed by complete remission (no significant signs or symptoms for 6 months) before developing dysthymia. After 2 years (1 year in children and adolescents) of dysthymia, episodes of severe depression may be superimposed; in this case, both diagnoses are made.

E. Absence of a manic episode (see Diagnostic Criteria for a Manic Episode) or a distinct hypomanic episode (see Diagnostic Criteria for Bipolar Disorders Not Else Classified).

E. The condition of dysthymia is not superimposed on a chronic psychotic disorder, such as schizophrenia or delusional disorder.

G. The presence of an organic factor that could underlie and maintain the disorder (for example, long-term administration of antihypertensive drugs) has not been established. Determine whether the type is primary or secondary: Primary type: The mood disorder is not associated with a pre-existing, chronic, non-mood, Axis I or Axis III disorder, eg, anorexia nervosa, somatogenic disorder; substance abuse disorder, anxiety disorder, or rheumatoid arthritis. Secondary type: The mood disorder is clearly related to a pre-existing, chronic, non-mood, Axis I and Axis III disorder.

Define early or late onset: Early onset: onset before age 21 years.

Late onset: Onset of disease at age 21 or older. Features of mental status examination are the same as for major depressive disorder. Those with dysthymia may experience depressive symptoms that are nearly as severe as those with major depressive disorder; however, their duration does not meet the diagnostic criteria for a major depressive episode. Dysthymia is considered as a chronic disease, and does not occur in the form of attacks with intervals of time during which there are no pathological symptoms. However, dysthymic individuals may exhibit temporary fluctuations in symptom severity. The main symptom is a depressive mood, characterized by a feeling of sadness, seeing the world in black, sinking into the blues, and a decrease or lack of interest in normal activities. Patients with dysthymia are often sarcastic, nihilistic, brooding, demanding, and complaining. Therefore, doctors sometimes get irritated and do not even believe the complaints of such patients. Dysthymic patients, by definition, do not have psychotic symptoms.

Symptoms associated with dysthymia include changes in appetite and sleep, decreased self-esteem, loss of energy, psychomotor retardation, decreased sexual desire, and excessive concern for one's health. Patients sometimes complain that they have difficulty concentrating and that work or school is a torment for them. Pessimism, hopelessness and helplessness give dysthymic patients the appearance of being masochists. However, if the pessimism of these patients is directed outward, then they can be indignant at the whole world, complain about the poor treatment of them by relatives, children, parents, colleagues and the “system”.

Disturbances in social activities sometimes force the patient to consult a psychiatrist. Patients with dysthymia may also have difficulties in family life due to the patient's emotional inability to maintain intimate relationships or due to sexual dysfunction (eg, impotence). Social withdrawal and difficulty concentrating interfere with patients' ability to work. They often do not go to work or perform social duties due to physical illness. All this very often leads to divorce, dismissal from work, and poor performance at school.

Example.

A junior administrator, 28 years old, was recommended to undergo “maintenance” therapy after visiting a doctor. The girl received a degree in administrative affairs and moved to California more than 1 year ago and began working in a large company. She complained that she felt “depressed” about everything: about her job, her husband, her prospects for the future.

She had previously undergone intensive psychotherapy. She visited the “analyst” 2 times a week during 3 years of college and the “behaviorist” for a year and a half during graduate school. The patient complained of a constant feeling of depression, depression and pessimism, which began at the age of 16-17 years. Although she did reasonably well in college, she constantly wondered about those students who were truly "bright." She had dates during college and graduate school, but the patient noted that she would never choose someone who she described as “special” as a companion, so as not to feel inferior and timid. As soon as a girl met such a person, she remained adamant and walked away as quickly as possible, then reproaching herself and dreaming about him for many months. She believed that these tactics helped her, although she could not remember a period of time when she was not depressed.

Shortly after graduate school, she married a man she had been dating for some time. She had moderate feelings for him, did not consider him “special” and married because she “needed a husband” as a companion. Soon after their marriage, the couple began to quarrel. She didn't like the way he dressed, his job, or his parents; he, in turn, found her too domineering, picky and gloomy. She felt that she had made a mistake by marrying him.

