Dysthymia is a so-called affective disorder and is also called dysthymic disorder or chronic depression. It has many similarities with “common” depression, but the symptoms are usually milder.
What is dysthymia?
Dysthymia is a chronic depressive mood. It is also known as depressive neurosis, neurotic depression, or depressive personality disorder. Sufferers show the typical symptoms of depression, such as fatigue, joylessness, or sleep disturbances. Although the symptoms are not as pronounced as in normal depression, they do occur over a longer period of time. It is not uncommon for dysthymia to develop as a chronic permanent mood. Characteristic for dysthymia is the early onset. Usually, mainly adolescents and young adults are affected by the permanent mood. Sometimes even for a lifetime.
Causes
The exact causes of dysthymia have not yet been determined. Rarely is there only one underlying cause of the disease. Rather, it is an interaction of various factors that trigger and cause the disease. In genetic studies, a familial clustering of dysthymia has been observed. This does not mean that depression is inherited, but that those affected have a higher risk of developing depression because they react more sensitively to triggering factors. Situations that can lead to depression due to extremely high stress levels include poverty, unemployment, separations from partners, the loss of loved ones, or a person’s own illness. How well affected individuals can cope with these mental stresses depends on their genetic makeup on the one hand and their resilience on the other. Resilience is the term used to describe a person’s inner strength, his or her mental resilience. People with a high level of resilience are significantly less likely to suffer from dysthymia than people who are not resilient. Resilience is primarily shaped by positive experiences in childhood. Biochemically, changes in the brain can be detected in depression. Thus, there is an imbalance between chemical messengers. In dysthymia, serotonin and norepinephrine are particularly affected. The stress hormone cortisol is also found in high concentrations in the urine of depressives. However, it is still unclear whether these changes are a consequence or cause of depression.
Symptoms, complaints, and signs
Symptoms of dysthymia vary greatly from patient to patient. Sufferers often feel joyless, listless, tired, and lacking in strength and courage. They have no self-confidence and not infrequently feel overwhelmed by small things. Cleaning out the dishwasher can thus become a seemingly insurmountable obstacle. Patients may suffer from sleep disorders. Sleep is not very restful, so that those affected feel as if they are exhausted in the morning and sometimes do not even manage to get out of bed. Many can no longer go about their work. Another characteristic of dysthymia is the feeling of numbness. The sufferers feel as if they are frozen or dead. Positive feelings seem to no longer exist, even negative feelings such as anger or sadness can no longer be felt. Even the memory of feelings can disappear; depending on the duration of the illness, the sufferers may not even remember that they were once happy, laughed or enjoyed something. Dysthymia manifests itself not only psychologically, but also physically. In addition to the sleep disturbances already mentioned, dysthymia can also manifest itself in the form of loss of appetite, loss of libido, dizziness or gastrointestinal complaints. No organic causes are then found for these symptoms. The symptoms of dysthymia are not as severe as those of acute depression, but those affected often suffer from them for years to decades.
Diagnosis
Many dysthymic moods go undetected. This is partly because sufferers cannot muster the energy needed to see a doctor. In addition, the stigma of a mental illness should not be underestimated, even in this day and age. Secondly, many of those affected do not take their symptoms seriously enough themselves and consider them to be normal mood swings.If the symptoms of depression are masked as physical complaints, a diagnosis is even more difficult and is often only made after a long odyssey of doctors. If dysthymia is suspected, a detailed discussion should be held with a psychologist or a physician, ideally a psychiatrist. The diagnosis is made with the help of the ICD-10 diagnosis and classification system. At least two core and two additional symptoms must occur over a period of at least two weeks. Core symptoms include depressed mood, loss of pleasure, and decreased drive. Additional symptoms include sleep disturbances, inner turmoil, or suicidal thoughts.
Complications
Although dysthymia is often milder than major depression, affected individuals may be suicidal. The risk of suicide in this case is often underestimated. Conversely, however, not every person suffering from dysthymia is suicidal. Therefore, it is particularly important to clarify this issue in each individual case. People who think about death, have suicidal fantasies or plan their own death should confide in someone else if possible. A doctor, psychologist or therapist may also be considered for this purpose. In acute cases, inpatient treatment is appropriate for suicidal tendencies – however, outpatient therapy with medication or psychological methods is often possible if the affected person is stable enough. Particularly without treatment, dysthymia runs the risk of developing into depression (major depression). Psychologists also speak of a double depression. Such a depressive episode is usually more severe than dysthymia. As a further possible complication, dysthymia can also become chronic: In this case, the depressive state persists permanently. However, therapy can bring improvement or complete recovery even in chronicized dysthymia. In addition to dysthymia, other psychological complications may develop, manifesting as other mental illnesses. Furthermore, social and occupational complications (for example, inability to work) may occur.
