Advice for Coping with Chronic Depression

By Jane Collingwood

What is it?
Chronic depression, also known as dysthymia or dysthymic disorder, is a form of low-grade depression which can last for several years. If you, or someone you are close to, are experiencing dysthymia then you may be on the look-out for more information on coping with the condition.
Briefly, dysthymia is a depression lasting at least two years without any substantial remission. It is said to affect roughly six in every hundred people. In contrast to clinical depression, dysthymia does not prevent a person from functioning normally. It does, however, prevent full enjoyment of life. People with dysthymia feel continuously disheartened and in a state of despair.
The definition of dysthymia also includes at least two of these symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness. Dysthymia and major depression can occur together, and this is known as double depression.
So what can be done?
Family doctors often fail to recognize dysthymia, so most sufferers are undertreated. But once it is diagnosed, dysthymia is usually treated with psychotherapy and/or drugs. However, there are many lifestyle changes which can also help.
Is psychotherapy best?
Due to the long-term nature of dysthymia, a non-drug treatment is ideal. Many forms of psychotherapy can be considered, and while the therapist must remain patient, short-term goals should be set in order to improve daily functioning. Cognitive therapy, interpersonal therapy, and solution-focused therapy can be tried, as well as family, couples and group therapy.
How about medication?
Research studies have suggested a significant reduction in dysthymia symptoms with antidepressants. But this is not a straightforward matter – other studies have found no improvement, so the pros and cons must be weighed up on an individual basis.
A review in 2003 found tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) to be equally effective for dysthymia. While cheaper, TCAs such as imipramine (Tofranil) were more likely to cause side-effects than SSRIs like fluoxetine (Prozac) and sertraline (Zoloft).
What alternatives are available?
A range of alternative treatments exist which may benefit dysthymia. Extracts of St John’s wort have been found as effective as antidepressants for treating mild to moderate depression. Overall, though, the evidence is “inconsistent and confusing”, according to a 2005 review.
Some favourable results have been found for omega-3 fatty acids, either consumed as oily fish or as a supplement. It’s possible that future studies will show a definitive benefit, and in the meantime, oily fish has no known side-effects and can certainly be recommended for physical health.
Lifestyle changes
Other dietary supplements which may help include the B vitamins, potassium, and zinc. Of course, a healthy balanced diet is always a good idea, and making food look and smell appealing may encourage a suppressed appetite. Cutting down on, or avoiding, caffeine, alcohol and nicotine is a step in the right direction as they all have a bearing on physical and mental well-being. Seek professional help if necessary.
The herb valerian may be useful to combat the insomnia sometimes caused by dysthymia, and ginseng may benefit low energy levels. Aromatherapy, acupuncture, and other complementary therapies could also be tried.
Regular exercise is important for everyone, but can be particularly beneficial to people with dysthymia. Exercising releases the ‘happy’ chemicals called endorphins, and increases self-esteem. It will also help counteract overeating and promote good sleep.
Social support
For many people, the support of friends and family is invaluable in learning to cope with their dysthymia. Nevertheless, help and support from strangers can sometimes be easier to receive, and this is where support groups come in. Community-based support groups help many people to share their feelings, find friendship, and develop coping skills. Belonging to a dysthymia support group, together with psychotherapy, can substantially improve the chances of recovery.
Can dysthymia affect children?
Dysthymia is present in up to five per cent of children and eight per cent of adolescents. While the main symptom in adults is sadness, children and adolescents often display anger or irritable mood. It can have consequences on children’s social skills and education, later impacting on professional life and setting in place a vicious circle which may later trigger major depression.
As children with dysthymia often have multiple problems, treatment should involve a range of measures together with adequate support for the parents or caregivers.
Hopes for recovery
A full recovery from dysthymia is slow and not guaranteed, but around 70 per cent of patients do recover after four years. Of these, 50 per cent are likely to have a recurrence, so it may be sensible to continue with the successful measures which led to recovery.
A final word
Although depression can be devastating to all areas of a person’s everyday life, many people still believe that they should be able to shake off the symptoms by themselves. Because of this, people with dysthymia may not recognize that they have a treatable disorder or may avoid seeking treatment because of feeling shame or stigma. But, even if it takes several months, the majority of people can be helped to feel better.
Lastly, do call your doctor if your symptoms worsen or don’t improve despite treatment, or if you have thoughts of death or suicide.