Dysthymia , now known as persistent depression disorder ( PDD ), is a mood disorder consisting of the same cognitive and physical problems as depression, with more fewer symptoms but more durable. This concept was coined by Robert Spitzer as a substitute for the term "depressive personality" in the late 1970s.
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 1994 (DSM-IV), dysthymia is a serious state of chronic depression, lasting for at least two years (one year for children and adolescents). Dysthymia is less acute and severe than major depressive disorder. Because dysthymia is a chronic disorder, patients may experience symptoms for years before being diagnosed, if the diagnosis occurs at all. As a result, they may believe that depression is part of their character, so they do not even discuss their symptoms with doctors, family members or friends.
Dysthymia often coincides with other mental disorders. "Double depression" is the occurrence of severe depression episodes other than dysthymia. Switching between periods of dysthymic atmosphere and periods of hypomanic mood is an indication of cyclothymia, which is a mild variant of bipolar disorder.
In DSM-5, dysthymia is replaced by persistent depressive disorders. These new conditions include major chronic depressive disorder and previous dysthymic disorders. The reason for this change is that there is no evidence for meaningful differences between these two conditions.
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Video Dysthymia
Signs and symptoms
The characteristics of Dysthymia include a long period of depression feeling combined with at least two other symptoms that may include insomnia or hypersomnia, fatigue or low energy, eating changes (more or less), low self esteem, or feelings of despair. Poor concentration or difficulty making decisions are treated as another possible symptom. The mild degrees of dysthymia can cause people to withdraw from stress and avoid opportunities for failure. In the case of more severe dysthymia, people can even withdraw from daily activities. They will usually find a bit of fun in their usual activities and entertainment. Diagnosis of dysthymia can be difficult because of the subtle nature of the symptoms and patients can often hide them in social situations, making it challenging for others to detect symptoms. In addition, dysthymia often occurs at the same time as other psychological disorders, which adds to the level of complexity in determining the presence of dysthymia, especially as there is often overlap in the symptoms of the disorder. There is a high incidence of comorbid disease in those with dysthymia. Suicidal behavior is also a special issue with people with dysthymia. It is important to look for signs of major depression, panic disorder, generalized anxiety disorder, alcohol and substance abuse and personality disorder.
Maps Dysthymia
Cause
There is no known biological cause that applies consistently to all cases of dysthymia, which indicates the origin of various disorders. However, there are some indications that there is a genetic predisposition for dysthymia: "The rate of depression in a family of people with dysthymia is as high as fifty percent for the early onset form of the disorder". Other factors associated with dysthymia include stress, social isolation, and lack of social support.
In a study that used identical and fraternal twins, the results suggest that there is a stronger likelihood of identical twins depressed than fraternal twins. This provides support for the idea that dysthymia is partly caused by hereditary factors.
Co-happening condition
"At least three quarters of patients with dysthymia also have chronic physical illness or other psychiatric disorders such as an anxiety disorder, cyclothymia, drug addiction, or alcoholism". Common common conditions include severe depression (up to 75%), anxiety disorders (up to 50%), personality disorders (up to 40%), somatoform disorders (up to 45%) and substance abuse (up to 50%). People with dysthymia have a higher than average chance of developing severe depression. A 10-year follow-up study found that 95% of dysthymia patients had episodes of severe depression. When episodes of intense depression occur over dysthymia, the state is called "double depression."
Double depression
A double depression occurs when a person experiences a major depressive episode over an existing dysthymia condition. It is difficult to treat, because patients receive these major depressive symptoms as a natural part of their personality or as part of their lives that are beyond their control. The fact that people with dysthymia may receive these worsening symptoms as inevitable may delay treatment. When and if such people seek treatment, treatment may not be very effective if only major depressive symptoms are treated, but not dysthymic symptoms. Patients with dual depression tend to report a much higher level of despair than normal. This can be a useful symptom for mental health care providers to focus on when working with patients to treat the condition. In addition, cognitive therapy can be effective for working with people with dual depression to help change negative thinking patterns and give individuals new ways to see themselves and their environment.
It has been suggested that the best way to prevent double depression is to treat dysthymia. Combination of antidepressants and cognitive therapy may help in preventing major depressive symptoms from occurring. In addition, exercise and good sleep hygiene (eg, improving sleep patterns) are considered to have an additional effect on the treatment of dysthymic symptoms and prevent them from worsening.
Pathophysiology
There is evidence that there may be early-onset neurological indicators of dysthymia. There are several different brain structures (corpus callosum and frontal lobes) in women with dysthymia compared to those without dysthymia. This may indicate that there is a developmental difference between the two groups.
