Dysthymia

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F34.1 Dysthymia
ICD-10 online (WHO version 2019)

The term dysthymia ( displeasure of ancient Greek : dysthymós = "grumpy" and thymos = "mind") stands for long-lasting depressed mood. It is a mood disorder that consists of the same cognitive and psychological patterns as depression - but with symptoms that are less pronounced but instead last much longer.

The term was introduced by Robert L. Spitzer in the late 1970s to replace the term "depressed personality". Other names for the same clinical picture include dysthymia, neurotic depression , dysthymic disorder , chronic depression, or persistent depressive disorder .

definition

The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines dysthymia as a serious form of chronic depression that lasts for at least two years (or one year for children and adolescents). However, it is less acute and severe than major depression.

Because dysthymia is chronic, sufferers usually endure its symptoms for many years before being diagnosed, if diagnosed at all. This allows them to believe that melancholy is part of their personality and therefore withholds their complaints and symptoms from doctors, family members or friends.

distribution

Globally, the number of dysthymic cases per year is estimated at 1.5% of the population. At 1.8%, it is somewhat more common in women than in men, at 1.3%. The prevalence of dysthymia is estimated to be higher in the US than in other countries, ranging from 3% to 15%.

Symptom picture

Dysthymia has a number of typical features:

  • little energy and drive,
  • low self esteem
  • a low capacity for joy in daily life ( anhedonia )

Mild forms of dysthymia can help avoid situations where stress, rejection, or failure are possible. In more severe cases of dysthymia, one may even withdraw from everyday activities and find little enjoyment in ordinary activities and pastimes. Diagnosing dysthymia can be difficult because the symptoms are subliminal in nature. They can often be well hidden by patients in social situations, making them difficult for others to discover.

Demarcation

Dysthymia often occurs with other mental disorders . If depressive episodes also occur, one speaks of a double depression in the English-speaking world . If periods of slightly clouded (dysthymic) mood alternate regularly with periods of slightly euphoric mood, then it is more likely to be cyclothymia , a slight variant of bipolar disorder .

causes

There are no known biological causes that apply to all cases of dysthymia, which is believed to be a result of the broad nature of the disorder. However, there is evidence that dysthymia may be at least partially genetic, as cases of dysthymia are more common in families: "The rate of depression in families with cases of dysthymia is at least 50% for the early-onset form of the disorder."

Other factors associated with dysthymia include stress, social isolation, or a lack of social support.

Comorbidities

In addition, dysthymia is often associated with other mental disorders. This makes it even more difficult to discover dysthymia, especially because the symptoms of different disorders overlap. Even suicidal behavior may occur with dysthymia, which is why it is imperative for signs of depression , panic disorder , generalized anxiety disorder , alcohol and drug abuse and personality disorder to seek.

The following mental illnesses often occur simultaneously with dysthymia: Depression (up to 75%), anxiety disorders (up to 50%), personality disorders (up to 40%), somatoform disorders (up to 45%) and alcohol and drug abuse (up to 50%). Up to 31% of all ADHD sufferers suffer from dysthymia.

The risk of developing major depression is higher than average for people with dysthymia. A ten-year study found that 95% of dysthymic patients had experienced a depressive episode. If intensive depressive episode occurs in addition to dysthymia, one speaks of a double depression (Engl. Double depression ).

Double depression

A double depression ( double depression ) occurs when someone experienced with an existing dysthymia also an episode of major depression. Such a condition is difficult to treat as patients often view symptoms of depression as a natural part of their personality or as a part of their life that is beyond their control. Since people with dysthymia often accept their worsening symptoms as inevitable, starting treatment can be delayed. If and when such patients do turn to a doctor, treatment may fail if only the symptoms of depression are treated, but not those of dysthymia.

A major symptom of double depression is hopelessness; Patients give significantly higher values ​​of hopelessness. It can be useful in the psychiatric treatment of double depression to pay particular attention to this symptom. In addition, cognitive therapies can be effective in changing negative mindsets in double depression patients and opening up new ways for them to perceive themselves and their environment.

To prevent double depression, it is often suggested that dysthymia be treated. It is believed that the onset of symptoms of major depression can be averted by a combination of antidepressants and cognitive therapies. Exercise and regular sleeping habits may have a moderate additional effect in treating dysthymic symptoms and preventing their deterioration.

Pathophysiology

There is scientific evidence to suggest the existence of neurological indicators of early-onset dysthymia. There are brain structures ( corpus callosum and frontal lobes ) that are different in women with dysthymia than in women without dysthymia, which suggests that there are developmental differences between these two groups.

Another study explored the differences between individuals with dysthymia and other individuals with functional MRI techniques. This results in additional evidence for the neurological indication of the disorder, as some brain regions were found that function differently. For example, the amygdala , which is associated with processing negative emotions (such as fear), was more active in patients with dysthymia. The study also found increased activity in the insular bark associated with emotions of grief. Increased activity was also found in the cingulate gyrus , which acts as a bridge between attention and emotions.

