Depression is a mood disorder that comes in many forms. As with other mental health conditions, clinical depression isn’t just measured by how it impacts your ability to function. It’s also by your internal experience—how you think and feel. If you’ve been experiencing low or moderate levels of depression that have lasted for long periods of time, you may want to find out more about dysthymia—a low-grade, chronic depression that persists for at least 2 years. Learn about its symptoms, causes, and, most importantly, how best to treat it.
What is dysthymia?
Dysthymia, or persistent depressive disorder, is a low-grade, chronic form of depression that lasts at least 2 years.
Feeling down from time to time is part of life, but there’s nothing ordinary about daily sadness, losing interest in activities, and feeling hopeless about life in general.
The symptoms of depressive disorders like major depressive disorder (MDD) and situational depression often cause people to miss work or school. Depression can also impact other areas of your life, like your home and social life.
But with persistent depressive disorder, you may continue to show up for commitments and responsibilities despite the difficulty you’re experiencing. If you’ve felt depressed for 2 or more years and also have other symptoms of depression, like feelings of hopelessness or low energy, you may have persistent depressive disorder. You may also experience physical symptoms.
Just because you’re still able to function doesn’t mean you aren’t experiencing a serious mental health condition. Treatment is warranted, recommended, and beneficial.
If you think you may have this condition, you’re not alone. Here are some stats about this mental illness:
- Women are more likely to develop dysthymia than men.
- 3.4% of American adults will develop dysthymia at some point in their lives.
- Persistent depressive disorder is associated with a higher risk of addiction.
- Up to 50% of people with dysthymia also have an anxiety disorder.
Dysthymia is distinguished from everyday sadness by its relentlessness. People with persistent depression have symptoms most of the time, on most days, for years at a time. Dysthymia symptoms won’t always stop you from functioning, but they will likely keep you from thriving and living your fullest life.
Persistent depressive disorder symptoms
The symptoms of dysthymia are similar to major depressive disorder but differ in duration and severity. Unlike MDD, which is experienced acutely in cycles lasting 2 – 6 months, dysthymia is characterized as moderate depression lasting at least 2 years.
Symptoms of persistent depressive disorder include:
- Feelings of sadness, worthlessness, and hopelessness
- Loss of interest in activities
- Low self-esteem
- Thoughts of suicide
- Unintended weight loss or gain
- Self-harm, including suicidal thoughts or actions
People frequently overlook the signs of persistent depressive disorder. It’s one of the reasons dysthymia can go undiagnosed for so long. Often, those experiencing it can’t remember a time when they felt differently because a state of low-grade depression just feels like the baseline.
Without a healthy point of reference, you may endure depression for years without realizing that life could be better.
Major depressive disorder vs. persistent depressive disorder
MDD is more intense than dysthymia, often making day-to-day functioning nearly impossible. In addition to the symptoms listed above, people with MDD may experience:
- Feelings of sadness, hopelessness, and despair
- Loss of interest in activities and hobbies
- Changes in weight or appetite
- Changes in sleep, either sleeping too much or too little
- Moving and talking more slowly than usual
- Tiredness, fatigue, low energy, or decreased productivity
- Sense of worthlessness
- Feelings of guilt or shame
- Physical symptoms, like unexplained pain and headaches
- Difficulty thinking clearly, concentrating, or making decisions
- Thoughts of death and suicide, or attempting suicide
If you have 5 or more of the above symptoms simultaneously for at least 2 weeks, or if depression has disrupted your life significantly, it’s likely severe enough to warrant a diagnosis of major depressive disorder.
Yes, there are differences between these two disorders, but dysthymia vs. depression isn’t always the right way to approach this issue. Why? Major depression and persistent depressive disorder aren’t mutually exclusive, meaning that it’s possible to have both conditions at once.
In fact, over 75% of people with dysthymia will have at least one episode of major depression in their lifetimes.
If you believe you have either of these conditions, it’s essential to talk with a healthcare professional about depression for further evaluation.
People sometimes use non-clinical terms like “functioning” or “high-functioning depression” to describe this disorder. But these labels may actually contribute to the belief that people with persistent depressive disorder symptoms don’t need or deserve the same kind of treatment as those with other types of depression.
It’s important to underscore the fact that “functioning depression” isn’t a diagnosis, nor is it a term used in clinical contexts.
Many people believe a common myth about “functional” depression: if you’re able to function, you don’t really have depression. For this reason, one of the issues people with persistent depressive disorder often face is the delay of treatment. Misinformation continues to impede timely medical care for this condition.
The truth is this: the best time to get dysthymia treatment is the earliest point when it will benefit you. If you’re experiencing symptoms, you don’t have to wait until the moment when you feel like you can’t wait any longer. Treatment for depression is available right now.
