# Diagnosing and treating dysthymia



## Into The Light

how is it determined if a person has dysthymia? i know there are certain criteria that need to be met but i still find it hard to go by that list.  can it be accurately determined? or is it normally just a guess at best?

the other question i have is how is it treated? can it be cured?


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## Retired

*Re: dysthymia*

*DSM-IV Criteria for Dysthymic Disorder*

According to the DSM-IV, dysthymia is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms: 


poor appetite or overeating 
insomnia or hypersomnia 
low energy or fatigue 
low self-esteem 
poor concentration or difficulty making decisions 
feelings of hopelessness

In addition, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. 

Further, the symptoms cannot be due to the direct physiological effects of a the use or abuse of a substance such as alcohol, drugs or medication or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

_Criteria summarized from:_

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

*National Mental Health Association*

*What is Dysthymia?*
Dysthymia (the Greek roots of the word mean “bad state of mind” or “ill humor”) is a disorder with similar but longer-lasting and milder symptoms than clinical depression. By the standard psychiatric definition, this disorder lasts for at least two years, but is less disabling than major depression; for example, victims are usually able to go on working and do not need to be hospitalized.

*How Common Is It?*
About three percent of the population will suffer from dysthymia at some time - a rate slightly lower than the rate of major depression. Like major depression, dysthymia occurs twice as often in women as it does in men. It is also more common among the poor and the unmarried. The symptoms usually appear in adolescence or young adulthood but in some cases do not emerge until middle age. 


*Warning Signs*
The warning signs of dysthymia are:


poor school/work performance 
social withdrawal 
shyness 
irritable hostility 
conflicts with family and friends 
physiological abnormalities 
sleep irregularities 
parents with major depression 
At least three-quarters of people with dysthymia have some other psychiatric or medical disorder as well.

*Current Treatments for Dysthymia*
Therapy: 

• Psychotherapy or cognitive therapy (also known as “talk therapy”) is used to alter people ’s self-defeating thoughts. 
• Behavioral therapy may help people learn how to act in a more “positive approach” to life and to communicate better with friends, family, and co-workers. 
• Medications: 
Tricyclic antidepressants, the standard treatment for major depression, may be useful for dysthymia

In many cases, the symptoms are hard to recognize and classify, and the response to treatment is unpredictable. Most people with dysthymia see only their family doctor, who may misdiagnose them, especially if the main complaints are physical. Many people do not think of themselves as depressed, and are relieved to be told they have a treatable illness. Unfortunately, mental health professionals are usually consulted only when major depression develops, although dysthymia alone may lead to alcoholism or suicide. Even when it is recognized, dysthymia is difficult to treat. The longer a depression lasts the slower the recovery.


I don't know if the reference to tricyclics being the treatment of choice for dysthymia in the information by the  National Mental Health Association is slightly dated, you may wish to pursue that question with a physician. 

Hope this info provides a few insights into your query.


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## David Baxter PhD

*Re: How do you know if you have dysthymia?*

Basically, the treatment for dysthymia is pretty much the same as for depression: CBT, lifestyle changes, and/or medications.


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## Into The Light

if one has dysthymia for x amount of time, can anything be said about how long it will take to recover from it?


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## Halo

BBC 



> Current Treatments for Dysthymia
> Therapy:
> 
> ? Psychotherapy or cognitive therapy (also known as ?talk therapy?) is used to alter people ?s self-defeating thoughts.
> ? Behavioral therapy may help people learn how to act in a more ?positive approach? to life and to communicate better with friends, family, and co-workers.
> ? Medications:
> Tricyclic antidepressants, the standard treatment for major depression, may be useful for dysthymia



If you look at the current treatments for Dysthymia I don't see how it is possible to put a definitely timeline on the recovery.  I think that it will differ for many people dpending on finding the right medication, the right dosage, the right therapists, the amount of therapy needed etc.  I think that it is probably no different than many other illnesses which require medication, therapy and time.

Of course, this is just my opinion but someone with more specific knowledge may want to add something.


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## David Baxter PhD

That's a pretty good summary, Halo (except the part about trycyclics, which are no longer the standard treatment for depression).

Everyone is different. Some people recover from major depression in a few months; some people take years. The same is true for dysthymia, anxiety disorders, PTSD, or anything else.


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## Into The Light

i was afraid that would be the answer, that it just all depends. i guess i just need to learn to be patient. thanks halo and dr. b.


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## KarenRB53

David Baxter said:


> That's a pretty good summary, Halo (except the part about trycyclics, which are no longer the standard treatment for depression).
> 
> Everyone is different. Some people recover from major depression in a few months; some people take years. The same is true for dysthymia, anxiety disorders, PTSD, or anything else.




I have been diagnosed with Dysthymia with Major Depression.  What is the best treatment for dysthymia w/major depression?  I have had psychotherapy for many years on and off.  Prozac seems to be the only antidepressant that lifts my depression however once it builds up in my system it causes hypomania.  I do take ativan and it helps however I wish there was something to use with the Prozac that would prevent the hypomania.  My pdoc has prescribed several mood stabilizers but they actually make me too depressed so I can't take them.  Thanks, Karen


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## David Baxter PhD

Hmmm... hypomania in response to an SSRI is usually indicative of bipolar disorder (or cyclothymia). Has your doctor tried varying the dose of the mood stabilizer and/or using Prozac in combination with a mood stabilizer?


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## KarenRB53

David Baxter said:


> Hmmm... hypomania in response to an SSRI is usually indicative of bipolar disorder (or cyclothymia). Has your doctor tried varying the dose of the mood stabilizer and/or using Prozac in combination with a mood stabilizer?




My pdoc did mention that I could be Bipolar2 but doesn't like labels.
He had me try Zyprexa and Risperdol but they both were too strong even at lowest dosage.  I also tried Lamictal but the same thing happened.  The mood stabilizers seem to be too strong for me.  So then he had me try the benzos, Xanax which actually made me a little hyper, and clonazepam which made me depressed and we settled on ativan which works.  Could you suggest a combination that I might try.  I do have family history of bipolar and major depression.

Thanks


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## David Baxter PhD

I'm not a physician, Karen. I have no medical training and cannot prescribe medications.

However, there are other choices for mood stabilizers besides Lamictal (lamotrigine), including Topamax and Lithium. Zyprexa and Risperdol are not mood stabilizers _per se_ - they are part of a family of drugs with the unfortunate name of "atypical antipsychotics", used to treat schizophrenia but at smaller doses also used to treat bipolar disorder and to augment SSRI antidepressant medications. The benzodiazepines on their own won't help either depression or bipolar symptoms, though they may help with any accompanying anxiety.

If Prozac works for you otherwise, I would suggest asking your doctor about using that in combination with one of the mood stabilizers. Bear in mind that I know nothing about your medical history and he may have had reasons for not considering the other options for mood stabilizers.


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