Public servant and communicator Ana Bacovis felt the first symptoms of dysthymia — or persistent depressive disorder — in her pre-adolescence. At the age of 13, she suffered from low self-esteem, had problems with relationships and began to have a bad outlook on life.
“I saw myself as a very realistic person, but I was actually pessimistic. You end up in a situation where you think it’s normal,” she says.
It took some time for her parents to realize that their daughter’s behavior was unusual. Moments of anger and irritability were the indications for them to lead Ana to seek help.
“We have a distorted view of depression, but I had points of joy, very high peaks of euphoria, then it ended and sadness came”, he recalls.
Even with the initial symptoms of the disorder, she only received a diagnosis when she already had more advanced signs of depression. Upon receiving medical attention, the young woman learned that she suffered from dysthymia and that she had a moderate degree of anxiety.
Like Ana, it is very common for many patients to receive the diagnosis of this type of depression after decades of living with the symptoms. Often, the most evident signs are confused with the personality, “way” of the individual and can be underdiagnosed even by doctors.
“The most common story that occurs is someone who has some form of mild depression or dysthymia, but only when the symptoms of depression get more severe does the patient seek help and discover that he suffers from the disorder”, highlights Marcelo Heyde, psychiatrist and professor. from the School of Medicine of the Pontifical Catholic University of Paraná (PUCPR).
What is dysthymia?
Persistent depressive disorder is a chronic form of depression and can begin in childhood or adolescence, before age 21. According to the World Health Organization (WHO), dysthymia affects approximately 6% of the world population.
The main difference between her and the classic type is that, in this one, the person can be functional and carry out their activities normally. However, working, studying and other everyday actions are a little more difficult to do.
“She does the activities with a higher cost of the routine and with a reduced productivity because of the symptoms. She is functional, but at the cost of greater effort”, explains Márcia Haag, psychiatrist and professor at Universidade Positivo, in Curitiba (PR).
According to experts heard by BBC News Brazil, there is still no consensus on what causes dysthymia. Usually, the disorder can be multifactorial and generated by stressors during childhood, genetic and biological predisposition, trauma or social issues.
“It is possible to notice that in adulthood, it is very common for the patient to arrive crying easily and when he goes to investigate, he was a quieter child and had difficulties in relationships”, emphasizes Bianca Breda, psychologist and specialist in cognitive therapies at Hospital das Clínicas from the USP School of Medicine (FMUSP).
In Ana’s case, she only discovered the disease because of her work at a support center for children and adolescents who were victims of sexual abuse. By having psychological care on site, the young woman could understand what was happening to her.
How to identify and differentiate from the classic type?
Unlike other episodes of depression, which are easier to recognize, dysthymia has “camouflaged” characteristics of its own.
In addition to the longer duration, the most common signs can manifest themselves through tiredness, fatigue, low self-esteem, indecision and exaggerated pessimism.
In the common and best known depression, the person tends to show exacerbated symptoms of sadness, discouragement, lack of interest in things, loss of appetite and other signs that can be noticed by people around 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 or severe. It is usually linked to some event”, says Breda.
It’s not personality
This disorder is considered one of the most difficult types of depression to diagnose and in many cases it is confused as being “of the personality”.
Because of this common error, diagnosis becomes late and harms patients in the search for the correct treatment, which can occur after decades. It is essential, according to experts, to stop saying that a certain person is boring, “cricri”, that he is and has been that way his whole life and, therefore, will not change anymore.
“Dysthymia comes slowly and slowly, however, over the years, despite being mild, the functional impact is great, as the person gains nicknames such as grumpy and bad-tempered. This is culturally accepted, but it delays the diagnosis and also reinforces neuroticism, which is a personality trait of seeing things more negatively”, explains the PUC-PR psychiatrist.
The public servant, for example, had difficulties in relating at school and did not know why. “I was always much more insecure, especially in love, and I blocked myself a lot,” she says.
She also believed that all these feelings were part of her behavior, and that, with time, they could pass. But that didn’t happen and the mood swings happened frequently.
“Those who have dysthymia have a very troubled life with themselves. We end up getting irritated at some point”, says Ana.
How to seek help and treat the disorder
It is essential that the patient seek early care to avoid underdiagnosis. Often, when there is a specific complaint regarding another disease, he may not seek a psychiatric service and, in a general way, receive a diagnosis of another disease and dysthymia goes unnoticed.
“Depression itself has up to 50% of cases that are not diagnosed by primary care physicians. Imagine the dysthymia that a person can complain of tiredness, fatigue and low self-esteem. It is quite common to associate it with other psychiatric illnesses, anxiety disorders and substance use,” says Haag.
The late diagnosis, reinforces the doctor, can also interfere with the emergence of other diseases or worsen each one of them.
“Dysthymia and depression affect the body in a systemic way and can worsen chronic clinical conditions such as diabetes, hypertension and rheumatological diseases, causing the patient to need larger doses of drugs or a superior combination of drugs to stabilize that condition”, he says. Is it over there.
As there is still a taboo in relation to mental health, identifying the disorder can be even more complicated. The recommended thing is to seek care with psychologists and psychiatrists, who will evaluate the case and be able to determine the correct therapeutic line, which can be done with medication or only psychotherapy.
At the time 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, the public servant interrupted therapy sessions, but since the beginning of the covid-19 pandemic, in 2020, she has returned with treatment. Since returning with psychological counseling, he has noticed a significant improvement.
Specialists reinforce the importance of not interrupting treatment without authorization from a health professional and that the evolution of the disorder needs to be observed continuously.
Medical follow-up can last months or years, but it is essential to improve the patient’s symptoms and quality of life.
Where to get help?
CAPS and Basic Health Units (family health, health posts and centers)
UPA 24h
Samu 192
hospitals
Emergency Room
CVV – Life Appreciation Center (emotional support and suicide prevention)
188 (toll free from any landline or mobile phone)
www.cvv.org.br (chat, Skype or email)
This text was originally published here
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