Dealing with Dysthymia/Curing Chronic Depression/Determining if it’s Dysthymia
Dysthymia goes by many names, including neurotic depression, “mild” depression, dysthymic disorder, and chronic depression. It is one of the two main kinds of clinical depression, and is two times more likely to occur in women than in men. It often goes untreated, because its symptoms tend to be milder than those of more serious forms of depression, as well as the fact that sufferers of this form of depression can usually function fairly normally in society, despite their symptoms. The information and our questions below are not meant as a tool for you to perform a self-diagnosis, and to then self-treat your symptoms. However, they can provide you with some insight as to whether you or someone you know might be suffering from dysthymia. If you are not sure whether it is necessary to see a doctor or counselor for your symptoms, it is likely best for you to err on the side of caution and seek professional advice, as it may be more applicable your particular situation.
[Video] About chronic depression and dysthymia
The exact cause of dysthymia is still currently a bit of a medical mystery. However, studies have pointed to a number of possible suspects, including:
- neurochemical imbalances,
- chronic stress,
- extended childhood trauma
- and social circumstances that include isolation and a lack of emotional support systems.
Whether you have already been diagnosed with the disorder and are wishing to learn more, or are researching it because you suspect that you may suffer from it, there is no reason to feel alone or ashamed about your symptoms. Accurate statistics on dysthymia, as well many other types of mental illness, are difficult to come up with due to patients under reporting their symptoms or not coming forward with them at all. However, an article that was published by Harvard included the statistic that as much of six percent of the US population has experienced an episode of dysthymia at least once in their lifetimes, and that half of those people were experiencing symptoms within the past year. The numbers may sound small at first, but they represent somewhere around 19,085,357 different people, with different stories, but all suffering from the same symptoms.
Signs and Symptoms
What exactly are the symptoms of dysthymia, you might ask? They can include all of the following, but for a diagnosis to be made two or more of these symptoms must be consistently present for at least two years. For the diagnosis to be made in children, though, the length of time that symptoms must be present is reduced to one year.
- Disturbances in sleep patterns (too little or too much sleep)
- Low energy and fatigue
- Increases or decreases in appetite
- Difficulty concentrating, making decisions, and remembering details
- Chronically low self esteem
- Impairment in judgment
- A general “down in the dumps” feeling
- Lack of motivation, for even small tasks
- Feelings of hopelessness
- Social withdrawal
- Excessive and unreasonable guilt
- Anhedonia, which is the inability to feel pleasure from activities that you once enjoyed, and
- A negative view of oneself, one’s future, other people, and life events.
Dying for a Diagnosis?
Getting diagnosed with dysthymia can be difficult for a number of reasons. Patients may be embarrassed, find what they are going through difficult to talk about, or worry that their condition is “all in their head”, and this may keep them from sharing all of the details of their symptoms with their doctor or counselor. According to healthguidance.org, four out of five patients suffering with dysthymia never seek treatment or diagnosis at all. This may be because of the fact that they have been dealing with their symptoms for as long as they remember, and therefore believe that what they are experiencing is “just how life is”.
In the elderly, diagnosis can be particularly challenging, because common signs of dysthymia may be confused (by doctors and patients alike) as simply apathy, irritability, or dementia. Those who are dealing with difficulty concentrating and patients actually are brave enough to seek a diagnosis, and doctors are attentive enough to make the correct remembering details are commonly misdiagnosed as having Attention Deficit Disorder.
When you are ready to get up from feeling down and seek treatment, it can reduce your anxiety about the situation to know what to expect from your doctor. It is likely that your general practitioner will begin by asking you questions from a brief screening test for depression. (Two common ones are the Hamilton Rating Scale for Depression, and the Patient Health Questionnaire.) Both these tests are available online, however it should be noted that these tests are not designed to be self-administered because of the difficulty of interpretation of some of the clinical terms. The test should be facilitated by an experience psychiatrist or other health care professional. You should answer everything with openness and honesty, without fear of judgment, because it is vital to provide as much information as you can in order to get an accurate diagnosis and to begin feeling better as soon as you can. If the results of your screening suggest dysthymia, a standard clinical interview with a mental health practitioner can confirm the diagnosis, and you can begin receiving treatment for your symptoms.