When should you see a doctor?
If depressed moods persist for more than a few days, a doctor should be consulted. Symptoms that indicate dysthymia include joylessness, listlessness, and lack of self-confidence. Anyone who increasingly suffers from these complaints must seek professional advice in any case. In particular, people who are in an emotionally stressful phase of their lives should talk to a therapist – ideally before dysthymia has fully developed. At the latest when depression triggers physical complaints such as loss of appetite or a dwindling libido, an emergency situation is present. Since those affected often do not take action against the dysthymia themselves, the closer environment is called upon. Anyone who notices a psychological change in an acquaintance should talk to them about it. Together, they should then consult a therapist. If a partner, relative or friend expresses suicidal thoughts, a crisis counselor must be consulted immediately. It is advisable to contact the telephone counselling service and to talk to the person affected in parallel. In the long term, dysthymia must always be treated by a psychologist or, if necessary, as part of a hospital stay.
Treatment and therapy
In milder courses of dysthymia, sports and exercise therapies, relaxation methods, or herbal preparations such as St. John’s wort extract can be helpful. In more severe and long-term courses, the therapy of dysthymia is based on three pillars. The first pillar is pharmacotherapy with antidepressants. The second pillar is formed by psychotherapeutic methods. Behavioral therapy, systemic therapy and depth psychological therapies are among the therapies of choice in the treatment of dysthymia. Complementary other therapies, such as occupational therapy, can be used as a third therapeutic pillar.
Outlook and prognosis
The prognosis of dysthymia depends on the presence of several influencing factors. They include the age of the patient at the initial manifestation, genetic stresses, and the presence of other mental illnesses. Eating disorders, personality disorders, or obsessive-compulsive and anxiety disorders are classified as unfavorable factors.In these patients, the cause of the symptoms must be determined so that a change in the health condition as well as relief can occur. Without seeking treatment, the prognosis for dysthymia is considered unfavorable. The signs of the disease are difficult to recognize and often develop over a long period of time. In the further course, a chronic development often develops over several years, in which a depression also develops. The symptoms of the double depression that then develops vary in their intensity and in the duration of their occurrence. Phases of remission are possible, but do not last permanently. The risk of suicide in these patients is increased and is 10%. In about 40% of those affected, dysthymia develops into major depression as the disease progresses. This diminishes the prospect of recovery and in most cases leads to years of discomfort. The prognosis improves as soon as the patient takes psychotherapy as well as drug treatment.
Prevention
It is not uncommon for depression to result from too much stress and being overwhelmed. One prevention option is therefore to deal adequately with stressful situations. This can be learned through various procedures such as mindfulness training, relaxation procedures or through special stress management seminars. Unnecessary obligations should be reduced in favor of things that bring pleasure. Regular exercise is also said to have a preventive effect.
Aftercare
The person affected by dysthymia usually has only a few measures or options for aftercare, so the person affected by this disease is primarily dependent on a quick and early diagnosis. In this context, the relatives and friends in particular must also persuade the affected person to undergo treatment, as otherwise the symptoms may deteriorate further. Self-cure does not occur with dysthymia, so treatment by a doctor is always necessary. In most cases, the affected person is dependent on treatment by a psychologist, although various exercise therapies can also alleviate the symptoms of dysthymia. Some exercises from these therapies can also be repeated by the affected person in his own home and thus promote healing. Furthermore, taking medication can also alleviate these symptoms, although care must be taken to ensure that the correct dosage is taken and that it is taken regularly. In general, loving care and support from friends and family also have a positive effect on the course of dysthymia. The patient’s life expectancy is usually not negatively affected by dysthymia.
Here’s what you can do yourself
To find joy in life again, people suffering from dysthymia should first of all confide in a doctor or psychotherapist and discuss the further course of action with him or her. Seeking help is not a sign of weakness, but represents the first and decisive step towards effective treatment. In addition to the therapy suggested by the doctor, a reorganization of everyday life can counteract excessive demands and pressure to perform. This includes, above all, lowering the demands on oneself, taking regular breaks to relax, and cultivating one’s hobbies. Sport is an excellent way to reduce tension, strengthen self-esteem and experience a sense of achievement. Excessive ambition is out of place here; the focus must always be on the joy of movement. If stress cannot be avoided, for example at work, it helps to learn special techniques for coping with stress. It is also important to free oneself from unnecessary obligations and to learn to say “no” without remorse. Social contacts must also not be neglected: Regular conversations with friends and acquaintances, which do not exclude problems and feelings, train social skills and help the soul to regain its balance. Joint activities provide support and create positive moments that can contribute significantly to overcoming dysthymia.
