[wi_fighter]

First meeting with my new psychiatrist this morning. She actually LISTENED to me, unlike the other one I had. She filled out a four-page interview form and took tons of notes. My old Pdoc said I had major depression. This one says I have dysthymia, which is harder to treat. Oh goody.

We talked about my sleep problems and how I felt great after getting some sleep on Ambien, but that it quit working after a week. She put me on a low dose of trazodone for sleep and is having me stay on Celexa for the time being because that's one of the meds they can prescribe so I can get it for $8 a month. Lexapro isn't available to them, so I'd have to continue paying $94 a month at a private pharmacy.

She's going to have me see how the trazodone works in combination with the Celexa. If I'm sleeping well but still feeling blah, she's going to switch my antidepressant and is going to have a low threshold to switch. She's not going to make me wait a couple of months since I've already been back on Celexa for a month.

She also referred me for therapy.

Dysthymia. It sounds so much more palatable than depression. Too bad it has to be resistant to treatment.

[bebop]

I have dysthymia also and was diagnosed years ago with it. I took several meds but nothing ever helped me so I guess it really is resistant. I was also told by that T that is just meant I had had depression for many years. Now I have read more about it it sure makes more since to me. I never stuck with treatment either. Good luck with your therapy and meds!! I am rooting for you!

[wi_fighter]

I was just reading the info here about dysthymia. It sure sounds a lot like me, especially regarding therapy. The T I had this past fall and winter was so pushy for me to make changes instantly and would poo-poo me if I couldn't follow through or didn't do what he said exactly, that I got fed up with him and started canceling appointments.

I've got my fingers crossed that the lack of sleep is the major issue. I just feel like absolute crud when I'm not getting sleep. I can't function with work and then I get depressed because I'm not making enough money, I get tied to the computer for 12+ hours in order to reach daily goals, and then I have no time left for a life. Which leaves me more depressed, which makes it hard to sleep, which makes it harder to work, and on and on.

When I get restful sleep, I feel NORMAL I have energy and direction and concentration. I get my work done in 6-8 hours and have time to actually spend time with other people and relax at the end of the day and even do some much-needed housework. I feel alive and useful. So maybe the sleep is causing the dysthymia, especially since I noticed it's gotten worse ever since I had the kids. Once they were sleeping through the night, then my H was bugging me for sex instead of letting me catch up on sleep. Then the marital problems started kicking in the more he'd pressure me to be something I couldn't be, and it just kept snowballing. Now all of the pressures are off of me, but I'm still not sleeping so I'm still in a constant state of sluggishness. I think that would make anyone depressed, to always feel like you're walking around in a fog, half awake, not being able to retain or comprehend easy info.

My doc at the County just didn't seem all that interested in tweaking meds. This one, who's a woman too, seems to really be ready to be aggressive with treatment, so I've got my fingers crossed that I'll have some improvements soon. If the Celexa/trazodone combo doesn't cut it, I guess I'll shell out the big bucks for Lexapro and see how that combo works, since the Lexapro does really help with my mood. I'm just hoping to keep treatment as cost effective as possible. Anyway, I'm rambling.

[Dezdemona]

That's awesome, Wi! I'm so happy for you! I was diagnosed with Dysthymia about three years ago. I'm still figuring out medications and doctors. I know what you mean about having a shrink who doesnt listen to you. I'm so happy that you've found someone who listens. Good luck! ((((((WI)))))

[wi_fighter]

I was expecting the doctor to just rush me in and out in 15 minutes like they usually do, especially since it's a government run clinic, but we spent an entire hour together. I was impressed. She's really nice too.

I hope I don't spend years getting meds adjusted. I had success with the Lexapro as far as the low mood, but it didn't do anything for the sluggishness. I held off on refilling it in case I could get it through the mental health dept., but no luck there. I've got my fingers crossed that I'll get some sleep and have the same results I did when Ambien was working (knock wood).

I'm just holding out until 9:00 before I take the trazodone and settle in for the night. The dog seems to have other ideas. She's in no mood to settle down right now.

[JustBen]

I have a hunch that dysthmia is actually a personality disorder--it sure seems to be a long-term and consistent pattern. That would also explain why it's so tough to treat using our current model. If it's anything like other personlity disorders, then a long-term slow treatment style would seem to work the best.

found this on National Mental health association website... its a bit old 1991but it had some numbers and so on where you can get more information about the disorder.

http://www.nmha.org/infoctr/factsheets/26.cfm

Dysthymia

What is Dysthymia?
Dysthymia (the Greek roots of the word mean “bad state of mind” or “ill humor”) is a disorder with similar but longer-lasting and milder symptoms than clinical depression. By the standard psychiatric definition, this disorder lasts for at least two years, but is less disabling than major depression; for example, victims are usually able to go on working and do not need to be hospitalized.

How Common Is It?
About three percent of the population will suffer from dysthymia at some time - a rate slightly lower than the rate of major depression. Like major depression, dysthymia occurs twice as often in women as it does in men. It is also more common among the poor and the unmarried. The symptoms usually appear in adolescence or young adulthood but in some cases do not emerge until middle age.

Warning Signs
The warning signs of dysthymia are:

poor school/work performance
social withdrawal
shyness
irritable hostility
conflicts with family and friends
physiological abnormalities
sleep irregularities
parents with major depression
At least three-quarters of people with dysthymia have some other psychiatric or medical disorder as well.

