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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

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Dysthymic Disorder in Males Over Age 50

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  1. Dysthymic Disorder in Males Over Age 50

  2. 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

  3. 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.

  4. Diagnostic Criteria:Symptoms in the presence of depression include: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.Symptoms have been present more often than not during the last two yearsAfter the initial two years of symptoms major depressive episodes may be superimposed with dysthymic disorderWhen diagnosing a specifier of early or late onset must be assignedSymptoms cause clinically significant distress of impairmentin social, occupational, or other important areas of functioning.

  5. 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 Treatment Options For Dysthymic Disorder

  6. And Then There’s Therapy…… Q. Is therapy a viable option for this population? • 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)

  7. What Cognitive Behavioral Therapy Does Cognitive therapy combines behavioral strategies with cognitive techniques to • help the client identify faulty or inaccurate assumptions • monitor these automatic thoughts or cognitions for connections to behavior and affect • look for evidence for and against the faulty assumption • begin to replace the faulty cognitions with more reality-based interpretations • to learn to identify and debunk dysfunctional thoughts and beliefs that distort experiences (Beck,Rush, Shaw & Emery 1979)

  8. Cognitive Behavioral TherapyPros 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

  9. 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

  10. Cognitive Therapy Plan Handout • Questions, comments, wrap-up

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