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Dysthymia

Dysthymia or dysthymic disorder is a form of the mood disorder of depression characterised by a lack of enjoyment/pleasure in life that continues for at least two years. It differs from clinical depression in the severity of the symptoms. While dysthymia usually does not prevent a person from functioning, it prevents full enjoyment of life. Dysthymia also lasts much longer than an episode of major depression. Outsiders often perceive dysthymic individuals as 'dour' and humourless. more...

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Often a stressful or overwhelming situation, like having a first baby (see postpartum depression), will throw a dysthymic individual into a major depression. When a major depressive episode occurs on top of dysthymia, clinicians may refer to the resultant condition as double depression.

Approximately 6% of the population of the United States has dysthymia.

Classical use of the term

The term dysthymia originally referred to a sub-clinical psychotic condition. The Greek roots of the term dysthymia suggest the interpretation: "abnormal, or disordered feelings".

Classical dysthymia refers to "feeling" something as a reality which is not a reality, for example "feeling" that one knows what others think - or "understanding" an underlying social dynamic which is not real. This thinking pattern would lead sufferers to see themselves as "prophets" or as "highly intuitive healers". Such people may imagine that they can "feel" underlying hostilities which do not exist.

These people often endure social estrangement because they continually inject disordered judgments, which result from their abnormal "feelings". These disordered feelings and the way that dysthymics may express them within social settings are usually considered intensely strange.

This definition of dysthymia used to cover a broad band of disorders, which may very likely result in anti-social behaviors.

Treatment

Some people with dysthymia respond to treatment with antidepressant medications. For mild or moderate depression, the American Psychiatric Association in its 2000 Treatment Guidelines for Patients with Major Depressive Disorder advises that psychotherapy alone or in combination with an antidepressant may be appropriate. A 2002 study involving 375 patients found a St John's wort extract effective for treating mild to moderate depression.

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Dysthymia and testosterone
From Townsend Letter for Doctors and Patients, 12/1/04 by Robert A. Anderson

A decline in hypothalamic-pituitary-gonadal (HPG) axis function is often seen in elderly men, and dysthymic disorder is common. Symptoms of both HPG axis hypofunction and dysthymic disorder include dysphoria, fatigue, and low libido. Total testosterone levels were measured in 32 men meeting criteria for dysthymic disorder and 175 in a comparison group who had scored below the median on a validated depression scale in a male aging study. Median testosterone level of 295 ng/dl in those with dysthymia was significantly lower than levels of 423 mg/dl in those with no depression.

Seidman SN, Araujo AB, Roose SP et al. Low testosterone levels in elderly men with dysthymic disorder. Am J Psychiatry 2002 Mar; 159(3):456-9

COMMENT: Total testosterone levels were lower in elderly men with dysthymia than in men without depressive symptoms. Dysthymic disorder in elderly men may be related to HPG axis hypofunction. Few will find this conclusion a surprise. In dysthymic men, behavioral approaches need to be included in the treatment plan. Antidepressants may lift mood but adversely affect libido and potency. When patients are fully informed about the ramifications of different choices, they will often engage the will to make the harder choice, the one requiring more effort and work outlay, when the dots are connected with the greater possibilities.

Robert Anderson is a retired family physician. In mid-career, his practice took a holistic turn as decades passed. He has authored five major books, Stress Power!, Wellness Medicine, The Complete Self-Care Guide to Holistic Medicine (co-author), Clinician's Guide to Holistic Medicine (McGraw Hill, 2001), and The Scientific Basis for Holistic Medicine, (6th edition 2004), now available from American Health Press, holos@nwi.net. Anderson was the founding president of the American Board of Holistic Medicine, past president of the AHMA, former Assistant Clinical Professor of Family Medicine at the University of Washington and currently Adjunct Instructor in Family Medicine at Bastyr University.

COPYRIGHT 2004 The Townsend Letter Group
COPYRIGHT 2004 Gale Group

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