Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Is Major Depression More Disabling?

Dysthymic Disorder can only be diagnosed after an injured employee has been depressed for ~2 years. Major Depression is more frequently diagnosed after injury than this Dysthymic Disorder. Which is worse?

Dysthymic (pronounced: diss-thy-mick) Disorder consists of waxing and waning depressive symptoms spanning a two year period.

If a person has a situational depression as a result of an event in the past six months, it is called _Adjustment Disorder with Depressed Mood_ and most often subsides as the event becomes further in the past.

While the word MAJOR in Major Depressive Disorder sounds significant, those with a major depressive episode often recover quickly and may not be disabled by their symptoms.

During the course of a recent study, the patients with dysthymic disorder had more symptoms, functioned worse, and were significantly more likely to attempt suicide and be hospitalized than were patients with episodic major depressive disorder.

The estimated 5-year recovery rate for dysthymic disorder was 52.9%. For patients who recovered, the estimated risk of relapse was 45.2% during an average of 23 months of observation. Patients with dysthymic disorder spent approximately 70% of the follow-up period meeting full criteria for mood disorder. For patients with dysthymic disorder who never met the criteria for major depressive disorder before the study, the estimated risk of having a first lifetime major depressive episode in the 5-year period was 76.9%.

As a result of their data, dysthymic disorder which usually pre-dates injury is a severe condition. Almost all patients with dysthymic disorder eventually develop major depressive episodes. Although the disorder by definition has only mild to moderate symptoms, this study shows that it is a chronic condition with a protracted course and a high risk of relapse.

Thus, if you have an injured worker with diagnosed Major Depressive Disorder, it is important to find out if he/she had long been suffering from Dysthymic Disorder before the injury.

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