Recently she has had difficulties at work. She performed the most insignificant jobs at the company, and she was never entrusted with significant or prestigious matters. She admits that she was often careless in completing the work assigned to her, never did more than what she was told, and never showed persistence or initiative in front of management. She felt that she would never advance in her career because she did not have the necessary “connections,” and she thought the same about her husband, and yet she dreamed of money, position and power.

The patient and her husband communicated with several other married couples. Usually the men in these couples were her husband's friends. She was sure that women found her uninteresting, unexpressive, and that the people who treated her well were no better than her.

Under the burden of dissatisfaction with her marriage, her job and social position, a feeling of fatigue and dissatisfaction with “life” appeared; in this state, she sought help from a doctor for the third time.

DSM-III1-R Diagnosis: Axis I: Dysthymia Disorder Discussion. This woman's family life and professional activities were affected by chronic depression, low self-esteem and pessimism. Although she currently complains of a loss of interest and energy, this appears to be a common condition for her. Because her depression was not severe enough to meet the criteria for a major depressive episode, and her mood disorders and associated symptoms had persisted for more than 2 years, a diagnosis of dysthymia disorder was made.

Alcohol and drug abuse . Alcohol and drug abuse always presents a dilemma for the physician. This abuse may itself develop as a result of dysthymia, and conversely, alcohol and drug abuse may result in symptoms that are indistinguishable from those seen in dysthymia. However, treatment of primary dysthymia can lead to the elimination of alcohol and drug dependence syndrome.

Course and prognosis

The course and prognosis of dysthymia depend to some extent on the subtype of this disorder. The prognosis of secondary dysthymia depends on the course of the primary disorder. On the contrary, with early onset of primary dysthymia, the course can be so chronic that the patient perceives pathological symptoms as part of his nature. Early onset of primary dysthymia, especially with a poor family history, can progress to major depressive disorder. Studies conducted in patients diagnosed with depressive neurosis have shown that approximately 20% develop major depressive disorder, 15% develop major depressive episode with hypomanic episodes (i.e., bipolar II disorder), and less than 5% develop major depressive disorder with hypomanic episodes (i.e., bipolar II disorder). bipolar disorders develop. In addition to a family history of mood disorders, a positive response to antidepressant therapy is also a factor indicating the possibility of developing major depressive disorder in the future. In late-onset primary dysthymia, the type of onset, prognosis, and course can vary significantly.

Suicides . Suicide is possible in most mental disorders, but the proximity of dysthymia to depression causes particular concern. It is necessary to carefully collect anamnesis regarding previous suicide attempts, family history of suicide, and suicidal ideation in the patient to assess his suicidal potential. When treating these patients with psychopharmacological drugs, it must be remembered that the presence of large doses of these drugs in the patient can be used for the purpose of suicide.

Diagnosis and subtypes

The diagnosis of dysthymia is made based on the presence of specific criteria outlined in the DSM-III-R. The symptoms included in criterion A must have been observed within the last two years (1 year for children and adolescents); the period of absence of symptoms should not exceed 2 months. Although major depressive disorder may not be present during the first two years of dysthymia symptoms, dysthymia is diagnosed only when complete remission has occurred after an initial major depressive episode within 6 months before dysthymia symptoms develop. If a major depressive episode occurs 2 years or more after the onset of dysthymia symptoms, the patient is given both diagnoses. The presence of symptoms of dysthymia and major depressive disorder is called “double depression” by some doctors. These patients typically experience more frequent and severe depressive episodes than patients without dysthymia. Criteria that do not meet the diagnosis of dysthymia include a family history of hypomania, psychotic symptoms, or residual schizophrenia. If a patient with symptoms of dysthymia has a specific organic factor that can cause these symptoms, or they can be caused by the use of a certain drug, then the diagnosis of dysthymia is excluded. As mentioned above, there are also primary or secondary subtypes and early or late onset.

DSM-III-R recommends multiple diagnoses, if necessary. Secondary dysthymia can be diagnosed in the same way as other Axis I or Axis III disorders (i.e., medical illnesses). Primary dysthymia is diagnosed as an Axis II personality disorder when dysthymia is secondary to an underlying personality disorder.

