Ana Bacovis felt the first symptoms of dysthymia —persistent depressive disorder— in her preadolescence. At 13 years old she suffered from low self-esteem, she had problems with her social relationships and began to have a dark vision of life.
“I saw myself as a very realistic person, but in reality I was pessimistic. People end up falling into a situation in which that feels normal,” says this communicator and public servant.
It took her parents a while to realize that their daughter’s behavior was unusual. The spikes of anger and irritability what he had were the signs for Ana to seek help.
“We have a distorted view of depression. I had moments of joy, very high peaks of euphoria. Then that would end and the sadness would come », she recalls.
Even with the initial symptoms of the disorder, he only got a diagnosis when he already had more advanced signs of depression. Upon receiving medical attention, the young woman learned that she suffered from dysthymia and that she presented a moderate degree of anxiety.
Like Ana, it is very common for many patients to receive a diagnosis of this type of depression after living with the symptoms for decades. Often, the most obvious signs are confused with the personality, the “way of being” of the individual. And this can lead to underdiagnosis.
“The most common story out there is that of someone who has some kind of mild depression or dysthymia, but only when the symptoms of depression become more severe does the patient seek help and discover that they have the disorder,” says Marcelo Heyde, doctor psychiatrist and professor at the Faculty of Medicine of the Pontifical Catholic University of Paraná (PUCPR).
what is dysthymia
The Persistent depressive disorder is a chronic form of depression and can begin in childhood or in adolescence, before the age of 21. Dysthymia affects approximately 6% of the world’s population, according to the World Health Organization (WHO).
The main difference between dysthymia and the classic type of depression is that, in the case at hand, the person can be functional and carry out their activities normally. However, working, studying and other Everyday actions are a bit more difficult to do.
«The activities can be done but with a higher cost in the routine and a reduced productivity due to symptoms. The person is functional, but at the cost of greater effort”, explains Márcia Haag, psychiatrist and professor at the Positivo University of Curitiba.
According to the experts consulted by the BBC, there is still no consensus on the causes of dysthymia. As usual, the disorder may be multifactorial and generated by stressors during childhood, genetic and biological predisposition, trauma, or social issues.
«It is possible to notice that in the adult phase the patient arrives at the consultation and has easy tears, but when it is deepened and investigated, it is discovered that it was a silent child with difficulties to relate”, points out Bianca Breda, psychologist and specialist in cognitive therapies at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (FMUSP).
In Ana’s case, she discovered that she had this disease thanks to her work in a support center for children and adolescents who were victims of sexual abuse. By having psychological care in place, the young woman was able to understand what was happening.
How to identify dysthymia and distinguish it from classic depression
Unlike other episodes of depression, which are easier to recognize, dysthymia has its own “camouflaged” characteristics.
In addition to having a longer duration, the most common signs can manifest through tiredness, fatigue, low self-esteem, indecision and exaggerated pessimism.
In common depression, the best known, the person tends to show exacerbated symptoms of sadness, discouragement, lack of interest in things, loss of appetite and other signs that can be perceived by the environment and by the patient himself.
“In depression there is a greater intensity, the suffering of a person with depression is usually greater and we classify it as mild, moderate and severe. It is usually linked to some event”, says Breda.
It’s not the personality
Dysthymia is considered one of the types of depression more difficult to diagnose and in many cases it is confused as something “of the personality”
Due to this common mistake, diagnosis is often late and hinders patients in seeking the correct treatment, something that can take decades.
It is essential, according to experts, to stop saying that a certain person is boring, that he is like that and has been like that all his life and that, therefore, he will not change anymore.
«The dysthymia It comes slowly and stealthily. However, over the years, despite being mild, the functional impact is great, as the person earns nicknames and labels of grumpy and moody. This, which is culturally accepted, is delaying the diagnosis and also it reinforces neuroticism, a personality trait that makes you see things in a negative way”, Heide explains.
In Ana’s case, she had difficulty relating at school but didn’t know why. “I’ve always had a much greater insecurity, especially in love. I was blocking a lot,” she says.
She believed that all those feelings were part of her attitude and that, in time, it might pass. But that didn’t happen and mood swings occurred frequently.
«Whoever has dysthymia has a very conflictive relationship with himself. At some point you end up getting angry, “says Ana.
How to seek help and treat the disorder
It is essential that the patient seek early help to avoid underdiagnosis. Many times, when there is a specific complaint about another illness, psychiatric support is not sought and, in general, the diagnosis of that other illness is received and the difference goes unnoticed.
“Depression itself has up to 50% of cases going undiagnosed by primary care physicians. Imagine what happens with dysthymia, where a person may complain of feeling tired, fatigued, and low self-esteem. It is quite common to associate it with other psychiatric illnesses, anxiety disorder and substance use”dice Haag.
Late diagnosis, reinforces the doctor, It can also interfere with the appearance of other diseases. or worsen each of them.
“Dysthymia and depression affect the body systemically and It can worsen some clinical conditions such as diabetes, hypertension and rheumatic diseases, causing the patient to need higher doses of drugs or a superior combination of drugs to stabilize this condition, “he says.
As there is still a lot of taboo around mental health issues, identifying the disorder can be even more complicated. It is recommended seeking care with psychologists and psychiatrists, who will evaluate the case and will be able to determine the correct therapeutic line, which can be done with medication or only psychotherapy.
At the time that Ana discovered dysthymia, she continued with psychotherapy and “alternative” therapies since, due to her age, her psychologist preferred not to prescribe medication.
For a few years, this public servant interrupted therapy sessions, but since the start of the pandemic, in 2020, she has returned. Since then he has noticed a significant improvement.
The specialists reinforce the importance of not interrupting treatment without the authorization of a health professional and that the evolution of the disorder must be continuously observed.
Medical follow-up can last for months or years, but it is essential to improve the patient’s symptoms and quality of life.