Dysthymia Depression
also know on chronic depression
dysthymia or persistent depressive disorder

Criteria for Dysthymia or PDD

The clinical criteria for what we think of Dysthymia disorder and what is now called PDD is as follows:

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.

Note: In children and adolescents, mood can be irritable and duration must be at least 1 year

. B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.

D. Criteria for a major depressive disorder may be continuously present for 2 years.

E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism). H. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.

Although we often think of Dysthymia depression as less severe, it’s chronicity or the length of time a person suffers from it, can have even more damaging effects than a person with a single or multiple episodes of major depression with recovery periods in between. Long term or chronic, persistent depression, seems to be associated with worse outcomes.

Facts about Dysthymia Depression

• • According to research on dysthymic depression, most cases occur before the age of 21.
  • Struggling with depression at a young age can be a predictor of having a struggle with the illness in later life. This suggests it’s important to get into therapy and develop healthy coping mechanisms early and tools to combat your depression.
  • Risk factors include early trauma, a family history of depression, and ADHD.
  • It appears to have a genetic component. It is common in people who have first degree relatives with major depression. If you have parents who have depression, you are more likely to be diagnosed with this.
  • Dysthymic depression relates to higher risk of substance abuse in later life.
  • Dysthymic depression is more common in females than males.
  • There is a high degree of impairment in the quality of life functioning and social support as well as struggles in marriage among people who have dysthymia depression.
  • Some of people diagnosed with dysthymia that will convert to bipolar disorder
  • It negatively affects workplace performance, salary, and close relationships with friends.
  • Chronic depression has been shown to reduce the effectiveness of your immune system and is related to inflammation, it has been shown to cause neurological changes in the brain, and cognitive distortions, which can further exacerbate these risks.

• People with chronic depression are at a higher risk of developing diabetes and arthritis. Also, other mental health illnesses and suicidality.

Despite all these facts, when I work with women in therapy with dysthymia depression they often  function and are often are unaware that they are suffering from depression. A major depressive episode can be a serious dramatic departure from functioning, but dysthymic depression is so chronic that it can seem like a personality. In fact, much has been written about difficulty distinguishing between Dysthymia and depressive personality disorder. It is difficult, depressive personality

disorder consists of a negative outlook on life, being self critical and pessimistic.

Further, complicating all of these diagnostic issues, especially for children is the issue of the symptom of apathy. Apathy often appears as no motivation and goal directed activity. In children and adolescents, this event often looks like laziness. So often I have parents come in and they are treating their depressed child with punishment because they are perceiving them as lazy, when in fact they are experiencing the symptom of apathy as a result of their depression.

Therapy and Treatment

Dysthymia Depression is one of the most important diagnoses for women to  get therapy for, because of the seriousness of it and the long term impact on a person’s sense of self worth and quality of life. Early identification and treatment are associated with the best outcome.

Therapy for Dysthymic depression consists of :

• Improving the symptoms that you are presenting with,
• Helping you or your child to connect with a social network,
• Improving your workplace relationships, friendships, and marriage, Improving  your functioning and overall quality of life.
• Your therapist should help you to focus on improving your sense of hopelessness, and identify false beliefs and unfriendly views of people and the world and how that influences the way you think act and feel.
• Therapy  should help you identify how you or your depression is interfering with you or your child’s ability to engage in the things that are valuable to you.
• Treatment   will also often include an antidepressant, as research has shown dysthymia disorder responds best to therapy and antidepressants in combination.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Johnson, D., Dupuis, G., Piche, J., Clayborne, Z., & Colman, I. (2018). Adult mental health outcomes of adolescent depression: A systematic review. Depression and Anxiety, 35(8), 700-716. doi:10.1002/da.22777

Junko Ishizaki and Masaru Mimura, “Dysthymia and Apathy: Diagnosis and Treatment,” Depression Research and Treatment, vol. 2011, Article ID 893905, 7 pages, 2011. https://doi.org/10.1155/2011/893905.

More at the National Institute of Mental Health

Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.