What is Dysthymia? Symptoms, Diagnosis and Treatment 

Introduction. Dysthymia or Persistent Depressive Disorder (PDD)

The old term “Dysthymia” called in the new nomenclature “Persistent Depressive Disorder” (PDD), is a form of long-lasting depression. It has similar symptoms as the clinical depression (Major Depressive Disorder (MDD), but their last longer.

Despite the less severe symptoms compared to Major Depressive Disorder dysthymia may have even more debilitating effect on the individual’s life.

In DSM-5 the diagnosis “Dysthymia” has been replaced with the diagnosis “Persistent Depressive Disorder”. This term comprises the former diagnosis of Chronic Major Depressive Disorder and the old diagnosis “Dysthymic Disorder”. The common diagnosis for both entities has been created due to no significant differences between the two conditions.

Symptoms of dysthymia

Since dysthymia is a chronic disorder, individuals may experience symptoms for years before receiving a diagnosis. They tend not to discuss their symptoms with doctors, believing that it’s part of their character. The condition is characterized by an extended period of depressed mood and at least two additional symptoms, such as insomnia or fatigue. Individuals may also experience low self-esteem, feeling hopelessness and easy irritable. The patients can also have difficulty concentrating or making decisions.

Mild dysthymia may cause people to withdraw from stressful situations, while more severe cases may result in a withdrawal from daily activities and a lack of enjoyment in daily life.

Diagnosing dysthymia

Making the diagnosis for dysthymia can be challenging due to the subtle nature of symptoms. Secondly the patients may hide the symptoms in social situations, making it difficult for others to detect them. The other diagnostic problem is that dysthymia often occurs alongside other psychiatric disorders. often overlapping its symptoms. Comorbid with dysthymia are such psychiatric disorders as panic disorder, generalised anxiety disorder, alcohol and substance use disorders, PTSD, bipolar disorder, and personality disorders.

Suicidal behaviour is also a particular problem for those with dysthymia, making early diagnosis and treatment critical. Persistent Depressive Disorder can have long-lasting effects on an individual’s life, leading to isolation and a decreased quality of life.

DSM 5 criteria for dysthymia

The criteria for persistent depressive disorder (dysthymia) include:

1.           Depressed mood for most of the day, for more days than not, for at least two years (one year for children and adolescents).

2.           Presence of two or more of the following symptoms:

•            Poor appetite or overeating

•            Insomnia or hypersomnia

•            Low energy and low self-esteem

•            Poor concentration or difficulty making decisions

•            Feelings of hopelessness

3.           During the two-year period (one year for children and adolescents), the individual has never been without the above symptoms for more than two months at a time.

4.           The illness causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

5.           The symptoms are not due to a substance or medical condition, nor are they better explained by another mental disorder.

It is important to note that the DSM-5 criteria for dysthymia have replaced the previous DSM-IV criteria, which referred to dysthymia as a different disorder. In the DSM-5, persistent depressive disorder encompasses both chronic major depressive disorder and the previous dysthymic disorder.

Causes of dysthymia

We are not able to clearly identify the root causes of dysthymia. However, evidence suggests a genetic predisposition, with depression occurring in up to fifty percent of families with early onset of the symptoms. Other factors linked to dysthymia include stress, social isolation, and lack of social support. In a study using identical and fraternal twins, results indicated a stronger likelihood of both identical twins having depression than fraternal twins, suggesting that heredity plays a role in the development of dysthymia.

Treatment for dysthymia

While the exact cause of dysthymia remains unknown, early diagnosis and treatment can help manage symptoms and improve overall quality of life. It is vital to seek medical attention if experiencing symptoms of dysthymia. The outcome of treatment of dysthymia is lower than for the acute form of depression and tends to last longer. The best results can be achieved by the combination of pharmacotherapy and psychotherapy.

Psychotherapy

Psychotherapy is one of the treatment options. In fact, cognitive-behavioral therapy (CBT) is the most studied type of therapy. Psychodynamic psychotherapy has been used to treat PDD, but there is a lack of empirical evidence for their effectiveness.

While psychotherapy alone can be effective, pharmacotherapy is generally more effective in direct comparisons. However, a combination of psychotherapy and medication is proved to be the most effective approach. Ultimately, the choice of treatment depends on the individuals and their specific needs, as well as the severity of their symptoms.

Pharmacotherapy

In direct comparison to psychotherapy pharmacotherapy (treatment with medication) turned to be more effective. Antidepressants, specifically SSRIs, are often prescribed as a first-line treatment due to their tolerable nature. The most commonly prescribed antidepressants for dysthymia include escitalopram, citalopram, sertraline, fluoxetine, paroxetine, and fluvoxamine. However, it takes an average 6-8 weeks before the patients feel the therapeutic effects. Patients with dysthymia often need to try different brands of medication before finding one that works for them. In some cases, a combination of different antidepressants with different mechanisms of action may be necessary. In therapy resistent cases using the augmentation with lithium, lamotrigine, or thyroid hormones may be successful.

Combining medication with psychotherapy

It’s important to note that medication alone may not be enough to effectively treat dysthymia. In fact, a combination of medication and psychotherapy may be the most effective approach. While medication can help manage symptoms, therapy can help address underlying issues, creating an insight, and providing coping mechanisms. However, finding the right medication and dosage can take time. The second challenge can be the treatment resistance due to dysthymia’s chronic nature. Therefore, it’s crucial to work with an experienced psychiatrist to ensure the proper choice of medication and to avoid potential side effects.

Conclusion

Dysthymia is a chronic form of depression with ongoing feelings of sadness, hopelessness, helplessness, and irritability. The dysthymic symptoms last longer but they are less pronounced than those of Major Depressive Disorder (MDD).

Although there is no clear cause of dysthymia, psychiatrists believe that dysthymia is a multifactorial disorder with underlying genetic predisposition and triggering factors such as childhood trauma and environmental circumstances.

Due to its chronic nature dysthymia can have a significant impact on a person’s life. Early diagnosis and treatment are critical to managing symptoms and improving overall quality of life. Without treatment, the symptoms can persist for years. The effective treatment for dysthymia consists of medication or psychotherapy, or combination of both.