Online Chronic Depression Quiz Questions
Do I have chronic depression or dysthymia? If you are still feeling unsure about whether or not you should see a health professional, perhaps these online quiz questions can help you to decide.
When answering, though, be sure to take (at least) the past two years into consideration, as dysthymia is a long-term disorder.
- Do you often face difficulty falling asleep at night?
- Do you suffer from- nightmares? Tossing/turning? Frequent waking?
- Have you experienced a serious decline in sex drive?
- Do you often feel the need to “put on a happy face” in order to hide feelings of sadness and guilt from loved ones?
- Do you feel a lack of the confidence that you used to have, for no apparent reason?
- Do you lack motivation, so that even small tasks tend to feel like a major chore?
- Does making even simple decisions feel like a challenge?
- Do you have difficulty making “small talk” and isolate yourself socially?
- Are you withdrawn from your peers?
- Do you feel guilty about not being able to enjoy time with loved ones and friends the way that you used to?
- Have you been feeling hopeless about your condition to the extent that you have considered harming yourself, or even committing suicide?
If you answered “yes’ to some or most of these questions, then it is highly recommended that you seek advice from either your general practitioner or a mental health professional in your area, as this quiz is not meant for self-diagnosis.
Remember, even if it turns out that dysthymia is not what is causing you to feel unhappy and unfulfilled, the sooner you seek help, the sooner you will be able to rule it out and take steps to improve your condition.
Treatment for Chronic Depression and Dysthymia
You do not have to feel hopeless forever! After you have taken the first step, and gotten diagnosed with dysthymia, there are a number of ways to approach your treatment. Firstly, there are several kinds of therapy that can help you to not only reduce your symptoms, but to better understand them and, thus, become more adept at handling them.
Here are some of the most popular kinds, and a quick overview of each:
- Interpersonal therapy helps patients to cope with personal disputes, separation, loss, and transitions between social roles- which can all contribute to, bring about, or exacerbate existing depression.
- Psychodynamic therapy, which is also known as insight-oriented therapy, can help patients to resolve internal emotional conflicts, especially if they are derived from childhood experiences.
- Behavioral treatment improves patients’ social skills and teaches them new ways to cope with stress and to unlearn learned helplessness; this may help with the sense of hopelessness that is commonly experienced with chronic depression.
- Cognitive therapy identifies and provides resources to correct thought patterns that promote self-defeating attitudes. It also can help with problem solving, and teaches patients to be more aware of what exacerbates their symptoms.
- Supportive types of therapies provide advice, reassurance, sympathy, and education about your illness. Support groups and self-help groups can usually be found through asking your mental health care provider if they know of any in the area that they think may be a good fit for you. With more and more outreach and awareness movements for mental illness gaining ground on social media outlets- online support groups and self-help forums can be found on sites such as Facebook with only a quick search; you should not use these as a primary treatment, but they can offer extra support and a forum to ask others with your condition what works best to help them manage their symptoms.
Another option for treating chronic depression may be medication. Only an open discussion with you doctor or psychiatrist can determine whether one is necessary, and if so which one might be the right fit for you. However, the most commonly prescribed medications for treating dysthymia are Selective Serotonin Reuptake Inhibitors (SSRI). Among these are
- Zoloft (sertraline),
- Paxil (paroxetine), and
- Effexor (venlafaxine).
It is worth noting that the dosages given to people with dysthymic disorder are often higher than those given to people with more major depressions, in addition to the fact that they sometimes take longer to take effect in patients with chronic depression.
Most patients, though, do find that they are responsive to their medications when they stick with them and follow the directions of their doctors. Sometimes SSRIs produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms tend to fade with time. Sexual dysfunction can also sometimes be caused as a side effect of these medications, and is typically addressed by adjusting one’s dosage, or by switching medications altogether
It is crucial for patients not to stop taking medications on their own, even if they do not think that they are working, are experiencing side effects, or feeling “cured” or better. If you experience any reactions to your medications that you do not think are normal, or that could be dangerous, report them to the doctor that prescribed them right away. He or she can best determine whether or not it will be beneficial for you to stop taking your medications or not- and if so- your dosage will be slowly reduced instead of suddenly stopped.
