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Depression: Major Depression & Unipolar Varieties

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Introduction and Types of Depression

Major Depression and other Unipolar DepressionsClassic Symptoms of Major DepressionUnderstanding Mood Episodes in DepressionThe Course of Major DepressionDSM Specifiers for Major DepressionPrevalenceFormal DSM Diagnoses for Other Depressive Mood DisordersSymptoms - Dysthymic DisorderFormal DSM Diagnoses Continued

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Symptoms - Dysthymic Disorder

Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Updated: Sep 19th 2007

People diagnosed with Dysthymic Disorder do not experience a full major depressive episode, and therefore cannot be said to have Major Depression. Instead, they experience a less intense, but longer duration (chronic, or long term) depressed mood that occurs for most of the day, more days than not over the course of at least two years (or one year for children and adolescents). Symptom-free periods, during which there are few or no mood symptoms, never last longer than two months.

During periods of depressed mood, at least two of the following symptoms are present: changes in appetite, changes in sleep patterns, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. In addition, the individual has never experienced a manic episode, a mixed episode, or a hypomanic episode. Mood symptoms must also occur solely during the course of the mood disorder and not as part of some other disorder that may be occurring simultaneously (such as Schizophrenia or Delusional Disorder).

Dysthymic Disorder affects between 3 and 6% of the population each year. Women are twice as likely to be diagnosed with dysthymia as men. Individuals with Dysthymic Disorder often think that they have MDD, which is often their reason for seeking treatment. Although the two disorders are similar (and both are treatable), they are also distinct; with different patterns of onset, duration, and severity.

Simply put, Dysthymia is less severe than Major Depression. People with Dysthymia are able to maintain a higher level of functioning than individuals experiencing a Major Depressive Episode. The difference in severity between the two disorders is something that individual patients can experience subjectively when they consider how they have come to define "normal mood." A Major Depressive Episode is clearly a departure from people's normal mood and behavior. In contrast, Dysthymic individuals will have generally experienced a low-grade "down in the dumps" feeling for so long that they don’t remember feeling any other way. For such individuals, the low-level depressed feeling that characterizes Dysthymia is their normal mood.

Approximately 10% of people with Dysthymia will get better without treatment, and 10% will go on to develop Major Depression. The other 80% or so of people with Dysthymia may linger in a Dysthymic condition for years. Fortunately, the same treatments that work to help people suffering with Major Depression are also helpful for patients with Dysthymic Disorder.

Though Dysthymic Disorder and Major Depressive Disorder are separate conditions, they can co-occur simultaneously. When individuals experience both Dysthymia and MDD at the same time, their illness is sometimes referred to as "double depression." We provide more details about double depression towards the end of this document.

Some mental health professionals use the terms Dysthymic Disorder and Neurotic Depression interchangeably. The term "neurotic depression" was initially used to describe any type of depression that did not produce psychotic features such as hallucinations or delusions. Eventually, the term was used to describe milder forms of long-term depression (today's dysthymia). The term neurotic depression is no longer used for purposes of diagnosis.

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low grade depression - - Nov 5th 2009

Hello there...I know a thing or two about mental health - I work in the field. I wanted to share my story because I seriously think I have dysthymia, and have thought this for a while now.

As a child, I remember some sad times as we went through the recession, and my mother was quite stressed at the time. I was very close with my sister, but somehow recall never really being a happy child.

The happiest times for me were in undergrad - I lived on my own, was academically a high achiever, and was in a love relationship in which I was in complete control, and was very much loved. I was young, healthy, vibrant, and happy. That relationship ended and my next relationship was very different - I didn't feel loved in the same way, and the girl was very 'unavailable'. At the same time my mother was going through cancer, I entered grad school, my grandma died and my dad was having health problems (among other problems). I remember during this time, staying in bed for the entirety of the weekend, and feeling fatigued and soooo tired and 'dead'. It was hard to work. I couldn't cry for some reason. I remember wishing I'd just melt into the mattress...just melt away. I am shocked remembering this.

I never got that bad again...but since that time I can't say i've been happy. A good day is about a 7 on a happiness scale but that is rare....for many days over the past years i've been at a 5 or 6. I keep telling myself that I'm accomplished, have great loving family, a few close friends....but my 'happiness' doesn't seem to last very long and i know the sadness will creep back. I would never harm myself, but at times I wish I could just disappear or fall asleep and not wake up.

