PSYCH 101: Dysthymic Disorder

I don't like labeling people. My preference is for using labels, or diagnoses (that I'll be discussing in Psych 101), to describe collections of behaviors and/or thinking (and feeling) patterns, and/or ways of relating to people, that interfere with ones pursuit of a happy life. My way of thinking about this helps guide my Cognitive-Behavioral treatment approach. In Psych 101 I won't focus so much on the origins of the bad habits/patterns, though I am very familiar with them. My focus will be explaining the diagnosis, as defined in the Diagnostic and Statistical Manual (DSM-IV-TR), and offer some suggestions about treatment, the way I would do it.



"Dysthymic Disorder [is described as] a chronically depressed mood that occurs for most of the day more days than not for at least two years. In children the mood may be irritable, instead of depressed" for at least a year. I describe it as a mild depression (as opposed to a major depression), and it can influence sleep, appetite, energy level, self-esteem, cause poor concentration, difficulty making decisions, feelings of hopelessness and helplessness, negativity, pessimism, and self-isolation. Sounds pretty bad. It feels bad too.



Treatment can be successful without the use of medication, though I often suggest the use of St. John's Wort (a tea/herb) along with counseling. Recovery from Dysthymic Disorder can be difficult because it requires changing certain thinking, feeling, and behavior patterns at a time that the person is feeling low energy and motivation, feelings of helplessness and pessimism. And, as you know, habits are hard to break. You have to push yourself. Take a small step to start, and be persistent. It helps to have a support system, even though you don't want to be around people. Socialize, exercise, find other activities that distract you from the depressed thoughts and feelings. Learn to balance the negative thinking with positive thoughts and optimism. Often the feelings are triggered by unresolved grief. Explore that possibility, and commit to resolving those feelings of loss (and associated anger, guilt, and sadness) by talking and/or writing about them. The biggest culprit, I think, of triggering the depression is an overload of stress. Examine the sources of stress in your life, and control it better. You know my feeling about this. If happiness is not a part of your life you have got to fix that. If you suffer from Dysthymic Disorder, try some of the things I suggest here (also see my MENTAL NOTES blog of March 4, 2007, "Curing Depression...").

Curing Depression,... Finding Happiness

If you're depressed you've got to do something to cure it. Severe depression will likely require that you get some help from me or a psychiatrist (in the office). That is, if the depression is interfering in your life in a major way. Symptoms would likely include isolation, sadness, hopelessness and helplessness, pessimism, no enjoyment, no motivation, low energy, thinking at times that life is not worth living (thinking of doing something about that), staying in bed, crying spells. Sounds pretty bad, huh? It is. Even if you're just not happy, do something about it. Life is about being happy, after all. Exercise, socialize, practice positive and optimistic thinking, play, laugh, relax (more on managing stress later), develop a hobby, spend time in a loving relationship. Find your happiness. Easier said than done, you might say. And you'd be right, except it is worth it and it is possible. It requires breaking some old thinking and behavioral habits, and developing new ones. You may have to push yourself to get it done. But do it!

Some of you know about our recent vacation to Costa Rica. We learned a lot about this small ecologically-minded Central American country. In additon to a lot of beauty, they haven't had an army for many years. The money they would use to support armed forces they put towards education. CR has one of the highest literacy rates in the world! They also push the concept of Pura Vida (Pure Life). You're taught from a young age that life should be good. Let's develop that expectation for ourselves and our children. Pura Vida!