If your personal beliefs, religion, other medications, or any other reasons mean that you are completely against taking, or unable to take, an antidepressant, there are a few “natural” options on the market that have been rumored to be effective in the treatment of chronic depression.
St. John’s Wort & Tryptophan for treating chronic depression
St. John’s Wort has been used extensively in Europe to treat “mild” depressions. However, some studies claim to have proven it no more effective in treatment of dysthymia than a placebo, and the United States Food and Drug Administration published a Public Health Advisory Letter stating that it can negatively interfere with numerous medications, including seizure medications, antidepressants, heart disease medications, chemotherapy medications, and oral birth control pills. The letter went on to say that it also interacted with certain antidepressants, which seems a bit counterproductive if the goal of using it is to reduce your dysthymia symptoms. Overall, the research on the herb seems to be generally inconclusive at the moment, and you should consult your doctor if taking St. John’s Wort is the route you are considering taking for trying to treat your depression.
5-hydroxytryptophan (5-HTP) is another “natural” option that is manufactured from the essential amino acid tryptophan, which can be found in most dietary proteins. Many dysthymia sufferers who have tried 5-HTP in pill form claim that it did indeed improve their symptoms, which makes sense. It increases the levels of serotonin in the brain, similarly to many antidepressants.
It seems that this remedy is more promising than St. John’s Wort, as research conducted by the University of Oxford Department of Psychology suggested that 5-HTP are better than placebo at alleviating depression. However, the study went on to state that further studies needed to be conducted in order to evaluate its safety and effectiveness before it could be recommended for widespread use in treating depression.
Getting the dosage of this substance can be quite tricky, as too little can lead to an increase in appetite and emotional upset, but too much can also be harmful. If you are interested in learning more about the viability of using 5-HTP to treat your dysthymia, ask your physician or mental healthcare provider about it before coming to any conclusions on your own.
Suggestions for Sustainable Support Tactics
Various mind-body techniques can also be helpful for chronic depression; although they cannot heal the disorder on their own, they can make extremely effective as support tactics. Techniques that have been reported by patients to be effective include:
- Tai chi
- Guided imagery
- Massage therapy
- Music or Art therapy
- Spirituality, and
- Taking an interest in one’s overall health- by being more physically active and making changes in your diet.
The Road to Recovery: Living with your Chronic Depression
There are numerous outreach groups and programs to raise awareness about living with various types of depression, including dysthymia. Beyond Blue is an exemplary one of these, and it is based in Australia. It was established in October 2000, originally as a national five-year initiative, with the goal for creating a community response to depression. Its intent was to start a movement to move depression away from being just a mental health service issue and towards being acknowledged, respected, understood, and respected by the wider community. A quick internet search or a question to your mental healthcare provider can help you to find out about similar organizations and movements in your area, and you may find it quite uplifting and fulfilling to join them or contribute to their cause.
Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. That is, the parts of the brain involved in mood, thinking, sleep, appetite, and behavior actually appear different on MRIs than those of people who do not suffer from the illness. So, the next time someone decides to be disrespectful or simply doesn’t understand your depression, and tries to tell you that it is “all in your head”, you may find it therapeutic (and a good way to lighten the mood) to make a joke out of their remark, and explain to them that it actually is!
Unfortunately, the burden of dysthymia disorder is further increased when you partake in certain behaviors, as the depression appears to be associated with behaviors linked to other chronic diseases. In most studies, it is difficult to determine whether depression is the result of an unhealthy behavior or whether depression causes the behavior. However, it is recommended that you do your best to avoid the following in order to help your recovery along, and to lessen your symptoms:
- Alcohol consumption (It also can interfere with medications!)
- Physical inactivity
- Sleep disturbance
Dysthymia is associated with a high risk of relapse, but a diagnosis doesn’t have to be a death sentence. The Kaplan-Meier estimated recovery rate from dysthymic disorder was 73.9%, with a median time to recovery of 52 months. Among patients who recovered, the estimated risk of relapse into another period of chronic depression was 71.4%. To help to prevent relapse, it is highly suggested that patients continue to do whatever it was that helped them to reach recovery in the first place, regardless of whether or not they feel better or “cured”. This can be talk therapy, medications, or even picking up a new hobby or two- it’s personal, and it’s powerful!