08 December 2005

Dysthymia: a disabling condition

Many people are unaware of the chronic, milder form of depression, called dysthymia.

Most people have an idea what depression is, as all of us at some time in our lives have felt an overwhelming sense of despair and a hopelessness, whether it lasted for an afternoon, or longer. When we think of depression in a clinical sense, most of us are referring to Major Depression, which although severe, usually occurs as an episode. An episode can last from a few weeks to a few months, and only very rarely a few years.

There is another form of depression though, which is more chronic, and does last for years, sometimes up to even twenty or thirty years. It is known as Dysthymia.

According to Martin B Keller, M.D. from Brown University: "This so-called chronic depressive disorder, Dysthymia, had largely been discounted in importance until recently. The sufferers of this disorder were among the most difficult to treat, and the limited data from controlled trials caused much frustration for clinicians. Treatment by clinicians tended to be exclusively psychotherapeutic in nature. There was a real question about whether or not the disorder belonged in the province of medical psychiatry."

Dysthymia, by definition, is a milder but more chronic form of Major Depression. It shares many of the symptoms of Major Depressive Disorder, but differs in its course. In it the symptoms are somewhat milder but remain relatively unchanged over longer periods of time.

To be diagnosed with Dysthymia you have to have had a persistently depressed mood for at least two years, during which you cannot have been without symptoms for more than two months. Some of the symptoms include:

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

The typical age this disorder begins is a person's early twenties, but it has also been found to begin a lot earlier, which sadly is associated with the disorder lasting longer, being more difficult to treat, and a stronger likelihood of the disorder running in the family.

General medical conditions
According to Dr Rush (University of Texas) and Dr Thase (University of Pittsburgh): "Mood disorders in general, and chronic depressions in particular, are associated with significant impairment in work and interpersonal, family and marital function. These lower levels of functioning are associated with a poorer prognosis. The Medical Outcomes Study found that physical, and general health functioning were worse in depression than in most other chronic general medical conditions (e.g. hypertension, diabetes mellitus, arthritis, and gastrointestinal and pulmonary disorders)."

They also state that the co-occurrence of general medical conditions is known to be common among depressed patients, particularly those with chronic forms. This co-occurrence can also lead to the person's chances of recovering from the general medical condition becoming worse.

Imagine feeling constantly depressed, where everything in your day feels like another obstacle to be overcome, to feel tired all the time, and to have mostly negative thoughts about yourself and the future. Now imagine feeling this way for years. The problem is though, that although you feel bad, you don't feel that bad, so even though you don't excel at your job, you can still manage to keep it, and although you sometimes worry about how you feel, it is never bad enough to warrant hospitalization, although you do seem to have to visit the hospital often for other illnesses. So you carry on for years, unhappy and never seeking the help you need. It is no wonder Dysthymia is one of the most disabling disorders.

Without treatment, studies have shown that the condition of people suffering from Dysthymia tends to progressively deteriorate over time. It is also relatively common for Major Depressive Episodes and Dysthymic Disorder to co-occur. 42% of Dysthymia sufferers will also experience a Major Depressive Episode at some point in their lives. This underlines the importance of seeking help for this disorder.

The recent focus on Dysthymic Disorder has also brought the spotlight onto its various treatments. More and more studies are being done to find newer and more effective ways to treat this disorder. According to Drs Rush and Thase: "The aim of treatment is full symptomatic remission, which can be obtained with medication alone in some, but not all, patients. Both response and symptom remission are associated with significant functional improvement." At the moment a combination of medication and psychotherapy has been shown to be the most effective treatment, although both require patience and a commitment to getting well.

Where to go for help
If you suspect you or someone close to you is suffering from this disorder, for more information, counselling and referrals to appropriate mental health professionals, contact the Depression and Anxiety Support Group, Monday to Friday, 8am to 7pm, Saturdays, 8am to 5pm, and on Sundays, 9am to 1pm, on (011) 783-1474/6.

- Katherine Baine, Depression and Anxiety Support Group

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