Is Dysthymic Disorder a Second-Rate Depression?

Dysthymic Disorder, used to be called Dysthymia, is a low-grade and yet chronic depression characterized by feelings of sadness or depression associated with lack of interest to do things and some physical symptoms such as lack of energy, sleep, and concentration.
Psychological symptoms such as feelings of hopelessness, helplessness, and worthlessness can also occur. In addition, some patients harbor thoughts of death and feelings of emptiness.
This is a type of clinical depression that is supposed to be "milder" than Major Depressive Disorder (MDD used to be called Major Depression) because the symptoms dont necessarily happen everyday. Unlike patients who suffer from MDD, Dysthymic patients are not bed-bound, still able to work, and does not appear to be sick. But most of these individuals complain that they haven't felt "normal" or "happy" for a long time.
Moreover, Dysthymic Disorder is manifested by lack of drive and motivation. Hence, relatives and friends tend to misinterpret their mood and behavior. Some patients endure the stigma of being considered "lazy" or not "motivated enough" to do worthwhile goals.
As time passes by, patients with this disorder have difficulty functioning. But because they still appear normal, the illness is not recognized and patients don't get treated early. A lot of times, they are not referred to a psychiatrist.
So is Dysthymic Disorder a second-rate psychiatric disorder? Based on my experience, patients experience considerable emotional turmoil. In fact, some dysthymic patients eventually develop a more serious depression called Major Depressive Disorder. When "double depression" (dysthymic disorder and major depression occurring together) happens, patients are so depressed that they become a threat to themselves and become functionally impaired. At this time, psychiatric hospitalization becomes necessary.
So Dysthymic Disorder is a serious health problem that should be recognized and treated promptly. It is an illness that somehow hides its existence from everyone including clinicians and patients themselves.
What is the treatment? Dysthymic disorder can be treated by antidepressants and psychotherapy. Most patients respond to treatment although some still suffer despite adequate treatment. Also, there are some individuals who only respond minimally. As such, this illness can be more challenging to treat than others.

Antidepressant Found To Extend Lifespan In C. Elegans

A team of scientists led by Howard Hughes Medical Institute (HHMI) investigator Linda B. Buck has found that a drug used to treat depression can extend the lifespan of adult roundworms.
Buck and colleagues Michael Petrascheck and Xiaolan Ye report in the November 22, 2007, issue of the journal Nature, that the antidepressant drug mianserin can extend the lifespan of the nematode Caenorhabditis elegans by about 30 percent.
Intriguingly, the drug may act by mimicking the effects of caloric restriction, which has been shown to retard the effects of aging in a variety of animals ranging from worms and flies to mammals.
“Our studies indicate that lifespan extension by mianserin involves mechanisms associated with lifespan extension by dietary restriction,” said Buck, a member of the Basic Sciences Division of the Fred Hutchinson Cancer Research Center in Seattle. “We don’t have an explanation for this. All we can say is that if we give the drug to caloric restricted animals, it doesn’t increase their lifespan any further. That suggests the same mechanism may be involved.”
Researchers don’t yet understand exactly how mianserin staves off the effects of aging. But the drug appears to act the same way in both C. elegans and humans: by blocking certain receptors for the neurotransmitter serotonin. Serotonin is a chemical that cells use to communicate, helping them regulate many functions, including mood, appetite, and sensory perception.
As an antidepressant, mianserin is marketed under different trade names in countries outside the United States, including Bolvidon, Norval, and Tolvon. Buck said it was a surprise to find that a drug used to treat depression in humans could extend lifespan in worms. The researchers in Buck’s lab found that in addition to inhibiting certain serotonin receptors in the worm, it also blocked receptors for another neurotransmitter, octopamine.
A number of observations support the idea that serotonin and octopamine may complement one another in a physiological context, Buck explained, with serotonin signaling the presence of food and octopamine signaling its absence or a state of starvation. C. elegans, for instance, usually only lays eggs when food is on hand. But serotonin stimulates egg laying in the absence of food, while octopamine inhibits egg laying even when food is nearby. Another example of interplay between the two chemicals is that pharyngeal pumping, the mechanism by which worms ingest food, is jump-started by serotonin and thwarted by octopamine.
“In our studies, mianserin had a much greater inhibitory effect on the serotonin receptor than the octopamine receptor,” she said. “One possibility is that there is a dynamic equilibrium between serotonin and octopamine signaling and the drug tips the balance in the direction of octopamine signaling, producing a perceived, though not real, state of starvation that activates aging mechanisms downstream of dietary restriction.”
Buck and her colleagues chose to focus on the effects of mianserin based on the results of a search through 88,000 chemicals for agents that extended the lifespan of nematodes. They found 115 such chemicals. In follow-up studies of one chemical, they found four additional compounds, including mianserin, that extended lifespan by 20-33 percent. All four compounds inhibit certain types of serotonin receptors in humans.
“We screened a wide variety of chemicals without knowing anything about them except that they were small molecules,” Buck noted. “By screening adult animals with this extremely varied panel of compounds, we hoped to identify drugs that could increase lifespan in adults, even though some might have a deleterious effect on the developing animal.”
By identifying drugs that influence lifespan, Buck added, it may be possible to home in on how those drugs act and contribute to a growing body of knowledge about the genetic mechanisms of aging.
“Other researchers have done beautiful work using molecular genetic approaches to identify genes involved in aging,” she said. “We decided to take a chemical approach. By finding chemicals that enhance longevity, and then finding the targets of those chemicals, it may be possible to identify additional genes important in aging. In addition, the chemical approach could point to drugs suitable for testing in mammals.”
Buck said that her group has yet to identify what kinds of cells are affected by the drug, because while the serotonin receptors involved are only found on neurons, many types of cells–not just cells of the nervous system–have receptors for octopamine.

