In dysthymia, symptoms tend to last for years, interfering in the most diverse parts of the patient’s life: career, studies, relationships, among others. Therefore, in the end, it can end up being as heavy as major depression, since the patient often does not even realize that he is sick and cannot get out of this condition.
Another point to be noted is that, in pure dysthymia, there are no depressive episodes, but a constant bad mood . While in major depression one can easily detect the onset of symptoms, in Persistent Depressive Disorder, the patient believes that they are part of his personality and does not remember when it all started.
Recurrence of episodes of major depression is also common, which does not occur in dysthymia, which is continuous.
Dysthymia causes and risk factors
As with other types of depression, the causes are not yet known, but they appear to be a mixture of biological and environmental factors to which the patient is subjected.
Chemical imbalance and differences in brain structure
Many people who suffer from Persistent Depressive Disorder have anatomical differences in the brain. Although we are not sure what these differences represent, one day we hope to be able to understand if there is something in this configuration that causes the disturbance.
Another difference between a depressed brain and a healthy brain is the chemical imbalance , in which excitatory neurotransmitters such as serotonin and norepinephrine appear to be unregulated.
These neurotransmitters are closely related to the regulation of mood, sleep, food and other important functions for human well-being.
There is evidence of the existence of genes related to depression, it is known that it is more common in people whose families have a history of the disease. Children of dysthymic parents may be up to 50% more likely to suffer from the disorder than children of parents without the disease.
In addition, the presence of any psychological disorder in the family is a risk factor for dysthymia.
As with any type of depression, bad experiences can be a trigger for triggering dysthymia. These experiences are often traumatic events , such as the loss of a loved one, high levels of stress , a history of abuse of any kind, among others.
Not infrequently, the disorder starts in adolescence, a stage in which the individual goes through hormonal changes and several processes that alter his way of thinking and seeing the world.
In addition, the maturation of the brain occurs in a heterogeneous way, that is, some parts mature more quickly than others, which interferes a lot with the reasoning and reflection capacities.
The brain tends to keep the circuits that are used frequently active, while discarding those that are not used much, so the more bad experiences the teenager has, the more these circuits will strengthen in the brain, causing it to grow surrounded of bad feelings and may develop dysthymia or even major depression.
Dysthymia may also be related to other medical conditions such as cardiovascular disease and diabetes . In addition, brain damage can also cause disorders in the functionality of neurotransmitters and causing chemical imbalance.
Dysthymia rarely comes alone, and is often masked by other psychiatric disorders. Are they:
- Major depression (double depression);
- Anxiety disorders;
- Personality disorders;
- Somatoform disorders;
- Chemical dependency.
The symptoms of dysthymia are not so different from those present in major depression. They appear in a smaller number (in major depression the patient must have at least 5 symptoms), duration (to be considered major depression they must be present for at least 2 years) and intensity. Know the main signs:
- Feelings of sadness, emptiness and hopelessness;
- Loss of interest in daily activities, including those I used to like to do;
- Fatigue and lack of energy;
- Low self-esteem, frequent self-criticism and feelings of helplessness;
- Difficulty concentrating and making decisions;
- Excessive irritability or anger;
- Decreased productivity;
- Avoidance of social situations (isolation);
- Feelings of guilt and concern for the past;
- Increased or decreased appetite;
- Problems sleeping.
In children and adolescents
As dysthymia can start during childhood or adolescence, attention should be paid to the possible symptoms that children and adolescents demonstrate.
They may be irritable, get bad grades at school, have no desire to play and / or go out with friends, among others.
Especially in adolescence, it is difficult to have a diagnosis of dysthymia, as many attribute these feelings and behaviors to the phase that the person is going through.
In fact, this stage of life is marked by different and often complicated behaviors, but it is extremely important that parents are attentive and listen to their children, validating these feelings and going after help when necessary.
Often the adolescent shows interest in seeking professional help and the parents do not pay attention, precisely because of the phase in which they find themselves. However, this simple act could prevent the condition from worsening, as well as the appearance of other psychopathologies that start during adolescence and even later.
