Among the clinical variants of depression is its mild, but stable form – dysthymia. In dysthymia, one can state a sullen mood, a feeling of unmotivated dislike for close people, constant internal discontent and irritation, reflecting personality traits that react excessively to external difficulties. There is a form of dysthymia with a predominance of various pain and fatigue.
In dysthymia, constant depression is maintained for at least two years, with no more than a two-month break. For her, typical: constantly dark mood, “eternal” irritability or anxiety. Most of the events of life are interpreted from a negative point of view, frequent complaints of poor health, condemnation of the people around them. People with dysthymia may have short periods of well-being, but usually they are limited to a few days or weeks. Patients are prone to dark thoughts. They complain that they do not sleep well, they feel uncomfortable, but generally cope with the basic requirements of everyday life.
It should be noted that among persons suffering from dysthymia, the risk of one or several “major depressive episodes” is 90%.
Dysthymia or “minor depression” is a chronically occurring depressive disorder. This pathology is more common than severe depression, but is rarely detected. Even in civilized countries, most people seek specialized help about 10 years after the onset of the disease.
The well-known resistance of dysthymia to treatment is likely due to its close interweaving with the personality characteristics of patients. Up to 25% of persons suffering from this pathology belong to the group of patients resistant to treatment. The significance of dysthymia is also due to the fact that this condition is usually combined with other mental illnesses: neurotic disorders, personality disorders, mental disorders in children (for example, attention deficit syndrome with increased activity, mental retardation).
Dysthymia accompanies such chronic neurological and somatic diseases as multiple sclerosis, irritable bowel syndrome, acquired immunodeficiency syndrome, hypothyroidism, etc. Given the high frequency, manifestations of dysthymia are particularly relevant in elderly somatic patients. The phenomenon of somatization of dysthymia in the elderly is well known. Against the background of constant pain or cancer, dysthymia forms especially easily. Often it occurs in persons who abuse alcohol or drugs. Dysthymia is recorded in the structure of remission in recurrent depression or schizophrenia. At the same time, it may form as a result of a once-experienced depressive episode.
Today, it is generally accepted that dysthymia is in many respects a hereditary disease, since relatives suffering from this disorder often have affective pathology.
At present, many psychiatrists practically all of the range of disorders described previously as neurotic depression qualify within the framework of dysthymia (“depressive neurosis”, “minor depression”). At the same time, there is a point of view according to which neurotic depression is traditionally understood as a psychogenic disease in the form of a protracted depression characterized by depressed mood with “dull longing” without a vital shade and projection into the future; lack of true affect fluctuations, psychomotor inhibition; sleep disorders in the form of waking up in the middle of the night with anxiety.
In clinical psychology, the term “dysthymia” is sometimes used to refer to a group of affective and obsessive states in people with a high neurotic level and introversion.
Primary dysthymia with early onset (up to 21 years) and late (after 45 years), as well as secondary dysthymia accompanying neurotic disorders (Akiskal H., 1983) are distinguished. Dysthymia, especially in children (the onset of the disease usually refers to childhood and adolescence), can easily turn into a more pronounced mental disorder; approximately 50% of persons with signs of dysthymia develop bipolar depression or a depressive episode of moderate severity occurs.