Dysthymia: Symptoms, Treatments, Neurological Underpinnings - Research Paper Example

Dysthymia Introduction A high point of discouragement that leads to suicidal thoughts and suicidal attempts is a condition which is regarded as depression (Grohol, 2008). This is a clinical disorder in which the depressed mood and other symptoms are high enough to mess up with social, work and family life leading to dysthymia. Dysthymia is a mild mood disorder which consists of chronic (long-term) depression. It is Greek word which means “bad state of mind” or “ill humor” (Schuyler, 2004). It is also known as chronic depression or neurotic depression. The major depression and dysthymia are of the same kind but they are different in their strength. This is because the strength of major depression is greater than dysthymia disorder. It affects people of all ages that include children and adults but has been observed to have high potency to occur mostly in women (Zieve, 2012). The minimum time period used in the dysthymia symptoms is two years (Schuyler, 2004). According to the American Psychiatric Association (APA) and Diagnostic and Statistical Manual of Diseases (DSM-IV) 4th Edition, “the adults with dysthymic disorder describe themselves as dependent and depressed” (Zieve, 2012). According to the first edition of Diagnostic and Statistical Manual of Diseases (DSM-I), dysthymia is a severe stage of chronic depression but is less sensitive and severe than the major depression (Schuyler, 2004). Dysthymia disturbs the routine functions of a sufferer as he feels low self esteem and hopeless, often think of being overly critical and becomes incapable of having fun (Griffiths, Ravindran, Merali & Anisma, 2000). APA Diagnostic Manual recommends an alternative definition for the dysthymia symptoms due to the fact that dysthymia is much similar to major depression symptoms (Schuyler, 2004). It has replaced the original words from the definition with some new keywords, namely: social withdrawal, irritability and guilt (Ishizaki & Mimaura, 2011). Importantly, these words are different from sleep disturbance and appetite as these are the symptoms for major depression. The symptoms, treatments, neurological underpinnings of the dysthymia disease along with the contemporary attitudes towards the treatments of dysthymia will be discussed in this research paper (Griffiths, Ravindran, Merali & Anisma, 2000). The treatments of dysthymia include cognitive behavioral therapy (CBT), pharmacological (medications) and alternative therapeutic treatment (psychotherapy). Symptoms An adult can suffer from some of these symptoms that are symptoms for dysthymia and major depression: Poor appetite Insomnia Fatigue Low self esteem Difficulty making decisions Feeling of hopelessness Thoughts of death or suicide Treatments As dysthymia is a serious illness; however, fortunately it is easily treatable (Grohol, 2008). For any chronic illness, early diagnosis and treatment can reduce the intensity of the disease and it can also reduce the possibility of developing an occurrence of major depression. A number of things can be done to improve the symptoms of dysthymia like getting sufficient sleep, following a nutritious diet, try to talk to someone the sufferer trust the most, try to exercise regularly and always seek activities that can make the sufferer happy (Ishizaki & Mimaura, 2011). The methods used for the treatment of dysthymia are psychotherapy, medications (pharmacology) and primary care physician. Cognitive Therapy The combination of both the therapies i.e. psychotherapy and medication is considered as the best treatment approach for the sufferer s of dysthymia (Schuyler, 2004). Many types of psychotherapies are available for the treatment of dysthymia (Ibid.). Cognitive Behavioral Therapy (CBT) is widely recognized as the client-centered therapy (Schuyler, 2004). It is considered as a therapy environment in which the sufferer’s needs are unconditional acceptance and response. The therapy should be conducted with respect to the sufferer’s temperament and the early termination of the therapy can occur if the sufferer feels that the therapist did not respect him (Ibid.). CBT helps the sufferer to become aware of the symptoms that either the symptoms are becoming better or worse. According to the New England Journal of Medicine, the sufferers were assigned by CBT program in which the antidepressant Nefazodone with the method of CBT was given to check the short term treatment of major depressive disorders through psychotherapy (Martin & et al., 2000). The results of the program showed that half of the sufferers of dysthymia responded to short term treatment with either Nefazodone or CBT as the treatment of both the antidepressant with CBT is much better than alone (Keller & et al., 2000). Pharmacological Treatment The pharmacological treatment of dysthymia is done with antidepressants which are defined as a type of drug used to treat depression and these drugs have an undesirable side effect. The antidepressants can control the negative thoughts of the sufferers and enhances their energy level (Griffiths, Ravindran, Merali & Anisma, 2000). The antidepressants take a minimum of six weeks to work and control the disease. To control the side effects of the antidepressant, a medicine with the minimum side effects should be given to the sufferer. The type of antidepressant given to the dysthymic sufferer is Selective Serotonin Reuptake Inhibitors (SSRIs) as this is the most commonly prescribed