Durban - Do you constantly feel down and have a negative view of the world?
Are you sleeping too much, perhaps eating too much? You may have a disorder called dysthymia.
New York clinical psychologist Mike Abrams defines it by saying an individual with dysthymic disorder is “chronically down, fatigued and negative about life”.
The meaning of dysthymia has changed over the years. The literal meaning is from the Greek, “dys” - bad - and “thymia” - mind or emotions - implying simply an “ill nature”.
However, medical professionals place the condition on the mood disorder spectrum and describe it as mild but chronic depression.
But University of the Witwatersrand academic Shirra Moch says dysthymia is more than minor depression. A senior lecturer in the Centre for Health Science Education, Moch says when dysthymia is untreated - as it often is - it can lead to major depressive disorder (MDD) and significant debilitation.
“The long period before diagnosis contributes to great suffering and also perpetuates a pessimistic and hopeless world view,” she says in a paper titled “Dysthymia: more than ‘minor’ depression”, published in the SA Pharmaceutical Journal.
Up to 60 percent of dysthymic patients develop MDD.
The problem is that many people with dysthymia think their low mood is normal, and they don’t seek help. “The longer the patient suffers from untreated dysthymia, the more impaired his or her social, psychological and emotional functioning becomes.”
Whereas MDD can be diagnosed after two weeks of symptoms, for dysthymia to be diagnosed the patient must have experienced symptoms for two years. These include poor appetite or overeating, insomnia or excessive sleep, low energy or fatigue; low self-esteem, poor concentration, difficulty making decisions, and hopelessness. The acute form of the illness occurs before the age of 21, when symptoms may be gradual, while the late onset is any time after 21 and is often sparked by an event such as a bereavement.
George* can relate. Diagnosed with dysthymia when he sought treatment in his late twenties, he says he often felt depressed as a child. “I was very shy and introverted, and would never initiate friendship with other children. I thought there was something wrong with me that made me different, and I dreaded school. I couldn’t concentrate in class.”
His home life was unhappy and when he was sent to boarding school his mood improved. However, his parents could not afford to keep him there and he had to come home.
“I didn’t finish matric and went to work in a bank. I always felt anxious dealing with customers and, again, did not make friends.”
After moving to another city, where he went home every night to an empty flat, he tried to commit suicide.
Now in his fifties George is in a low-paid job and says, “I feel I have not fulfilled my potential.”
He admits he often uses alcohol to “self-medicate” after a tough day at work or an upsetting incident. Substance use is common among people with dysthymia; Moch says 75 percent of dysthymic patients have another physical or psychiatric condition such as anxiety disorder, substance addiction or personality disorder, and these exacerbate the condition and make it harder to treat.
Owing to the low self-esteem associated with the illness, patients “often view themselves as a victim or underdog in interpersonal exchanges”, Moch says. George concurs, saying that he often feels inferior in relationships, and is offended if even a sales assistant is offish with him. “I immediately think, this person doesn’t like me, and I become defensive.”
Though there appears to be a genetic link to the illness, there is not a lot of research evidence to back this, says Moch. However, the main cause appears to be aberrant neurotransmitter signalling and hormone abnormalities.
“These can be perpetuated by chronic stress, adult or childhood trauma or social isolation.”
Treatment involves pharmacological and non-pharmacological approaches such as psychotherapy, says Moch, but a combination of medicines and regular psychotherapy sessions works best. Doing regular exercise and maintaining a healthy diet are also indispensable contributors to recovery, she says.
The most common antidepressant that is prescribed is an SSRI (selective serotonin re-uptake inhibitor) but medical professionals are also prescribing SNRIs (serotonin-norepinephrine reuptake inhibitors) and Bupropion. These medications address the imbalances in the brain’s transmitters, such as GABA, serotonin, dopamine and norepinephrine.
George agrees he has found great relief from taking medication, though finding the right combination and dosage, with the help of his psychiatrist, was a difficult process.
He has also benefited greatly from interpersonal therapy with a clinical psychologist, which has helped him deal with relationships at work and socially.
“My therapist also persuaded me to stay at my job when I wanted to walk out. I was very impulsive,” he says.
He has regular sessions with a cognitive behaviour therapist who has helped him enormously. “She challenges my negative thoughts, which makes me change my emotions and thus my behaviour. I no longer let my negative thoughts take control of me. A technique I have learnt is to clarify things before I jump to a conclusion. So, if I suspect someone is being rude to me, I ask a question. I clarify before acting out. For example, I will say something like, ‘You seem upset, is something wrong?’ More often than not she will say yes, she is exhausted or the boss picked on her or whatever. Then I have proved to myself that it is her stuff - her bad mood has got nothing to do with me,” he says.
Discerning which are the effects of his illness and what is real is a constant challenge.
“Still, when someone is rude to me I feel like a child, dismissed, humiliated, and I want to attack. But then I realise those thoughts come from way back, when I was a powerless child, and I can tell myself it is not worthwhile to react.
“Cognitive behaviour therapy (CBT) enabled me to realise there was no one outside myself who could change me. I had to change my own thoughts, emotions and behaviour. I have learnt not to give away my power, that by using the techniques of CBT you can have control over a situation. I can’t change my view of people and situations, but I can change my reaction.”
* Not his real name
Sunday Tribune