Dysthymia or dysthymic disorder
What is dysthymia?
The dysthymic disorder (previously defined depressive neurosis or simply dysthymia) is a chronic and milder form of depression, a disease belonging to the mood disturbances. When it comes to dysthymia, the depressive episode is continuous (it can last for years) and involves multiple aspects of the life of those affected.
The first to speak of alteration mood was Hippocrates, father of Medicine: he spoke of melancholy referring to an accumulation of black bile in the brain, in ancient Greece considered a treasure chest of the soul and human feelings.
So what is the meaning of the praola dysthymia? The word "dysthymia" also comes from the Greek, and literally means "bad mood". In fact, the subjects affected by dysthymic disorder have more nuanced and therefore subtle symptoms; they are often considered too pessimistic people, always low in spirits, with low self-esteem, insecure.
But, before going into dysthymia, let's do a little order and give some definitions.
It is important to first distinguish a episode from a disorder:
- a episode depressive (or any other kind) occurs for a limited period of time. This is the case with depression reactive, resulting from a bereavement or a stressful event which resolves itself within a few weeks or months;
- a disorder it is defined by multiple episodes that recur over time, or by the presence of depression persistent with symptoms that persist for a long time.
We said that Dysthymia is classified as a mood disorder, but where exactly is it in this classification? And especially, what it means to have a mood disorder? It's a more serious thing than being "simply" down in the dumps, or pessimistic, as well as energetic, sunny, euphoric: Mood disturbances are alterations of the tone mood outside the "range" of a healthy person, which in fact have repercussions on the social and working life and on the self-image of those affected.
A more intuitive example: if we imagine the mood of a healthy person as a straight line, the changes in mood will be deflections below that line (which can manifest as Major Depressive Disorder or Dysthymic Disorder) or peaks above it (defined as manic episodes, that is, more or less prolonged or persistent manifestations of excessive euphoria). It may also happen that the mood of a subject may have a trend similar to a roller coaster, so to speak, that is, have some peaks manic followed by gods deep episodes of depression. This is what happens in the case of the Bipolar disorder. If these fluctuations were less large and protracted over time, we speak of cyclothymia. Thus, just as Dysthymia is a chronic and mild form of Clinical Depression, cyclothymia is a chronic and less "intense" oscillation of bipolar disorder.
Now, to put things in order, let's summarize the mood disorders with the classification provided by the DSM-IV (Statistical and Diagnostic Manual of Mental Disorders, edited by the American Psychiatry Association):
- Major depressive disorder (recurring episodes, with varying degrees of intensity)
- Dysthymic disorder
- Depressive disorder not otherwise specified (when the symptoms do not reflect the criteria for the diagnosis of either of the previous two).
Bipolar disorders (in which, we recall, episodes of depression alternate with episodes of mania)
- Bipolar disorder
Let's focus now on deflections of mood. We can clarify the difference between Dysthymia and Depressive Disorder by keeping the line as an example: Depressive Disorder is a deep, more or less lasting deflection, which then returns to join the straight line. Dysthymia, on the other hand, takes a much longer and more continuous path below the line, but goes less "in depth". In the course of dysthymia, however, an episode of major depression, isolated from the common course of the dysthymic disorder: we will then speak of double depression.
What in our example is an area below the line, in the daily life of a person with dysthymia is the manifestation of symptoms. Important for the diagnosis is that they occur for at least two years, with a break no longer than two months. For children and young people, the minimum time for diagnosis is one year.
What are the symptoms of dysthymic depression? Among the symptoms of dysthymia we recognize:
- Sleep disturbances: such as insomnia or hypersomnia; the subject finds it very difficult to fall asleep at night, or sleeps more than necessary and has difficulty getting out of bed;
- Depressed mood in the morning;
- Low self-esteem and low self-confidence
- Asthenia (feeling of generalized physical weakness) and increased fatigue;
- Eating disorders such as increased or decreased appetite (hyperphagia and hyporexia, respectively);
- Feeling of despair (deflected mood often mistaken for inappropriate pessimism by family members and acquaintances)
- The subject shows little interest or pleasure in things and a certain detachment in many situations of daily life;
- Decreased sexual desire
- Difficulty concentrating or maintaining work or social commitments;
- Feelings of despair.
