Mood disorders: Dysthymic Disorder and Cyclothymic Disorder

According to the 2005 National Comorbidity Survey-Replication study, about 20.9 million American adults, or 9.5 percent of the population ages 18 and older, have mood disorders. These include major depressive disorder; dysthymic disorder (a chronic, mild depression); cyclothymic disorder (a milder form of bipolar disorder) and bipolar disorder (also called manic depression). Major depressive disorder is, by itself, the leading cause of disability among Americans age 15 – 44, according to the World Health Organization. In this post, I discuss dysthymic disorder and cyclothymic disorder (NIH Fact Sheet)

From WebMD:

When you think of mood disorders, depression and bipolar disorder likely first come to mind. That’s because these are common, severe illnesses and leading causes of disability. Depression and bipolar disorder can be emotionally crippling, making it difficult to live life to its fullest. What you may not know is that two milder versions of these mood disorders can also take a toll, and can go undiagnosed. These are called dysthymic disorder and cyclothymic disorder.

Mood Disorders: What Is Dysthymic Disorder?

This mood disorder is a less severe form of depression. Although less extreme, dysthymic disorder causes long-lasting moodiness. With dysthymic disorder, low, dark moods invade your life nearly every day for two years or more. Dysthymia is contrasted with a full major depressive episodes that lasts two years or longer, which is called chronic major depression.

Dysthymic disorder can occur alone or along with other psychiatric or mood disorders. As with depression, dysthymic disorder is more common in women than in men. A family history of mood disorders is not uncommon. This mood disorder tends to appear earlier than major depression, although it can begin anytime from childhood to later in life.

Up to 5% of the general population is affected by dysthymic disorder, but its cause is not well understood. A combination of factors likely conspires to create this mood disorder. These factors may include:

• Genetics
• Changes in brain neurotransmitters such as serotonin
• Chronic stress or medical illness
• Isolation
• Poor coping strategies
• Other mood disorders

These factors can feed off each other. For example, if you always see “the glass as half empty,” you may be more vulnerable to depression. And a chronic mood disorder can sensitize you to stress, further feeding your risk for depression.

Symptoms of Dysthymic Disorder

In addition to chronic low moods, common symptoms of this mood disorder include:

• Feelings of hopelessness or helplessness
• Trouble sleeping or daytime sleepiness
• Poor appetite or eating too much
• Fatigue or low energy
• Low self-esteem
• Trouble concentrating or making decisions

A diagnosis of dysthymic disorder requires at least a two-year history of depressed mood for most of the day on most days, along with at least two of the symptoms noted above. Although some symptoms may overlap, you may be less likely to have weight or sleep changes with dysthymic disorder than with depression. You may also tend to withdraw more and have stronger feelings of pessimism and inadequacy than with major depression.

Treatment for Dysthymic Disorder

Staying in a constant state of moodiness is no way to live. That’s one reason to seek treatment. Another is that dysthymic disorder can also increase your risk for physical diseases. Yet another reason to pursue treatment? If left untreated, this mood disorder can develop into more severe depression. It can also increase your risk for attempting suicide.

A two-pronged, long-term treatment approach includes medication combined with “talk therapy.” Either medication or psychotherapy can be effective for dysthymic disorder, and sometimes a combination of both may work best.

Antidepressants , such as selective-serotonin reuptake inhibitors or tricyclic antidepressants, are often used to treat dysthymic disorder. Because you may need to continue treatment for a lengthy period, it’s important to consider which medications have fewer side effects. You may need to try more than one medication to find the one that works best. But know that it may take several weeks to take effect. Take your medications as your doctor instructs. If they’re causing side effects or still not working after several weeks, discuss this with your doctor. Don’t suddenly stop taking your medications.

Specific kinds of talk therapy, such as cognitive behavioral therapy (CBT) or interpersonal therapy (IPT) are known effective forms of psychotherapy that treat dysthymic disorder.  A structured treatment lasting for a certain period of time, CBT involves recognizing and restructuring thoughts. It can help you change your distorted thinking. IPT is also a time-limited, structured treatment. Its focus is on addressing current problems and solving interpersonal conflicts.

Some studies also suggest that aerobic exercise can help with mood disorders. This is most effective when done four to six times a week. But some exercise is better than none at all. Other changes may also help, including seeking social support and finding an interesting occupation. Used for patients with seasonal affective disorder, bright-light therapy may also help some people with dysthymic disorder.

Mood Disorders: What Is Cyclothymic Disorder?

Bipolar disorder causes severe, unusual shifts in mood and energy that affect your ability to do normal tasks at home, school, or work. Cyclothymic disorder is often thought of as a mild form of full-blown bipolar disorder.

With cyclothymic disorder, you also have brief mood swings from mild or moderate depression to euphoria and excitement (hypomania). But the duration and severity of depressions are less severe than usually seein in bipolar disorder. For example, you may feel an exaggerated sense of productivity or power, but you don’t lose connection with reality. In fact, some people feel the “highs” of cyclothymic disorder are even enjoyable. They tend to not be as disabling as they are with bipolar disorder.

Up to 1% of the U.S. population — equal numbers of men and women — has cyclothymia. Its cause is unknown, but genetics may play a role; cyclothymia is more common in people with relatives who have bipolar disorder. Symptoms usually appear in adolescence or young adulthood. But because symptoms are mild, it is often difficult to tell when cyclothymia begins.

Symptoms of Cyclothymic Disorder

A diagnosis of cyclothymic disorder may result from simply describing symptoms like these:

• Episodes that alternate between mild depression and hypomania, which last for at least 2 years.
• Symptoms that persist, creating fewer than 2 symptom-free months in a row.
• A greater tendency to be irritable or in a dark mood than euphoric or happy.

The episodes of cyclothymic disorder are often somewhat unpredictable. Either depression or hypomania can last for days or weeks, interspersed with a month or two of normal moods. Or, you may have no “normal” periods in between. In some cases, cyclothymic disorder progresses to full-blown bipolar disease.

Treatment for Cyclothymic Disorder

Some people with mild symptoms of cyclothymia are able to live successful, fulfilling lives. Others find their relationships troubled by depression, impulsive actions, and strong emotions. For these people, short-term medications may bring relief. However, cyclothymic disorder may not respond as well to medications as does bipolar disorder. A combination of mood stabilizers and psychotherapy is most effective. Mood stabilizers include lithium and antiseizure drugs such as Depakote, Tegretol, or Lamictal.