I keep trying to give myself therapy - ask myself 'what would 9/10 look like? what would make you happy? what do u want from life? what are the good things in your life?" All I want is to be happy!!! And even if i was granted all the 'things' i wanted, i still don't think i'd be a 9/10.

So....thanks for posting to those of you who have....I know I'm not alone.

Frank.

Confessions from a Dysthymic - FC Mendel - Sep 30th 2009

About a year ago I was diagnosed with Dysthymia. At the time I was studying mental health in school and so I did make an effort to learn about the condition. One of the first things I found was that much less is understood about Dysthymia when compared with other related disorders like Major Depression. Where information is available to the public, Dysthymia typically always explained by virtue of the ways in which it is not major depressive disorder, and little more. This was a disappointment - a common experience for someone suffering with depression. I'm quite sure that the current picture of the relationship between dysthymia and other forms of depression is not as clear as these descriptions suggest.

However, this lack of strong information, especially in the public eye, has lead me to be at least more willing to talk about my problems than I might be otherwise. As such, I've decided to confess some of my own struggles with this condition.

Prior to the year that I was diagnosed, I was working a good job and studying hard in my 3rd year of university. Progressively I fell behind at work and in my studies. Eventually I began drinking too much, probably due to the stress associated with my declining motivation.

I began to recluse socially and in the span of a year I had dissociated myself from most of my friends and family. I quit my job and abandoned my course work. This cost me financially and irreparably damaged my relationships with school faculty, not to mention friends and family. At the time I found it very hard to understand why I would do these things. I felt very guilty about my poor performance at school and work. It had been my goal for over 2 years to get that job, and I remember thinking that I should be happier about it when it happened. I was doing more or less exactly what I wanted to do, and I loved the work but I still wasn't happy.

I still don't really understand why I stopped working hard and attending my courses. At one point I would remain in the house for full weeks on end, and would sleep for large parts of the day and night. This transition from working to hardly leaving home happened gradually but did not take very long. One day I woke up drunk and had this terrible feeling that I was doing something horribly wrong with my life. It reminded me of a story I read about William James' father who would sometimes wake up in a terrible panic. Looking at my situation as an outsider I was a real mess, but I felt anywhere from indifferent to very badly about the situation. I didn't know what to do, but on some level I just didn't care.

Since being diagnosed I have failed on one occasion to properly deal with my problem. For the second time in 2 years I lost one whole term of courses and have not yet completed my degree. Once again I am at a very low point in my life. I've spent less time out doors this week than I have in writing this passage tonight.

Dealing with a Dysthymic episode is intellectually challenging and emotionally taxing. I think that when you're trying to cope with this disorder you have to find ways to hold onto the things that you used to feel about yourself and remain in contact with those around you to give you some perspective. You have to remind yourself who you are and what matters to you on a daily basis, almost like a mantra.

When I'm dealing with this condition, my natural inclinations are suspect. I often tend to think things like "I'm not capable of achieving my goals", "I'll never achieve anything in my life", "I'm not smart enough", "The people around me don't have time for my problems", "I just don't care anymore."

These tenancies are a real challenge to deal with, and they are very pervasive. When you are the abuser and the victum of abuse, its very difficult to stage an intervention. Even when our judgements are negative I think we tend to hold onto them and even defned them irrationally. Its hard to really believe that our ability to value ourselves has become comprimised. After months of continuously feeling a certain way about yourself its very difficult to fight off with rational thinking.

I have found that I can think logically about my disorder but can often fail to act accordingly. This discontinuity between what I think i should do and what I end up doing leads me to question myself in so many different ways. I find it difficult to trust my thoughts and emotions and believe that my words lack sincerity because I often do not follow through on them and do what I know to be correct. After several months of feeling really poorly about things it leads me to wonder if I am wrong about the world on my better days. Maybe people simply overstate their own self worth, their own intelligence... Perhaps I am right to be pessimistic. Perhaps I do not deserve to be happy. Perhaps being happy is not worth the effort.

