DEAR DOCTOR K:
I was recently diagnosed with dysthymia. Can you tell me more about this condition? Is it the same as depression?
Dysthymia is a form of depression. It is less severe than major depression, but usually lasts longer. Many people with dysthymia describe having been depressed as long as they can remember. They also are at a greater risk of developing major depression.
Dysthymia is not quite as common as full-blown depression, but still is fairly common. During the course of a year, about two people out of every 100 will suffer from dysthymia. It is about twice as common in women as in men.
The symptoms of dysthymia are similar to those of major depression, but they tend to be less intense. In both conditions, a person can:
- Have a low or irritable mood.
- Experience a decrease in pleasure.
- Have low energy.
- Feel relatively unmotivated.
- Feel disengaged from the world.
- Experience an increase or decrease in appetite and weight.
- Sleep too much or have trouble sleeping.
- Have difficulty concentrating.
- Feel indecisive.
- Feel pessimistic.
- Have a poor self-image.
Dysthymia lasts for long periods, sometimes starting in childhood. As a result, a person with dysthymia tends to believe that depression is part of his or her character. He or she may not even think to talk about it with doctors, family or friends.
I remember telling a patient that I thought he suffered from dysthymia. He replied, “I don’t have any kind of depression. I’m just grumpy.” His wife added, “His mother says he was born grumpy.”
Treatment usually includes emotional support and education about depression. Cognitive behavioral therapy examines and helps correct faulty, self-critical thought patterns. Psychotherapy can help sort out conflicts in important relationships or explores the history behind the symptoms.
An antidepressant medication can be very helpful. Antidepressants recommended for dysthymia are the selective serotonin reuptake inhibitors (SSRIs such as fluoxetine); serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine); mirtazapine; and bupropion.
Your doctor may add a different type of drug to your treatment — for example, a mood stabilizer or anti-anxiety medication.
With treatment, symptoms often go away completely. However, continued treatment is usually necessary to prevent symptoms from returning. What is important is treatment, not diagnostic labels.
My patient who insisted he was just “a grumpy person” agreed to try an antidepressant. Two months later, the patient told me he wasn’t sure if the medicine was helping, but added that he would be happy to stay on it. His wife said, “You really should,” and then turned to me and said, “He’s not grumpy anymore.” Whether the treatment cured dysthymia or grumpiness, what mattered was that two people were happier.