Is dysthymia a high-functioning depression?
What's dysthymic disorder anyway?
That's what I'm going to talk about in this video today.
I'm Dr. Tracey Marks, a psychiatrist,
and I publish weekly videos about mental health education
and self improvement.
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This video is based on a few viewer questions
combined into one.
But here's one of the questions from missMediaChick
and I'm gonna read part of it to you.
"Dr. Tracey Marks,
"would you consider doing a video about dysthymia?
"I'm a 47 year old and I've been dealing with it
"since I was about 14.
"I started having some major depressive symptoms in my 20s
"as well but I never understood what was going on.
"I'm a light-hearted, creative person who enjoys connecting
"with people emotionally but so much of my life
"has been overridden by my dysthymia,
"making everything dull and gray
"and draining away my desire to engage in everything.
"I was finally diagnosed when I was 30
"and have been on meds since and spent 12 years
"with an amazing psychotherapist who's helped me arrive
"where I am today."
Take note of this.
"My father has narcissistic personality disorder
"and I'm sure I don't have to explain to you
"what hell he made out of my childhood.
"After tons of hard work I'm actually in quite
"a mentally and emotionally healthy place.
"I feel amazing.
"But dysthymia it's a constant battle,
"trying to figure out the right medication
"with major depressive episodes interrupting it."
There's a little bit more to this but I just wanted
to give you a feel of what she experiences.
So thank you missMediaChick for the question.
High-functioning depression is a term people will use
to note that someone's depression is not getting in the way
of their day-to-day functioning.
Perhaps they're able to still go to work, or school,
take care of their family,
and this is in contrast to a low-functioning
depressed person who may not be able to get out of bed,
or may not even be bathing,
or failing classes 'cause they just can't pull
it together enough to do these things.
So high-functioning is really more of a descriptive term
and not really an official diagnosis.
But the reason it can be associated with dysthymia
is because dysthymia is like having a depression,
but the symptoms are not as severe.
And they persist for a minimum of two years.
So it's kind of like having a low hanging cloud over you,
that makes it hard for you to feel enjoyment
and satisfaction with your life.
You may even find yourself feeling more negative
than other people around you
and you just don't feel happy.
One of the things that I ask patients
when I'm doing an evaluation is,
when was the last time you felt good?
People who have major depression and have episodes
that come and go,
they may say,
oh it was about three years ago?
Or even if they've had depression a long time,
they can usually point back to a time in their life
when they didn't feel depressed.
Even if it was years ago.
Whereas the person with dysthymia will usually say,
I don't ever remember feeling good.
Or, I've always felt this way.
It's hard for them to recognize a period of time
where they didn't feel bad.
And that's because the symptoms that they experience
are chronic and long-lasting.
But here's an important point though, in 2013,
we had a new edition of the Diagnostic
and Statistical Manual and we changed the name
from dysthymic disorder to persistent depressive disorder.
The name is a little misleading though
because the symptoms are not as severe
as with major depression,
so in some ways it really is like
a higher-functioning depression.
Let's take a quick look at the criteria
and I'm gonna read this from the Manual.
So for persistent depressive disorder,
you need a depressed mood for most of the day,
for more days than not, for at least two years.
And in children though, in adolescents,
the mood can be irritable and not depressed,
and last for a year instead of two years.
While depressed you must have two or more of the following.
Poor appetite or overeating, insomnia or hypersomnia,
low energy or fatigue, low self-esteem,
poor concentration or difficulty making decisions,
and feelings of hopelessness.
One of the big differences here between this
and a major depressive episode,
is you need two of the six things,
instead of five of nine things with major depression.
And I have a video defining
and talking about major depression.
I'll put a link in the corner for it.
Another big thing that's missing
with persistent depressive disorder
as compared to major depressive disorder,
is the lack of suicidal thinking that you can see
with major depression.
The next requirements are during the two year period,
or one year for children and adolescents,
is that you can't go more than two months
without any symptoms.
There's some other criteria like, you can't have,
you couldn't have had a manic episode,
or there can't be a medical diagnosis,
or medical illness that could account for these symptoms.
A person can have a major depressive episode
that occurs on top of the persistent depressive episode
and what that would look like
is a person who's chronically depressed
and they may be managing okay
but they're generally not happy
and then they slip into a deeper depression.
Now they have more the symptoms that you see
with a major depressive episode.
These would be things like feeling worthless, or hopeless,
or even feeling suicidal.
They may even have significant weight loss or weight gain.
With persistent depressive disorder, or dysthymia,
you may see, you may have changes in your appetite,
but it may not translate to a change in your weight.
If you get a major depression on top
of your persistent depressive disorder,
we call it a double depression.
When is it likely for you to develop
a persistent depressive disorder?
It's something that can build up early,
that can start as early as childhood,
all the way up until early adulthood.
A risk factor for it developing in childhood,
is losing a parent, or parental separation.
missMediaChick speaks to this in her question,
when she says that her father was narcissistic.
Although he may have been physically present,
I would argue that if he was narcissistic and lacked empathy
which can come with narcissistic personality disorder,
that lack of empathy creates an emotional disconnect
that can be experienced by a child as a separation of sorts.
It's like you can just never really attach.
So this may have set up missMediaChick
to develop a chronic depressive disorder beginning
in her adolescent years.
Now this is all hypothetical
because I don't really know missMediaChick or her father,
but this is just a possible explanation.
How do you help dysthymia?
Sometimes psychotherapy alone can treat your depression.
However, often a combination of medication
and therapy is best.
If you become seriously depressed,
and get the double depression,
it's probably best to consider medication to knock out
the major depression and then continue your work
with the dysthymia with the things
that you learn in therapy.
That's it.
Thanks for watching.
Leave me a question, if you have one,
or a comment about your experiences.
And like the video if you like it.
See you next time.
(funky alternative music)
♪ I am what I am today 'cause I did it my way ♪
♪ And nothin' ya'll can say ♪
♪ In this life or the next one ♪