A 50 year old male presents with a 3 year history of irritability, low mood, lack of interest in Surroundings and general dissatisfaction with everything. There is no significant disruption in his sleep or appetite. He is likely to be suffering from:
C i.e. DysthymiaLong standing atleast for 2 years (1 year in children & adolescents) of low grade subthreshold depressive symptoms (not severe enough to be called major depression) exclusive of indicators of severity (such as suicidality and psychomotor disturbance and featuring symptoms more than signs (i.e. more subjective than objective)Q indicate diagnosis of dysthymic disorder. Absence of psychomotor agitation or retardation and uncharacteristic (very very rare) presence of marked disturbances in libido & appetite differentiate it from major depression in which these features are relatively more commonQ.Dysthymia (Meaning bad mood/ill humored) DisorderClinical PinctureLong standing insidious onset sub threshold depression of fluctuating or persistent nature dating back to late childhood or the teens, preceding any major depressive episodes by years, even decades.A return to low grade depressive pattern is the rule following recovery from superimposed major depressive episodes, if any, hence the name double depression.Low grade chronic depressive profile marked by fluctuating complaint consisting of gloominess, pessimism, lethargy (low drive), self doubt, lack of joie de vivre (i.e. low enjoyment of life), yet endowed with self critical attitudes & suffering for others.Typically work hard (back bone of society), devoting their lives to jobs that require dependability & great attention to detail, but do not enjoy their work. At their best, they invest what ever energy they have in work, leaving none for leisure or social activities.They are satisfied with nothing, complain of everything and brood about their usefullness of existence. Their entire existence is a burden for them.Often complain of having been depressed since bih. They view themselves as belonging to an aristocracy of suffering. These hyperbolic descriptions of suffering in absence of more objective signs of depression label them characterological depression.Both ICD-10 & DSM-IV stipulate a 2 year duration of low grade depressive symptoms (not severe enough to be called major depression) exclusive of such indicators of severity as suicidality and psychomotor disturbanceDiffers from major depression in that symptoms tend to outnumber signs (more subjective than objective depression)Q. So marked disturbances in libido and appetite are uncharacteristic, and psychomotor agitation or retardation is not observedQ.Other differential diagnosis, chronic fatigue syndrome present with disabling fatigue & typically deny depressive symptoms; patients with fibromyalgia complain of pain; by contrast typical dysthymic patient cannot stop relating to physician their titany of depressive symptoms. Polysomnography may differentiate fibromyalgia from dysthymia
Major depression
No psychiatric disorder
Dysthymia
Chronic fatigue syndrome