Stereotype of a dysthymic person
Because dysthymia is often mistaken for a defective personality, it ends up creating a stereotype. Therefore, it is believed that dysthymic people are bitter and moody, complain about everything, are explosive, pessimistic and difficult to live with.
Often, the patient himself thinks that of himself, without even suspecting the possibility of a disease – not least because many cases begin during adolescence, a stage in which a large part of the individual’s identity is being formed. In addition, the individual usually has low self-esteem and a high sense of self-criticism, which means that he has no real knowledge of himself, incapacitating him from perceiving the problem.
However, it is important to note that not all patients who suffer from the disease behave like this . Like any psychiatric disorder, the disease manifests itself in different ways in each person, and it cannot be believed that, just because someone is a complainer, it is a case of dysthymia.
In fact, there are dysthymics who do not have this complaining trait so much, and their symptoms are more focused on self-deprecating and pessimistic behavior.
Can dysthymia get worse?
Dysthymia itself is characterized by milder feelings. Still, things can get more complicated because the mere fact of having dysthymia does not exclude the possibility of episodes of major depression .
People with dysthymia are more susceptible to these episodes than healthy people. When they develop the condition, it is called double depression , since the individual starts to have two types of depression.
How is the diagnosis of dysthymia made?
There is no test capable of detecting dysthymia, and, in most cases, the diagnosis is made because of the patient’s personal history. However, in order to exclude the possibility of other diseases, the psychiatrist may request laboratory tests. Know more:
According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), published by the American Psychiatric Organization , dysthymia can be diagnosed when the patient “has depressed mood most of the day, indicated by subjective report or observation made by other people, for a period of at least 2 years ”.
In addition, at least two of the following criteria are present in these years:
- Increased or decreased appetite;
- Insomnia or hypersomnia;
- Low energy or fatigue;
- Low self esteem;
- Difficulty making decisions;
- Difficulty concentrating;
- Feelings of hopelessness.
During that time, there could be no absence of these symptoms for more than 2 consecutive months. The patient may also have had one or more episodes of major depression, without disqualifying the diagnosis of dysthymia.
In the case of children and adolescents, the time of manifestation of these symptoms decreases to 1 year, instead of 2.
The DSM-5 also establishes that the patient cannot have had episodes of mania, hypomania or mixed episodes without ever meeting the criteria for the diagnosis of cyclothymic disorder, a type of bipolar disorder in which the symptoms do not constitute depressive or hypomanic episodes themselves. .
Finally, dysthymia can only be diagnosed when:
- The problem cannot be better explained by persistent schizoaffective disorder, schizophrenia, delusional disorder, schizophrenia spectrum disorder and other specified psychotic disorder or schizophrenia spectrum disorder and other unspecified psychotic disorder;
- The symptoms are not caused by substance use (drugs of abuse, medication, etc.) or other medical conditions (such as hypothyroidism);
- Symptoms cause significant clinical distress or impairment of social functioning.
To make sure it is not another disease that can mimic dysthymic depression, your doctor may recommend a TSH test or a complete blood count . These tests look for signs of hypothyroidism or anemia , which can be the cause of the symptoms.
In rare cases, imaging tests, especially of the brain, can be ordered to check for injuries or changes in the structure that may be causing problems.
Does dysthymia have a cure? What is the treatment?
As with any psychiatric disorder, the possibility of a cure is uncertain. Therefore, the term remission of symptoms is preferred , since relapses end up being common after treatment.
However, this does not mean that the treatment is ineffective. In fact, the medications and therapies available can greatly improve the patient’s quality of life, but it will probably be a chronic treatment, that is, it can last from months to years.
What determines the most appropriate treatment?
The choice of treatment is made according to the severity of the patient’s symptoms , in order to avoid the administration of very strong doses and resources unnecessarily.
In addition, this choice can be influenced by factors such as personal preferences, treatment methods that have been tried before, treatment of comorbidities, among others.
Does the treatment affect the personality?
A major concern for those who are going to start drug treatment is how much it can change their personality. Having lived most of his life believing that these feelings and behaviors were his personality, he may hesitate when treating the disease, for fear of losing his identity.
