Dysthymia: how to differentiate it from depression?

A review of the characteristics of dysthymia, explaining how to distinguish it from depression.

Depressive disorders have increased after the COVID-19 pandemic, even in children and adolescents.

We commonly associate sadness with depression, but it is important to differentiate between the states of sadness that we can all experience as adaptive and the different depressive disorders that can occur. It is important to make visible and know this frequent problem, since it allows us to identify the symptoms and ask for professional help when required.

Dysthymia or persistent depressive disorder is a little known depressive disorder, but very prevalent in society. in society. As its symptoms are less intense than those of major depression, it is more difficult to detect by the environment or the person him/herself, and it can evolve for years without professional help.

Nevertheless, dysthymia has a negative impact on the quality of life of the people generating problems of health, in the social relations and in the work.

What is dysthymia really?

The persistent depressive disorder (dysthymia) is a disorder of chronic course and lower intensity than major depression. It consists of a depressed mood most of the days for at least two yearsaccompanied by sleep disturbances, low energy, low self-esteem, lack of concentration, difficulties in making decisions and/or feelings of hopelessness.

Dysthymia usually has an earlier age of onset than major depression, often beginning insidiously in adolescence or young adulthood, this being an indicator of a more chronic course. In relation to gender differences, the prevalence is higher in women.

How do I know if I have dysthymia?

The symptoms of dysthymia can vary over the years in appearance and intensity. in appearance and intensity. They usually generate discomfort and affect the proper performance of daily activities. Among the most frequent are the following:

• Loss of interest in daily activities.
• Feeling of emptiness or sadness
• Hopelessness
• Lack of energy
• Low self-esteem, self-criticism, feelings of worthlessness and guilt
• Difficulty concentrating and making decisions
• Decreased activity and productivity
• Irritability
• Social isolation
• Alterations in eating habits
• Sleep disturbances

In order to be diagnosed with persistent depressive disorder the above symptoms must persist for at least two years in adults or one year in adolescents and children.. In the latter, the symptoms of dysthymia may include depressed mood and irritability.

Can dysthymia affect social functioning?

Although not a core symptom of depressive disorders, both social functioning and the ability to maintain and enjoy relationships are compromised with dysthymia's own symptoms. The most prominent are anhedonia, lack of motivation and loss of interest.. Thus, it is common for people with persistent depressive disorder to have poorer intimate relationships and less satisfying social interactions.

The main disturbances in social functioning derive from reduced desire to communicate, increased sensitivity to rejection or negative evaluation, problems in emotional identification, and reduced ability to find effective solutions to interpersonal problems.

Difficulties in interpersonal relationships may contribute to maintaining the disorder and are a major focus of the disorder. and are a major focus of therapy.

Can dysthymia co-occur with other mental disorders?

The literature shows that comorbidity in this disorder is common, especially with major depressive disorder and other anxiety disorders, as well as with substance abuse disorder.

Among anxiety disorders, social anxiety disorder and generalized anxiety disorder have been found to be the most commonly associated with dysthymia. In addition, it is estimated that 10% of people with dysthymia eventually develop major depression.

And what are the causes?

The etiology of the disorder is not yet clear, but its multifactorial nature has been studied. its multifactorial nature has been studiedthat is, dysthymia can result from the interaction of biological, social and psychological factors. At the Biological level, affectations have been observed in brain structures such as the amygdala, the hippocampus, the prefrontal cortex and the anterior cingulate cortex; as well as the hypothalamic-pituitary-adrenal axis and the noradrenergic system.

At the psychosocial level it has been shown that the experience of stressful events during childhood or youth may predispose to dysthymia.. At the socio-familial level, dysthymia has been associated with being without a partner and/or the loss or separation of parents in childhood.

Vulnerability factors that have been observed are: history of depression in first-degree relatives, substance use disorder and antisocial personality disorder.

How does it work in therapy?

Treatment for dysthymia is similar to that for major depression, with cognitive-behavioral therapy being the treatment of choice for dysthymia with mild symptomatology.

For moderate and severe episodes, the combination of cognitive-behavioral therapy with pharmacological treatment is recommended. The main objectives of psychotherapeutic intervention are the following:

• Mood improvement, reducing symptoms such as anhedonia, inability to experience or perceive positive events and hopelessness, among others.
• Behavioral activation, establishing a series of activities with the intention of recovering the pleasant areas of life.
• The identification of dysfunctional beliefs and behaviors and their subsequent replacement by more adaptive ones.
• Stress management and learning of appropriate coping strategies for adaptation to other crises or difficulties.
• The training of social and communication skills for the development of satisfactory social interactions that reduce isolation.
• Effective and functional problem solving and decision making.

Author: Carla Carulla, child and adolescent psychologist at Elisabet Rodríguez Psicologia i Psicopedagogia.