Americanization Is Linked to Depression

A study of 439 U.S. and Mexican-born Latinas seeking pregnancy and postpartum services at public health clinics in San Antonio uncovered elevated levels of depression among the more "Americanized" women, report researchers from The University of Texas School of Public Health and The University of Texas Health Science Center at San Antonio in the most recent online issue of the Maternal and Child Health Journal.
"Americanization" or acculturation is the process by which immigrants adopt the lifestyle and customs of their host nation, and key indicators include preferred language and place of birth, lead author Marivel Davila said. Davila is a graduate student at the UT School of Public Health and a quantitative research analyst at the UT Health Science Center at San Antonio.
Elevated levels of depression were reported by the women born in the United States, as well as those who asked to conduct their interviews in English. Two non-acculturation variables were associated with elevated depression - being single and being pregnant.
"Screening for depression during pregnancy is important for this population group, given Latinas' high rates of fertility and births to single women, particularly among more acculturated U.S.- born Latinas," Davila and her colleagues wrote in the article.
According to the National Center for Health Statistics, single motherhood among Latinas in Texas exceeds the national average. In Texas in 2005, 43 percent of all Latina births were to single women. Nationally, the overall average was 37 percent.
"The sample for this study was a low-income population," Davila said. "Our conclusions may or may not be different for women in other socioeconomic status (SES) groups. Hence, more research needs to be conducted among Latinas from differing SES groups, including research focusing on the role of social support and cultural values/beliefs related to childbirth and pregnancy among Latinas."
The women were interviewed in eight family planning clinics and six prenatal clinics of the San Antonio Metropolitan Health District (SAMHD) between May and August of 2003. Of the participants, 318 were born in Mexico and 121 in the United States. They were given the choice of conducting the interview in English or Spanish.
"The higher prevalence rate of depression in Americanized Latina women is of concern in our community as the population demographics clearly indicate a significant rate of growth of this group in their childbearing years," said Fernando A. Guerra, M.D., director of health for the San Antonio Metropolitan Health District. "Thus, it is important to more clearly understand the circumstances that affect their physical and emotional well-being during pregnancy so that preventive measures can be initiated. This is critical for the overall health of both the mother and child."
Women in the study were part of the Perinatal Depression Project for Healthy Start, an initiative to provide mental health services to pregnant and postpartum women by SAMHD. They were screened for depressive symptoms using the Center for Epidemiologic Studies - Depression (CES-D) Scale, a 20-item, questionnaire designed to gauge the level of depressive symptoms over the previous week. Women with a score of 21 or greater were classified as having elevated depressive symptoms.
"Women who were US-born were significantly more likely than Mexican-born women to meet the cutoff score (21 on the CES-D scale)," the authors wrote. "Women who conducted their interview in English were significantly more likely to express depressive symptoms compared to women who conducted their interview in Spanish."
Davila said symptoms of depression may include: emotional stress, helplessness, irritability and anger. Symptoms specific to the pregnancy and postpartum period can include overly intense worries about the baby, and a lack of interest or fear of harming the baby.

