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Dysthymic DisorderDysthymic disorder is a form of depression that is not as debilitating as major depressive disorder. Dysthymic Disorder is sometimes called, neurotic depression (or Minor Depression). The implication is that Dysthymia is the result of psychological or social factors that create a depressive reaction as opposed to major depression which is endogenous and neurochemically based. While there is empirical evidence that suggests a familial pattern to Major Depression and therefore a genetic component, the line of differentiation is not so clear. This disorder is more common in women than men and is chronic depression that is continual in nature. Diagnostic criteria for Dysthymia include a course that lasts for 2 years of more. Only about 6% of the population will suffer from Dysthymic disorder. Factors that predispose one to Dysthymic Disorder include: A major loss in childhood (often an important caretaking person), a recent loss, chronic stress, the presence of a personality disorder with compulsive or dependent features, and alcohol or drug abuse. Often those persons who suffer from a major depressive disturbance will have a clearing of the more sever symptoms and chronically suffer from a “residue” of Dysthymic Disorder. This is called “double depression”. Dysthymia must be differentiated from Adjustment Disorder which usually results after a clearly identifiable stressor and resolves after the stress disappears. You will need to conduct an assessment and address any safety issues with your patient (e.g., suicide potential, self care issues) Establishing a good therapeutic rapport and relieving immediate symptoms is imperative. First, one must rule out depression as secondary to other conditions (e.g. medical, alcohol or drug abuse). During the clinical interview or assessment, you might use the BDI-II to measure the severity of the patient's depression. The assessment should include suicide and homicide risks. If suicidality is present, you should discuss the plan or means of suicide and take necessary action. A referral to a physician is a good idea to rule out any possible general medical condition that may pre-exist (obtain a release). A referral to a physician will be necessary also to obtain an antidepressant medication evaluation. Some theoretical approaches that seem to be helpful are supportive, cognitive-behavioral and interpersonal psychodynamic. When patients exhibit mild or moderate symptoms psychotherapy is the number one treatment. However, it has been shown that both medication and psychotherapy together may be most effective in some cases. Supportive psychotherapy will allow space for the client to express their concerns and to ventilate. Often depressed persons feel that no one cares and no one will listen- so listen! The primary reason for using a cognitive behavioral approach is to help patients change their thinking and behavior. The interpersonal therapy helps to refine social functioning. Finally, explain the diagnosis and treatment suggestions to the patient. Make sure you are supportive and nonjudgmental to relieve some of the patient's immediate symptoms. Find out what type of support the patient has and elicit community resources. Watch for countertransference issues. Often a depressed client can evoke anger or protective behaviors due to overt or covert helplessness. Be aware of your own responses to the client and utilize these to assist in deepening your understanding of the clients struggle.
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