Theraverse . January 25, 2024

Remember the F.R.I.E.N.D.S theme song,

It’s like you’re always stuck in second gear
When it hasn’t been your day, your week, your month
Or even your year…

Do these lines hit you harder than you expected?

Have you been feeling blue for too long?

To all those people, who for the past couple of years have found themselves exhausted, sad and feeling hopeless through most of the day, more days than not. Experiencing a mild yet persistent difficulty in concentrating at work or enjoying activities that you once found pleasure in. Having issues with sleep and appetite. Along with concerns with decision making and a pattern of blaming yourself, leading to low self-esteem and feelings of worthlessness.

These symptoms may not be severe enough to qualify for the diagnosis of Major depression Disorder (MDD) but that does not mean your symptoms are invalid. You may be experiencing something called Persistent Depressive Disorder (PDD) also known as Dysthymia. This is a mild yet long-term form of depression.

Symptoms of Dysthymia

• Depressed mood that occurs for most of the day for more days than not, for a period of at least 2 years or at least 1 year in children and adolescents
• Major depression may exist before dysthymia and major depressive episodes may occur during dysthymia. The superimposition of these two is also known as Double Depression.
• Individuals may describe their mood as ‘sad’ or ‘down in the dumps’.
• Usually early onset (childhood/adolescence) and chronic course.
• Withdrawn from society, loss of interest, and lack of productivity.
• There may also be associated feelings of inadequacy, guilt, irritability, and anger.

How is it different from MDD

Symptoms of dysthymia occur at a lower frequency than symptoms of MDD. MDD is significantly more severe and acute than dysthymia and can be diagnosed in as little as 2 weeks. Rather than MDD’s neurological and psychomotor features, social-motivational impairments are more characteristic of Dysthymia. Although pharmacotherapy may have higher effectiveness when used for MDD than with some subsets of Dysthymia, SSRI’s are still used in the short-term treatment of dysthymia. The course of dysthymia is believed to be worse than the course of MDD. However, they can be distinguished on the basis of HPA functioning; dysthymia may be associated with persistent functional changes of HPA activity

Risk factors

Persistent depressive disorder often begins early in childhood, the teen years or young adult life and continues for a long time. Certain factors appear to increase the risk of developing persistent depressive disorder, including:

• Having a first-degree blood relative, such as a parent or sibling, with major depressive disorder or other depressive disorders.
• Traumatic or stressful life events, such as the loss of a loved one or major financial problems. These may also often lead to maladaptive coping strategies.
• Personality traits that include negativity, such as low self-esteem, being too dependent or self-critical, or always thinking the worst will happen.
• Reduced positive perception of social interaction, health perception, cognitive functioning, alertness, energy/vitality, and life satisfaction.
• History of other mental health disorders, such as a personality disorder or any other comorbid conditions such as anxiety.

Perpetuating factors

Perpetuating factors are essentially those that maintain the problem and even exacerbate it at times, instead of resolving it.

• Personality Factors: Certain personality traits, such as a negative thinking pattern, pessimism, or low self-esteem, can contribute.
• Cognitive Factors: Negative thinking patterns, for example the use of cognitive distortions, can perpetuate and maintain dysthymia.
• Social Support: Lack of a strong social support system or experiencing strain in relationships can exacerbate dysthymia. Isolation or loneliness can contribute to the maintenance of the symptoms that one is experiencing.
• Behavioral Factors: Unhealthy lifestyle choices, such as poor diet, lack of exercise and substance abuse, can be a major contributor to the symptoms.
• Chronic Stress: Prolonged exposure to stress without adequate coping mechanisms can perpetuate dysthymia. The body’s stress response, if constantly activated, can contribute to the maintenance of depressive symptoms.

Depressive personality disorder Vs MDD

The old concept of a “depressive personality” was a theoretical framework that suggested some individuals had a personality structure prone to experiencing long-term or chronic feelings of sadness, pessimism, and hopelessness. It was considered a pervasive trait rather than a diagnosable mental disorder. This concept implied that individuals with a depressive personality tended to see the world through a consistently negative lens, often displaying traits like low self-esteem, chronic self-criticism, and a gloomy outlook on life. However, this idea of a depressive personality isn’t formally recognized in modern psychiatric classifications like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

On the other hand, Major Depressive Disorder (MDD) is a clinical mental health condition categorized in the DSM-5. It involves a distinct set of symptoms that significantly impact an individual’s ability to function.

Treatment for Dysthymia

• The primary aim of treatment for dysthymia is to resolve depressive symptoms, reduce the risk of developing other mood disorders and improve psychosocial functioning.
• Antidepressants are also useful and prolonged maintenance of treatment may be beneficial. It was associated with reduced daily hassle perception, increased uplift perception, diminished reliance on emotion-focused coping styles, and reduced feelings of loneliness.
• Discontinuation of antidepressant treatment was found to be associated with an 89% rate of relapse in a 4-year maintenance study.
• Hormonal manipulations have also been shown to influence dysthymic symptoms and can alleviate some symptoms like anhedonia, loss of motivation and energy, inability to cope, worry, emotional numbness, and sadness.
• Cognitive behavioral psychotherapy, which focuses on the helplessness and hopelessness associated with dysthymia, and teaching adaptive coping skills may also be beneficial.
• Treatment must be carefully administered because those treatments which permit residual dysthymic features to persist (eg, inadequate antidepressant dosage or insufficient duration of treatment) may also favor recurrence of this illness.

By Jensita Grace (In-house Psychologist, Theraverse)

References:

Persistent depressive disorder – Symptoms and causes – Mayo Clinic. (2022, December 2). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929

Griffiths, J., Ravindran, A. V., Merali, Z., & Anisman, H. (2000). Dysthymia: a review of pharmacological and behavioral factors. Molecular Psychiatry, 5(3), 242-261.

Hirschfeld, Robert M. A. (1994). Major Depression, Dysthymia and Depressive Personality Disorder. British Journal of Psychiatry, 165(S26), 23–30. doi:10.1192/S0007125000293252

Ryder, A. G., Schuller, D. R., & Bagby, R. M. (2006). Depressive personality and dysthymia: Evaluating symptom and syndrome overlap. Journal of Affective Disorders, 91(2-3), 217-227