In fact, treatment will improve symptoms, and the patient will set aside some behaviors and thoughts that he previously believed to be part of himself. However, this will give more space for the person’s real personality to appear. This is an opportunity to discover who you really are in addition to the disease .
The drug treatment is done, mostly, by means of antidepressants. There are three categories of antidepressants used, and it is up to the doctor to choose which one is most appropriate for the patient. Understand:
Selective serotonin reuptake inhibitors (SSRIs)
These antidepressants act on a neuron structure called the Recapture Pump. This pump pulls excess neurotransmitters back into the cell, so that they are destroyed and not become loose in the spaces between neurons.
By inhibiting the reuptake pump, these drugs increase the availability of serotonin (which is usually unregulated) in the patient’s brain.
Some examples of these drugs are:
- Paroxetine ( Pondera );
- Sertraline ( Zoloft );
- Citalopram ( Cipramil );
- Fluoxetine ( Prozac );
- Escitalopram ( Lexapro );
- Fluvoxamine ( Luvox ).
Selective serotonin and norepinephrine reuptake inhibitors (ISRSN)
SSRIs are similar to SSRIs, but they also act on norepinephrine reuptake pumps, another neurotransmitter possibly lacking in dysthymic patients. The drugs often indicated are:
- Venlafaxine ( Efexor XR );
- Duloxetine ( Cymbalta ).
Tricyclic antidepressants (ADT)
Tricyclic antidepressants also act by blocking the reuptake of neurotransmitters, but without so much selectivity, that is, they often act on more than one neurotransmitter.
They were the first antidepressants to be discovered and are seldom used today, precisely because of their low selectivity and side effects, but they are still available on the market because many patients adapt well to them.
Some examples of these antidepressants are:
- Imipramine ( Tofranil );
- Desipramine (Norpramin);
- Clomipramine ( Anafranil );
- Amitriptyline ( Tryptanol );
- Nortriptyline ( Pamelor );
- Doxepin (Sinequan);
- Maprotiline ( Ludiomil ).
Multimodals are a relatively new class of drugs for the treatment of depression. Unlike traditional antidepressants, multimodals act on a greater number of receptors and neurotransmitters.
Therefore, they are able to bring other benefits to the patient, such as protection of cognition. In other words, they protect the processes of thought, concentration and memory of patients.
Some examples of multimodal antidepressants are:
- Vortioxetine ( Brintellix );
- Trazodone ( Donaren ).
Melatoninergic agonist antidepressants
These drugs are similar to melatonin, the sleep hormone, and help regulate biological rhythms, imitating their mechanism of action.
They are effective in combating depression, as there is a direct relationship between the disease and the imbalance of biological rhythms (duration of sleep and wake periods). This relationship is already so consolidated that it is estimated that about 80% of people who have depression have some change in sleep.
Therefore, melatoninergic agonist antidepressants are a good option for the treatment of the disease. The main sold on the market is Aglometina ( valdoxan ).
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
The latency period is the time that is expected from taking the medication to its therapeutic effect. Antidepressants usually have a long latency period, as it takes time for a substance to break down all barriers and have an effect on the central nervous system.
While the medication does not have its full effect, the patient may feel a slight improvement, but still have negative thoughts. Due to this delay, the individual may stop using the medications, believing that they are not helping. Thus, the treatment is not done properly. Psychological monitoring at this stage is of utmost importance, so that the patient does not fail to use the medication.
There is also the possibility of worsening some symptoms during the start of treatment, which may be due to the brain trying to balance itself chemically. The patient’s caregivers should be aware of suicidal and self-destructive thoughts and behaviors during this period, in addition to discouraging attempts to drop the medication due to the alleged ineffectiveness.
Drug treatment helps in the chemical balance of the brain, but real and lasting improvement depends on psychotherapy. This is because it seeks to identify the patient’s thought patterns and modify them from the root. It is not simply a matter of “thinking positive”, but a long process of reconstructing the patient’s mentality.
