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Symptoms
By Mayo Clinic Staff

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Fall and winter seasonal affective disorder (winter depression)

Winter-onset seasonal affective disorder symptoms include:
•Depression
•Hopelessness
•Anxiety
•Loss of energy
•Heavy, “leaden” feeling in the arms or legs
•Social withdrawal
•Oversleeping
•Loss of interest in activities you once enjoyed
•Appetite changes, especially a craving for foods high in carbohydrates
•Weight gain
•Difficulty concentrating

Spring and summer seasonal affective disorder (summer depression)

Summer-onset seasonal affective disorder symptoms include:
•Anxiety
•Trouble sleeping (insomnia)
•Irritability
•Agitation
•Weight loss
•Poor appetite
•Increased sex drive

Seasonal changes in bipolar disorder

In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania). This is known as reverse seasonal affective disorder. Signs and symptoms of reverse seasonal affective disorder include:
•Persistently elevated mood
•Hyperactivity
•Agitation
•Unbridled enthusiasm out of proportion to the situation
•Rapid thoughts and speech

When to see a doctor

It’s normal to have some days when you feel down. But if you feel down for days at a time and you can’t seem to get motivated to do activities you normally enjoy, see your doctor. This is particularly important if you notice that your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation.

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DEFINITION:
By Mayo Clinic Staff

Seasonal affective disorder (also called SAD) is a type of depression that occurs at the same time every year. If you’re like most people with seasonal affective disorder, your symptoms start in the fall and may continue into the winter months, sapping your energy and making you feel moody. Less often, seasonal affective disorder causes depression in the spring or early summer.

Treatment for seasonal affective disorder includes light therapy (phototherapy), psychotherapy and medications. Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

CAUSES
By Mayo Clinic Staff

The specific cause of seasonal affective disorder remains unknown. It’s likely, as with many mental health conditions, that genetics, age and, perhaps most importantly, your body’s natural chemical makeup all play a role in developing the condition. A few specific factors that may come into play include:
•Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may disrupt your body’s internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.
•Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in seasonal affective disorder. Reduced sunlight can cause a drop in serotonin that may trigger depression.
•Melatonin levels. The change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood.

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Mindfulness exercises: How to get started

Looking to start living in the moment? Find out how to use mindfulness exercises to develop a greater awareness of the world around you.
By Mayo Clinic Staff

If you’ve heard of or read about mindfulness — a form of meditation — you might be curious about how to practice it. Find out how to do mindfulness exercises and how they might benefit you.

What is mindfulness?

Mindfulness is the act of being intensely aware of what you’re sensing and feeling at every moment — without interpretation or judgment.

Spending too much time planning, problem-solving, daydreaming, or thinking negative or random thoughts can be draining. It can also make you more likely to experience stress, anxiety and symptoms of depression. Practicing mindfulness exercises, on the other hand, can help you direct your attention away from this kind of thinking and engage with the world around you.

What are the benefits of mindfulness exercises?

Practicing mindfulness exercises can have many possible benefits, including:
•Reduced stress, anxiety and depression
•Less negative thinking and distraction
•Improved mood

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Treatments and drugs
By Mayo Clinic Staff

The two main treatments for dysthymia are medications and talk therapy (psychotherapy). Medications appear to be more effective at treating dysthymia than psychotherapy when either is used alone. Using a combination of medications and psychotherapy may be slightly more effective.

Which treatment approach your doctor recommends depends on factors such as:
•Severity of your dysthymia symptoms
•Your desire to address emotional or situational issues affecting your life
•Your personal preferences
•Previous treatment methods
•Your ability to tolerate medications
•Other emotional problems you may have

Medications for dysthymia

Types of antidepressants most commonly used to treat dysthymia include:
•Selective serotonin reuptake inhibitors (SSRIs)
•Serotonin and norepinephrine reuptake inhibitors (SNRIs)
•Tricyclic antidepressants (TCAs)

Finding the right medication

SSRIs are often the antidepressant of choice because, in general, they work well and their side effects are more tolerable. Which antidepressant or a combination of medications is best for you depends on your individual situation.

If you’re bothered by side effects, don’t stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off, and quitting abruptly may cause a sudden worsening of depression. Don’t give up until you and your doctor find a medication that’s suitable for you. Talk with your doctor or pharmacist about possible side effects to weigh the benefits and risks. In some cases, side effects may go away as your body adjusts to the medication.

When you have dysthymia, you may need to take antidepressants long term to keep symptoms under control.

Antidepressants and increased suicide risk

Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry “black box” warnings, the strictest warnings for prescriptions. In some cases, children, adolescents and young adults under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, people in these age groups must be closely monitored by loved ones, caregivers and health care providers.

Psychotherapy for dysthymia

Psychotherapy can help you learn about your condition and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy coping skills and stress management. Psychotherapy can also help you:
•Learn to make decisions
•Reduce self-defeating behavior patterns, such as negativity, hopelessness and a lack of assertiveness
•Improve your ability to function in interpersonal social and work situations

You and your therapist can discuss which type of therapy is right for you, your goals for therapy, and other issues, such as the length of treatment.

