Definition

Persistent mood disorders are mood disorders that last for at least 2 years. These disorders include dysthymia or persistent depressive disorder and cyclothymia or hypomanic disorder.

Dysthymia or Persistent Depressive Disorder (PDD)

Persistent depression is a form of chronic or long-lasting depression with varying levels of severity. This disorder is characterized by a depressed mood most of the day, for several days, for at least 2 years.

In children and adolescents, this disorder must occur for at least one year to be called persistent depressive disorder. Persistent depression can occur alone or in conjunction with other psychiatric disorders or mood disorders.

Cyclothymia

Cyclothymia or cyclothymic disorder is often considered a mild form of bipolar disorder. In this disorder, you have periods of low-grade mania (hypomania) as well as brief periods of depression that don't last as long (less than 2 weeks) as in a major depressive episode. Hypomania in cyclothymic disorder does not progress to a manic episode.

For example, you may feel like you are experiencing decreased productivity and excessive energy, but you are not experiencing derealization or feelings of unreality. In fact, some people find the peak of cyclothymic disorder to feel pleasurable. Unlike bipolar mania, people with cyclothymic disorder tend to still be able to carry out activities.

Causes

The cause of persistent mood disorders is not known for certain at this time. However, it is thought that genetic factors or family history play a role.

Risk Factor

Like depression, dysthymia is more common in women than men. This mood disorder tends to appear earlier than major depression, although it can start at any time from childhood to adulthood. Up to 4% of the general population may experience dysthymia. The causes are still not well understood. A combination of factors likely plays a role in this mood disorder. These factors include:

• Genetics
• Abnormalities in brain function involved in processing mood
• Long term medical illness
• Isolation
• Strategies and problems of poor adjustment to problems

These factors can influence each other. This chronic mood disorder makes sufferers more easily stressed and increases the risk of depression.

In cyclothymia, approximately 1% of the United States population, with equal numbers of men and women, has cyclothymic disorder. The cause is unknown, but genetics is thought to play a role. Cyclothymia is more common in people with relatives who have bipolar disorder. Symptoms usually appear in adolescence or young adulthood. However, because the symptoms are mild, it is often difficult to know when cyclothymia begins.

Symptoms

Dysthymia or persistent depression

In addition to long-term moodiness, common symptoms of this mood disorder include:

• Feelings of hopelessness or helplessness
• Difficulty sleeping or feeling sleepy during the day
• Poor appetite or eating too much
• Poor concentration
• Fatigue or lack of energy
• Low self-confidence
• Difficulty concentrating or making decisions

Cyclothymia

The diagnosis of cyclothymic disorder is made based on the appearance of the following symptoms:

• Episodes involving brief, recurring periods of depression, as well as at other times episodes of hypomania. This pattern of episodes must be present for at least 2 years
• Symptoms persist, interspersed with one or two months without symptoms

Episodes of cyclothymic disorder are often unexpected. Both depression and hypomania can last for days or weeks, interspersed with a month or two of normal mood. Or you may not even have a normal period at all. In some cases, cyclothymic disorder can progress to full-blown bipolar disorder.

Diagnosis

Diagnosis of dysthymia in adults requires:

• At least 2 years of history of depressed mood most times of the day, almost every day, accompanied by at least two of the symptoms mentioned above.
• Usually sufferers tend not to experience weight changes or sleep disturbances in dysthymia compared to depression.
• May also tend to be more withdrawn, feel pessimistic, and feel inadequate compared to major depression.

The diagnosis of cyclothymic disorder is made based on the appearance of the following symptoms:

• Episodes involving brief, recurring periods of depression, as well as at other times episodes of hypomania. This pattern of episodes must be present for at least 2 years.
• Symptoms persist, interspersed with one or two months without symptoms.

Management

Experiencing persistent long-term depression is not a good way to live. Therefore, this disorder needs to be treated immediately. Apart from that, dysthymia can also increase the risk of physical illness. However, another reason is that if left untreated, this mood disorder can develop into more severe depression. Severe depression will increase your risk of attempting suicide.

Antidepressant drugs are often used to treat dysthymia. Due to long-term use of medications, it is important to consider which medications work best and have few side effects.

Patients may be able to get more than one drug to find the best one. However, it may take several weeks to see the effects of the medication used. Successful treatment for chronic depression often takes longer than for acute (non-chronic) depression. Take medication as instructed by your doctor. If side effects appear or the drug has not shown its effect, discuss this with your doctor. Do not stop treatment suddenly.

Dysthymia treatment is more effective when combining antidepressants and psychotherapy. Certain types of talk therapy, such as cognitive behavioral therapy (CBT), psychodynamic psychotherapy, or interpersonal therapy (IPT), are known to be effective forms of psychotherapy for treating dysthymia. CBT teaches how to recognize and restructure thoughts. This can help change distorted thoughts. Meanwhile, IPT focuses on overcoming current problems and resolving interpersonal conflicts. Psychodynamic psychotherapy teaches you to understand unhealthy or unsatisfying patterns of behavior and motivation that you may not realize can lead to depression.

Some studies also show that aerobic exercise can help treat mood disorders. This exercise is most effective when done four to six times a week. However, some practice is better than none at all. Other efforts can also help, including seeking social support and finding work you like.

Some people with mild symptoms of cyclothymia can lead successful and fulfilling lives. Meanwhile, others can experience depression, act impulsively, and have strong emotions. In these people, short-term treatment may help with symptoms. However, cyclothymic disorder may not respond as well to medications as bipolar disorder. A combination of mood stabilizers and psychotherapy is the most effective treatment.

Complications

Complications of persistent dysthymia or depression include:

• Reduces quality of life
• Major depression, anxiety disorders, and other mood disorders
• Substance abuse
• Conflict with family and partner
• Problems at school and work and decreased productivity
• Chronic pain and other medical illnesses
• Suicidal thoughts or behavior
• Personality disorders or other mental disorders

Meanwhile, complications of cyclothymia include:

• If left untreated, it can cause emotional problems that will affect life
• High risk of developing bipolar disorder
• Substance abuse
• Experiencing anxiety disorders
• At risk of having suicidal ideas or behavior

Prevention

There is no definite way to prevent persistent mood disorders. Because it usually begins in childhood or adolescence, screening children for risk factors can help detect the disorder early.

Some steps you can try to reduce the risk of this disorder are:

• Stress control
• Seek help from family and friends, especially when experiencing problems
• Seek treatment as early as possible when the first symptoms appear to prevent the disorder from worsening
• Get regular treatment to prevent recurrence and complications

When to See a Doctor? 

Because these feelings have been going on for a long time, you may think that these feelings are normal and part of your life. However, if you already know that it is a persistent emotional disorder, immediately consult a psychiatric specialist.

If you or your relative who suffers from this disorder has thoughts of suicide or hurting others, immediately call the local emergency telephone number or take them to the emergency room.

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