Abby: Dysthymia, chronic depression
Dear Dr. Roach: I recently was diagnosed with dysthymia. I have had a basically unhappy life, with three marriages and three divorces. I often have felt that suicide is right at hand, yet I manage to get through each crisis. I am at a loss as to how to handle any more stress, and I shudder when I read that there is no cure for dysthymic disorder.
Can you write about this mental illness to help those out there dealing with the disease?
Dear H.B.W.: Dysthymia, also called persistent depressive disorder, is a type of chronic depression. To be diagnosed with dysthymia, one must have a depressed mood for most of the day, more days than not, for at least two consecutive years, and also have two or more of the following: change in appetite, change in sleep pattern, low energy or fatigue, low self-esteem, difficulty with concentration and hopelessness.
Dysthymia is not common, but it certainly is not rare, with about 3 percent of people being diagnosed in their lifetime. It seems to be increasing over time.
Dysthymia is different from the more common major depression in several ways, but especially in the long duration of symptoms. It is possible to have dysthymia and major depression, sometimes called "double depression." There are many risk factors, including traumatic events in childhood or adulthood, and it does tend to run in families, especially with women.
Having a diagnosis of any kind of depression does not mean one is a "weak" person, any more than any other medical condition.
Indeed, it is a very difficult diagnosis for the individual and the family and loved ones of the person suffering from dysthymia. Oftentimes, the symptoms are not recognized, and, frequently, there is a long delay in making the diagnosis, which is unfortunate, since there is effective treatment.
Both psychotherapy and medication are effective treatments for many people with dysthymia; however, some people can be resistant to treatment. Treating with both psychotherapy and medication is probably more effective than either one alone.
It often takes many tries to find the right treatment.
Because depression often gives a sense of hopelessness, many people don't even seek treatment. It can be very hard for both patient and family, with the patient not wanting to go for treatment and the family wanting to respect his or her wishes or just giving up.
In this case, having a supportive family who doesn't give up and helps bring the patient in for treatment, to either a primary care doctor or a psychiatrist, is essential for treatment.
Email questions to ToYourGoodHealth@med.cornell.edu.