antidepressant. The brand names and medical formulas of the antidepressants which are given to the sufferer of dysthymia are Prozac (Fluoxetine), Paxil (Paroxetine), Zoloft (Sertraline), Luvox (Fluovoxamine), Celaxa (Citalopram) and Lexapro (Escitalopram) (Martin & et al., 2000). Some other antidepressants are also given for the treatment of dysthymia that include Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) (Ibid.). A study of treatment of dysthymia was conducted by the Sequenced Treatment Alternatives to Relieve Depression (STAR*D). According to their results, the sufferer should try several treatments to complete the treatment of dysthymia (Griffiths, Ravindran, Merali & Anisma, 2000). If the sufferer wants to get the main benefit of the antidepressant, then he has to switch to other antidepressants available. The Selective Serotonin Reuptake Inhibitors (SSRIs) have negative side effects so it cannot be given to a sufferer for a long time period. For this process, other antidepressants treatments are given that include Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) (Martin & et al., 2000). The sufferer should not stop their medication without doctor’s permission as this will also leave great side effects on the body of the sufferer. Alternative Therapeutic Treatment The alternative therapeutic treatment for the dysthymic sufferer s is psychotherapy which is defined as the treatment of the disease by means of talk-therapy rather than medications (Sansone & Sansone, 2009). Psychotherapy for the sufferers of dysthymia is available in different types as it helps the sufferer to understand their mood, behavior and thoughts. When the sufferer understands his inner feelings, he can lead his complete life successfully (Licinio, Botls & Gold, 1997). When the psychotherapy begins, a mental health professional will conduct an evaluation test to check the sufferer’s current state of mind and mood type (Sansone & Sansone, 2009). Psychotherapy focuses on the short term treatments for a disease because in short time the sufferer emphasize his attainable goals as through this method can bring the sufferer back to their life. In dysthymia, the sufferer generally learns to live with chronic unhappiness in his life. Instead of focusing on the sufferer’s current mood state, the realistic goals should be established early so that the sufferer can recover in a very short time interval. The benefits of psychotherapy are that the sufferer learns to make decisions, reduces self defeating behavior, reduces hopelessness and the sufferer improves his ability to perform better in his social and family relationships. Group therapy is defined as the type of psychotherapy in which many sufferers sit together and discuss their problems with each other under the presence of a therapist (Griffiths, Ravindran, Merali & Anisma, 2000). Goal therapy is considered as helpful in the treatment of dysthymia in a way that sometimes the sufferer becomes shy or does not want to tell the whole story to the therapist accurately. However, from this technique the sufferer can help other sufferers because when two or more sufferers will discuss their problems with each other they will find a solution for that problem. Measures of Effectiveness The measure of effectiveness that includes validity, efficacy, symptom, behavior management and recidivism is that to check the therapy will work on the sufferer or not. The first method through which we can assess the sufferer’s current status is observation. To confirm what type of therapy should be given to the sufferer is by self reporting in which the client himself tells all his problems to the therapist (Sansone & Sansone, 2009). An alternative effectiveness measure is social stability which shows that whether the sufferer is neurologically stable or not. If the sufferer is not in a stable position, then the therapist will have to check another treatment to measure the effectiveness. But the main measure of effectiveness is by self reporting of the sufferer (Griffiths, Ravindran, Merali & Anisma, 2000). According to the research, the women are more likely to develop dysthymia disorder as they have a greater chance of developing recidivism (Licinio, Botls & Gold, 1997). If no treatment will be given, recidivism will occur. It is a disorder which requires all the time care. If the medications are not taken carefully, the disorder can occur again. Rates of Symptom Reduction According to the research done on the two treatments of dysthymia i.e. Sertraline and interpersonal psychotherapy to check the most effective treatment that was conducted in 2002 and the research concludes that Sertraline and interpersonal psychotherapy are the most effective treatment for the sufferers of dysthymia (Browne et al., 2002). The main symptom of the dysthymia disorder is the recurring negative bad memories. In this disorder; if the treatment is not conducted accurately, the bad memories can reoccur again. The other symptoms which are shown by the sufferer is that he avoids contacting with the therapist when this disorder starts, it comes with different symptoms and when the sufferer does not understand it he avoids contact with the therapist (Licinio, Botls & Gold, 1997). If the sufferer’s treatment not starts, this will lead to the social isolation and the sufferer will not go to any other place because the sufferer thinks that his feelings and emotions will not be understood by any one so it is better to stay away from them (Sansone & Sansone, 2009). Selecting