Another study, which used fMRI techniques to assess differences between individuals with dysthymia and others, found additional support for neurological indicators of the disorder. The study found several areas of the brain that function differently. The amygdala (associated with processing negative emotions such as fear) is more active in dysthymia patients. The study also looked at increased activity in the insula (which is associated with sad emotions). Finally, there is an increase in activity in the cingulate gyrus (which serves as a bridge between attention and emotion).
A study comparing healthy individuals with people with dysthymia suggests there are other biological indicators of the disorder. The anticipated results arise when healthy individuals expect fewer negative adjectives to apply to them, whereas people with dysthymia expect fewer positive adjectives to apply to them in the future. Biologically these groups are also distinguished in healthy individuals showing greater neurological anticipation for all types of events (positive, neutral, or negative) than those with dysthymia. This provides neurological evidence of the easing of emotions that people with dysthymia have learned to protect themselves from too strong negative feelings, compared to healthy people.
There is some basic genetic evidence for all types of depression, including dysthymia. A study that uses identical and fraternal twins suggests that there is a stronger likelihood of identical twins being depressed than fraternal twins. This provides support for the idea that dysthymia is partly caused by hereditary factors.
A new model recently appeared in the literature on the HPA axis (a structure in the brain that can be activated in response to stress) and its involvement with dysthymia (eg phenotypic variations of corticotropin release hormone (CRH) and arginine vasopressin (AVP), and down-regulation of adrenal function) as well as the cerebellar brain mechanism. Because this model is very provisional, further research is still needed.
Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), published by the American Psychiatric Association, characterizes dysthymic disorders. Important symptoms involve the feeling of depressed individuals for most of the day, and part of the day, at least for two years. Low energy, sleep disturbances or appetite, and low self esteem usually contribute to a clinical picture as well. Patients often have dysthymia for years before being diagnosed. The people around them often describe the sufferer in words that are similar to "just a moody person". Note the following diagnostic criteria:
- For most of the day for two or more years, adult patients report a depressed mood, or appear depressed to others for most of the day.
- When depressed, the patient has two or more:
- decreases or appetite increases
- decreased or increased sleep (insomnia or hypersomnia)
- Fatigue or low energy
- Reduce self-esteem
- Decrease in concentration or problem making decisions
- Feelings of despair or pessimism
- During this two-year period, the above symptoms have not been absent for more than two consecutive months.
- During the duration of a two-year period, patients may experience episodes of lasting great depression.
- The patient has not had a manic, hypomanic, or mixed episode.
- Patients never meet the criteria for cyclothimic disorders.
- Depression does not exist only as part of chronic psychosis (such as schizophrenia or delusional disorder).
- Symptoms are often not directly caused by medical illness or by substance, including substance abuse or other drugs.
- The symptoms may cause significant problems or difficulties in the social, occupational, academic, or other major areas of the life function.
In children and adolescents, moods can be irritable, and the duration should be at least one year, unlike the two years required for diagnosis in adults.
Early onset (diagnosis before age 21) is associated with more frequent relapse, psychiatric hospitalization, and more coexisting conditions. For younger adults with dysthymia, there is a higher co-occurrence in personality disorder and symptoms tend to be chronic. However, in older adults suffering from dysthymia, psychological symptoms are associated with medical conditions and/or stressful life events and losses.
Dysthymia can be contrasted with major depressive disorder by assessing the acute nature of the symptoms. Dysthymia is much more chronic (long lasting) than a major depressive disorder, where symptoms can appear only for 2 weeks. Also Dysthymia often appears at an earlier age than Major Depressive Disorder.
Prevention
Although there is no clear way to prevent dysthymia from occurring, some suggestions have been made. Because dysthymia often first occurs in childhood, it is important to identify children who may be at risk. It may be beneficial to work with children in helping to control their stress, increasing endurance, increasing self-esteem, and providing a strong social support network. This tactic can help counteract or delay dysthymic symptoms.
Treatment
Often, people with dysthymia will seek treatment not necessarily because of depressed mood, but rather because of increased levels of stress or due to personal difficulties that may be related to the situation. This is hypothesized because of the chronic nature of the disorder, and how the feeling of depression is often regarded as a characteristic pattern for the individual with the condition. So, only when the person is experiencing an increase in stress that he thinks will go to some kind of trained professional to relieve symptoms. Usually through the administration of Structured Clinical Interviews for DSM-IV that dysthymia is first diagnosed. At this point, with the help of a trained professional, a particular line of care is often discussed and then selected. It is important to consider all the factors in a person's life that may be affected when deciding on a particular course of care. In addition, if one of the treatment methods does not work for a particular individual, it may be worth trying something else.
