What is a dysthymia?The symptoms of dysthymia vary greatly from patient to patient. Those affected often feel joyless, impotent, tired, powerless and discouraged.
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Dysthymia is a chronic depressive mood. It is also known as depressive neurosis, neurotic depression or depressive personality disorder. Those affected show the typical symptoms of depression such as tiredness, joylessness or sleep disturbances. Although the symptoms are not as pronounced as in normal depression, but occur over a longer period of time.
Not infrequently, the dysthemia is a chronic chronic indigestion. Characteristic of the dysthmy is the early onset. Usually adolescents and young adults are especially affected by the persistent mood. Sometimes even for a lifetime.
The exact causes of dysthemia are not yet clear. Rarely, the disease is based on only one cause. Rather, it is an interaction of various disease-causing and disease-causing factors. In genetic studies, a familial accumulation of dysthymia was observed.
This does not mean that the depression is inherited, but that those at risk have a higher risk of developing depression because they are more sensitive to triggering factors. Situations that can lead to depression through an extremely high level of stress include, for example, poverty, unemployment, separations from partners, the loss of loved ones, or one's own illness.
How well affected people can deal with these emotional burdens depends on their genetic make-up and their resilience. Resilience is the inner strength of a person, his mental resilience. People with high resilience suffer from dysthemism much less frequently than people who are not resilient. Resilience is characterized above all by positive experiences in childhood.
Biochemically, changes in the brain can be detected in depression. So there is an imbalance between chemical messengers. Serotonin and norepinephrine are most affected in dysthemia. The stress hormone cortisol is also found in the urine of depressives in high concentration. However, it is still unclear whether these changes are a consequence or cause of depression.
Symptoms, complaints & signs
The symptoms of dysthymia vary greatly from patient to patient. Those affected often feel joyless, impotent, tired, powerless and discouraged. They have no self-confidence and often feel overwhelmed by little things. Dismantling the dishwasher can thus become a seemingly insurmountable obstacle. Patients may suffer from sleep disorders.
The sleep is not very relaxing, so that those affected in the morning feel like being wheeled and sometimes can not even get out of bed. Many can no longer work. Characteristic of dysthymia is also the feeling of numbness. The patients feel like they are frozen or dead.
Positive feelings no longer seem to exist, even negative feelings such as anger or grief can no longer be felt. Even the memory of feelings can disappear, so those affected can not even remember, depending on the duration of the disease, that they were happy, laughed or enjoyed something.
The dysthymia does not only express itself psychically, but also physically. In addition to the above-mentioned sleep disorders, dysthymia may also manifest as loss of appetite, loss of libido, dizziness or gastrointestinal discomfort. There are no organic causes for these symptoms. The symptoms of dysthemia are not as pronounced as in acute depression, but sufferers often suffer years or even decades from them.
Many dysthymic moods remain undetected. This is partly because the sufferers can not muster the necessary energy to talk to a doctor. In addition, the stigma of a mental illness is not to be underestimated even today. On the other hand, many sufferers themselves do not take their symptoms seriously enough and consider them to be normal mood swings.
If the symptoms of depression are masked as a physical ailment, a diagnosis is even more difficult and is often asked only after a long doctor's odyssey. If there is a suspicion of dysthymia, a detailed discussion should be held with a psychologist or a physician, at best with a psychiatrist.
Diagnosis is made using the ICD-10 diagnostic and classification system. There must be at least two major and two additional symptoms over a period of at least two weeks. The core symptoms include depressed mood, loss of pleasure and decreased drive. Additional symptoms include sleep disorders, inner restlessness or suicidal thoughts.
Although dysthymia is often milder than major depression, sufferers may be suicidal. The suicide risk is often underestimated. Conversely, not every person suffering from dysthymia is suicidal. That is why it is particularly important to clarify this question on a case-by-case basis.
People who think of death, have suicidal fantasies or plan their own death should, if possible, confide in another person. This is also a doctor, psychologist or therapist in question. In cases of acute suicide, inpatient treatment is appropriate - however, outpatient treatment with medication or psychological methods is often possible if the person is stable enough.
Especially without treatment, dysthymia is in danger of developing into major depression. Psychologists also speak of double depression (double depression). Such a depressive episode is usually more pronounced than dysthymia.
In addition, dysthymia may also chronify as another potential complication: the depressive state persists in this case. However, therapy may also bring improvement or complete recovery in chronic dysthymia. In addition to dysthymia, other psychological complications may develop that manifest themselves as other mental illnesses. In addition, social and professional complications (for example disability) may occur.
