Persistent depressive disorder, which is also known as dysthymia, is a continuous long
term form of depression which is less severe. Most people with this disease describe it as they
always feel depressed as long as they can remember or having a feeling of drifting in out of
depression. It usually starts in childhood and tends to run in the family. It is commonly found in
women, but in men, it might go undiagnosed since men don’t like talking about their mood.
Sadly, their no known single cause of dysthymia. Persistent depressive disorder is a disorder that
should not be ignored, and one is required to seek a psychotherapist.
Diagnosis
Persistent depressive disorder is usually diagnosed by the duration the patient has had
since it can go on for years. Its symptoms include a person losing interest in normal daily
activities, feeling hopeless, lack of productivity, having low self-esteem and an overall feeling of
being inadequate. It can also include symptoms such as overeating, oversleeping and diminished
capacity to feel pleasurable things. It usually or sometimes erupts into a major depression as a
result of loss or as a response to a certain stressor. (Patel & Rose, 2020) This leads to a double
depression where a major depression wraps itself around dysthymia. In children, the symptoms
may vary a little in that the child may lose appetite, and children may experience insomnia.
Grouchy and hostile behavior, as well as frequent complaints on issues such as headaches,
stomachaches, or fatigue, are symptoms of persistent depressive disorder in children.
Theories of Etiology
Modernization and advancement of medicine have resulted in the continued evolution of
etiology on depression. Generally, dysthymia is caused by biological, social and psychological
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factors. Biological factors such as genetics, neurology, hormones, immunological factors play a
significant role in dysthymia. This is because they are based on the reaction to stressors and
processing information, which is emotional. The occurrence of dysthymia at earlier ages is often
associated with chronicity and impairment. The occurrence of depression at different ages can
shed light on different causal factors. Some risk factors associated with dysthymia include
genetics, history of mental illness, sense of self-worth, trauma and social determinants of health.
Ethiologiacal models are usually diathesis-stress models that make experiences that are
stressful to trigger depression. Some of the environmental stressors which can cause dysthymia
include stress, which is chronic, childhood exposure to adversity and certain life events. The
biological events which were stated earlier, and personal vulnerabilities such as interpersonal and
personality factors usually add to cause dysthymia and can also be affected by depressive states.
(Larson et al.)However, for some individuals, the persistence of these symptoms is not always
typical, and it has become a significant challenge for the people who do research why some
people experience different symptoms as compared to others.
Treatment
The treatment of persistent depressive disorder is usually the use of psychotherapy and
medication. The type of psychotherapy to be used usually depends on a number of factors, which
may include the nature of stressful events, whether the family is available or not, social support,
and what the person prefers( McCullough et al.). The therapy usually includes emotional support
and giving out education about depression and how it can be overcome. Correction of self-
critical and faulty life thought patterns is examined through cognitive behavior therapy.
Reccomendation of antidepressants such as serotonin reuptake inhibitors (SSRIs such as
fluoxetine), serotonin-norepinephrine reuptake inhibitors (SNRIs) as venlafaxine), mirtazapine,
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and bupropion are also advised. In children, the disorder can be treated by the use of family
therapy, whereby the parents talk to their children, thereby knowing some of the contributing
factors. The school which the child goes to should also be involved for the child to have
specialized treatment or care.
The therapist initially focusing on behavioral changes on Bonnie, such as exercise, in my
opinion, was right. One of the major signs of dysthymia is low self-esteem, which is usually
associated with a person's ability to socialize with others. The only way to increase a person’s
self-esteem is by giving him time to socialize with those around him. They may articulate the
patients' strengths in this case, they may complement how good Bonnies knitting and sewing is,
making her gain a little courage, which is essential. According to The Havard Medical school,
exercising is an excellent way of protecting and enhancing brain activity. This is because regular
exercises release brain chemicals, which are vital concentration and prevent cognitive decline,
which can help with the symptom of loss of concentration.
What I would do differently is advise her to take time and spend time with her father and
learn to perceive her marriage as a result of love rather than the natural requirement of having a
partner. Spending time with her father let her understand why He broke up with her mother. This
is because the divorce took a toll on her, and probably it’s the reason why she changed her
opinion about life. This might help her change the feeling of unworthiness, and maybe she might
feel wanted again. Viewing her marriage as a result of love may make her engage in pleasurable
activities such as sex more passionately and spend more time feeling worthy, showing full
affection and wanted.
I would also advise her, although it might be challenging to keep up with the treatment
she should do for her family since her family loves her. Her dedication and keeping faith in the
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medication which was recommended will help her get through this disorder. Also, advising her
on the possible implications that this disorder has on her children should be advised. Children
should be brought up in a positive environment. If parents are committed to work, they play, go
to church, and participate in community activities. It makes the children avoid depression in the
early stages of life
A meaningful engagement in life is where one engages either frequently and consistently
in doing activities that make them happy. It is usually marked by purpose and belief. In Bonnie's
case, she is not even content with her marriage. She doesn’t spend quality time with her husband.
Spending time with one's significant other helps one have a happy marriage. She does not like
socializing, which is probably why she is not included in out of office social events by her fellow
co-workers. This shows she doesn’t like participating in meaningful engagements. She rather
spend time doing her knitting and sewing than being with friends and family. Therefore I agree
with the therapist's suggestions.
Depression can be avoided by participating in daily activities. Some of these activities
which shelter me as a person include visiting friends and family, taking part in a group outing,
and attending community events. This is because social interactions improve physical, emotional
health, and mental health. Physical activities such as participating in outdoor games and maybe
doing yoga are also important. Depression can also be avoided by having a sense of purpose.
Taking up a hobby or doing past time activities such as yoga can also help with preventing
depression. Family, which is always associated with love and compassion, is crucial in one
mentals health. The feeling of belonging and having someone you can talk to is sometimes
undermined but essential in having a healthy mind. Speaking to a therapist can also help.
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Nowadays, therapy can be done through phone calls and video calls. Why should you suffer in
silence when an expert is always a phone call away?
Persistent depressive disorder represents a disorder of chronic depression, and the
outcome is similar or can be worse as compared to that of a major depressive disorder. If
dysthymia is gone and treated, the complications can be very similar to that of untreated mental
illness. Untreated depression can result in an increase in health costs and a decrease in adhering
to medication and adhering to treatment such as Bonnie did. Therefore patients should be
educated to have better knowledge and understanding of the causes and how persistent
depressive disorder can be treated. This might result in a better outcome since they can adhere to
medication after learning of its importance. Persistent depressive disorder should not be ignored
since it’s a serious mental condition. One should seek medical attention or help in order to be
treated or to reduce its side effects.
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References
Patel, R., & Rose, G. (2020). Persistent Depressive Disorder. Ncbi.nlm.nih.gov. Retrieved 10
November 2020, from https://www.ncbi.nlm.nih.gov/books/NBK541052/.
Larson, S. L., Owens, P. L., Ford, D., & Eaton, W. (2001). Depressive disorder, dysthymia, and
risk of stroke: thirteen-year follow-up from the Baltimore epidemiologic catchment area
study. Stroke, 32(9), 1979-1983.Publishing, H. (2020). Regular exercise releases brain
chemicals key for memory, concentration, and mental sharpness, from the May 2013.
Kriston, L., Von Wolff, A., Westphal, A., Hölzel, L. P., & Härter, M. (2014). Efficacy and
acceptability of acute treatments for persistent depressive disorder: a network
meta‐analysis. Depression and anxiety, 31(8), 621-630.
McCullough Jr, J. P., & Clark, S. W. (2017). Persistent depressive disorder (dysthymia) and its
treatment.