Differential diagnosis Symptoms similar to those observed in dysthymia may occur in some organic and idiopathic disorders. If a patient exhibits symptoms of dysthymia, especially if these symptoms have been observed for a period of time less than 2 years, all of the following differential diagnoses should be considered: diseases of organic etiology - physical illness (cancer, heart disease), drug use, drug dependence syndrome any substance; severe depressive disorder; bipolar disorder; depressed or mixed type; cyclothymia, generalized mood disorder; anorexia nervosa; bulimia; obsessive-compulsive disorder; ego-dystonic homosexuality; personality disorders - borderline states, dependent type, tendency to act out ideas; somatogenic disorders.

Treatment

Hospitalization is usually not indicated for patients with dysthymia; however, in the presence of severe clinical manifestations, severe social and professional disorders, as well as suicidal thoughts, patients should be hospitalized. Although many clinicians believe that dysthymia is difficult to treat with psychopharmacological drugs, it should be resorted to if treatment with psychotherapy alone is ineffective, as well as if there is a family history of severe symptoms and mood disorders, decreased FBS latency on the sleep EEG, and abnormal neuroendocrine parameters. tests. First, heterocyclic antidepressants are usually used (possibly with the addition of lithium or T3). You can start with monoamine oxidase inhibitors if the pathological symptoms are dominated by insomnia, hyperphagia, severe anxiety and a multiplicity of somatic complaints - a syndrome sometimes called atypical depression or hysterical dysphoria. If heterocyclic antidepressants and monoamine oxidase inhibitors are ineffective, treatment with lithium alone may be recommended. The use of sympathomimetics, such as phenamine (5-15 mg / day), can also have a good effect, if care is taken when prescribing these drugs so as not to cause addiction.

As a psychotherapy, individual-oriented psychotherapy ; there is a lot of evidence that it has the most pronounced effect in dysthymia; however, this type of therapy should sometimes be combined with pharmacotherapy. This psychotherapeutic approach is based on attempts to connect the development and persistence of depressive symptoms with the characteristics of personality disorder to unresolved conflicts in early childhood. Treatment can address the presence of equivalents of depression, such as addiction to certain substances or childhood disappointments as precursors to adult depression. The patient's ambivalent relationships with his parents at the moment, as well as with friends and other persons surrounding him at the present time, are explored. It is very important in this therapy, which is focused on developing criticism of one’s condition, to know how the patient is trying to satisfy an excessive need for approval from others and cope with low self-esteem and superego problems. Other types of psychotherapy used for dysthymia include interpersonal, cognitive and behavioral therapy.

Interpersonal therapy for depression ( IMT ) . The patient's interpersonal relationships at a given time and the ways in which he copes with stress are examined, with the goal of reducing depressive symptoms and increasing self-esteem. MAT is given over a course of approximately 15 weeks and can be combined with antidepressant therapy.

Behavioral therapy . Behavioral therapy for depression is based on the theory that depression is caused by the loss of positive reinforcement due to separation, death, or sudden change in environment. Various treatment methods are aimed at achieving the following goals: increasing activity and promoting pleasant sensations, teaching the patient to relax. It is believed that the most effective way to combat depressive thoughts and feelings is to change the behavior associated with these manifestations in patients with depression. Behavioral therapy often uses what is called "learned helplessness" in some of these patients, who are ready to face any challenge in life with a feeling of powerlessness. There is considerable overlap between different behavioral approaches.

Cognitive therapy . Cognitive therapy is a method by which the patient is taught to think and behave in such a way as to eliminate painful negative attitudes towards himself, the world and his future life. This is short-term therapy focused on current problems and their resolution.

Family therapy can help both the patient and his family in the fight against this disorder, especially in cases where there is a biologically determined subaffective syndrome. Group therapy can help the patient overcome interpersonal problems in their social life.

Characterological dysthymia

This form of mental disorder is characterized by the constant presence of a pessimistic mood. Patients do not receive satisfaction from everyday events and feel sad all the time.

Previously, these characteristics were considered personality manifestations. Today, mental health professionals are not convinced that this view is correct. Psychiatrists believe that constant pessimism indicates the presence of dysthymia. It should be added that, in addition to depression, the condition of such patients is characterized by periodic statements about the hopelessness of life and their own uselessness.

Patients look lethargic, sad, apathetic, they take even minor troubles to heart. Such people grumble all the time, they are dissatisfied with their surroundings, are uncritical of their own condition, and tend to blame others for all troubles. Because of this behavior, even family and friends who used to empathize with the sick begin to shun them over time.