Transcript Dysthymic Disorder in Males Over Age 50

Dysthymic Disorder in
Males Over Age 50
Depression Facts:
• Males over age 50 are more likely to complete a suicide
• Males over age 50 are less likely to receive treatment for
depression than females of the same age
• Depression care represents one of few areas of healthcare
where females receive a higher quality of care than males
• Males over age 50 may find it harder to report symptoms of
depression because of socialization of gender roles: the “tough
guys don’t complain” mentality
Unique Characteristics of Dysthymia:
•Persons with dysthymia may be embarrassed about
seeking treatment since they don’t have a “good reason”
for feeling depressed.
•Clients may report they’ve “always just felt a little down”
•Family members may say “he/she’s just always been gloomy”
•Persons with this disorder tend to think about death all the time so that
these thoughts become normalized
•Persons with dysthymia tend to see death as a viable option for ending
their pain
•Dysthmia most often presents in a primary MD’s office
•Dysthymia is under diagnosed especially among the target population of
males over the age of 50
•Dysthymia is most often treated with medication and therapy is seldom
offered as an option.
Diagnostic Criteria:
Symptoms in the presence of depression include: poor appetite or
overeating, insomnia or hypersomnia, low energy or fatigue, low selfesteem, poor concentration or difficulty making decisions, and feelings of
hopelessness.
Symptoms have been present more often than not during the last two
years
After the initial two years of symptoms major depressive episodes may be
superimposed with dysthymic disorder
When diagnosing a specifier of early or late onset must be assigned
Symptoms cause clinically significant distress of impairment
in social, occupational, or other important areas of functioning.
Treatment Options For Dysthymic Disorder
•
•
•
Testosterone: “You’re not
depressed you’re just getting a little
older…” (wink, wink) Medication
is available in transdermal gel,
intramuscular injection, and oral
medication
Thyroid: blood chemistry analysis
of thyroid function is checked
because hypothyroidism mimics
depression
Antidepressant medications:
MD’s are more likely to prescribe a
course of antidepressant
Commonly Prescribed
Antidepressants
Wellbutrin
Celexa
Prozac
Paxil
Effexor
Luvox
Elavil
Zoloft
Remeron
And Then There’s Therapy……
Q. Is therapy a viable option for this population?
A. The May 2001 issue of The Journal of Family
Practice says consider “for patients with
dysthymia, Problem-Solving Treatment for
Primary Care (PST-PC), if available, as a
treatment alternative to medication….” (Barrett,
et al 2001)
What Cognitive Behavioral Therapy Does
Cognitive therapy combines behavioral strategies with
cognitive techniques to
1. help the client identify faulty or inaccurate
assumptions
2. monitor these automatic thoughts or cognitions for
connections to behavior and affect
3. look for evidence for and against the faulty
assumption
4. begin to replace the faulty cognitions with more
reality-based interpretations
5. to learn to identify and debunk dysfunctional thoughts
and beliefs that distort experiences
( Beck,Rush, Shaw & Emery 1979)
Cognitive Behavioral Therapy
Pros and Cons
Pros:
• Time sensitive. A typical course of
therapy might be 15 sessions
divided into bi-weekly then weekly
sessions for about 11 weeks total
• May be more appealing to older
clients because focus is on changing
behavior versus a person centered
exploration
• May be more attractive to insurers
because of the relatively short
course
• Progress is measurable using the
Beck Depression Scale weekly and
making comparisons
Pros and Cons Continued:
Cons:
• Dysthymia clients may have lived with symptoms too
long to adequately identify them as problematic
behavior
• Older clients may resist the cognitive nature of therapy
because “you can’t teach an old dog new tricks”
• Cognitive therapy requires outside work that older
clients may resist due to illiteracy, poor vision, etc.
• Lack of studies to prove efficacy of cognitive behavioral
therapy over other psychotherapeutic interventions
• Cognitive Therapy Plan Handout
• Questions, comments, wrap-up