There are several approaches that can treat dysthymia, with Cognitive Behavioral Therapy being the most recommended. Understand:
Cognitive Behavioral Therapy (CBT)
CBT focuses on the identification and correction of cognitive errors, that is, the way the individual thinks. Some cognitive errors common to dysthymics are:
- Dichotomous thinking: Thoughts of everything or nothing;
- Rumination: Too many thoughts about disturbing ideas, mainly related to the past. Rumination is the thought focused on “if I had done this” or “if it had not happened”, among others;
- Minimizing the positive and maximizing the negative: Do not give importance to what is good and care too much for what is bad.
All of this can be identified and corrected with the help of the therapist. It is a slow process, which does not happen overnight, but over time the patient changes his negative thought patterns and beliefs, thus improving his mentality, his way of seeing the world.
The Gestalt – therapy aims to emphasize the here and now, thinking of the way in which the phenomenon is presented, rather than trying to explain why.
Focusing on what is being presented, he argues that the elements behind the phenomenon are contained in the experience of the visible, with no need to analyze the situation in the search for these elements.
This attitude can be of help to the dysthymic, who usually ruminates and wants to understand the reason for things, since it focuses on what is really being presented to him, out of his head, out of his thoughts.
It is worth mentioning that Gestalt-therapy sees the depressive experience as something that does not arise in isolation, but rather through the individual’s relationship with his surroundings. Therefore, it seeks to address, also, the way in which the individual relates to his partners, family and friends.
Analytical-oriented psychotherapies seek to resolve the patient’s unconscious conflicts through free association. In these techniques, the individual is free in his speech, which makes the unconscious to show itself more easily in the speech. When the psychoanalyst captures something that resurfaces from the unconscious, he helps the individual to work on it and solve the problem.
It is usually an approach very focused on trauma and difficult experiences, which may have been thrown into the unconscious in order to help the patient move forward. However, many times these experiences still cause distress, without the patient knowing why.
These therapies seek such experiences and try to bring them to the conscious in a way that the patient can understand and overcome.
There are many other approaches that can help the individual to treat his problem, but it is up to the therapist to analyze the patient’s situation, the techniques that can be used and the resources available to then plan how the treatment will be done.
In some cases, the use of natural remedies can help the patient to improve his mood. There are two herbs currently widely used in dysthymia:
Hypericum ( Hypericum perforatum )
Also known as St. John’s wort, its mechanism of action is very similar to that of traditional antidepressants, but in a lighter and more subtle way. Therefore, it is only indicated in mild and moderate depressive states.
It can be consumed in the form of teas and capsules.
Rhodiola ( Rhodiola rosea )
Indicated to reduce fatigue and tiredness , Rhodiola is widely used in European countries. It works by improving concentration, brain performance and helping to combat slightly depressed thoughts and behaviors.
These and other types of treatments such as flowers, supplements, etc., should not be used without the doctor’s knowledge. Some of these methods have no evidence of their effectiveness, nor are they sure of their safety.
It is important to report to the doctor all medications you take before starting treatment with these natural remedies, as they can interact with other substances and cause unpleasant side effects.
Complementary integrative therapies
Formerly known as “alternative therapies”, complementary integrative therapies are therapeutic practices that can assist clinical treatment, but which are not necessarily linked to scientificity.
There is evidence that these practices help the patient to become stronger in the fight against diseases, both physical and mental, but they are not able to cure these diseases and should not be used as alternatives to clinical treatment, but in conjunction with him. .
Some examples of complementary integrative therapies are:
- Massage: Through the manipulation of soft tissues (muscles), massage helps to relieve tension and stress, being especially effective in the treatment of pain;
- Acupuncture: Chinese technique that consists of applying small needles to certain points of the body, putting pressure on those points. It is believed that this pressure moves still energies, which helps in the patient’s physical and emotional well-being;
- Meditation: Through attention focused on a single stimulus (usually breathing), it promotes serenity to the patient;
- Yoga: Works the patient’s physical and emotional conditioning through stretching techniques and breathing exercises;
- Tai chi chuan: Chinese martial art that uses exercises to work the body and mind;
- Mental relaxation techniques: This is a form of meditation induced by words and mental images;
- Music Therapy: Works the sense of hearing in the search for relaxation through sounds from nature or musical instruments;
- Aromatherapy: Uses the sense of smell to promote good feelings;
- Phytotherapy: Herbs are used in the form of tea, capsules or tinctures, to relieve symptoms. It should only be done if the doctor responsible for the treatment has knowledge, as it can cause food and / or drug interactions.
