Dysthymia in Children as a Depressive Disorder

Dysthymia, also known as dysthymic disorder or DD, is a milder but chronic depressive disorder that is sometimes seen in children.

Like other depressive disorders, the course of dysthymia varies in children. While the DSM-IV criteria require a child to experience symptoms for at least one year to be diagnosed with dysthymia, the median dysthymic episode for children is 3.9 years.

Approximately 3 percent of children meet the criteria for dysthymia. Some researchers argue that a higher percentage of children actually have DD, but because of its chronic nature, symptoms are often mistakenly attributed to personality. In fact, children with DD may not complain of feeling depressed or sad because they do not recognize their mood as being different from what they normally feel.

Symptoms of DD are similar to those of major depressive disorder, but are less severe and are less likely to impair daily functioning.

Symptoms may include:

• Depressed mood
• Sadness
• Feelings of hopelessness and/or worthlessness
• Withdrawal from friends and family
• Low self-esteem
• Eating or sleeping pattern changes
• Unexplained physical ailments
• Lack of concentration
• Thoughts or action of self-harm or suicide
• Inability to experience pleasure or joy
• Irritability
• Restlessness or fatigue

Despite the milder symptoms of dysthymia, it is still thought that its chronic nature may interfere with a child's development of interpersonal relationships, positive self-esteem, and problem-solving skills.

Recovery for children with dysthymia is likely. However, the majority of children will have another dysthymic episode in the future. Approximately 75 percent of children who experience a dysthymic episode will also experience a major depressive episode, a shorter but more severe depressive disorder. When a child who has dysthymia experiences a major depressive episode, the combination is called double depression.

Factors that may increase a child's likelihood of developing double depression were identified by Dr. Daniel Klein and colleagues in a 10-year follow-up of children with dysthymia. Identified risk factors were:

• First dysthymic episode at a young age
• Co-existing anxiety disorder
• Strong family history of major depressive disorder
• Poor early relationship with mother
• History of sexual abuse
• Underlying personality disorder

It has been noted that children with double depression may have shorter episodes of major depressive disorder. According to Dr. Kovacs and colleagues, this is because it is easier for a child to return to a baseline mood of dysthymia, or mild depressive symptoms, than a baseline with no presence of depressive symptoms. Nonetheless, all depressive disorders require treatment in children.

Like other depressive disorders, dysthymic disorder is associated with serious short- and long-term consequences, such as poor academic and social performance, substance abuse, and increased risk of suicide. Of course, not all children with dysthymia will experience negative outcomes, but given the association, treatment is recommended.

Treatment options for children with dysthymia are typically psychotherapy, medication, or a combination approach.

Be sure to talk to your child's pediatrician or other mental health providers if she has symptoms of dysthymia or another depressive disorder. Depressive disorders should never be left untreated in children.