Current Treatments for Dysthymia
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.
Medications:
Tricyclic antidepressants, the standard treatment for major depression, may be useful for dysthymia

In many cases, the symptoms are hard to recognize and classify, and the response to treatment is unpredictable. Most people with dysthymia see only their family doctor, who may misdiagnose them, especially if the main complaints are physical. Many people do not think of themselves as depressed, and are relieved to be told they have a treatable illness. Unfortunately, mental health professionals are usually consulted only when major depression develops, although dysthymia alone may lead to alcoholism or suicide. Even when it is recognized, dysthymia is difficult to treat. The longer a depression lasts the slower the recovery.

For More Information:
Contact your local Mental Health Association, community mental health center, or:
National Mental Health Association
2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center 800/969-NMHA
TTY Line 800/433-5959

National Foundation for Depressive Illness (NFDI)
PO Box 2257
New York, NY 10016
Phone: (800) 248-4344

Depression Awareness, Recognition, and Treatment (DART)
National Institute of Mental Health
5600 Fishers Lane, Room 10-85
Rockville, MD 20857-8030
Phone: (800) 421-4211

American Psychiatric Association
1400 K Street, NW
Suite 501
Washington, DC 20005
Phone: (202) 682-6000

Source: The Harvard Mental Health Letter, May 1991 issue

Hi WI
I hope your new meds work for you. And I'm glad you've found a therapist you like.

[wi_fighter]

I tried 25 mg on Monday. It didn't work. I tried 50 mg last night. It still didn't work. Guess it's 75 tonight. Doc said I could go up to 100 before I need to call her and let her know.

I haven't met my therapist yet, just my psychiatrist. I have no idea when I'll first see my new T.

[Dezdemona]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
JustBen said:
I have a hunch that dysthmia is actually a personality disorder--it sure seems to be a long-term and consistent pattern. That would also explain why it's so tough to treat using our current model. If it's anything like other personlity disorders, then a long-term slow treatment style would seem to work the best.

</div></font></blockquote><font class="post">

Woa. May I ask as to where you got this idea? I've only seen it classified as a mood disorder. Although I have not read about personality disorders at all, I have read alot about Dysthymia, and it is actually a form of depression, which I would think would be in a class on its own...then again I'm not a shrink so...

[wi_fighter]

Everything I've read so far shows it as being a mood disorder, a chronic form of depression. Yes, I would say it affects your personality, just like any form of depression does, but I wouldn't say that would make it a personality disorder.

Dysthymic Disorder
SYMPTOMS

Dysthymic Disorder (also known more generally as "dysthymia") is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, the mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:

* Poor appetite or overeating
* Insomnia or hypersomnia
* Low energy or fatigue
* Low self-esteem
* Poor concentration or difficulty making decisions
* Feelings of hopelessness

Furthermore, in order to be diagnosed with Dysthymic Disorder, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. This generally means that the person needs to have had an uncomplicated, long-term, low-grade depression for two or more years in order to meet this diagnosis.

In order to meet the diagnostic criteria for Dysthymic Disorder, the symptoms may not be due to the direct physiological effects of a the use or abuse of a substance (for instance, alcohol, drugs, or medications) or a general medical condition (e.g., cancer or a stroke). The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

General Treatment for Dysthymic Disorder


Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

[Rapunzel]

WI, that sounds so familiar to me. Dysthymia has been one of my diagnoses too, and it fits. I have had depression for most of my life, but only sometimes as severe as major depression. And it doesn't mean that your previous diagnosis was wrong - major depressive episodes often come and go, especially for people with dysthymia. Sleep problems go along with it for me too. I haven't been on prescription meds, but St. John's Wort helped a lot for me - with the depression and the insomnia too, especially when I also took valerian and/or chamomile at bedtime.

I can see Ben's point about dysthymic disorder belonging with the personality disorders. As I am sure Ben is aware, it is classified with the mood disorders, and I think it has aspects of both. Mood is definitely involved, and there are longstanding patterns that can seem like it is part of the personality. Part of what separates personality disorders from clinical disorders is that personality disorders tend to be based on traits that seem like they are consistent with the person's nature (ego-syntonic), while Axis I (clinical) disorders feel more foreign to your nature (ego-dystonic). Some people with dysthymia might feel like they have been depressed so much that it is part of who they are. I have felt that way. But I don't feel that way about depression/dysthymia to the extent that I do my personality disorders. I feel that dysthymia is most appropriately grouped as it is with the mood disorders. But the classification of mental disorders is more fluid than it may appear sometimes. The DSM isn't so much like a bible as it is sometimes treated. In fact, it gets revised regularly as the general consensus of the field changes.

Dysthymic disorder seems to me to often go along with certain personality disorders. It also seems to have a lot in common with seasonal affective disorder, and sleep problems, and major depression can often come into the picture too. I think that we tend to try to pin things down more precisely than it is really accurate to do sometimes. It would be more realistic to look at people all as individuals who have various symptoms that sometimes have something in common.

Rap

[JustBen]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
Dezdemona said:Woa. May I ask as to where you got this idea?

</div></font></blockquote><font class="post">

Right out of my own head--like I said, just a hunch. I'm aware that it's currently classified as a mood disorder, but I think that's a mistake. Here's a quote from the DSM-IV about Personality Disorders:

"Personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts. Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Personality Disorders. The essential feature of a Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture..."

So, yeah, I think dysthymia fits neatly into that category. It's clearly a long-term enduring pattern. (Until the early 20th-Century, people who exhibited these behaviors were said to have "melancholic" personalities.) I don't get bent out of shape about labels, though, unless they have some kind of practical significance. The importance of this label, as I see it, is that it's led a lot of researchers and therapists to treat this problem with a category of treatment that's appropriate for mood disorders. (Then, when such treatment is less than successful, they blame the disorder.)

I'm not married to this hunch, but I think it might be a good idea to look at dysthymia as a personality disorder for a few years and see what kind of treatments can be developed for it.