Depression is one of the most common-and serious-mental health problems facing people today. Each year, more than 1 in 20 Americans suffers from a depressive disorder. Dysthymia-often referred to as long-term depression-is characterized by persistent depressive symptoms that may last for years (at least two years in adults, and at least one year in children or adolescents).

While the symptoms of dysthymia are not as disabling as those for major depression, people who suffer from this depressive condition experience significantly decreased energy, general negativity, and an overall sense of dissatisfaction and hopelessness that pervades most, if not all, areas of their life.

Quite often, there is seemingly nothing to blame the onset of dysthymia on, no significant loss or life change. This can be confusing and frustrating for the person suffering from the depression, as well as for family, friends, and co-workers.

Symptoms of Dysthymia

People who suffer from dysthymia may experience varying levels of the following symptoms:

  * Persistent sad, anxious, or empty mood.

  * Decreased interest or pleasure in hobbies and activities that were once enjoyed.

  * Feelings of hopelessness, pessimism.

  * Feelings of guilt, worthlessness, helplessness.

  * Insomnia, early-morning awakening, or oversleeping.

  * Decreased energy, fatigue, feeling “slowed down.”

  * Difficulty concentrating, remembering, making decisions.

  * Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Causes

Almost 10 million Americans suffer from dysthymia each year. For some people, dysthymia is the result of a combination of factors, while for others, a single cause can be responsible for the onset of the depressive symptoms. Common contributing factors include the following:

Stressful Life Events

Catastrophic illness or death of a close family member or friend, divorce, career crisis, moving to a new place, financial problems, or any unwelcome change in life patterns can be risk factors for depression. Research also indicates that stressors in the form of social isolation or early-life deprivation can lead to permanent changes in brain function that increase susceptibility to depressive symptoms. For some individuals, stressful life events can contribute to recurrent episodes of dysthymia.

Severe or Chronic Illness

Severe or long-term illness can bring on or aggravate dysthymia. Up to 60% of chronic pain patients suffer from some degree of clinical depression. There are also illnesses that may be directly related to depressive disorders, such as strokes, heart disease, certain types of cancer, thyroid disease, diabetes, Parkinson’s disease, Alzheimer’s disease, and hormonal abnormalities. When it occurs with other illnesses, dysthymia is frequently unrecognized and goes untreated. This can lead to unnecessary suffering since dysthymia is highly treatable, even when it occurs with other disorders. Individuals or family members with concerns about the occurrence of depression with another illness should discuss this issue with their physician.

Medication Side-Effects

Some medications cause depressive symptoms as side effects; among them are pain relievers for arthritis, cholesterol-lowering drugs, certain medications for high blood pressure and heart problems, and bronchodilators used for asthma and other lung disorders. In addition, different drugs can interact in unforeseen ways when taken together. It is important that each physician and pharmacist knows all the different types and dosages of medicine being taken and discusses the possible side effects with the patient.

Biological Factors

Genetics research indicates that vulnerability to depressive disorders results from the influence of brain chemistry imbalance acting together with environmental factors. Modern brain imaging technologies are revealing that in dysthymia, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters-chemicals used by nerve cells to communicate-are out of balance.

Co-Occurrence of Depression and Anxiety

Research has revealed that dysthymia can co-exist with anxiety disorders (e.g., panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social phobia, or generalized anxiety disorder). Studies have shown an increased risk of suicide attempts in people with co-occurring dysthymia and panic disorder, the anxiety disorder characterized by unexpected and repeated episodes of intense fear and physical symptoms, including chest pain, dizziness, and shortness of breath. Rates of dysthymia are especially high in people with post-traumatic stress disorder, a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Substance Abuse and Addictions

It is estimated that 25% of people with substance abuse suffer from depressive disorders.

Family History

Evidence suggests that dysthymia runs in families. Still, just because a person has a family history of dysthymia does not guarantee that he or she will develop it. Similarly, a person may get dysthymia even if no one else in their family has experienced it.

Treatment

The sooner dysthymia is treated, the sooner recovery can begin. The American Psychiatric Association reports that 80% to 90% of all people with depressive disorders-even those with the severest cases-improve once they receive appropriate treatment. Basic ways to treat dysthymia include therapy, medication, and a combination of the two.

Therapy

There are therapists who are especially skilled at helping people who are suffering from dysthymia. Therapy provides a safe, comforting, and confidential setting in which to receive the kind of help and understanding that can best assist in first relieving, then understanding, and finally recovering from the effects of dysthymia. It can take as few as one to two weeks for people to receive relief from their symptoms with therapy.

Medication

Antidepressant medication is often the first step in treating cases of dysthymia because of the relatively quick relief it can bring to physical symptoms. Once medication treatment begins, minor improvement is usually seen in one to two weeks and the full effect of relief becomes evident approximately three to four weeks later.

Combination of Therapy and Medication

In some cases, neither therapy alone nor medication alone may treat dysthymia as quickly or thoroughly as the patient or the therapist would like. For these cases, both types of treatment used together can have very successful results. For those who suffer from chronic dysthymia, combination therapy is especially helpful in dealing with the condition and how it affects their lives.