Dysthymia: Hope for chronic depression—and suicidality
Date: December 7, 2022
Times: 12:00 PM-3:30 PM Eastern
Speaker: Greg Dubord, MD
Accreditation: 9.0 Mainpro+ Credits
The Dysthymia module covers three related topics: brief CBT for dysthymia (assumes ten-minute appointments), victimhood culture (an exacerbant on the rise), and brief CBT for suicidality (focusing on what to say in the moment).
NOTE: The new DSM-5-TR (released on March 18) refers to dysthymia as persistent depressive disorder.
1. DYSTHYMIA. The persistently depressed deserve great compassion. After faring poorly in the genetic lottery, many proceed to experience worse day-to-day luck than your average bear.
May 18, 2000 was a historic & happy day in psychiatry. That morning the New England Journal of Medicine published the results of a landmark dysthymia treatment study. The large NIMH investigation found that with "CBT 2.0", over 85% of the chronically depressed improved 50% or more. Notably, the 681 patients in the multicentre trial were “real-life” dysthymics: they’d been depressed more-days-than-not for over 23 years (with an average “double depression” duration of over 8 years), over 59% had a personality disorder, and over 33% had a substance abuse history.
More happy news: If you're selective & strategic, you can incorporate many key elements of the "CBT 2.0" treatment package into the ten-minute appointments typical of primary care. And if you do, your dysthymic patients will thank you—thereby lifting a heavy weight off your shoulders.
2. VICTIMHOOD CULTURE. Victimhood culture is on the rise, and its impacts are becoming very widespread. Although victimhood culture is a short topic in the Dysthymia module, it's undoutedly the spiciest one.
Historically, we had an honor culture (e.g., “Offend my house, and we shall duel with pistols at noon”). When the smoke cleared, honor culture was largely replaced by the dignity culture in which most of us were raised (e.g., “Sticks and stones may break my bones, but names will never hurt me”). Today victimhood culture is ascending. Victimhood culture is characterized by an external locus of control, a sensitivity to slight, and a heavy reliance on compentation mediated by third parties.
Where did victimhood culture originate, and why is it growing so fast? What is its impact on the prognosis of our dysthymic patients? Where might victimhood culture lead, and what solutions are at hand?
3. SUICIDALITY. Most physicians have a sense of despair regarding suicidality. There is a widespread lack of confidence in screening, a deep uncertainty about how to manage the risk, and often a feeling of shame (accompanied by nasty self-criticism) when Something Bad happens.
In this highly anxiolytic conclusion to the Dysthymia module, we begin with a review of the science and CPGs regarding suicide risk factors, suicide screening, and suicide-prevention interventions.
We then focus on what really matters: precisely what to say (and how to say it) in the here & now with the suicidal patient to reduce their motivation to act. Several dozen strategies are reviewed and practiced within the workshop.
Please do join us! After completing the Dysthymia module, many physicians report they wish they’d taken it at the start of their careers, asserting that they could have spared themselves a significant amount of stress & heartache.
See also Depression: CBT's Pathway Out