The patient can also seek resources in faith, if he has one, as long as he always bears in mind that clinical treatment is indispensable for the improvement of his symptoms.
When left untreated, dysthymia can bring complications to the patient’s life. In addition, when compared to individuals with major depressive disorder, those affected by dysthymia are more likely to have psychiatric comorbidity (when the patient has 2 or more psychiatric illnesses simultaneously).
In general, dysthymic individuals are more at risk of developing anxiety disorders and substance use disorders. Understand:
Unemployment and poor performance
Due to poor self-esteem, it is not uncommon for the individual not to make an effort and to have a poor academic and work performance. In addition, absenteeism (frequent absences) can lead you to unemployment and make it impossible for you to attend classes, lectures and other academic activities.
A person with dysthymia is much more likely to develop major depression than a healthy person.
When there is a suspicion of an episode of major depression associated with dysthymia, then the diagnosis of “persistent depressive disorder (dysthymia) with major depressive episodes” is made, which can be intermittent (which occurs at intervals of time), with current episode (if it is occurring), intermittent with no current episode (if it has already passed) or persistent.
Cognitive errors such as rumination and negative maximization are risk factors for the development of an episode of major depression, things that, unfortunately, are present in the daily life of the dysthymic individual.
Alcohol abuse and drug addiction
Not infrequently, people with negative views about life appeal to drugs of abuse and excessive use of alcohol in order to alleviate the emotional pain they feel. This can lead them to a chemical dependency, which hinders the patient’s improvement and is configured as another disorder to be treated.
Suicidal ideation and suicide attempts
Suicidal ideation is characterized by the mental representation of suicide, that is, the patient often thinks about taking his own life and even makes plans for it. When approached by a psychologist at this stage, it is possible to prevent a suicide attempt.
However, when not receiving treatment, this ideation can become an attempt.
Anxiety disorders are characterized by the patient’s excessive concern or apprehensive expectation. Because it is linked to neurotransmitters that provide the brain with a feeling of well-being and happiness, such as serotonin, dopamine and norepinephrine, it can be related to dysthymia.
Living with dysthymia
Living with dysthymia is not easy, and patients know this very well. Constant negative thoughts, bad mood and unwillingness to live can be quite limiting, but with treatment, all of this tends to improve.
During treatment, the patient can do more for himself, taking actions that can positively influence his life. Understand:
Taking care of physical health
As much as the focus of treatment is to take care of mental health, physical health is also extremely important for the recovery of the patient, since illnesses are a risk factor for depression. Habits such as physical exercise, good nutrition and hygiene are beneficial for treatment.
Avoid alcohol and other drugs
Drug treatment can be hindered by the use of alcohol, but the most important thing is to avoid chemical dependency, which is somewhat frequent in dysthymic patients.
What to do if someone I love has dysthymia?
Receiving the news that someone you love suffers from the disorder can be horrible and you may feel helpless, but know that you can help. In some cases, you already know that the person has the disorder, but they themselves refuse to accept it. In such cases, the process becomes a little more difficult, but not impossible.
Here are some tips on what to do when someone you love has dysthymia:
Encourage the person to seek medical help
Often, the dysthymic is unable to take the first step to seek medical help, however much he wanted to. So, help her find a psychiatrist or psychologist, help make an appointment and, if possible, go with her the first time.
If the individual does not admit to needing help, the ideal is to keep the dialogue open, without forcing it. This is because seeking help for someone who does not want to be helped is useless, since they will not accept treatments.
Talk about feelings
People have a misconception that pain should not be talked about and tend not to talk about feelings. However, it can help the person himself to better understand what he is feeling and ask for help. Be sure to ask about how she is feeling with the treatment, if she needs any help with anything, etc.
