According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Persistent Depressive Disorder or Dysthymia represents a consolidation of the DSM-IV-defined chronic major depressive disorder and dysthymic disorder (commonly referred to as “Dysthymia”). People with dysthymia describe their mood as sad or “down in the dumps,” but dysthymia is more than simply feeling sad. Dysthymia is a chronic form of depression that can cause people to lose interest in normal daily activities, have low self-esteem and an overall feeling of inadequacy, feelings of hopelessness, and difficulty with productivity. Given the chronic nature of dysthymia, these feelings can last for years and negatively impact relationships, employment, education, and other daily activities. People with dysthymia often find it difficult to be “upbeat,” even during good times. They might be perceived as gloomy, pessimistic, or a complainer.
While the depressed mood experienced with dysthymia is not as severe as a major depressive disorder, a diagnosis of dysthymia requires having experienced a combination of depressive symptoms for two years or more. According to the National Institute of Mental Health (NIMH), dysthymia affects approximately 1.5% of the adult population in the United States. 49.7% of these cases are considered “severe”, and the average age of onset is 31 years. Dysthymia can affect children and adolescents. Data from NIMH shows that depressive disorders (major depressive disorder or dysthymia) affect approximately 11.2% of 13 to 18-year-olds at some point during their lives and that girls are more likely than boys to experience a depressive disorder.
The exact cause of dysthymia is unknown, but as with major depressive disorder it may include more than one cause, including some of the following:
- Brain chemistry – some brain regions have been implicated in dysthymia
- Genetics – having a first degree relative with a depressive disorder increases the risk
- Environmental/life events – loss of a parent during childhood, traumatic events such as loss, financial problems, and high levels of stress can trigger dysthymia
- Personality traits that include negativity – low self-esteem, pessimistic, self-critical, dependent upon others
- History of other mental disorders.
The essential feature of dysthymia is a depressed mood that occurs for most of the day, for more days than not, for at least two years for adults or one year for children and adolescents. Symptoms of dysthymia can come and go over time, and the intensity of the symptoms can change, but symptoms don’t disappear for more than two months at a time. Symptoms of dysthymia can include:
- Poor appetite or overeating
- Loss of interest in daily activities
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem, self-criticism, or feeling incapable
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
- Decreased activity and productivity
- Social isolation
- Irritability or anger
- Sadness or feeling down
- Feelings of guilt
- In children, depressed mood and irritability are often primary symptoms.
Due to the chronicity of symptoms, people sometimes feel like persistent sadness is just part of life. If you do experience symptoms of dysthymia, it’s important to seek treatment. A great first step is to get a physical evaluation from your primary care physician to rule out any potential medical causes of the symptoms. Keep a log of your symptoms over a few weeks to help your doctor gain a better understanding of how the symptoms impact your daily living. The two main treatments for dysthymia include medication and psychotherapy, but your treatment plan will depend upon factors such as severity of the symptoms, your preferences, your ability to tolerate medications, and previous mental health treatment. For children and adolescents, psychotherapy is the first recommendation.
The types of antidepressants most commonly used to treat dysthymia include the following:
- SSRIs (Selective serotonin reuptake inhibitors)
- TCAs (Tricyclic antidepressants)
- SNRIs (Serotonin and norepinephrine reuptake inhibitors)
It’s important to ask your doctor for detailed information about any potential side effects of medication and to discuss any history of suicidal thoughts or attempts. Though antidepressant medications can cause uncomfortable side effects for some, you should never abruptly stop taking these medications. Always consult your prescribing physician before making any changes to medication.
Talk therapy, or counselling, is a general form of treating dysthymia by discussing your symptoms and how they impact your life with a mental health provider. There are many benefits of psychotherapy, including:
- Crisis and symptom management
- Identifying triggers that contribute to your dysthymia and coping strategies to manage them
- Identifying negative beliefs and replacing them with positive ones
- Learning adaptive problem-solving skills
- Exploring ways to build positive relationships with others
- Improving self-esteem
- Learning to set and attain personal goals
Any treatment plan for dysthymia should include healthy changes in lifestyle, including:
- Establishing healthy sleep patterns
- Daily exercise
- Assistance with life skills, as necessary
While there is no “cure” for depressive disorders, people living with dysthymia can live happy and fulfilling lives. Symptoms can ebb and flow over time, but creating a solid support system and seeking professional help will help you along your journey to recovery.
Credit: Katie Hurley for Psycom, DSM-V.