Showing posts with label thoughts of death. Show all posts
Showing posts with label thoughts of death. Show all posts

Dysthymia - Mild Form of Chronic Depression

What is Dysthymia?





Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression. With dysthymia, the depression symptoms can linger for a long period of time, perhaps two years or longer. Those who suffer from dysthymia are usually able to function adequately but might seem consistently unhappy.



In other words, Dysthymia is a common type of a low-grade depression. Harvard Health Publications states that, “the Greek word dysthymia means ‘bad state of mind’ or ‘ill humor’. As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer.



At least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism.



Dysthymia “affects approximately 3% of the population and is associated with significant functional impairment. According to the National Institute of Mental Health, approximately 10.9 million Americans aged 18 and older are affected by dysthymia. While not disabling like major depression, dysthymia can keep you from feeling your best and functioning optimally. Dysthymia can begin in childhood or in adulthood and seems to be more common in women.





What Causes Dysthymia?



Experts are not sure what causes dysthymia. This form of chronic depression is thought to be related to brain changes that involve serotonin, a chemical or neurotransmitter that aids your brain in coping with emotions. Major life stressors, chronic illness, medications, and relationship or work problems may also increase the chances of dysthymia.



What Are the Signs and Symptoms of Dysthymia?



The symptoms of dysthymia are the same as those of major depression but not as intense and include the following:



• Persistent sad or empty feeling.

• Difficulty sleeping (sleeping too much or too little).

• Insomnia (early morning awakening).

• Feelings of helplessness, hopelessness, and worthlessness.

• Excessive shyness.

• Feelings of guilt.

• Loss of interest or the ability to enjoy oneself.

• Social withdrawal.

• Loss of energy or fatigue.

• Difficulty concentrating, thinking or making decisions.

• Poor school/work performance.

• Changes in appetite (overeating or loss of appetite).

• Observable mental and physical sluggishness.

• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

• Irritable hostility.

• Constant conflicts with family and friends.

• Thoughts of death or suicide.





Diagnostic criteria



The essential symptom involves the individual feeling depressed almost daily for at least two years, but without the criteria necessary for a major depression. Low energy, disturbances in sleep or in appetite, and low self-esteem typically contribute to the clinical picture as well. Sufferers have often experienced dysthymia for many years before it is diagnosed. People around them come to believe that the sufferer is 'just a moody person'. Note the following diagnostic criteria, offered by The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association:



1. During a majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.

2. When depressed, the patient has 2 or more of:

  • Appetite decreased or increased.

  • Sleep decreased or increased.

  • Fatigue or low energy.

  • Poor self-image.

  • Decreased concentration and decisiveness.

  • Feels hopeless or pessimistic.

  • Excessive muscle pain, particularly upper back, and feet.

3. During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.

4. During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.

5. The patient has not had any Manic, Hypomanic or Mixed Episodes.

6. The patient has never fulfilled criteria for Cyclothymic Disorder.

7. The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).

8. The symptoms are often not directly caused by a general medical condition or the use of substances, including prescription medications.

9. In contrast to major depression, these symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000). People suffering from dysthymia are usually well capable of coping with their everyday lives (usually by following particular routines that provide certainty).



In children and adolescents, mood can be irritable and duration must be at least 1 year, in contrast to 2 years needed for diagnosis in adults.





Treatments for Dysthymia



Medications



In multiple clinical studies, both Prozac and Tofranil have been shown to be effective treatments for Dysthymia. The response rate to antidepressant therapy is usually around 62%; whereas the response rate to placebo therapy ranges from 19% to 44%.



Therapy



• Psychotherapy or cognitive therapy (also known as "talk therapy") is used to alter people's self-defeating thoughts.

• Behavioral therapy may help people learn how to act in a more "positive approach" to life and to communicate better with friends, family, and co-workers.



Psychotherapy is used to treat this depression in several ways. First, supportive counseling can help to ease the pain, and can address the feelings of hopelessness. Second, cognitive therapy is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to learn how to accept the life problems that cannot be changed. Third, problem solving therapy is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression. Behavioral therapy can help you to develop better coping skills, and interpersonal therapy can assist in resolving relationship conflicts.



Sources and Additional Information:

http://www.webmd.com/depression/guide/chronic-depression-dysthymia

http://en.wikipedia.org/wiki/Dysthymia

http://www.medicinenet.com/dysthymia/article.htm

http://www.healthyplace.com/depression/main/dysthymia-minor-depression/menu-id-68/

http://www.psychologyinfo.com/depression/dysthymic.htm

Major depression with psychotic features



Psychotic major depression (PMD) is a type of depression that can include symptoms and treatments that are different from those of non-psychotic major depressive disorder (NPMD). PMD is estimated to affect about 0.4% of the population (or one in every 250 people). Note that roughly 25 percent of people who are admitted to the hospital for depression suffer from what's called psychotic depression.



Psychotic depression is characterized by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren’t really there) or delusions (irrational thoughts and fears). Often psychotically depressed people become paranoid or come to believe that their thoughts are not their own (thought insertion) or that others can ‘hear’ their thoughts (thought broadcasting).









Symptoms
Currently, PMD is considered a severe form of major depression, but patients with mild or moderate depression may still have psychotic features. Many people with PMD experience delusions, which are beliefs or feelings that are untrue or unsupported.



