Although belonging to the same category of mood disorders, depression and cyclothymia and dysthymia have distinct characteristics that lead to different diagnoses.
It is necessary to take into account all these differences so as not to confuse these psychopathologies and to be able to use the appropriate measures to overcome the disorder from a diagnosis and an adapted treatment (always proposed by mental health professionals).
In this article we present to you the main differences between depression, cyclothymia and dysthymiaso that you know its distinctive features approximately.
What are these mental disorders?
Before naming the main differences between the terms, let’s see how each is defined.
Depression is a mental disorder that is characterized by pathological sadness as the main symptoms, loss of mood, low self-esteem, anhedonia or loss of pleasure and decreased mental agility. In many cases, depression also leads to persistent suicidal thoughts.
The definition of dysthymia or persistent depressive disorder is relatively imprecise, as it is understood as mild depression, but with a longer duration of involvement. However, it also presents a significant danger for the physical integrity of the person, since it leads to self-destructive behavior through unhealthy habits and increases the risk of developing other psychopathologies.
Ultimately, Cyclothymia is defined as labilitychange in mood throughout, i.e. from a sad state to a relatively euphoric state.
Key Differences Between Depression, Cyclothymia and Dysthymia
Despite classifying the three mental disorders as mood affects, the characteristics that define the three terms are different and will give rise to different patterns of presentation of affective impairment.
1. Group of disorders to which they belong
As we have already pointed out, all three conditions are classified as mood disorders. Within this classification, there are two groups: depressive disorders and bipolar disorders. However, in reference to major depression and dysthymia, these two conditions are considered part of depressive disorders.
In contrast, cyclothymia is defined as a type of bipolar disorder with quantitative and qualitatively different characteristics from the other variants, but which is nevertheless included in this clinical picture.
2. Main symptoms of each disorder
Major depressive disorder presents with characteristic symptoms: depressed mood most of the day (pathological sadness), decreased interest or ability to experience pleasure (anhedonia), loss or increase in appetite or weight ( change of more than 5% in one month), insomnia (difficulty sleeping) or hypersomnia (increased drowsiness), restlessness or psychomotor slowing, fatigue or feeling of loss of energy, feeling of worthlessness and guilt, decreased the ability to concentrate or repetitive thoughts of death or suicidal thoughts. Of all these symptoms, at least five must be experienced and one of them must be number 1 or 2.
Dysthymia shows, as a main symptom and should be present, a sad mood most of the day, most days. In addition to the criteria above, you must have at least two of the following symptoms: loss or increase in appetite, insomnia or hypersomnia, lack of energy or fatigue, low self-esteem, difficulty concentrating and making decisions or feeling hopeless.
Ultimately, depressive symptoms and hypomanic symptoms must be present in cyclothymia without meeting the criteria for a diagnosis of a depressive or hypomanic episode. Of these, hypomania is characterized by an abnormally elevated or enlarged mood and increased energy or abnormal intentional activity, as well as three or more of the following symptoms: exaggerated self-esteem and sense of grandeur, decreased need for sleep (needs only three hours), wordy and very talkative, quick thinking or brainstorming, easily distracted, increased psychomotor activity or restlessness, and heavy involvement in pleasurable activities with serious consequences.
3. Minimum duration of each disorder
In addition to showing different symptoms, different durations are also needed to be able to diagnose each disorder. So five of the above symptoms should be present for depression for at least two consecutive weeks. On the other hand, in the two cases of dysthymia and cyclothymia, the time required will be longer, since in both cases they are disorders of greater persistence and chronicity.
To diagnose dysthymic disorder or persistent depressive disorder, which is the name given to it in the 5th edition of the American Psychiatric Association’s Diagnostic Manual (DSM 5), sad mood most of the time must be present for at least two years (one year if the patient is a minor). It should also be noted that during this period there cannot be more than two consecutive months without presenting criteria A and B which refer to the persistent sad mood and the two or more complementary symptoms that it must manifest.
With reference to dysthymia, an episode of major depression may occur during the period of the disease, thus making it possible to diagnose dysthymia and clarify whether the depressive episode is currently present or not.
As we said, cyclothymia is also a persistent disorder, but in this case bipolar, symptoms must be present for at least two years, can be unique if the subject is a child or an adolescent. Additionally, during this two-year time interval, symptoms were present for at least half the time and the individual was not symptom-free for more than two months.
4. Age of onset for each disorder
The typical age of first onset of the disease is also different. Regarding major depressive disorder, the age group where the condition is most likely to appear is 18 to 29 years. On the other hand, the other two pathologies generally appear earlier, in the case of dysthymia it is common for the onset to occur in childhood (6-11 years) or adolescence (12-28) and cyclothymia at the ‘adolescence.
5. Sex in which each disorder is most prevalent
In general, mood disorders are more common in women, but in the case of bipolar disorder, the prevalence between the sexes is equal. Thus, in both depression and dysthymia there will be a higher percentage of women affected, in depression with a proportion 1.5 to 3 times higher in women than in men, and in dysthymia with a proportion of twice the female population.
On the other hand, when cyclothymia is linked to bipolarity, the proportion of men and women affected in the general population is equal, it is true that if we look at the clinical population, that is to say the subjects who go in consultation and we were diagnosed with a higher proportion of women.
6. Prevalence of each disorder
Of the three disorders, the most common by far is major depressive disorder, the DSM-5 has an annual prevalence of 7%; this percentage may vary according to gender or location, since for example in rural populations this prevalence decreases.
With regard to dysthymia, the percentage of the annual disorder is 0.5, although in childhood the prevalence of this condition is higher than that presented in major depression, since on average the depressive disorder displays 2%; in place, dysthymia reaches 6.4%.
Finally, cyclothymia shows a vital prevalence, which refers to the percentage of subjects who have had the disease at some point in their life, of 0.4-1%.
7. Recommended treatments
Regarding treatment, we observed that the mode of intervention in major depressive disorder and dysthymia is similar, and pharmacological treatment can be carried out and psychotherapeutic.
Different drugs such as monoamine oxidase inhibitors (MAOIs) have been tested for drug treatment. which act mainly by increasing serotonin, norepinephrine and tyramine; tricyclics that increase norepinephrine, serotonin and dopamine and serotonin reuptake inhibitors that increase the concentration of this neurotransmitter, the latter being the most used, as they have fewer side effects.
But it has been proven that drug treatment alone is not enough. For greater effectiveness, it is necessary to supplement it with psychological treatment. The most proven and best outcome has been cognitive-behavioral treatment, which uses both behavioral techniques (for example, planning enjoyable and activating activities to provide sources of motivation and stimuli), and cognitive (where you work on cognitive restructuring in order to improve the dysfunctional beliefs of the patient).
In place, the drugs used to treat cyclothymia will be more similar to those tested for bipolar disorder, but at lower doses. For example, mood stabilizers, such as carbamazepine or lithium, may be prescribed. With regard to therapeutic treatment, cognitive-behavioral treatment is also used, although emphasis is placed on another treatment that focuses on the interpersonal sphere and social rhythm, since in patients with this psychopathology , it is very important to maintain a stable sleep routine.schedule food and activity so that the person does not destabilize.