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Tests and diagnosis
By Mayo Clinic Staff

If your doctor suspects you have dysthymia, exams and tests may include:
•Physical exam. The doctor may do a physical exam and ask in-depth questions about your health to determine what may be causing your dysthymia. In some cases, dysthymia may be linked to an underlying physical health problem.
•Lab tests. For example, your doctor may order a blood test called a complete blood count, do blood tests to check your folate and Vitamin D levels, or test your thyroid to make sure it’s functioning properly.
•Psychological evaluation. This evaluation includes a discussion about your thoughts, feelings and behavior and may include a questionnaire to help pinpoint a diagnosis.

Checking for other conditions

Several other conditions have symptoms that may resemble dysthymia. Your doctor or mental health provider’s evaluation will help determine if you have dysthymia or another condition that can affect your mood, such as major depression, bipolar disorder or seasonal affective disorder.

Diagnostic criteria for dysthymia

To be diagnosed with dysthymia, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

For a diagnosis of dysthymia, the main indication for an adult differs somewhat from that of a child:
•For an adult, depressed mood most of the day for two or more years
•For a child, depressed mood or irritability most of the day for at least one year

In addition to that, you must have at least two of these symptoms, and they must cause distress or interfere with your ability to function in your daily life:
•Poor appetite or overeating
•Sleep problems
•Tiredness or lack of energy
•Low self-esteem
•Hopelessness
•Poor concentration
•Trouble making decisions

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Preparing for your appointment
By Mayo Clinic Staff

Your doctor may ask about your mood during a routine medical appointment if you seem to be sad or down. Or you may decide to schedule an appointment to talk about your concerns. Because dysthymia often requires specialized mental health care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment.

What you can do

Prepare for your appointment by making a list of:
•Any symptoms you’ve had, including any that may seem unrelated to the reason for which you scheduled the appointment
•Key personal information, including any major stresses or recent life changes
•All medications, vitamins, supplements or herbal preparations that you’re taking
•Questions to ask your doctor

Taking a family member or friend along can help you remember something that you missed or forgot.

Basic questions to ask your doctor include:
•Why can’t I get over dysthymia on my own?
•How do you treat dysthymia?
•Will talk therapy (psychotherapy) help?
•Are there medications that might help?
•How long will I need to take medication?
•What are some of the side effects of the medication you’re recommending?
•How often will we meet?
•How long will treatment take?
•What can I do to help myself?
•Are there any brochures or other printed materials that I can have?
•What websites do you recommend visiting?

Don’t hesitate to ask questions any time you don’t understand something.

What to expect from your doctor

During your appointment, your doctor will likely ask several questions about your mood, thoughts and behavior, such as:
•When did you first notice symptoms?
•How is your daily life affected by your symptoms?
•What other treatment have you had?
•What have you tried on your own to feel better?
•What things make you feel worse?
•Have any relatives had dysthymia, major depression or another mental illness?
•What do you hope to gain from treatment?

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CAUSES:
By Mayo Clinic Staff

The exact cause of dysthymia isn’t known. Dysthymia may have causes similar to major depression, including:
•Biochemical. People with dysthymia may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
•Genes. Dysthymia appears to be more common in people whose biological (blood) relatives also have the condition.
•Environment. As with depression, environment may contribute to dysthymia. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems or a high level of stress

RISK FACTORS:

Risk factors
By Mayo Clinic Staff

Certain factors appear to increase the risk of developing or triggering dysthymia, including:
•Having a first-degree relative with dysthymia or major depression
•Stressful life events, such as the loss of a loved one or financial problems
•Interpersonal dependency where the person relies excessively on approval, reassurance and attention from others and then this approval is significantly reduced or no longer occurs

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DEFINITION:
By Mayo Clinic Staff

Dysthymia (dis-THIE-me-uh) is a mild but long-term (chronic) form of depression. Symptoms usually last for at least two years, and often for much longer than that. Dysthymia interferes with your ability to function and enjoy life.

With dysthymia, you may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. People with dysthymia are often thought of as being overly critical, constantly complaining and incapable of having fun.

SYMPTOMS:

Symptoms
By Mayo Clinic Staff

Dysthymia symptoms in adults may include:
•Loss of interest in daily activities
•Sadness or feeling down
•Hopelessness
•Tiredness and lack of energy
•Low self-esteem, self-criticism or feeling incapable
•Trouble concentrating and trouble making decisions
•Irritability or excessive anger
•Decreased activity, effectiveness and productivity
•Avoidance of social activities
•Feelings of guilt and worries over the past
•Poor appetite or overeating
•Sleep problems

In children, dysthymia sometimes occurs along with attention-deficit/hyperactivity disorder (ADHD), behavioral or learning disorders, anxiety disorders, or developmental disabilities. Examples of dysthymia symptoms in children include:
•Irritability
•Behavior problems
•Poor school performance
•Pessimistic attitude
•Poor social skills
•Low self-esteem

Dysthymia symptoms usually come and go over a period of years, and their intensity can change over time. But typically symptoms don’t disappear for more than two months at a time. In general, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality.

