Ask Doctor K: Dysthymia is a mild but prolonged type of depression

DEAR DOCTOR K: My doctor says I suffer from “dysthymia.” A friend says this is just a nice word for depression. What is dysthymia?

DEAR READER: Dysthymia is a type of depression. Periods of dysthymia tend to last longer than periods of depression. In fact, many people with dysthymia describe having been depressed as long as they can remember. Dysthymia typically is less severe than major depression; however, people with dysthymia are more likely to develop major depression in the future.

Dysthymia is not quite as common as full-blown depression. During the course of a year, about two people out of every 100 will suffer from dysthymia. It is about twice as common in women as in men.

The symptoms of dysthymia are like those of major depression. In both conditions, a person can:

• Have a low or irritable mood (grouchy).
• Feel relatively unmotivated or apathetic.
• Feel disengaged from the world.
• Feel pleasure less often, from anything that normally gives pleasure, from eating to sex.
• Have little energy.
• Experience an increase or decrease in appetite and weight.
• Sleep too much or have trouble sleeping.
• Have difficulty concentrating.
• Feel indecisive.
• Feel pessimistic.
• Have a poor self-image.

Dysthymia lasts for long periods, sometimes starting in childhood. As a result, people with dysthymia tend to believe that their symptoms are just a natural part of their personality: “That’s just me,” they say. They may not even think to talk about it with doctors, family or friends.

I remember telling a patient that I thought he suffered from dysthymia. He replied, “I don’t have any kind of depression. I’m just grumpy.” His wife added, “His mother says he was born grumpy.”

Cognitive behavioral therapy examines and helps correct self-critical thought patterns that contribute to the “grumpiness.” Psychotherapy can help sort out conflicts in important relationships that also may be involved.

An antidepressant medication can be very helpful. The most commonly prescribed are the selective serotonin reuptake inhibitors (SSRIs such as fluoxetine); serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine), mirtazapine and bupropion.

Your doctor may add a different type of drug to your treatment – for example, a mood stabilizer or anti-anxiety medication.

With treatment, symptoms often go away completely. However, continued treatment is usually necessary to prevent symptoms from returning. What is important is treatment, not diagnostic labels.

My patient who insisted he was just “a grumpy person” agreed to try an antidepressant. Two months later, he and his wife came to my office. The patient told me he wasn’t sure if the medicine was helping. He said he’d stay on it if I thought he should. Before I could answer, his wife said, “You really should! You’re not grumpy anymore.” He shrugged, looked at me, and said: “She probably knows me better than I know me.”

Clearly, the two of them had a strong relationship. It grew stronger when he continued with the treatment.

(This column is an update of one that ran originally in September 2012.)

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.