Therapy
Psychotherapy is often effective in treating dysthymia. Different modalities have proven to be beneficial. Empirical-based care, such as cognitive-behavioral therapy, has been investigated to show that through appropriate treatment, symptoms may disappear over time. Other forms of speech therapy (eg psychodynamic psychotherapy, interpersonal psychotherapy) have also been said to be effective in treating the disorder. It may be useful for people diagnosed with dysthymia to develop better coping skills, look for the root cause of symptoms, and work to change wrong beliefs (such as when the patient believes he is worthless).
In addition to individual psychotherapy, group psychotherapy and self-help, or support groups, can be an effective treatment line for dysthymia as well. Through this treatment modality, problems such as self-esteem, confidence, relationship problems/skills, assertiveness skills, cognitive restructuring, etc., can be worked out and strengthened.
Drugs
The first line of pharmacotherapy is usually the SSRI due to its more tolerable nature and reduced side effects compared to an irreversible monoamine oxidase inhibitor or tricyclic antidepressant. Studies have found that the average response to antidepressant drugs for people with dysthymia is 55%, compared with a 31% response rate to placebo. The most commonly prescribed antidepressants/SSRIs for dysthymia are escitalopram, citalopram, sertraline, fluoxetine, paroxetine, and fluvoxamine. It often takes an average of 6-8 weeks before the patient begins to feel the effects of this drug therapy. In addition, STAR * D, a multi-clinical government study, found that people with depression as a whole will generally need to try different brands of drugs before finding one that works specifically for them. Research shows that 1 in 4 people who switched drugs get better results regardless whether the second drug is SSRI or other types of antidepressants.
In a meta-analytic study from 2005, it was found that SSRIs and TCAs were equally effective in treating dysthymia. They also found that MAOI has little advantage over the use of other drugs in treating this disorder. However, the authors of this study warned that MAOI should not be the first line of defense in the treatment of dysthymia, as they are often less tolerable than their counterparts, such as SSRIs.
Temporary evidence supports the use of amisulpride to treat dysthymia but with increased side effects.
Combination treatments
The combination of antidepressant drugs and psychotherapy has consistently proven to be the most effective treatment line for people diagnosed with dysthymia. Working with psychotherapists to address the causes and effects of disorders, in addition to taking antidepressants to help relieve symptoms, can be very beneficial. This combination is often the preferred treatment method for those with dysthymia. Looking at various studies involving treatment for dysthymia, 75% of people responded positively to combination of cognitive behavioral therapy (CBT) and pharmacotherapy, whereas only 48% of people responded positively to CBT or medication alone.
In a meta-analytic study from 2008, researchers found an effect size of -.07 (Cohen d) between pharmacological treatments and psychological treatments for depressive disorders, suggesting pharmacological treatments to be slightly more effective, although the results were not found statistically. important. This small effect applies only to SSRIs, with TCA and other pharmacological treatments showing no difference from psychological treatments. In addition, there are several studies that produce results that show that severe depression responds better to psychotherapy than to pharmacotherapy.
Resistance
Due to the chronic nature of dysthymia, treatment resistance is rather common. In such cases, augmentation is often recommended. Such treatment Augmentations may include lithium pharmacology, thyroid hormone augmentation, amisulpride, buspirone, bupropion, stimulants, and mirtazapine. In addition, if the person also suffers from seasonal affective disorder, light therapy can be useful in helping to add therapeutic effects.
Epidemiology
Globally dysthymia occurs in about 105 million people per year (1.5% of the population). It is 38% more common in women (1.8% females) than in men (1.3% of men). The lifetime prevalence rate of dysthymia in community settings appears to range from 3 to 6% in the United States. However, in the primary care setting, the tariff is higher in the range of 5 to 15 percent. The prevalence rate of the United States tends to be somewhat higher than rates in other countries.
See also
- Double depression
- Cyclothymia
- Anhedonia, a symptom of dysthymia characterized by decreased or non-existent ability to enjoy pleasure
- Influential influenced influences, PTSD symptoms, schizophrenia, and ASPD involving decreased or absent emotional responses
- Dysphoria, malaise or unhappy
- Atypical depression
- List of drugs used to treat major depressive disorder or dysthymia
References
External links
- The NIMH Depression Page
Source of the article : Wikipedia
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