What About The "milder" Depression: Dysthymic Disorder?

Case Study(Fictional):

"Jack is an 18 year old college student who was seeking psychotherapy because, after reading about depression in his "Introduction to Psychology" textbook, decided that the description fit him. Despite doing quite well in his classes he complained of feeling a constant tiredness. However, along with feeling tiredness, he also felt blue, down and hopeless. He described himself as being a loner, with a few friends but no girls, no dates and no sexual experiences. He also had no goals and no aspirations for himself. His parents remained married but unhappily so and that was one of those open secrets. His father was a teacher but always felt unfilled and openly stated how much he hated his job. His mother, a housewife, also seemed to never have any enthusiasm for life.

It soon became clear that Jack never really felt loved by his parents, whose lives seemed colorless and bland. The boredom of home was broken by episodes of loud arguing between his mother and father. The issues usually centered around money and how much his mother spent for food and clothing. The fights would suddenly erupt for no apparent reason and would fill him with enormous dread. Jack always experienced and ill defined sense of guilt, as though the lives of his parents would have been better had he never been born. A good student since elementary school, neither parent seemed to take any joy in his achievements and never expressed any goals they wished or hoped he would achieve.

Jack's therapist was the first adult male he ever remembered taking an interest in him. Jack became a long term psychotherapy patient who had a wonderful outcome in his therapy five years later."

Jack's story is not unusual. His symptoms fit the profile of someone coping with Dysthymia.

There is a lot of discussion about depression but, it is my impression, that much of the discourse centers around Major Depression and Bipolar Disorder. Of course, these last two are extremely serious because symptoms sometimes include delusions and hallucinations along with the very real threat of suicide.

However, there is a "milder" type of depression called Dysthymic Disorder. While many of the symptoms of dysthymia are less intense than Major or Unipolar Depression, they are more chronic in nature. In other words, Dysthymic Symptoms last for years, sometimes beginning during childhood and lasting through adulthood.

The way I like to think of and explain Dysthymia to people is to use the metaphor of a low grade fever. A low grade fever, caused by the flu or some type of infection, may not stop a person from going to work, but, it robs the individual of energy and is accompanied by low grade and transitory body aches. There may even be a mild sore throat with the fever, but nothing so bad as to cause alarm.

In a similar way, people with Dysthymia experience a lack of energy, feelings of sadness, low productivity, a lack of enthusiasm for anything, low self esteem, fatigue and transitory thoughts about life not being worth living or thoughts of suicide, along with many other symptoms shared with Major Depression but to a lesser degree. Overall, the Dysthymic individual experiences a pervasive sense of grayness and an inability to live life to the fullest.

Because Dysthymia lasts for years it is very debilitating and can spill over into Major Depression. People with Dysthymia are not immune from suicidal behavior. In other words, this illness is to be taken very seriously.

If you experience any of the symptoms associated with depression of any kind it is important that see your medical doctor. It is always important to rule out any disease process or neurological or organic disorder. If you are found to be in good health, the next step is psychotherapy with a Clinical Psychologist or Licensed Clinical Social Worker. Do not hesitate to seek help. You have nothing to lose but your feelings of misery.

Your comments and questions are welcome.

Allan N. Schwartz, PhD

Comments
  • JR

    Hello, Allan,

    Interesting. This sounds rather familiar - like something I experienced for many years, that led me into worse things - including major depression, and a certain affection for bottled consolation. Now that I seem to be over those - I still seem to experiencing something like major depression's kid brother. There are, of course, other labels that might fit, but this one I might look into further.

    Best regards and thanks,

    JR

  • Dr.T

    Another disorder that is often overlooked and tends to blend in with major depression and bipolar disorder is cyclothymia or cyclothymic disorder. This disorder is a mild form of bipolar disorder characterized by emotional ups and downs similar to those in bipolar disorder, but at a much milder stage. There may be short lived highs where the world seems all too promising, and lows where hopelssness and suicidal thoughts become a reality. What makes cyclothymia different from bipolar disorder is the intensity of the highs and lows, which are usually mild.

    Throughout my educational career in psychology, as an undergraduate especially, I did not hear too much about cyclothymic disorder, but rather I heard plenty of bipolar I and II disorder. Society and the media tend to lump different categories and characteristics of depression into one big pile, further confusing consumers of information on the various disorders under the umbrella term depression.

    I think what's most important is that we bring to the surface these other types of depressions so that individuals will not measure their symptoms, which may be a different type of depression, against major depression and bipolar disorder. This further keeps suffering individuals in the dark and confused over their emotional pain.

  • Victoria

    Hi,

    I would agree with you 100% on this Allan. Unfortunately, like other disorders unless their are concrete measurable symptoms people don't get taken seriously. I know that I was diagnosed with Dysthymia after my first overdose, and well how you describe it in your post makes perfect sence. If only people didn't have to be severe before they feel like they deserve help with something. Once you get "quote un quote" what seams to be a serious diagnosis all of a sudden doors open wide and I think it is one reason why people relapse so often because they don't feel like they deserve help because they don't fit the idea of someone who is depressed etc...

    It seams like preventive medicine is such an overlooked area of medicine. I know I kept in treatment because it was the right thing for me, and in the end going backword monetarily would have cost 10 times more than sticking with ensureing I move forward.

    Just some thoughts.

    Victoria

  • Sue

    Hi, as a community psychiatric nurse I get very frustrated by the attitude of many professionals who often attach negative labels to people who experience this illness. CBT is the current miracle cure all now being offered, often by people with as little as 12 weeks training!!! Whilst useful for some I find that it leaves many people with dysthymia feeling as if they have 'failed at therapy' and the professional convinced that the patient just doesn't want to put any effort in. I find that it is then quite common for people to have a personality disorder label attached to them. I would love constructive info that would help me to work with dysthymic patients and the sense of failure i often feel when I cannot help patients or fit it with my colleagues who discharge them.

  • Carlton

    do you know of any good books that address cyclothymia directly?

  • Allan N. Schwartz, PhD

    Carlton,

    I do not know of any such books, but that means nothing because they are probably out there. Perhaps Dr. T. would be good enough to direct us to such books?

    Dr. Schwartz

  • Anonymous-1

    How long can this condition persist ? I feel I have been like this since my teens ( I am 48 now).

    Maybe my life and career would not have been so shitty without that. Probably too late now...anyway. Sweet !

    Borred to death