Dysthymia (or dysthymic disorder) is a serious form of depression that, by definition, lasts for a period of at least two years. While it produces relatively moderate symptoms, its long-term effects on a person’s mood and life outlook can easily be as disruptive or debilitating as the effects associated with major depression (major depressive disorder). Mental health professionals commonly address the symptoms of dysthymia with a variety of medications classified as antidepressants, as well as with several different types of psychotherapy. Typically, these treatments work best when used in combination.
Dysthymia gets its name from the Greek term for melancholy or despondency. People with the disorder have some of the same symptoms found in people with major depression, including abnormally low energy levels, sleep disturbances, reduced mental focus and a depressed mood that features emotions such as helplessness, sadness, emptiness, or worthlessness. Other potential symptoms of dysthymia include appetite disturbances and a reduced level of self-esteem. People with major depression typically have more depressive symptoms than people with dysthymia, and those symptoms are generally more severe. However, while major depression tends to appear in isolated episodes of fairly short duration, dysthymia produces ongoing problems that disrupt an affected individual’s life for years at a time.
Three different classes of antidepressant medication are commonly used to address the effects of dysthymia: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). All of these medications achieve their effects by altering brain levels of chemicals called neurotransmitters, which foster coordinated brain activity by relaying signals between nerve cells called neurons. Several of these neurotransmitting chemicals—including substances called serotonin, norepinephrine, glutamate, gamma aminobutyric acid (GABA) and dopamine—play important roles in mood regulation and mood stability, and imbalances in these chemicals help create brain conditions that promote the onset of dysthymia and other forms of depression.
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Like all other neurotransmitters, serotonin is secreted by certain neurons in the brain for use in specific communications tasks, then gets broken down and reabsorbed back into those secreting neurons. As their name implies, SSRIs boost brain levels of serotonin by blocking (inhibiting) its normal rate of neuron reabsorption (reuptake); examples of these medications include sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac) and citalopram (Celexa). In addition to blocking normal serotonin reabsorption, NSRIs block normal reabsorption of the neurotransmitter norepinephrine; examples of these medications include desvenlafaxine (Pristiq), duloxetine (Cymbalta) and venlafaxine (Effexor). Tricyclic antidepressants also block normal serotonin and norepinephrine reabsorption; examples of these medications include imipramine (Tofranil), doxepin, protriptyline (Vivactil), and amitriptyline.
Forms of psychotherapy used to treat people recovering from dysthymia include cognitive behavioral therapy (CBT), psychodynamic therapy, and interpersonal therapy (IPT). Cognitive behavioral therapy is a relatively short-term form of weekly psychotherapy that focuses on specific difficult circumstances or situations in the life of a dysthymic person. It helps the affected individual understand how he or she acts within the context of those situations or circumstances, identifies specific thought patterns that contribute to poor or unwanted outcomes, and helps the affected individual learn new thought patterns that can lead to improved outcomes. Typically, this type of therapy is conducted in 10 to 20 separate sessions that can take place one-on-one or in group or family settings.
Psychodynamic therapy is an older form of psychotherapy that has its roots in the work of Sigmund Freud and other founders of psychoanalytic therapy techniques. It also addresses unhelpful behaviors that contribute to unwanted social or personal outcomes. However, rather than seeking relatively obvious present-day motivations for those behaviors, psychodynamic therapists look for motivations rooted in past behaviors, conflicts and relationships. By uncovering these motivations, participants in the therapy reduce their need or compulsion to engage in damaging behaviors in the present.
As its name implies, interpersonal therapy addresses the interpersonal conflicts that damage the relationships of people with dysthymia and other forms of depression. In some cases, these conflicts occur during active attempts at communication between the depressed person and others. In other cases, they occur because the depressed person withdraws from active communication. During one-hour sessions that occur weekly for a period of two or three months, interpersonal psychotherapists identify important conflicts and explain how they relate to the reinforcement of a depressed state of mind. Interpersonal psychotherapists also address the depression-related effects of excessive or unexpressed grief, as well as the effects of major life alterations (such as changes in employment, place of residence or relationship status) that dysthymic people and other depressed individuals frequently interpret as disproportionately negative or defeating.
Some people with dysthymia recover with the help of antidepressants alone, or with the help of psychotherapy alone. However, as stated previously, most people do best when they receive both medication and either cognitive behavioral therapy, psychodynamic therapy, or interpersonal therapy. In addition, dysthymia and other forms of depression frequently drop in intensity when affected individuals get regular aerobic exercise. In some cases, people with severe forms of dysthymia require hospitalization during the initial stages of their recovery.