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Depression: Major Depression & Unipolar Varieties
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What about the "milder" depression: Dysthymic disorder?

Allan Schwartz, LCSW, Ph.D.

Case Study(Fictional):

"Jack is an 18 year old college student who was seeking psychotherapy because, after reading about depression in his "Introduction to Psychology" textbook, decided that the description fit him. Despite doing quite well in his classes he complained of feeling a constant tiredness. However, along with feeling tiredness, he also felt blue, down and hopeless. He described himself as being a loner, with a few friends but no girls, no dates and no sexual experiences. He also had no goals and no aspirations for himself. His parents remained married but unhappily so and that was one of those open secrets. His father was a teacher but always felt unfilled and openly stated how much he hated his job. His mother, a housewife, also seemed to never have any enthusiasm for life.

It soon became clear that Jack never really felt loved by his parents, whose lives seemed colorless and bland. The boredom of home was broken by episodes of loud arguing between his mother and father. The issues usually centered around money and how much his mother spent for food and clothing. The fights would suddenly erupt for no apparent reason and would fill him with enormous dread. Jack always experienced and ill defined sense of guilt, as though the lives of his parents would have been better had he never been born. A good student since elementary school, neither parent seemed to take any joy in his achievements and never expressed any goals they wished or hoped he would achieve.

Jack's therapist was the first adult male he ever remembered taking an interest in him. Jack became a long term psychotherapy patient who had a wonderful outcome in his therapy five years later."

Jack's story is not unusual. His symptoms fit the profile of someone coping with Dysthymia.

There is a lot of discussion about depression but, it is my impression, that much of the discourse centers around Major Depression and Bipolar Disorder. Of course, these last two are extremely serious because symptoms sometimes include delusions and hallucinations along with the very real threat of suicide.

However, there is a "milder" type of depression called Dysthymic Disorder. While many of the symptoms of dysthymia are less intense than Major or Unipolar Depression, they are more chronic in nature. In other words, Dysthymic Symptoms last for years, sometimes beginning during childhood and lasting through adulthood.

The way I like to think of and explain Dysthymia to people is to use the metaphor of a low grade fever. A low grade fever, caused by the flu or some type of infection, may not stop a person from going to work, but, it robs the individual of energy and is accompanied by low grade and transitory body aches. There may even be a mild sore throat with the fever, but nothing so bad as to cause alarm.

In a similar way, people with Dysthymia experience a lack of energy, feelings of sadness, low productivity, a lack of enthusiasm for anything, low self esteem, fatigue and transitory thoughts about life not being worth living or thoughts of suicide, along with many other symptoms shared with Major Depression but to a lesser degree. Overall, the Dysthymic individual experiences a pervasive sense of grayness and an inability to live life to the fullest.

Because Dysthymia lasts for years it is very debilitating and can spill over into Major Depression. People with Dysthymia are not immune from suicidal behavior. In other words, this illness is to be taken very seriously.

If you experience any of the symptoms associated with depression of any kind it is important that see your medical doctor. It is always important to rule out any disease process or neurological or organic disorder. If you are found to be in good health, the next step is psychotherapy with a Clinical Psychologist or Licensed Clinical Social Worker. Do not hesitate to seek help. You have nothing to lose but your feelings of misery.

Your comments and questions are welcome.

Allan N. Schwartz, PhD