When dysthymia starts before age 21, it’s called early-onset dysthymia. When it starts after that, it’s called late-onset dysthymia.

When to see a doctor

It’s perfectly normal to feel sad or upset sometimes or to be unhappy with stressful situations in your life. But with dysthymia, these feelings last for years and interfere with your relationships, work and daily activities.

Because these feelings have gone on for such a long time, you may think they’ll always be part of your life. But if you have any symptoms of dysthymia, seek medical help. If not effectively treated, dysthymia commonly progresses into major depression. Sometimes, a major depression episode occurs in addition to dysthymia — this is called double depression.

Talk to your primary care doctor about your symptoms. Or seek help directly from a mental health provider. If you’re reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it’s a friend or loved one, a teacher, a faith leader, or someone else you trust

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You might decide on your own that you want to try psychotherapy, or a doctor, relative, friend or someone else may suggest psychotherapy to you. Here’s how to get started:
•Find a therapist. Get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). You can also find a therapist on your own — for instance, in the phone book or on the Internet, or through a local or state psychological association.
•Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of psychotherapy sessions a year. Also, talk to your therapist about fees and payment options.
•Review your concerns. Before your first appointment, think about what issues you’d like to work on. While you also can sort this out with your therapist, having some sense in advance may provide a good starting point.

Check qualifications

Before seeing a psychotherapist, check his or her background, education, certification, and licensing. Psychotherapist is a general term, rather than a job title or indication of education, training or licensure.

Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master’s or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.

Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.

Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline. The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.

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What you can expect
By Mayo Clinic Staff

Your first therapy session

Your first psychotherapy session is usually a time for the therapist to gather information about you and your needs. The therapist may ask you to fill out forms about your current and past physical and emotional health. It might take a few sessions for your therapist to fully understand your situation and concerns and to determine the best approach or course of action.

The first session is also an opportunity for you to interview your therapist to see if his or her approach and personality are going to work for you. Make sure you understand:
•What type of therapy will be used
•The goals of your treatment
•The length of each session
•How many therapy sessions you may need

Don’t hesitate to ask questions anytime during your appointment. If you don’t feel comfortable with the first psychotherapist you see, try someone else. Having a good fit with your therapist is critical for psychotherapy to be effective.

Starting psychotherapy

A therapist may have an office in a medical clinic or an office building or have a home office. You’ll probably meet with your therapist once a week or every other week for a session that lasts 45 to 60 minutes. Psychotherapy, usually in a group session with a focus on safety and stabilization, also can take place in a hospital if you’ve been admitted for treatment.

Types of psychotherapy

There are a number of effective types of psychotherapy. Some work better than others in treating certain disorders and conditions. In many cases, therapists use a combination of techniques. Your therapist will consider your particular situation and preferences to determine which approach may be best for you.

Although many subtypes and variations on therapies exist, some psychotherapy techniques proven to be effective include:
•Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
•Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you handle stress, manage your emotions and improve your relationships with others
•Acceptance and commitment therapy, which helps you become aware of and accept your thoughts and feelings and commit to making changes, increasing your ability to cope with and adjust to situations
•Psychodynamic and psychoanalysis therapies, which focus on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts
•Interpersonal psychotherapy, which focuses on addressing problems with your current relationships with other people to improve your interpersonal skills — how you relate to others, such as family, friends and colleagues
•Supportive psychotherapy, which reinforces your ability to cope with stress and difficult situations

Psychotherapy is offered in different formats, including individual, couple, family or group therapy sessions, and it can be effective for all age groups.

During psychotherapy

For most types of psychotherapy, your therapist encourages you to talk about your thoughts and feelings and what’s troubling you. Don’t worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort as time goes on.

Because psychotherapy sometimes involves intense emotional discussions, you may find yourself crying, upset or even having an angry outburst during a session. Some people may feel physically exhausted after a session. Your therapist is there to help you cope with such feelings and emotions.

Your therapist may ask you to do “homework” — activities or practices that build on what you learn during your regular therapy sessions. Over time, discussing your concerns can help improve your mood, change the way you think and feel about yourself, and improve your ability to cope with problems.

Confidentiality

Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:
•Threatening to immediately or soon (imminently) harm yourself or commit suicide
•Threatening to immediately or soon (imminently) harm or take the life of another person
•Abusing a child or a vulnerable adult (someone older than age 18 who is hospitalized or made vulnerable by a disability)
•Being unable to safely care for yourself

Length of psychotherapy

The number of psychotherapy sessions you need — and how frequently you need to see your therapist — depends on such factors as:
•Your particular mental illness or situation
•Severity of your symptoms
•How long you’ve had symptoms or have been dealing with your situation
•How quickly you make progress
•How much stress you’re experiencing
•How much your mental health concerns interfere with day-to-day life
•How much support you receive from family members and others
•Cost and insurance limitations

It may take only weeks to help you cope with a short-term situation. Or, treatment may last a year or longer if you have a long-term mental illness or other long-term concerns.