Once my beliefs start to change, my logic can become very frail. For example; my relationship with my girlfriend has been deteriorating for several long months. We fell in love the moment we met and even after I moved away from school for a while we managed to stay together. Now, my personal financial problems and my emotionally distant tendencies put a strain on our relationship. Despite some effort to find work, I am unemployed and openly admit that I could look harder for a job. I am not in school and have no ambition. I know that if I were to find work it could help our relationship. Since that's the case, when I fail to look harder for work I begin to wonder if I really care about her and wonder if we would simply be better off apart. This is just one example. I find it very easy to doubt just about everything.

I often have trouble maintaining a regular sleep schedule. In general, I am sleeping perhaps an average amount, but I stay up slightly longer than usual. If I fell asleep at 10:30 on Monday night, chances are good that by next Monday I would be falling a sleep at 5am and waking up some time in the mid-afternoon. This trend continues and eventually I will be sleeping normal hours once again. This period of normal sleep lasts only a few nights.

I do not lead an active lifestyle. Growing up I played several sports including Basketball for a local traveling team. In high school I was a member of the student's council. I played on school sports teams and helped organize many school events. I no longer play any sports. I have lost almost all interest in spending time with other people.

I do not have very good personal hygiene and do not eat properly. When I get dressed for the day, I never have the intention of going outside. I shower perhaps 3 times a week. There's always a pile (or two) of laundry laying around. I'll often have 1-2 meals a day. I drink a lot of coffee and pop (cola). I brush my teeth once a day and sometimes less. I get my hair cut probably twice a year but I don't really know. I have not purchased new shoes in a long time so my shoes are worn out.

As mentioned before, I am socially reclusive. I typically think that I have nothing to offer others in a social situation. I also do not like most people that I meet. Generally speaking, I don't like people. These days, I have no close friends at all. I call home maybe once a month or less and visit 3-4 times a year or less.

I have financial problems. I'm in debt approximately $60,000 between my student debts and some outstanding credit. I have no income. As mentioned, I have been looking for work but find the idea of working in many different places to be very depressing. I honestly think I would decide to kill myself if I were working in a fast food restaurant or something like that. Somehow I think that working in such a place would give me an overwhelming sense of failure that I couldn't stand to bare.

I often contemplate suicide. I don't want to die, but I often think that people that I have an impact on would be better off in the long run without me. I don't expect them to feel the same way.

I occasionally get really angry with my life. The anger will kind of well up and I'll hit desk tops or counter tops. My hand has grown a high pain tolerance over time, and I find myself hitting things much harder now than I did before. Recently I hit the sink so hard that it broke into three peices. These behaviors are very destructive and unhealthy.

I have once again reached a breaking point and am in need of some form of treatment. My feeling is that the situation is quite hopeless, but in some other sense of the word I do hope to advance beyond this counterproductive cycle and lead a more enjoyable/progressive life. I do not yet know how this will happen. I am often unreceptive to the advice of others and perhaps this stems from my tendency to doubt everything. I have talked with therapists, but I haven't made much progress in therapy.

Hi Julie - - Oct 14th 2008

I hope you are feeling well/ better. Are you on meds now? I have self diagnosed myself and I think I have Dysthymic depression also. I am just doing research right now and it's not looking too good for us :( I just started taking Zoloft about a week ago so we'll see if that helps.

I am in my mid 30s, 3 kids, married so I do have a lot to lose too if I don't get well.

a life - Julie - Feb 28th 2008

I think this might be my kind of depression, although as a child I was always somewhat depressive. I remember becoming very depressed after my mother died of cancer when I was 16. I was productive for a time after and then around 19 became an alcohol abuser. My life was a nightmare until I had my last two children around my 30's. I put alcohol down and put everything into being a good Mother and wife. Until I found out my husband was lieing and cheating I became depressed again, paranoid that he was still lieing to me unable to ever trust him again. We wound up going through a hellish divorce and I've missed so much time with my children. What I have felt is my main purpose in life and the thing I feel I do better than anything. Being a Mother to my children. I only have my children half the time and we are in different States. The times that I have without them is hell to me. I feel more depressed in my life now than ever. I feel that I can't move to be productive, even though logically I know I have a lot to offer the world and community and I am a very hard worker I feel paralyzed, touchy I cry at anything I feel worthless ,guilty.I am so scared I'm going to leave this world without ever having the courage to experience a normal life . I never let my children see this side to me other than I can't seem to leave the house very much. This year they are with their father I will have them next year. The only thing I desire to really do with my life is to make a good role model for them so they can grow up and do great things and never have to experience this type of pain.

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