All that all day long, nearly every day.
Being a slight and lasting alteration of the tone of themood, often these symptoms are perceived by the affected person, or by those around him, as an integral part of the character. Having such a "subtle" course, it is not immediately diagnosed and appropriately treated and this leads the subject to be more and more introverted, unsure of their abilities and to live with anxiety and a sense of oppression the normal situations of everyday life, nevertheless managing to face them .
The debut of dysthymia can be:
- early: onset before age 21. These individuals are more likely to "slip" into a major depressive episode over the course of their life (with symptoms worsening, even thinking about suicide).
- late: onset after age 21.
Causes of dysthymia
What are the main causes of dysthymia? At the base of the dysthymia there is certainly a biological component, which however is not enough to explain all the symptoms and its course. Precisely for this reason, therapy is not based only on the use of drugs, but also on a psychotherapeutic approach, in order to intervene on the environment and on the family.
Let's start the analysis of the causes of dysthymia by focusing on biological factors:
- Genetics: some mood disorders, therefore also the dysthymic disorder, have a hereditary component. In fact, the onset is more common if there are first degree relatives affected.
- Nervous system (neurochemical hypothesis): speaking of this kind of disorder, it is inevitable to dwell on the nervous system, composed of a dense network of signals that affects our entire organism and also character, mood and moods. Drug therapy is useful precisely for this: it acts on the balance between the molecules that act as a signal in our brain and in particular, in this case, on those that influence mood. There Serotonin (commonly referred to as the "happiness hormone") is one of these and some antidepressant drugs aim to increase levels.
A good balance of the signal molecules of the nervous system is also important for sleep and in particular the REM phase, whose alterations, as we have seen, are among the symptoms of dysthymia.
- Endocrine system: the endocrine system is another important "signaling system" in our body that influences our response to stress, fertility, metabolism and much more. An excess of cortisol (also called a "stress hormone") could contribute to mood deflection symptoms.
Personality, social factors, behavioral and relationship mechanisms are equally important. There is no single aspect of personality to explain the onset of dysthymia, but some factors can certainly be taken into consideration:
- Excessive dependence on other people and their judgment;
- Tendency to perfectionism, to excessive self-criticism;
- Low self-esteem;
- Problems and difficulties in the relationship with the family since childhood;
- Traumatic events, such as the death of a loved one or the loss of a parent.
Hypothyroidism, Cushing's syndrome, and other organic, not necessarily endocrine, diseases could cause one deflection of mood, therefore it is up to the doctor to prescribe tests and laboratory tests to rule out an underlying disease as the cause of dysthymia:
- Complete blood tests (blood count);
- Tests for liver function (proteins and albumin, INR, transaminases, bilirubin) and thyroid function (TSH, fT4, fT3);
- Dosage of vitamin B12 and folate;
- Toxicological screening;
- Dexamethasone suppression test (stress response assessment);
- Test for HIV and for autoimmune diseases.
Excluding organic causes, one is important psychological evaluation of the patient: more or less recent trauma, the loss of a loved one or economic and social difficulties could lead to a diagnosis. It is important to ask the patient when the first symptoms began to manifest themselves and to let him express his thoughts, ideas and the difficulties he encounters in everyday life, because much of the symptomatology is determined by the perception that the patient has of himself and difficulties in everyday life.
Is there a cure for dysthymia? The therapeutic ideal for dysthymia is the association of psychotherapy and drug therapy: it is in fact essential to support the patient under both aspects in order to have a complete remission.
In the choice of therapy it is important to take into account the patient's preferences, his tolerance to drugs, the severity of the disorder and other subjective situations, especially of an emotional nature, which can in some way condition the therapeutic choice.
It is fundamental to reassure the affected patient and above all to explain his condition, so that he does not consider dysthymia as his way of being and therefore a moral and personal failure. It is also important to explain the mechanism and times of action of the drugs that will be used, so that the patient is not discouraged in the early "settling" times and willingly follows home therapy.
The most used drugs for the treatment of dysthymia are antidepressants such as:
- Selective serotonin reuptake inhibitors (ISRS);
- Tricyclic antidepressants;
- MAO inhibitors (mono-amino-oxidase)
- Other antidepressants