If You Have Depression Watch For Alzheimer’s Risk

Although individuals with depression may be more likely to develop Alzheimer’s disease, symptoms of depression do not appear to increase in the years before a diagnosis is made, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals. This suggests that depression is not a consequence of developing Alzheimer’s disease but may instead be a risk factor for dementia.
Previous studies have found higher levels of depressive symptoms (such as feeling sad) among patients with Alzheimer’s disease and its precursor, mild cognitive impairment, according to background information in the article. “The basis of this association is uncertain, however,” the authors write. “A leading hypothesis is that depressive symptoms do not constitute a true risk factor but rather a consequence of the disease.” If this were the case, symptoms of depression would likely increase during the early stages of Alzheimer’s disease.
Robert S. Wilson, Ph.D., of Rush University Medical Center, Chicago, and colleagues studied 917 older Catholic nuns, priests and monks who did not have dementia beginning in 1994. Participants had a yearly clinical evaluation that included a neurological examination, cognitive (thinking, learning and memory) testing and classification of Alzheimer’s disease or mild cognitive impairment. They also completed a 10-item scale assessing their symptoms of depression.
At the beginning of the study, 53.6 percent of participants reported no symptoms of depression, 23.9 percent reported one symptom, 9.7 percent reported two, 6.1 percent reported three and 6.8 percent reported four or more. During follow-up, 190 individuals developed Alzheimer’s disease. Those with more symptoms of depression at the beginning of the study were more likely to develop Alzheimer’s disease.
However, “those who developed Alzheimer’s disease showed no increase in depressive symptoms before the diagnosis was made, and this finding was not modified by age, sex, education, memory complaints, vascular burden or personality,” the authors write. “Among those without cognitive impairment at baseline, depressive symptoms did not increase in those who subsequently developed mild cognitive impairment.”
Symptoms of depression may be associated with changes in the brain that reduce its resistance to dementia, the authors write. “Understanding the mechanisms linking depressive symptoms with dementia could suggest novel approaches to delaying dementia onset because animal research suggests diverse means by which the adverse effects of chronic stress may be modified.”
Read more about the study linking Depression and Alzheimer’s Disease at HULIQ.

Selective Eating Disorder: Extreme Picky Eating Becomes a Medical Diagnosis

Children are often called “picky eaters” because of a hesitance to try new foods and seemingly surviving on little more than chicken nuggets and French fries. Most kids, as they get older, overcome the tendency to severely limit their diet; however, sometimes they grow into adults who continue extreme selective eating. The American Psychiatric Association is proposing a new medical diagnosis for this condition called “Selective Eating Disorder” or SED.
The British Journal of Clinical Child Psychology and Psychiatry describes selective eating disorder as a “little studied phenomenon of eating a highly limited range of foods, associated with an unwillingness to try new foods. When this happens social avoidance, anxiety and conflict can result.”
Read: Picky Eating Common in Autistic Children
SED is common in those with autism spectrum disorders.
Researchers at Duke University’s Center for Eating Disorders have initiated an online national public registry of selective eating. In less than five months, 7,500 people have fully registered for the Food FAD Study (Finicky Eating in Adults) with more who have started the survey but have not completed it. The registry offers a place for patients to report on their unusual eating preferences and habits, giving researchers an insight into the disorder.
Director Nancy Zucker stresses that “people who are picky aren’t doing this to be stubborn” but actually experience food differently than the rest of us. Researchers aren’t sure if biology or psychology is the driving force – both are likely involved. Zucker believes that SED patients may be “super tasters”, meaning they taste certain flavors more acutely than other people. Other theories suggest an early negative experience with food, such as childhood gastrointestinal issues.