Another study comparing healthy individuals with dysthymic patients suggests other biological indicators of the disorder. Study participants were shown adjectives that were either positive, negative, or neutral and were asked to indicate whether the term could refer to them over the next two weeks. As expected, healthy individuals in the study marked fewer negative adjectives as applicable, whereas patients marked fewer positive adjectives. Neurological measurements were also taken during the experiment, showing that the healthy group had a higher level of neurological activity than the dysthymic group, regardless of whether the term was positive, negative or neutral. This is read as neurological evidence that fits in with the observation that individuals with dysthymia have less emotional capacity than healthy individuals.

There is also evidence of a genetic cause for all types of depression, including dysthymia. In a study of identical and fraternal twins have a higher probability was found that both a -eiige twins have a depression as both two -eiige have one. This supports the thesis that dysthymia is at least partially determined by genetic descent.

In the 2000s, a new theory developed in the literature about the stress axis (brain structures that are activated during stress), which establishes a connection between the HPA axis and dysthymia.

Neurophysiological mechanism of action

The neurotransmitter serotonin is often assigned a central role in the development and course of affective disorders and dysthymia. Modern research in the field of neuropsychology seems to invalidate this view, however, as there is no scientific evidence for it so far.

The view that low serotonin levels contribute to a depressive disorder may be based on the conclusion from the observation that frequently used antidepressants - serotonin reuptake inhibitors - increase serotonin levels and lead to an improvement in symptoms. However, this is not scientifically sufficient to show that serotonin or any other type of chemical imbalance is a cause of dysthymia. More research is needed to elucidate the neurophysiological functioning of dysthymia.

diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association also describes dysthymia as Persistent Depressive Disorder . The leading symptom is that the individual has felt depressed on more than half of the days in the past two years. Low energy, restless sleep, unsteady appetite, and low self-esteem complete the clinical picture. Sufferers have often endured dysthymia for many years before being diagnosed; her fellow human beings describe her as a "melancholy person". Note the following diagnostic criteria:

  1. On more than half of all days within two or more years, the patient reports being in a moody mood or is perceived by others as being moody.
  2. While the patient is moody, usually two or more of the following criteria also apply to them:
    1. Decreased or increased appetite
    2. Less or more sleep ( sleep disorder or insomnia )
    3. Exhaustion or low energy
    4. Decreased self-confidence
    5. Decreased focus or difficulty making decisions
    6. Hopelessness or pessimism
  3. During this biennium, the above symptoms are never absent for more than two consecutive months.
  4. Major depression criteria can be met throughout the 2-year period.
  5. The patient had no manic , hypomanic, or mixed episodes.
  6. The patient has never met the criteria of cyclothymia .
  7. Depression is not part of a chronic psychosis (like schizophrenia or delusionalism ).
  8. The symptoms are not the result of the physiological effects of a substance (e.g. substance with potential for abuse or drug) or a medical disease factor (e.g. hypothyroidism ).
  9. The symptoms cause clinically significant distress or impairment in social, professional, or other important functional areas.

An early onset of dysthymia (diagnosed before the age of 21) is associated with a higher relapse rate, a stay in a psychiatric hospital, and other concurrent disorders. Younger adults with dysthymia have an increased incidence of personality disorders and symptoms are likely to be chronic. In older adults with dysthymia, the psychological symptoms are associated with medical ailments and with traumatic life events and losses.

Dysthymia can be differentiated from depression by examining how acute the symptoms are. Dysthymia lasts far longer than depression, the symptoms of which sometimes only last for two weeks. In addition, dysthymia often shows up at an earlier age than depression.

prevention

While there is no hard and fast way to prevent dysthymia from occurring, there are some suggestions. Since dysthymia often occurs in childhood, it is important to discover children who are at higher risk. It can be helpful to work with the children to get their stress under control, to increase their resilience, to increase their self-esteem and to offer strong social networks to support them. These methods can help prevent or delay the onset of dysthymic symptoms.

treatment

Often times, people with dysthymia seek treatment not because of a depressed mood, but because of increasing stress levels or because they have situational personal difficulties. It is speculated that this is due to the chronic nature of the disorder and the fact that depressed mood is often viewed as a characteristic of the individual. Therefore, especially during periods of increased stress, the person will seek professional help to combat the symptoms.

Typically, dysthymia is first diagnosed for DSM-5 through a structured clinical interview . At this point, with the help of a doctor trained in it, a number of treatment options are discussed and selected. When choosing treatment, it is important to consider all factors of personal life that can be affected. If a treatment method doesn't seem to work for a particular patient, it can be changed.

