Dysthymia?

It sounds like a city in Greece. Have you ever been to Dysthymia? It is such a fun place to visit- I take all of my vacations there!

No, it’s not a city, but I do seem to reside there. One might say it is a state of mind, but there is more to it than that. Depression is such a generic term the medical community must carve it up, to get a handle on what it is to be depressed so they can charge insurance companies when they treat the disorder. There are so many ways to look at depression, but no matter what flavor you have… it is no fun being depressed during an economic depression.

It seems I suffer from Dysthymia, my spectrum of the rainbow. The Wikipedia folk have a fine write-up over there and it is as good place as anywhere to get started. It is considered “a chronic depression, but with less severity than major depressive disorder. This disorder tends to be a chronic, long-lasting illness.”

“Dysthymia is a type of low-grade depression. Harvard Health Publications states that, “the Greek word dysthymia means ‘bad state of mind’ or ‘ill humor’. As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer.” Harvard Health Publications says, “at least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism”.

“The Primary Care Journal says that dysthymia “affects approximately 3% of the population and is associated with significant functional impairment”. Harvard health Publications says: “The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder.” “Most people with dysthymia can’t tell for sure when they first became depressed.”

Here are a few of the key symptoms that might offer clarity, with my comments in parenthesis:

[B]Feelings of hopelessness[/B] (not sure if I can continue writing this thread).

[B]Insomnia or hypersomnia[/B] (Sleep apnea since I was a young adult- I am now fifty years young).

[B]Poor concentration or difficulty making decisions[/B] (I guess I should include this symptom, but I am not sure where to place it in this list) (I guess I should include this symptom, but I am not sure where to place it in this list)

[B]Low energy or fatigue[/B] (/me takes nap before writing next line)

[B]Low self-esteem[/B] (I am a good person no matter what I think others see in me)

[B]Poor appetite or overeating[/B] ( OK, late night cookies have not been kind)

[B]Decreased concentration and decisiveness[/B] ( I’m not sure what to say here, other than that I have a tough time with complex tasks like writing… hmmm,, what next…)

[B]During a majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day[/B] ( try twelve years… two year sufferers are rookies!)

[B]The patient has not had any Manic, Hypomanic or Mixed Episodes.[/B] ( I plan to be a hippomaniac in the future)

[B]In contrast to major depression, these symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000).[/B] (They haven’t taken me to the big house yet because I am always one step ahead of them!)

[B]People suffering from dysthymia are usually well capable of coping with their everyday lives,usually by following particular routines that provide certainty.[/B] ( I am certain of my chronic routine of feeling depressed, if that counts. Besides, this seems like more of a statement than a symptom).

There you have it. If you have these symptoms welcome to life in Dysthymia, where a vacation means sleep, for it is the only way to get out of town. That is, other than the once in a while distraction that feels like depression took a holiday. Otherwise, part of me wishes I just had a major depression, so I could have at it and be done with it. My, don’t I sound dysthymic! LOL

I’d imagine the reader must think me strange to tout on about depression, but I have a reason and purpose- when I can cut through that fog of indecisiveness and muddled concentration. You see, I present a difficult case and think my mental health providers experience difficulty with the reality of my clinical profile because I was afflicted with GBS twelve years ago.

When I talk with my psychiatrist and therapist about chronic fatigue I can tell by their comments that they attribute it to feeling depressed. It is frustrating in that a behavioral treatment for fatigue related to depression is exercise and increased socialization. They say, “Get some exercise and the fatigue will go away… it is your metabolism” or “Perhaps it is a feeling you use in the form of defensive isolation… go to a party and have some fun!” I try and educate them somewhat about GBS and fatigue, but it is a tough thing to understand. Heck, my family does not understand the residual of fatigue, so I can’t expect mental health pros to get it.

Sometimes I fool myself into thinking I am not fatigued, just a lazy person. Perhaps my fatigue is part of my depression, that if I can receive the correct treatment for my mental disorder my body will feel better. I could then become more social and do the things I want to do, things I did prior to GBS. Am I suffering from chronic fatigue or am I just some fool who thinks he is tired all of the time? Perhaps this residual is merely in my head? Rats, there goes that mental confusion again!

Most recently, my psychiatrist suggested I try Methylin, an off brand of Ritalin, for my fatigue. It did not help at all. In fact, I felt like I drank 100 cups of coffee and I had tremors in my fingers, from which I found it impossible to write. Yikes. My guess is that it probably helps some depressed people gain the energy required to tackle the day, but not me. (I do take Wellbutrin, which seems to help ease my depression- more so than the SSRI antidepressants).

What percent of the GBS Residual Fan Club suffer from Dysthymia? Are you in treatment? If so, what medications and form of psychotherapy helps? Any magic cures for chronic fatigue? Does it matter from the perspective of mental health treatment if fatigue comes from depression or POST GBS residuals?