Dysthymia in Children and Adolescents

Signs and Symptoms

Dysthymia is a condition of depression in children and adolescents (adults too).  This disorder lasts longer (is more chronic) than Major Depression, but is less severe.

Two or more of the following:

  • Poor appetite -or- overeating (with weight loss or gain)
  • Insomnia -or- hypersomnia (sleep disturbances)
  • Low energy, fatigue
  • Low self esteem, self criticism
  • Poor concentration, difficulty making decisions
  • Feelings of hopelessness and helplessness

Associated Symptoms

  • Mood - sad, "down in the dumps" or angry and irritable
  • Social withdrawal, conflict with peers
  • Sees self as uninteresting, incapable, or inadequate
  • Feelings of guilt
  • Brooding about the past

These criteria are the signs and symptoms currently designated by the American Psychiatric Association for this disorder.  They are published in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994), and available in the public domain.  Diagnoses for mental health remain dominated by the medical model in this country.  A diagnosis is necessary for insurance coverage for services, and for determining a proper treatment plan.

A Dysthymic Disorder is characterized by these symptoms being present for most of the day, for more days than not, and lasting for a year.

These signs and symptoms can be from the child or adolescent's own report, or from observation by others (parents, teachers, friends, etc.).  In many children, the mood becomes so common to be seen as normal for the individual, and may not be reported as a complaint unless directly asked.  In order to obtain the diagnosis of Dysthymia, the child or adolescent will not have been symptom free for more than two months, and will not have met the criteria for a Major Depression or a manic episode.  Some children with this condition do go on to have a more severe depression.

These signs and symptoms cause significant distress, interference or impairment in the child's social, educational, or other important spheres of functioning.  Early onset for Dysthymia simply means symptoms start before age 21.  Sleep disturbances are highly common with this disorder.  Dysthymia occurs as often in girls as in boys.  Most kids with this condition have (or develop) poor social skills and are pessimistic.  It is more common when parents or siblings have a Major Depressive Disorder.

This disorder can be a result of having a general medical condition (such as diabetes).  It can be the result of substance abuse, a medication (prescription or over-the-counter) or exposure to a toxin in food, water or the environment.

What to do About Dysthymia

Therapy for the child or adolescent is the most common intervention for Dysthymia.  Individual therapy can be helpful to assist the child in identifying negative feelings and situations.  Counseling can help to build self esteem, emotional coping strategies, and positive social skills to improve friendships.  Strategies to help decrease emotional interference at school help to improve learning and performance, which are reinforcing to the child or adolescent.  Often teachers or guidance/adjustment counselors can participate by supporting recommendations and building more successful interactions and experiences.  Informed consent (signed permission) is required before the therapist can communicate with anyone about a child's treatment.

Family therapy is often helpful in improving parental understanding and establilshing positive parenting and parent-child interactions.  Children with Dysthymia can be frustrating since their symptoms are so persistent.  Parents and siblilngs can learn to accept the negative mood or ignore depressed feelings and thinking over time.  Regaining hope and learning to be positive are important for both the family and for the  individual with the disorder.  Some children benefit from a social skills training group therapy experience in addition to individual and family therapy.

In some cases, psychiatric medication can be helpful for a Dysthymic Disorder.  At times, a pediatrician may prescribe an anti-depressant, but often a child psychiatrist is the professional to consult.  There are many types of anti-depressants available, and having a qualified doctor is the best for selecting the proper treatment.  Most anti-depressants take effect slowly (10 days to 3 weeks) and may require increrased doses until a therapeutic result is produced.  Sometimes trials of other medications are necessary until an effective one is found.  Sometimes they are prescribed in combination with other medications.  Anti-depressants used with children and adolescents have been associated with an increased report of feelings of suicide in some cases, and parental and professional supervision during the intitial weeks of the prescription is necessary.  (No deaths have been associated due to their use.)

Finding a therapist can be a challenge.  Finding an available appointment can take time, and you may have to contact several referral sources in the process.  Finding the right match between therapist and the child or adolescent can also be challenging.  Not every therapist is right for every child.  Adolescents particularly do better with a therapist that is the same sex, since talking about themselves is more comortable.  Family therapists are even more rare and have special training.  Sometimes more than one therapist is involved treating a child and their family.  Many times a parent has to decide on treatment, as children or adolescents are often unwilling or unable to make the choice to ask for help.

If you think that your child or adolescent might have Dysthymia, or any other mental health issue, you should talk to a professional about what to do and how to get help.  Talking to your child's pediatrician is often a good way to get a referral to a competent psychologist, social worker or child psychiatrist.  Another great source for referrals is your health insurance company.  Many have on-line lists of professionals in their network of providers, or have a phone number on your insurance card to consult for referral sources.  If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions and to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family.  Or use the Contact Us form.  Psychotherapy can help to reduce problems related to Dysthymia.