In a meta study from 2008, a significant difference in the success of antidepressants and psychotherapeutic treatment could be found. In patients with dysthymia, drug treatment was more effective than psychotherapy.

psychotherapy

Dysthymia is often resistant to therapy. Different types of psychotherapy can be used to treat dysthymia. Empirically verified forms of treatment (such as cognitive behavioral therapy ) can resolve symptoms over time. Since the 1980s there has been a therapy specially developed for the treatment of chronic depression, the "Cognitive Behavioral Analysis System of Psychotherapy" (CBASP) . This approach was developed by the American psychologist James P. McCullough and integrates behavioral, cognitive, psychodynamic and interpersonal elements in an innovative way.

The psychodynamic psychotherapy and interpersonal psychotherapy may also be effective treatments. In particular, patients with dysthymia are advised to develop better coping strategies, to look for the causes of the symptoms, and to correct wrong viewpoints (such as belief in their own worthlessness). In addition to individual therapy, group therapy and support groups can be an effective part of treatment. The aim of the therapies is to strengthen self-awareness, self-confidence, self-assertion and other skills, as well as to think through relationship problems and patterns and cognitive restructuring.

Medication

Serotonin reuptake inhibitors are often the first form of drug treatment because they are usually better tolerated and have fewer side effects than many of the monoamine oxidase inhibitors or tricyclic antidepressants . Studies have found an average effectiveness rate of 55% when taking an antidepressant in people with dysthymia, versus 31% when taking a placebo . The most commonly prescribed serotonin reuptake inhibitors for dysthymia are fluoxetine , paroxetine , sertraline , and fluvoxamine . Most of these drugs must be taken for approximately 4 to 8 weeks before the patient begins to notice therapeutic effects.

The inter-clinic STAR * D study, conducted in the United States in 2013, found evidence that people with symptoms of depression often try different medications before finding one that works specifically for them. Of those who switched drugs, about a quarter said they were better off than before the switch, regardless of whether the second drug was a serotonin reuptake inhibitor or some other type of antidepressant.

In a 2005 meta-study, serotonin reuptake inhibitors and tricyclic antidepressants were shown to be equally effective in treating dysthymia. In the same study, monoamine oxidase inhibitors were also shown to have a marginal benefit in treating this disorder. However, monoamine oxidase inhibitors should not necessarily be the first drugs tried for treatment, as they are often less well tolerated than other classes of drugs.

combination

A combination of antidepressants and psychotherapy has been consistently identified in studies as the most effective treatment for people with dysthymia. In addition to antidepressants that help relieve the symptoms, additional psychotherapy that addresses the cause and effect of the disorder can be extremely beneficial. Various studies on the treatment of dysthymia have shown that 75% of patients respond positively to a combination of drug treatment and cognitive behavioral therapy, compared with only 48% of those who take only one of the two types of therapy.

Therapy resistance

Because the dysthymia is chronic, resistance to treatment is not uncommon. In this case, the use of treatment methods that are not yet established is recommended, including lithium therapy , increased thyroid hormones , buspirone , bupropion , stimulants and mirtazapine or z. B. cannabinoids (see cannabis as a medicinal product ) is also possible.

If there is also a seasonal affective disorder , light therapy can be useful.

See also

literature

  • Peter Hofmann (Ed.): Dysthymia. Diagnosis and therapy of the chronic depressive mood . Springer, Vienna [a. a.] 2002, ISBN 3-211-83764-7 .
  • Frank Steinhauer: Evaluation of the classificatory concept of dysthymia . University of Mainz , 1997 ( dissertation )

Web links

Wiktionary: Dysthymia  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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  2. ^ Daniel L. Schacter, Daniel T. Gilbert, Daniel M. Wegner: Psychology . 2nd Edition. Worth Publishers, New York 2011, ISBN 978-1-4292-3719-2 , pp. 564 .
  3. ↑ Information from MedlinePlus on Persistent Depressive Disorder (accessed July 2017)
  4. ↑ Jane Brody: Help awaits those who live with sadness . In: The News-Journal , p. 54. 
  5. ^ A b c Peter Falkai, Hans-Ulrich Wittchen: Diagnostic Criteria DSM-5 . 1st edition. Göttingen 2015, ISBN 978-3-8017-2600-3 , p. 115 ff .
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  11. ^ Baldwin, Rudge S. and Thomas S .: Dysthymia: Options in Pharmacotherapy . In: Practical Therapeutics . 4, No. 6, 1995, pp. 422 to 430.
  12. ^ Original: “ At least three quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, cyclothymia, drug addiction, or alcoholism. ”(Harvard Health Publication, 2005). Translation: "At least three quarters of all dysthymic patients also have a chronic physical illness or another psychiatric disorder, such as one of the anxiety disorders , cyclothymia , drug addiction or alcoholism ."
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  35. ↑ cannabis-med.org (PDF)