The Course of Dysthymia
Like other depressive disorders, the course of dysthymia varies in children. While the DSM-IV criteria requires a child to experience symptoms for at least one year to be diagnosed with dysthymia, the median dysthymic episode for children is 3.9 years.
Approximately 3% of children meet the criteria for dysthymia. Some researchers argue that a higher percentage of children actually have DD, but because of its chronic nature, symptoms are often mistakenly attributed to personality. In fact, children with DD may not complain of feeling depressed or sad because they do not recognize their mood as being different from what they normally feel.
Symptoms of Dysthymia
Symptoms of DD are similar to those of major depressive disorder, but are less severe and are less likely to impair daily functioning.
Symptoms may include:
- Depressed mood
- Feelings of hopelessness and/or worthlessness
- Withdrawal from friends and family
- Low self-esteem
- Eating or sleeping pattern changes
- Unexplained physical ailments
- Lack of concentration
- Thoughts or action of self-harm or suicide
- Inability to experience pleasure or joy
- Restlessness or fatigue
Despite the milder symptoms of dysthymia, it is still thought that its chronic nature may interfere with a child's development of interpersonal relationships, positive self-esteem, and problem solving skills.
Recovery and Double Depression
Recovery for children with dysthymia is likely. However, the majority of children will have another dysthymic episode in the future. Approximately 75% of children who experience a dysthymic episode will also experience a major depressive episode, a shorter but more severe depressive disorder. When a child who has dysthymia experiences a major depressive episode, the combination is called double depression.
Factors that may increase a child's likelihood for developing double depression were identified by Dr. Daniel Klein and colleagues in a 10-year follow-up of children with dysthymia. Identified risk factors were:
- First dysthymic episode at a young age
- Co-existing anxiety disorder
- Strong family history for major depressive disorder
- Poor early relationship with mother
- History of sexual abuse
- Underlying personality disorder
It has been noted that children with double depression may have shorter episodes of major depressive disorder. According to Dr. Kovacs and colleagues, this is because it is easier for a child to return to a baseline mood of dysthymia, or mild depressive symptoms, than a baseline with no presence of depressive symptoms. Nonetheless, all depressive disorders require treatment in children.
Like other depressive disorders, dysthymic disorder is associated with serious short- and long-term consequences, such as poor academic and social performance, substance abuse, and increased risk of suicide. Of course, not all children with dysthymia will experience negative outcomes, but given the association, treatment is recommended.
Be sure to talk to your child's pediatrician or other mental heath provider if she has symptoms of dysthymia or another depressive disorder. Depressive disorders should never be left untreated in children.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association: 2000.
Daniel N. Klein, Ph.D., Stewart A. Shankman, Ph.D, Suzanne Rose, M.A.Dysthymic Disorder and Double Depression: Prediction of 10-Year Course Trajectories and Outcomes. Journal of Research Psychiatry April 2008 42(5): 408-415.
Depression and Suicide in Children and Adolescents. Mental Health: A Report of the Surgeon General. Accessed: 02/12/2011. http://mentalhealth.about.com/library/sg/chapter3/blsec5.htm
Hana M. Vujeva, Wydol Furman. Depressive Symptoms and Romantic Relationship Qualities from Adolescence Through Emerging Adulthood: A Longitudinal Examination of Influences. Clinical Child & Adolescent Psychology. 40(1): 123-135.
Kovacs M, Obrosky DS, Gatsonis C, Richards C. First-Episode Major Depressive and Dysthymic Disorder in Childhood: Clinical and Sociodemographic Factors in Recovery. Journal of the American Academy of Child and Adolescent Psychiatry. 1997, 36:777-784.