If there is suspicion, ask about suicidal thoughts . Talking about it can help the person to change his mind and, if necessary, you can contact the person’s therapist or the Life Valuation Center (CVV), before it’s too late.
When talking to the person, try to stick to the positive details of the events. Do not push too hard, but also do not exalt those bad things that are happening.
Take care not to devalue that person’s feelings while trying to be positive, as often the person may complain about something and you saying that he has to think positive about that invalidates what he is feeling.
Encourage the person to stay active
Ask her to go for a walk, even if it is to take a short 20-minute walk, as this can help you regain some of the spirit lost by dysthymia.
However, be careful not to charge the person for actions, as the limitations of the disease can make them feel even worse, thinking badly of themselves, for not being able to do something you are asking for.
It is legal to encourage contact with nature and sunlight, which have already proved to be excellent sources of encouragement in studies carried out. Another thing to be encouraged is also the learning of a new hobby, or the resumption of an old one. All of this can help a person to regain their spirits for the things they like and for life.
Recognize your achievements
Although it doesn’t seem like a big deal to you, trying out a new hairstyle can be challenging for a dysthymic. Walking for 20 minutes, riding a bicycle or even giving a positive answer to a question can be things that, before, seemed impossible. So, recognize these achievements.
Do not confuse recognizing achievements with constantly congratulating, as this can also be harmful. The important thing is to see that the individual is making progress and that he deserves this recognition.
It is common for relapses to occur during treatment. The person may have improved significantly in the past few weeks and suddenly seems to be back to square one. It is important that you pay attention to the signs of a relapse and be there to support the person.
Never judge or ask questions like “but wasn’t everything okay?”, “Hadn’t you improved?”, As this is a temporary condition and, with treatment, the person will soon have positive results again.
Remember to note these relapses and ask the person to talk about it with the therapist and / or psychiatrist, as adjustments in therapy may be necessary.
Take care of yourself
By caring so much for a person who needs help, we can easily forget about ourselves. Get away when necessary, be sure to do the things you love, don’t take the person’s negativity personally, solve your problems before trying to solve other people’s problems.
You must recognize when your efforts to help the person are getting in the way of your happiness and personal fulfillment. It is not healthy to sacrifice yourself for someone else. In addition, this type of attitude can cause her to be overly dependent on you, which is not healthy for either of you.
What not to do?
Some attitudes that we have in relation to certain situations, usually not thought out, may not be of any help to the dysthymic patient. Indeed, certain comments may even make the situation worse. Some things not to do are:
Close to the dysthymic
Often, we end up shutting ourselves off to people who need our help, even because we think they don’t want to be disturbed. Sometimes the person wants to talk, but does not know how, and in these cases it is extremely important that you are open.
Disregard and devalue your feelings
Just because, for you, getting out of bed is an activity that does not require much effort, for some dysthymics, having to live life can feel more like a nightmare. Avoid comments like “there are worse people”, “it’s all in your head”, “we all go through this”, “you are crazy”, “just think positive”, because these are clear signs that you don’t understand what she is is passing and who does not believe in the legitimacy of these feelings. This type of attitude makes the person stop trusting you and keep everything to himself, making his condition worse.
Argue with these feelings
If she says she feels this way, try to understand that feeling and ask what you can do to help. Do not try to say that it does not make sense and that it is not real (however absurd the feeling is), as this shows that you do not consider these feelings to be true.
Charge the person’s attitudes
Understand that, due to the condition, she has her limits and some things can be very difficult for her. If she shows interest in something, support it, but don’t cover it later, as it will make her feel worse about herself.
How to prevent dysthymia?
There is no exact way to prevent dysthymia or any type of depression. However, taking action against stress and seeking help when you experience the first symptoms can help prevent the disorder from developing too much.
When it comes to preventing relapses, the most recommended option is clinical treatment. Avoiding triggering situations can also help, although it is very difficult to recognize a trigger in dysthymia, precisely because of the early onset of the disease.