Dysthymia (Persistent Depressive Disorder)

Overview

Dysthymia, now usually called persistent depressive disorder, is a chronic form of depression. Instead of the intense episodes seen in major depression, dysthymia involves a low, sad, or down mood that lingers most of the day, on more days than not, for at least two years (one year in children and teenagers). The symptoms may be milder than major depression but last much longer.

Because the low mood becomes a constant background, some people come to think of it as simply part of their personality. Yet dysthymia is a treatable medical condition. With talk therapy, medication, or both, many people experience meaningful relief and a better quality of life.

Symptoms

The central feature is a persistently low mood, present for two years or more, along with other symptoms. People with dysthymia often have:

• A down, empty, or sad mood most of the time
• Low energy or fatigue
• Poor self-esteem or feelings of inadequacy
• Difficulty concentrating or making decisions
• Changes in appetite (eating too little or too much)
• Sleep problems (sleeping too little or too much)
• A sense of hopelessness
• Reduced interest or enjoyment in everyday activities

Sometimes a major depressive episode occurs on top of dysthymia, a pattern sometimes called double depression. If you ever have thoughts of harming yourself, seek help immediately.

Causes

Like other forms of depression, dysthymia does not have a single cause. It is thought to result from a combination of factors:

• Brain chemistry: Differences in the brain's mood-regulating systems.
• Genetics: A family history of depression raises risk.
• Life experiences: Chronic stress, loss, trauma, or difficult early-life circumstances.
• Temperament: A tendency toward negative or pessimistic thinking.
• Other conditions: Chronic illness or other mental health conditions can contribute.

Risk Factors

• A family history of depression or other mood disorders
• Early-life trauma, loss, or chronic stress
• A tendency toward negative or self-critical thinking
• Other mental health conditions, such as anxiety
• Chronic physical illness
• Lack of social support

Diagnosis

A doctor or mental health professional diagnoses dysthymia based on a detailed conversation about your mood, symptoms, and how long they have lasted. There is no blood test for depression, but evaluation may include:

• A clinical interview reviewing your symptoms and their duration (at least two years for adults).
• Questionnaires that measure mood symptoms.
• A medical check to rule out conditions such as thyroid problems that can mimic depression.
• Screening for other conditions, such as anxiety or substance use.

Treatment

Dysthymia responds well to treatment, often a combination of therapy and medication.

• Psychotherapy: Talk therapies such as cognitive behavioral therapy help you recognize and change unhelpful thinking patterns and build coping skills.
• Antidepressant medication: Several types can help; finding the right one may take some trial and adjustment, and medications need to be taken consistently to work.
• Combined treatment: Therapy plus medication is often more effective than either alone for long-lasting depression.
• Lifestyle support: Regular exercise, good sleep, social connection, and limiting alcohol all support recovery.

Because dysthymia is long-standing, treatment may continue for an extended period, and ongoing support helps prevent relapse.

Prevention

• Seek help early when low mood persists rather than waiting
• Build and maintain supportive relationships
• Develop healthy ways to manage stress
• Keep up regular physical activity and good sleep habits
• Continue treatment as advised to reduce the risk of relapse

When to See a Doctor

See a doctor or mental health professional if you have felt down, empty, or hopeless most days for weeks or longer, or if low mood is affecting your work, relationships, or daily life. Seek help promptly if symptoms worsen.

If you have thoughts of harming yourself or of suicide, seek help immediately. Call your local emergency number or a suicide and crisis helpline right away, or go to the nearest emergency department. You do not have to face these thoughts alone, and help is available.

Related Topics

Frequently Asked Questions

References

1. National Institute of Mental Health (NIMH). Depression.
2. MedlinePlus, U.S. National Library of Medicine. Persistent depressive disorder (dysthymia).
3. Mayo Clinic. Persistent depressive disorder — Symptoms and causes.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.