What is the difference between major depression and dysthymia

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Click here. Administrated by Lynn Norton. This type of chronic depression is difficult to distinguish from dysthymia.

In principle, personality is usually lifelong, while moods come and go. But dysthymia has to last longer than any other psychiatric disorder in the manual. That can make it difficult to distinguish from a personality disorder — especially the group that includes avoidant, dependent, and obsessive-compulsive personality, with their symptoms of timidity, excessive worry, helplessness, and social withdrawal.

Some would prefer to speak of a depressive personality disorder instead. That diagnosis was removed from the official manual in but has been re-introduced as a possible topic of investigation. The proposed symptoms include a strong tendency to be critical of oneself and others, pessimism, guilt, brooding, and gloominess. Anhedonia and physical symptoms are not part of the definition, but this personality disorder otherwise has a great deal in common with dysthymia. Mood and personality are the emotional weather and emotional climate of individuals, so the symptoms of mood and personality disorders naturally overlap.

The thought schemas that cognitive therapists find at the roots of major depression and dysthymia — certain beliefs about the self, the world, and the future — are also the basis of depressive personality.

Disturbances in mood can have effects on a person's emotional state and social life that resemble a personality disorder. And people are more easily demoralized and recover more slowly from any stress or misfortune if they are pessimistic and self-critical by nature — or emotionally unstable, impulsive, and hypersensitive to loss.

Like major depression, dysthymia has roots in genetic susceptibility, neurochemical imbalances, childhood and adult stress and trauma, and social circumstances, especially isolation and the unavailability of help. Depression that begins as a mood fluctuation may deepen and persist when equilibrium cannot be restored because of poor internal regulation or external stress.

Dysthymia runs in families and probably has a hereditary component. There are few twin or adoption studies, so it's uncertain how much of this family connection is genetic. Nearly half of people with dysthymia have a symptom that also occurs in major depression, shortened REM latency — that is, they start rapid eye movement vivid dreaming sleep unusually early in the night.

The stress that provokes dysthymia, at least the early-onset form, is usually chronic rather than acute. Studies show that it usually has a gradual onset and does not follow distinct upsetting events.

In old age, dysthymia is more likely to be the result of physical disability, medical illness, cognitive decline, or bereavement. In some older men, low testosterone may also be a factor. Physical brain trauma — concussions and the like — can also have surprising long-term effects on mood that often take the form of dysthymia. At least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism.

In these cases, it is difficult to distinguish the original cause, especially when there is a vicious cycle in which, say, depression exacerbates alcoholism or heart disease exacerbates depression. The same vicious cycle exists in many other situations. For a person who is vulnerable to depression, every problem seems more difficult to solve and every misfortune causes more suffering. Depressed people give discouraging interpretations to every event in their lives, and these interpretations make them still more depressed.

Depression often alienates others, and the resulting isolation and low social support make the symptoms worse. The experience of chronic depression may sensitize the brain to stress, heightening its vulnerability to further depression. Most people with dysthymia are undertreated. They usually see only their family doctors, who often fail to diagnose the problem.

They may only complain about physical symptoms, or fail to complain at all because the disorder has become so much a part of them that they believe that is simply how life is.

In older people, dysthymia may be disguised as dementia, apathy, or irritability. A physician might ask an open question like, "How are things at home? There are also several brief screening questionnaires, including the Hamilton Rating Scale for Depression and the Patient Health Questionnaire. If the answers suggest dysthymia, a standard clinical interview can be used to confirm the diagnosis.

Like major depression, dysthymia is treated with psychotherapy and medications — usually the same medications and the same kinds of psychotherapy. The most common drug treatments are selective serotonin reuptake inhibitors like fluoxetine Prozac and sertraline Zoloft , or one of the dual action antidepressants such as venlafaxine Effexor. Get Involved Share Your Story. Get Involved Partner with Us. Advocacy Advocate for Change. Advocacy Policy Priorities.

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