Paranoid delusions or delusions of guilt may be the most common psychotic symptoms in PMD. Patients with PMD often have concerns that people are paying special attention to them or are trying to persecute them. Patients who experience delusional guilt may believe that they are being punished for past misdeeds or are responsible for problems they couldn’t possibly be responsible for.



Other common delusions include those in which people are concerned that something is terribly wrong with their bodies and physical health, when actually there isn’t anything wrong. Unlike other psychotic disorders, the delusions in PMD may not be very obvious. Delusions appear to be more common than hallucinations in PMD, but some people with PMD do hallucinate, or see or hear things that others do not. Auditory hallucinations (sounds) are perhaps the most common hallucinations seen in PMD. While other patients may report seeing, touching or smelling things that are not there, it is less common.



Other symptoms that are common in PMD are agitation, difficulty falling asleep, and frequent waking during the night. In addition, patients with PMD may have a greater suicide risk than patients with NPMD. Finally, those with PMD may have greater cognitive deficits (e.g., memory problems) than those with NPMD.



Diagnostic criteria
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely used manual for diagnosing mental disorders, patients who show at least six of the following symptoms in a period of two weeks may be diagnosed with PMD. In order to qualify for a PMD diagnosis, patients need to report either (1) or (2), and (10), along with three or four other symptoms (for a total of six). These symptoms also must be different from how patients felt or behaved at a previous time.
  1. Depressed mood most of the day nearly every day.

  2. Loss of interest or pleasure in all, or almost all, activities most of the day nearly every day.

  3. Significant weight loss or weight gain, OR decrease or increase in appetite nearly every day.

  4. Insomnia OR hypersomnia (sleeping excessively) nearly everyday.

  5. Psychomotor agitation (moving more quickly) OR retardation(moving more slowly) nearly every day, so much that other people notice.

  6. Fatigue OR loss of energy nearly every day.

  7. Feelings of worthlessness OR excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

  8. Diminished ability to think or concentrate, OR indecisiveness, nearly every day.

  9. Recurrent thoughts of death (not just fear of dying), recurrent ideas about suicide without a specific plan, or a suicide attempt or specific plan for committing. suicide

  10. Presence of psychosis (hallucinations/delusions).









Causes of Psychotic Depression
As is the case with other forms of depression, the exact causes of psychotic depression are not known. Research does however suggest that hereditary factors and a history of other depressive conditions such as bipolar disorder often play a role in susceptibility. In addition, abnormal levels of hormones in the bloodstream may also aggravate the onset of psychotic depression.



Psychotic depression is frequently associated with high levels of a hormone called 'cortisol' in the blood. (Cortisol is a hormone produced by the adrenal cortex. High levels of cortisol have been associated with stress.)



Treatment of Psychotic Depression
Treatment for psychotic depression requires a longer hospital stay and close follow-up by a mental health professional. Combinations of tricyclic antidepressants and antipsychotic medications have been most effective in easing symptoms. The addition of lithium to this combination can be beneficial for those with bipolar disorder. Electroconvulsive therapy is very effective for this condition, but it is generally a second line treatment.



Researchers are also studying the effectiveness of RU-486 (the “abortion pill” and “emergency contraceptive”), which is said to dramatically relieve psychotic depression.



Prognosis of Psychotic Depression
Treatment is very effective for psychotic depression and people are able to recover, usually within a year, but continual medical follow-up may be necessary. Generally, the depressive symptoms have a much higher rate of recurrence than the psychotic symptoms. It is important, however, that a person experiencing these symptoms be properly diagnosed because treatment is different than for other major depressive illnesses and risk of suicide is greater.





Sources and Additional Information:

Major Depression Symptoms

A person who suffers from a major depressive disorder (sometimes also referred to as clinical depression or major depression) must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person's normal mood. Social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. For instance, a person who has missed work or school because of their depression, or has stopped attending classes altogether, or attending usual social engagements.



A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one which is caused by a general medical condition. Major depressive disorder generally cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder. Typically the diagnosis of major depression is also not made if the person is grieving over a significant loss in their lives.









Depression varies from person to person, and it has special traits and specifics based on the age, gender, personality and other factors, but there are some common signs and symptoms to be observed.
Clinical depression is characterized by the presence of the majority of these symptoms:
  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)

  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Loss of interest in activities or hobbies once pleasurable, including sex.

  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

  • Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).

  • Psychomotor agitation or retardation nearly every day. Either feeling “keyed up” and restless or sluggish and physically slowed down.

  • Fatigue or loss of energy nearly every day. Feeling fatigued and physically drained. Even small tasks are exhausting or take longer.

  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day. Harsh criticism of perceived faults and mistakes.

  • Diminished ability to think or concentrate, or indecisiveness, nearly every day. Trouble focusing, making decisions, or remembering things.

  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment.

In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.



If you have 2 to 4 symptoms for a period of at least 2 years (1 year for a child), you may have a long-term form of depression called dysthymic disorder (dysthymia).



Many health professionals see people with general symptoms that may be difficult to link to depression. These symptoms, which commonly occur with depression, include:
  • Having digestive problems, including constipation or diarrhea.

  • Losing interest in sex or being unable to perform sexually.

  • Not moving or talking for hours.

  • Increased tearfulness, anger, and generally not feeling well, along with anxiety and tension.

  • Sometimes, a feeling of heaviness in the arms and legs.

  • Sensitivity to rejection.

  • Night Sweats and sudden awakening.









Sources and Additional Reading:
 
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