Dysthymia has only recently gained recognition as an independent depressive disorder. Persistent depressive disorder was officially introduced into The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guidebook clinicians use to diagnose mental health conditions, in 2013.
That’s why there’s limited research on persistent depressive disorder. Though we don’t understand the causes of dysthymia fully, they’re likely to overlap with major depression.
Research has long suggested that life events and genetics play a role in developing all types of depression, but so far, no genes have been linked to dysthymia.
Chronic forms of depression and other mental health conditions seem especially influenced by factors like childhood trauma and abuse. More research is needed to better understand how the causes of dysthymic disorder overlap with and differ from other depressive disorders.
Persistent depressive disorder was added to the DSM-V in 2013 to accommodate those who need psychiatric help but whose symptoms didn’t fit the criteria for MDD. To receive a dysthymia diagnosis, you must exhibit at least 2 symptoms of depression concurrently for a minimum of 2 years.
Your provider will also need to know about your mental health and medical history to rule out other mental illnesses and underlying causes for your depression, such as hypothyroidism or side effects from prescription medications.
The most effective treatments for persistent depressive disorder are a combination of prescription medication and talk therapy. Researchers have tried to figure out if therapy is more effective than medication, but so far, the results have been inconclusive.
Using both meds and therapy seems to be more effective than either on its own.
Treatment for dysthymia involves the same anti-depression medications as major depression: SSRIs and SNRIs. Some of these meds are FDA-approved to treat both anxiety and depression. These include paroxetine (Paxil), escitalopram (Lexapro), duloxetine (Cymbalta), and venlafaxine (Effexor).
SSRIs (selective serotonin reuptake inhibitors)
The meds in this class include fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro). When your brain releases serotonin, it triggers antidepressant effects. SSRIs slow down the rate at which the brain reabsorbs serotonin, allowing its benefits to last longer.
SNRIs (serotonin and norepinephrine reuptake inhibitors)
SNRIs are medications like Cymbalta, Effexor, and desvenlafaxine (Pristiq). These meds work in a similar way to SSRIs. But SNRIs slow the absorption of norepinephrine as well as serotonin. While serotonin is associated with mood, appetite, and pain control, norepinephrine has been linked to anxiety and motivation regulation.
Therapy has been shown to improve clinical outcomes for those with dysthymia, especially when used in conjunction with medications.
Talk therapy goes beyond just treating the symptoms of depression—it aims to help you acknowledge, understand, and overcome any underlying issues that impact mental health and overall wellness.
There’s no official recommendation for which type of therapy should be used for persistent depressive disorder. But cognitive behavioral therapy (CBT) seems a promising option.
Cognitive behavioral therapy has garnered a lot of attention in recent years for its efficacy in treating obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), substance abuse, and other mental health issues.
CBT helps to restructure the way you think by showing you how to recognize negative thought patterns, enabling you to disarm harmful self-talk in the moment and prevent it in the future.
Behavioral and lifestyle changes
Common behavioral and lifestyle suggestions that support mental health include physical exercise, a healthy diet, getting enough sleep, and managing stress.
Prioritizing these things can be challenging for anyone but are especially difficult for people with depression. Small, gradual changes tend to be easier to maintain in the long run, so start with something manageable.
Any progress you make counts and matters. Give yourself credit for every step you take in the right direction and go at your own speed.
This might mean committing to a walk around the block after work a few nights a week or limiting caffeine or alcohol. Whatever your goals are, focus on consistency rather than speed or perfection.
Seeking treatment for depression can feel overwhelming, especially if your daily life is already leaving you drained. Think you may have persistent depressive disorder? It’s essential to recognize periods of feeling better than usual as opportunities to reach out for help, rather than mistaking them as signs that you don’t need it.
People with dysthymia generally benefit from a combination of medication, talk therapy, and behavioral and lifestyle changes.
Everyone’s brain chemistry is different, so there’s no way of knowing whether a prescription medication will work for you until you try it. Generally, it takes 4 – 6 weeks before these meds start to help, which is another excellent reason to seek treatment sooner rather than later.
For millions of Americans, appropriate mental health care can mean the difference between functioning and thriving. Whether you have experienced depression for years or are just beginning to notice symptoms, now is the right time to get help.
No matter how you seek treatment, medical professionals are available to answer your questions and help you get the care you need. Don’t wait—get treatment now.
- Persistent depressive disorder, or dysthymia, is a long-lasting form of moderate depression.
- The causes of dysthymia aren’t fully understood but include life events, genetics, and environmental conditions like abuse and trauma.
- The most effective treatments are a combination of medication and talk therapy.
- Behavioral and lifestyle changes like exercise, stress reduction, and rest can further support your recovery.
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