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Pathophysiology: Dysthymic disorder is a depressive mood disorder characterized by a chronic course and an insidious onset. Many people with dysthymia describe lifelong depression. Symptoms usually last for at least two years, and often for much longer than that. Dysthymia interferes with your ability to function and enjoy life. With dysthymia, you may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. People with dysthymia are often thought of as being overly critical, constantly complaining and incapable of having fun. The exact cause of dysthymia isn't known. Dysthymia may have causes similar to major depression, including: Biochemical: People with dysthymia may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes. Genes: Dysthymia appears to be more common in people whose biological (blood) relatives also have the condition. Environment: As with depression, environment may contribute to dysthymia. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems or a high level of stress.
Treatment: The two main treatments for dysthymia are medications and talk therapy (psychotherapy). Medications appear to be more effective at treating dysthymia than psychotherapy when either is used alone. Using a combination of medications and psychotherapy may be slightly more effective. Which treatment approach your doctor recommends depends on factors such as: Severity of your dysthymia symptoms, desire to address emotional or situational issues affecting your life, your personal preferences previous treatment methods, your ability to tolerate medications. Symptoms: Dysthymia symptoms in adults may include: Loss of interest in daily activities Sadness or feeling down, Hopelessness, Tiredness and lack of energy, Low self-esteem, self-criticism or feeling incapable, Trouble concentrating and trouble making decisions, Irritability or excessive anger, Decreased activity, effectiveness and productivity, Avoidance of social activities, Feelings of guilt, Poor appetite or overeating, Sleep problems.
Epidemiology: The lifetime community prevalence of dysthymia is 6%. Dysthymia affects an estimated 36% of patients in outpatient mental health treatment. For major depressive disorders, females outnumber males, with a female-to-male ratio of 2:1 during their childbearing years. Patients with dysthymia recall unexplained unhappiness in preadolescent childhood. Whether the DSM-IV-TR adequately addresses dysthymia in children and adolescents is a matter of some controversy.