The symptoms of dysthymia are similar to those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, lack of interest in things most people find enjoyable, and a loss of energy (not all patients feel this effect). Appetite and weight can be increased or decreased. The person may sleep too much or have trouble sleeping. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a negative self-image. The symptoms can grow into a full blown episode of major depression. This situation is sometimes called "double depression" because the intense episode exists with the usual feelings of low mood. People with dysthymia have a greater-than-average chance of developing major depression. While major depression often occurs in episodes, dysthymia is more constant, lasting for long periods, sometimes beginning in childhood. As a result a person with dysthymia tends to believe that depression is a part of his or her character. The person with dysthymia may not even think to talk about this depression with doctors, family members or friends. Dysthymia, like major depression, tends to run in families. It is two to three times more common in women than in men. Some sufferers describe being under chronic stress. When treating diagnosed individuals, it is often difficult to tell whether they are under unusually high environmental stress or if the dysthymia causes them to be more psychologically stressed in a standard environment.
And from DSM diagnostic criteria:
1. 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.
2. When depressed, the patient has 2 or more of:
1. Appetite decreased or increased
2. Sleep decreased or increased
3. Fatigue or low energy
4. Poor self-image
5. Attachment to relatives other than parents.
6. Concentration and decisiveness decreased or increased
7. Feels hopeless or pessimistic
3. During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
4. During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
5. The patient has had no Manic, Hypomanic or Mixed Episodes.
6. The patient has never fulfilled criteria for Cyclothymic Disorder.
7. The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).
8. The symptoms are not directly caused by a general medical condition or the use of substances, including prescription medications.
9. These symptoms must result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000).
Which might leave one with the question: "What is 'clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning?"
Ah--here's an answer From "DSM IV-TR in Action, by Sophia F. Dziegielewski
The term "clinically significant indicates that the practitioner has clearly linked the symptoms present in the mental disorder with how the symptoms either stop or impair a client's current level of functioning. For example, an individual may at times exhibit the symptoms that match the criterion of a mental disorder, yet individual, social, or occupational functioning is not impaired. When this occurs, a diagnosis should not be given. A diagnosis should only be given when the client's symptoms are severe enough to either interfere with or disturb functioning."
Which leaves one to ask what "impaired" and/or "functioning" might mean =)
From the writer of Ecclesiastes:
Call me "the Quester." I've been king over Israel in Jerusalem. I looked most carefully into everything, searched out all that is done on this earth. And let me tell you, there's not much to write home about. God hasn't made it easy for us. I've seen it all and it's nothing but smoke—smoke, and spitting into the wind.
Life's a corkscrew that can't be straightened,
A minus that won't add up.
I said to myself, "I know more and I'm wiser than anyone before me in Jerusalem. I've stockpiled wisdom and knowledge." What I've finally concluded is that so-called wisdom and knowledge are mindless and witless—nothing but spitting into the wind.
Much learning earns you much trouble.
The more you know, the more you hurt.
Here's a question. What if you were the sexiest man or women in the world. And you had dysthymia. Would you *feel* like the sexiest man or women in the world?
Of course you would. By definition. It wouldn't feel really great though, I bet.
Solomon fucked up, in my opinion. Have you ever read this passage?
That night, there in Gibeon, God appeared to Solomon in a dream: God said, "What can I give you? Ask."
Solomon said, "You were extravagantly generous in love with David my father, and he lived faithfully in your presence, his relationships were just and his heart right. And you have persisted in this great and generous love by giving him—and this very day!—a son to sit on his throne.
"And now here I am: God, my God, you have made me, your servant, ruler of the kingdom in place of David my father. I'm too young for this, a mere child! I don't know the ropes, hardly know the 'ins' and 'outs' of this job. And here I am, set down in the middle of the people you've chosen, a great people—far too many to ever count.
"Here's what I want: Give me a God-listening heart so I can lead your people well, discerning the difference between good and evil. For who on their own is capable of leading your glorious people?"
God, the Master, was delighted with Solomon's response. And God said to him, "Because you have asked for this and haven't grasped after a long life, or riches, or the doom of your enemies, but you have asked for the ability to lead and govern well, I'll give you what you've asked for—I'm giving you a wise and mature heart. There's never been one like you before; and there'll be no one after. As a bonus, I'm giving you both the wealth and glory you didn't ask for—there's not a king anywhere who will come up to your mark. And if you stay on course, keeping your eye on the life-map and the God-signs as your father David did, I'll also give you a long life."
He should have asked for happiness. That's what I would have asked for. Delightful, overflowing, abounding happiness, which would overflow to everyone around me.
What would you ask for, if God made you the same offer he did Solomon?