198 CHAPTER 6
How would a clinician determine whether Mr. A, or someone else, suffered from
dysthymic disorder or MDD—what differentiates the two disorders? People with
dysthymic disorder are less likely to experience the vegetative signs associatedDepression in Children and Adolescents
In a given 6-month period, 1–3% of elementary-school children and 5–8%
of teenagers are depressed (Garber & Horowitz, 2002; Lewinsohn & Essau,
2002). Moreover, some clinicians and researchers are reporting depression
among preschool children, evidenced by avoidance, decreased enthusiasm
and increased anhedonia (Luby et al., 2006). Younger children who are de-
pressed are not generally considered to be at high risk to develop depression
in adulthood (Harrington et al., 1990; Weissman, Wolk, Wickramaratne, et
al., 1999). However, those who fi rst get depressed as teenagers are consid-
ered to be at high risk for developing depression in adulthood (Lewinsohn,
Rohde, et al., 1999; Weissman et al., 2006; Weissman, Wolk, et al., 1999).
Teenage depression has far-reaching effects: Depressed teens are more likely
than their nondepressed peers to drop out of school or to have an unplanned
pregnancy (Waslick, Kandel, & Kakouros, 2002).Dysthymic Disorder
Dysthymic disorder differs from major depressive disorder in that it involves fewer of
the symptoms of a major depressive episode, but they persist for a longer period
of time. Specifi cally, dysthymic disorder is characterized by depressed mood and as
few as two other depressive symptoms that last for at least 2 years and that do not
recede for longer than 2 months at any time during that period (see Table 6.4).
Because symptoms are chronic, people with dysthymic disorder often incorporate
the symptoms into their enduring self-assessment, seeing themselves as incompetent
or uninteresting. Whereas people with MDD see their symptoms as happening to
them, people with dysthymic disorder view their symptoms as an integral part of
themselves (“This is just how I am”), like Mr. A, in Case 6.3, below. If an individual
diagnosed with dysthymic disorder develops an MDE, he or she is considered to
havedouble depression. In that case, both MDD and dysthymic disorder are diag-
nosed. Individuals who have had double depression are likely to have more than one
MDE. Double depression may require longer treatment than dysthymic disorder or
MDD (Dunner, 2001).CASE 6.3 • FROM THE OUTSIDE:Dysthymic Disorder
Mr. A, a 28-year-old, single accountant, sought consultation because “I feel I am going
nowhere with my life.” Problems at work included a recent critical job review because
of low productivity, confl icts with his boss, and poor management skills. His fi ancée
recently postponed their wedding because she has doubts about their relationship,
especially his remoteness, critical comments, and lack of interest in sex.
Describing himself as a pessimist who has difficulty experiencing pleasure or
happiness, Mr. A has long felt a sense of hopelessness—of life not being worth living.
His mother was hospitalized with postpartum depression after the birth of his younger
sister; his father had a drinking problem. His high school classmates found him
gloomy and “not fun.”
Although not troubled by thoughts of suicide nor signifi cant vegetative signs of
depression, Mr. A. does have months when his concentration is impaired, his energy
level is lowered, and his interest in sex wanes. At such times, he withdraws from other
people (although he always goes to work), staying in bed on weekends.
(Adapted from Frances & Ross, 1996, pp. 123–124)Dysthymic disorder
A depressive disorder that involves fewer of
the symptoms of a major depressive episode,
but the symptoms persist for a longer period
of time.Double depression
Having both major depressive disorder and
dysthymic disorder.Phototherapy can be helpful to people who have
winter depression. Typically, a person using
phototherapy sits near special lights for an
average of 30 minutes per day.Pascal Goetgheluck/Photo Researchers