When should you go to the doctor?
If depressive moods persist for more than a few days, a doctor should be consulted. Symptoms that indicate a dysthymia are, among other things, joylessness, listlessness and lack of self-confidence. Anyone who increasingly suffers from these complaints must seek professional advice in any case. In particular, people who are in an emotionally stressful phase of life, should talk to a therapist - ideally even before the dysthymia has fully developed.
At the latest, when depression triggers physical symptoms such as loss of appetite or dwindling libido, there is an emergency situation. Since the affected themselves often do not act against the dysthymia, the closer environment is required. Anyone who notices a psychic change in a friend should address it.
Together then a therapist should be visited. If a partner, relative or friend expresses suicidal thoughts, a crisis counselor must be called in immediately. It is advisable to contact the telephone counseling and to talk with the person concerned. In the long term, dysthymia must always be treated by a psychologist or, where appropriate, as part of a hospital stay.
Treatment & Therapy
For less severe dystmias, sports and exercise therapies, relaxation procedures or herbal supplements such as St. John's wort extract may be helpful. In more severe and long-term processes, the therapy of dysthemia is based on three pillars. The basis is the pharmacotherapy with antidepressants.
The second pillar is psychotherapeutic procedures. Behavior therapy, systemic therapy and depth psychology therapies are among the therapies of choice in the treatment of dysthymia. In addition, other therapies such as occupational therapy can be used as a third pillar of therapy.
Outlook & Forecast
The prognosis of dysthymia is dependent on the presence of various influencing factors. These include the patient's age at first onset, genetic stress, and the presence of other mental illnesses.
Unfavorable factors include eating disorders, personality disorders or obsessive-compulsive disorders. In these patients, the cause of the complaints must be determined so that a change in the state of health and relief can occur.
Without the use of a treatment, the prognosis for dysthymia is unfavorable. The signs of the disease are difficult to detect and often develop over a long period of time. Frequently, over the course of several years, a chronic development develops during which depression develops in addition.
The symptoms of the double depression that occur then vary in their intensity and duration of onset. Phases of remission are possible but do not last for long. The suicide risk of these patients is increased and is 10%.
In around 40% of those affected, dysthymia causes severe depression as the disease progresses. This relieves the prospect of a cure and in most cases leads to years of discomfort. The prognosis improves as soon as the patient requires psychotherapy and drug treatment.
It is not uncommon for depression to be too stressful and overburdened. A prevention option is therefore an adequate way of dealing with stressful situations. This can be learned through various procedures such as mindfulness training, relaxation procedures or special stress management seminars. Unnecessary obligations should be reduced in favor of things that make you happy. Even regular exercise is said to have a preventive effect.
In the case of dysthymia, the person concerned usually has only a few measures or options for follow-up, so that the person affected primarily depends on a quick and early diagnosis for this disease. Especially the relatives and the friends have to persuade the affected person to a treatment, because otherwise a further worsening of the complaints can occur.
A self-healing does not occur in the dysthymia, so that a treatment by a doctor is always necessary. In most cases, the person concerned is dependent on treatment by a psychologist, although various exercise therapies can relieve the symptoms of dysthymia. Some exercises from these therapies can also be repeated by the affected person in his own home, thereby promoting healing.
Furthermore, the intake of medication can relieve these symptoms, with a proper dosage and a regular intake to pay attention. In general, the loving care and support of friends and family also has a positive effect on the course of dysthymia. The life expectancy of the patient is usually not adversely affected by the dysthymia.
You can do that yourself
In order to rejoice in life, patients suffering from dysthymia should first of all entrust themselves to a doctor or psychotherapist and discuss the further course of action with him. Seeking help is not a sign of weakness, but the first and decisive step towards effective treatment.
In addition to the therapy suggested by the doctor, a transformation of everyday life can counteract excessive demands and pressure to perform. Above all, this means reducing the demands on oneself, taking regular breaks and maintaining one's hobbies. Sport is a great way to relieve tension, boost self-esteem, and experience a sense of achievement.
Exaggerated ambition is out of place, the joy of movement must always be in the foreground. If stress can not be avoided in professional life, it helps to learn special stress management techniques. It is also important to free oneself from unnecessary obligations and to learn to say "no" without a pang of conscience.
Social contacts should also not be neglected: regular discussions with friends and acquaintances, in which also problems and feelings are not excluded, train the social competence and help the soul to find their equilibrium. Joint activities provide support and create positive moments that can significantly contribute to overcoming dysthymia.