Treatment The most effective treatment for dysthymia disorder is a combined treatment of psychotherapy with medications (Grohol, 2008). Through this method, it is confirmed that the sufferer can recover from it quickly. Psychotherapy helps the dysthymic sufferer to tell the therapist that which symptoms he is having. Then according to their symptom’s intensity, psychotherapy with the help of medications is given. The medications that are antidepressants help the sufferer to not get involved in negative memories (Licinio, Botls & Gold, 1997). Different psychotherapies are given to the dysthymic sufferers according to their intensity (Grohol, 2008). The types of psychotherapies are individual psychotherapy and group psychotherapy. Group psychotherapy has its own importance as sometimes the sufferer feels shy to tell his symptoms to the therapist. Neuropysiological Underpinnings Dysthymia for neurological basis is not constant so it is called fight or flight reaction. In every moment of life, sometimes the negative feelings come in our mind, so it is in our hand that we fight against the disorder or we take flight from that disorder (Griffiths, Ravindran, Merali & Anisma, 2000). According to a research, 30% of the dysthymia sufferers switch to unbalanced episode at a certain age. Most of the dysthymia sufferers have a family history of dysthymia as this is the most common cause of dysthymia. The cortex part of the brain is associated with the neurotransmitters that drive us to complete the challenges. The corpus callosum and frontal lobe that communicates between both the hemispheres is responsible for the dysthymia disorder. This disorder is most common in women (Browne et al., 2002). Contemporary Attitudes The contemporary attitudes towards the three treatments of dysthymia are that as discussed earlier, the women are more likely to experience the negative thoughts. This disorder main cause is that it runs in the family and can be genetically transferred to other offspring. The most common used treatment for the dysthymia treatment is by medication and psychotherapy. The most common medication that is given to the dysthymia sufferer is Selective Serotonin Reuptake Inhibitors (SSRIs). This is antidepressant medication which controls dysthymia sufferer’s depression (Sansone & Sansone, 2009). The most common psychotherapy given to the sufferers of dysthymia is group therapy in which a group is set to discuss their problems in the presence of the therapist. The sufferer who become shy in front of the therapist, can tell other people their problems because the suffer thinks that other people who are sitting in the group are like me and I can discuss my problems here. Sometimes the other form of therapy i.e. individual therapy also works in which the sufferer directly tells the therapist that through which symptoms he is suffering. Conclusion A long term depression with slight changes in the mood is known as dysthymia. A dysthymic sufferer is usually one who thinks of suicide and also makes such attempts. Importantly, it is gender sensitive and women are mostly affected by this disorder. In order to treat such patients, there are three types of treatments available, namely: Cognitive Behavioral Therapy (CBT), medications (Pharmacological Treatment) and Psychotherapy (Alternative Therapeutic Treatment). Brown et al. (2002) have found that the most effective treatment for dysthymic sufferers is a blend of pharmacological and alternative therapeutic treatment that is Sertraline and interpersonal psychotherapy. Group therapy is also recommended as contemporary mechanism to treat the dysthymic sufferers and achieve positive results. References Grohol, J. (2008). Dysthymia Treatment. Psych Central. Retrieved on March 10, 2013, from http://psychcentral.com/lib/2008/dysthymia-treatment/ Ishizaki J. & Mimaura M. (2011). Depression Research and Treatment. Retrieved on March 9, 2013 from http://www.hindawi.com/journals/drt/2011/893905/ Licinio J., Botls L.C. & Gold P. (1997). Dysthymia: from clinical neuroscience to treatment. Retrieved on March 9, 2013 from http://whqlibdoc.who.int/hq/1997/WHO_MSA_MNH_NRS_97.2.pdf Browne, G., et. al., (2002). Sertaline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. Retrieved on March 9, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/12063159. Dysthymia. (2005). Harvard Health Publications. Retrieved on March 9, 2013 from http://www.health.harvard.edu/newsweek/Dysthymia.htm Griffiths, J., Ravindran V.A., Merali Z., & Anisman, H., (2000). Dysthymia: a review of pharmacological and behavioral factors. Journal of Molecular Psychiatry. 5(3), pp. 242-261. Retrieved on March 9, 2013 from http://www.nature.com/mp/journal/v5/n3/full/4000697a.html Martin, B., et. al., (2000). A comparison of Nefazodone, the Cognitive Behavioral- Analysis System of Psychotherapy, & their combination for the treatment of Chronic Depression. The New England journal of Medicine. Pg. 1462- 1470. Retrieved on March 9, 2013 from http://www.nejm.org/doi/full/10.1056/NEJM200005183422001#t=abstract Sansone A. R. & Sansone A. L. (2009). Dysthymic Disorder. Journal of Psychiatry. 6(5) pp. 46-51. Retrieved on March 9, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719439/ Schuyler D. (2004). Cognitive Therapy for Dysthymia. Retrieved on March 9, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC474737/ Zieve, D. (2012). Dysthymia. Pub Med Health. Retrieved on March 9, 2013 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001916/ Read More