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Dysthymia – due to lack of serotonin

Sitting in a Cardiff cafe, chatting and laughing with one of her friends, it’s hard to believe Meryl Cubley has spent most of the past two decades in a bad mood.

She herself thought that ‘negative feelings, a lack of energy and having little enthusiasm for life were my personality’.

But four months ago, Meryl, now 38, was diagnosed with dysthymia — a little known yet common condition characterised by chronically low mood and energy, sleep and appetite problems as well as an aversion to social contact.

Meryl is now having treatment that is already transforming her life.
‘I’ve stopped cancelling engagements at the last minute and am seeing friends more regularly,’ she says.

She is also sleeping better and has lost weight.
And, perhaps most importantly, she says: ‘For the first time in years I am feeling better in my day-to-day life.’
The ‘old’ Meryl is a type we all recognise — the grumpy, glass-half-empty person who’s always in a bad mood.

We tend to dismiss them as naturally negative but, according to research, these cynical types deserve more sympathy because they are actually suffering from a form of depression linked to hormone imbalances.

As many as 3  per cent of the population is thought to be affected, but because they tend to cope with the demands of everyday life and work — something those with major depression usually struggle with — they can go untreated and undiagnosed for decades, even their whole life.

‘Sufferers are often unaware of a problem and see it as who they are,’ says Professor Craig Jackson, head of psychology at Birmingham City University.
‘This can begin to shape their personality and outlook on life, so they respond to life’s setbacks and knocks in a more negative fashion.

‘This deepens their low mood — so dysthymia can become a vicious circle that’s hard to break.’

Meryl’s case was typical. One study in the Journal of Clinical Psychiatry found that sufferers of dysthymia typically live with the illness for up to 30 years, and only half seek treatment.

Despite a successful career as a novelist and being in a stable relationship with her partner Richard, a housing officer, Meryl never felt a sense of enjoyment from life.
She was 19 and at university when she was first overcome by feelings of anxiety and hopelessness.

Her GP diagnosed depressive anxiety and prescribed beta blockers, but these ‘dampened my mood and made me feel numb and uninterested in everyday life’.
She was then prescribed an antidepressant, but this just made her more anxious, so she stopped taking it.

‘Also, I didn’t really believe I had depression to be honest.
‘I knew I felt down most days, was irritable and negative, but I never had a problem getting up and out. I thought it was part of who I was, and resigned myself to always feeling this way.’

Guidelines issued two years ago by the National Institute of Health and Clinical Excellence (NICE) say that for a diagnosis of dysthymia patients should have had any two symptoms of depression for at least two years. (For depression, they need to have had at least three symptoms for just two weeks.)

Such symptoms include feeling sad for more days than not, low energy, a low appetite or overeating, sleeping too much or too little, a negative outlook on life, withdrawing from social contact and experiencing little joy in everyday life.

‘People with dysthymia usually only experience one or two of these symptoms — but they usually have symptoms for longer,’ explains Dr Cosmo Hallstrom, a consultant psychiatrist and spokesperson for the Royal College of Psychiatrists.
As for cause, a combination of social, biological and psychological factors may be to blame, suggests Professor Jackson.

‘We often see dysthymia run in families,’ he says.
‘But though we don’t know if there is a genetic link, a child brought up by two chronically pessimistic parents, or where either parent have what psychologists call a “negative affectivity” (a pervasive nature to err on the more gloomy side), can be deeply impacted at a subconscious level.’

Dr Hallstrom adds: ‘Rather than being a symptom of dysthymia, chronic cynicism may, in fact, be a cause of it.
‘If you are raised or work in an environment where cynicism is pervasive, that can lead to dysthymia because it means constantly being critical, which can lead to the chronic negative outlook in someone with dysthymia.’

Dysthymia is linked to a lack of serotonin — a brain chemical that governs mood, he says.
Recent studies have found it may be caused by an imbalance of dopamine, another brain chemical.

‘We need a certain level of brain chemicals such as dopamine and serotonin to function well, and people that produce too little — or, in some cases, too much, thus upsetting this delicate balance — may experience symptoms of dysthymia,’ says Professor Jackson.

Typically, dysthymia symptoms begin in late teens or early adulthood, says Professor Paul Keedwell, a consultant psychiatrist at Cardiff University and author of How Sadness Survived: An Evolutionary Basis for Depression.
The problem often goes untreated because GPs don’t know enough to spot it, adds Dr Hallstrom.

‘For every one person with a depressive illness, there are up to three not diagnosed.
‘People with dysthymia will often fall into this group, because they will be functioning and may think nothing can be done.’
But left untreated, people with dysthymia are at higher risk of a major depressive illness.

According to research published in the journal Psychopharmacology Bulletin, 75 per cent of those with dysthymia will have at least one episode of full blown depression, and many will have more than one.

Many people will need to go through a major depressive episode where they stop functioning before they realise something is wrong and seek help, says Dr Hallstrom.
Meryl suffered five bouts of major depression.
‘During these times I would see my doctor and he would try me on yet another antidepressant,’ she says.

‘But they would either make me hyperactive and more irritable, or tired during the day.
‘Nothing worked, and I would stop taking them after a couple of weeks because of the side-effects and leave each episode to pass of its own accord.’
Between these bouts, Meryl ‘still wasn’t what you would call happy — I was low and irritable on most days.

‘I’d stay in whole weekends and not go out; or organise to meet friends and then feel down and cancel at the last minute.’
She was finally diagnosed last summer after she saw a new GP.
‘This new doctor asked specific questions about my symptoms — how I rated my everyday mood, how many hours I slept most nights, how my appetite was, and about my social life,’ says Meryl.

‘He explained that in between my depressive episodes, he believed I was suffering with dysthymia.
‘It was the first I had heard of it, but all the symptoms described me. It was a huge relief.’
According to Professor Keedwell, antidepressants such as serotonin reuptake inhibitors may work in some cases by regulating levels of serotonin and dopamine.
But generally the evidence for their effectiveness for dysthymia is weak. By contrast, the evidence for talking therapies such as Cognitive Behavioural Therapy (CBT) is strong, he says.

Stressolim, which is designed to naturally rebalance neurotransmitters in the brain, has a positive effect on Serotonin and dopamine levels, and therefore enhances mood.