Unit 2- ● Persistent depressive disorder (Dysthymia)

1. Etiology (Causes)

·       Biological Factors: Family history of mood disorders increases risk. Genetic factors play a role, but less so in late-onset cases.

·       Biochemical Factors: Dysregulation of neurotransmitters (serotonin, norepinephrine, dopamine, etc.) is implicated.

·       Psychosocial Factors: Early life trauma, chronic stress, and adverse childhood experiences can increase vulnerability.

·       Diathesis-Stress Model: Depression arises from a combination of biological predisposition and environmental stressors.

2. Pathophysiology

·       Neurotransmitter Dysregulation: Low levels of serotonin and norepinephrine are most commonly involved.

·       Hormonal Changes: Some patients show hyperactivity in the HPA axis (high cortisol levels).

·       Chronicity: Dysthymia is characterized by a long-term, less severe but persistent depressed mood (at least 2 years in adults).

3. Risk Factors

·       Family history of depression or mood disorders

·       Chronic medical conditions or disability

·       Lack of social support

·       History of trauma or abuse

·       Early loss of a significant other

·       Poverty or unemployment

·       Substance use

·       Female gender (higher prevalence)

4. Signs and Symptoms

·       Chronic depressed mood (most of the day, more days than not)

·       Low energy or fatigue

·       Poor concentration or difficulty making decisions

·       Low self-esteem

·       Feelings of hopelessness

·       Changes in sleep (insomnia or hypersomnia)

·       Changes in appetite (poor appetite or overeating)

·       Symptoms are less severe than major depression but more persistent

5. Complications

·       Impaired social and occupational functioning

·       Increased risk of developing major depressive episodes (“double depression”)

·       Higher risk of suicide and self-harm

·       Chronic medical problems due to poor self-care

6. Medical Management

·       Medications:

o   SSRIs (e.g., sertraline, fluoxetine): First-line due to favorable side effect profile

o   SNRIs (e.g., venlafaxine, duloxetine): Also effective

o   TCAs and MAOIs: Used less often due to side effects and dietary restrictions

o   Atypical antidepressants (e.g., bupropion, mirtazapine): May be considered

·       Psychotherapy:

o   Cognitive Behavioral Therapy (CBT): Helps patients identify and change negative thought patterns

o   Interpersonal Therapy: Focuses on relationship issues

o   Mindfulness-Based Therapy: Promotes present-moment awareness

·       Lifestyle Interventions:

o   Regular exercise

o   Sleep

• hygiene

o   Social engagement

7. Nursing Care

·       Assessment: Monitor mood, sleep, appetite, energy, and suicidal ideation

·       Therapeutic Communication: Be empathetic, nonjudgmental, and supportive

·       Education:

o   Teach about the chronic nature of dysthymia and the importance of ongoing treatment

o   Stress medication adherence and regular follow-up

o   Discuss side effects and when to report them

o   Encourage self-monitoring (journaling, mood apps)

·       Safety: Assess for suicide risk and implement safety plans if needed

·       Collaboration: Work with interdisciplinary teams (psychiatrists, therapists, social workers)

·       Support Systems: Encourage involvement of family and community resources