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Persistent depressive disorder (DYSTHYMIA)

Dysthymia is a consolidation of dysthymic disorder and chronic major depressive disorder, as mentioned in DSM-IV.

 

THE BASICS:

INTRODUCTION

In the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), dysthymia, and persistent depressive disorder have been broadly mentioned. Persistent depressive disorder can be defined as a depressive mood disorder, characterizes of early-onset (before age 21), and an insidious onset (childhood, adolescence). Early-onset is usually associated with a higher risk of co-morbidity and substance use disorders.

Traditionally, dysthymia was not considered so severe to be a disorder but, late the consequences of dysthymia have been getting grave; which includes increased suicide risk, severe functional impairment, etc.

DEFINITION

Dysthymia is a consolidation of dysthymic disorder and chronic major depressive disorder, as mentioned in DSM-IV.

• Depressed mood prevails for more days than not, as indicated by mental health experts, and stays for at least a period of 2 years. In the case of children and adolescents, irritable mood can prevail, for at least 1 year.
• Presence of at least two of the following symptoms, along with the depression:
• Poor appetite.
• Insomniac behavior.
• Fatigue.
• Low self-esteem.
• Poor concentration levels.
• Hopelessness.
• During the 2-year period (for adults), and 1 year (for children or adolescents) of the prevalence of issues, the individual faces the symptoms in the above-mentioned criteria for at least 2 months period.
• Characteristic features for the major depressive disorder may be present for almost 2 years.
• No reporting of either a manic episode or a hypomanic episode, along with fulfilling the criteria for cyclothymic disorder.
• The symptoms cannot be specifically explained by schizophrenic patients, or any other patients, along with their non-attributable nature to the effects of a substance-abuse or any other prevalent medical condition.
• A significant amount of distress or impairment is caused in various (social, occupational, etc.) important areas.

PREVALENCE

Persistent depressive disorder or dysthymia is an effective amalgam of a chronic major depressive episode(s) and dysthymic disorder. The average prevalence period is 12-months in the United States, which is approximately 0.5% for dysthymia, and for chronic major depressive disorder, it’s 1.5%.

GENDER DIFFERENCES

In the case of women, the prevalence of dysthymia was almost twice higher than men’s.

DIAGNOSTIC FEATURES OF DYSTHYMIA

One of the essential features of persistent depressive disorder is depressed mood persisting for a consecutive number of days. It should last for at least a period of 2 years, in the case of children and adolescents, 1 year.

Dysthymia is a consolidation of dysthymic disorder and chronic major depressive disorder. The occurrence of major depression may precede dysthymia. Individuals with the prevailing symptoms of major depressive disorder for nearly 2 years are usually provided a diagnosis of dysthymia or persistent depressive disorder, along with the major depressive disorder.

Individuals facing dysthymia (persistent depressive disorder) describe the low mood or “down in the dumps.”

RISK AND PROGNOSTIC FACTORS

• Temperament

The temperamental factor comprises of higher levels of neuroticism, the severity of symptom(s), poor global functioning, and prevalence of anxiety disorders.

• Environment

One of the various environmental factors includes parental loss or separation, during childhood.

• Genetic and physiological components

A persistent depressive disorder is highly likely to be affected by a dysthymic disorder or chronic major depressive disorder.

The majority of individuals having dysthymia, do have one or more immediate relative(s) with the same condition.

Various regions of the brain, i.e. amygdala, hippocampus, prefrontal cortex, an anterior cingulated area involved in dysthymia.

DIFFERENTIAL DIAGNOSIS

• Major depressive disorder

In case of persisting depressed mood for 2 years or more, along with more than two symptoms, then it can be said to meet the criteria for the dysthymic (persistent depressive) episodes. In that case, dysthymia is diagnosed.

The diagnosis majorly relies on the duration of prevalence, which is 2 years or more. If the symptoms meet the criteria for the diagnosis of episodes of depression, then it is diagnosed as major depression. It is not coded separately, rather diagnosed as a specifier along with the diagnosis of dysthymia.

In case of fulfillment of all the criteria for major depression, the specifier is “intermittent major depressive episodes, with current episode” is made.

In case of persistence of depressive episode(s) for minimum 2-years at a stretch, the specifier is “persistent major depressive episode” is made.

I case of a major depressive episode(s) criterion(s) is/are not currently present, but there has been a history of one major episode of depression (at least 2 years), then the specifier is “intermittent major depressive episodes, without current episode” is made.

In the case of no episode of depression in the past 2 years, then the specifier is “pure dysthymic syndrome” is made.

• Psychotic disorders

In the case of chronic psychotic disorders (schizophrenia, schizoaffective disorder, delusional disorder), the prevalence of depressive symptoms is common. No separate diagnosis of dysthymia is made in case of a non-occurrence of the symptoms.

• Depressive or bipolar disorder

Dysthymia has to be distinguished from a bipolar or depressive disorder. Depression or bipolar disorder consists of mood disturbance(s), physical examination, or laboratory findings that are done based on previous records.

• Substance-induced depressive or bipolar disorder

The involvement of a substance (a drug of abuse, a toxin, a medication) is useful in distinguishing a substance-abuse case or bipolar, from the case of dysthymia.

• Personality disorders

Often, a coexisting personality disturbance is observed along with the dysthymic symptoms, which when confirmed, the diagnoses for both are given.

COMORBIDITY

Those people with dysthymia (persistent depressive disorder) are at a higher risk zone for psychiatric comorbidity than the ones with major depressive disorder.

SYMPTOMS

Dysthymic symptoms generally do not persist for long, along with the change in its intensity. Along with this, major depressive episodes may occur during the occurrence of persistent depressive disorder, termed as double depression.

Symptoms of dysthymia may include:

Loss of interest in the majority of activities

Persistence of low mood

Constant feeling of hopelessness

Tiredness

Low self-esteem

Trouble-making decisions

Irritability

Decreased productivity

Feelings guilty

Poor appetite

Sleep disturbances

CAUSES

The exact cause of dysthymia is not known so far. It may involve certain other causes as well, such as:

Biological differences.

The brain goes through certain physical changes, during the episode(s) of dysthymia. The significance of the various alterations is still uncertain.

Brain chemistry.

Neurotransmitters as we know are natural brain chemicals, somewhere related to causing depression. Change(s) in the functioning of these neurotransmitters and their interaction with neuro-circuits (responsible for maintaining mood stability) may play a key role in the occurrence and treatment of depression.

Inherited traits.

The condition of dysthymia has its roots in the closely related or blood-relatives.

Life events.

Major depression brings along traumatic event(s) such as the loss of near-one, financial troubles, or increased stress levels, which can ultimately trigger dysthymia, in some people.

PREVENTIVE MEASURES

No sure way(s) can be specified for the prevention against dysthymia (persistent depressive disorder). It often starts in childhood.

Strategies involved in warding off symptoms are as follows:

• Getting control over stress increases our resilience and boosts self-esteem.
• Reaching out to friends and family, in times of crisis helps us in weathering off with the rough spells.
• Getting treated at the earliest helps prevent symptoms to become uncontrollable.
• Long-term maintenance treatment helps in preventing relapse.

Sources:

https://www.healthline.com/health/dysthymia#diagnosis

https://emedicine.medscape.com/article/290686-overview#a3