Dysthymia: Understanding Persistent Mild Depression and Seeking Treatment
Many people hear the word depression and immediately get a picture in their head of what that means—whether that’s sadness, suicidal thoughts, or feelings of hopelessness. But most people are probably not aware that there are actually many different types of depression, each of which is distinguished by the symptoms involved or the timing or duration of the illness. In this article, we’re going to take a closer look at a form of chronic depression known as dysthymia. We’ll discuss what it is, symptoms to watch out for, and treatment options that can help people suffering from this potentially disabling depressive disorder regain the life they thought they’d lost.
What Is Dysthymia?
As mentioned, dysthymia, or persistent depressive disorder (PDD), is a chronic form of depression. Though the symptoms experienced with this type of depression are milder than those seen with major depressive disorder, it’s not uncommon for people with dysthymia to experience major depressive episodes as well. In fact, it’s estimated that approximately three quarters of people with dysthymia also experience at least one episode of major depression—a situation that’s known as double depression.
Moreover, unlike major depression, in which people experience episodes of severe depression followed by periods characterized by a complete lack of symptoms, the chronic nature of dysthymia means that symptoms of depressed mood are consistently present.
However, most people with dysthymic disorder experience an insidious onset of symptoms, sometimes beginning as far back as childhood. And symptoms are so pervasive that they color an individual’s entire life until depression seems like an integral part of existence.
What Causes Dysthymia?
As with major depressive disorder, the exact cause of dysthymia isn’t known, but it’s thought to possibly be related to genetic differences, including alterations in brain structure and neurotransmitter levels.
In addition, at least three quarters of people with dysthymic disorder suffer from medical illnesses like chronic pain, other mood disorders, or substance abuse, the coexistence of which can make it difficult to pinpoint the exact cause of the dysthymia.
Prevalence of Dysthymia
According to the National Institute of Mental Health (NIMH), approximately 1.5% of adults in the United States experience symptoms of dysthymia each year, with women affected twice as often as men (similar to major depression).
However, some studies estimate numbers much higher than this—3% to 6% of the population—and postulate that as many as a third of people who receive outpatient mental health services in the United States suffer from dysthymia.
Risk Factors for Dysthymia
While genetic differences can make an individual more prone to dysthymic disorder, additional factors may also increase the risk of developing the condition. These include:
- Family history: People with a parent, sibling, or child with dysthymia are more likely to have the condition themselves.
- Life events: People who’ve suffered traumatic life events or long-term stress are more at risk of developing dysthymia.
- Personality traits: People with low self-esteem or pessimistic or dependent traits have a greater risk of developing dysthymic disorder.
- Mental health: People with a history of personality disorders or other mood disorders are more at risk of dysthymia.
Symptoms of Dysthymia
While the symptoms of dysthymia may wax and wane, they don’t typically disappear for more than 2 months at a time. Symptoms must also be present on a chronic basis. Therefore, the American Psychiatric Association defines dysthymia as depressed mood that’s present most of the time for a period of at least 2 years in adults and 1 year in children and adolescents. In addition, at least two of the following must be present:
- Poor appetite or overeating
- Insomnia or oversleeping
- Fatigue or low energy
- Low self-esteem
- Indecisiveness or poor concentration
Additional symptoms that may be seen with dysthymia include:
- Loss of interest
- Excessive worry or guilt
The insidious and chronic nature of dysthymia—as well as its intermingling with other medical conditions and mental illnesses—can make it difficult to diagnose. However, depressive disorders not only have a negative effect on quality of life, but studies have also found that people with depression are more than twice as likely to develop dementia.
Therefore, it’s important that people suffering from dysthymia seek the medical advice of a qualified health care provider who can help them get the treatment they need to improve their quality of life and prevent possible complications.
After first speaking with you about your symptoms, your health care professional may then ask you about your medical history and perform a physical examination and blood tests to rule out potential medical causes of depression.
Even after these tests, your primary care provider may continue to have questions, as the symptoms of dysthymia can be quite subtle. For this reason, you may be referred to a mental health professional for a psychological evaluation to help determine whether you have persistent depressive disorder or another mood disorder.
If you’ve been diagnosed with dysthymia, treatment will depend on a number of factors, including the severity of your symptoms and personal treatment preference.
However, studies have found that therapy that focuses on fostering a positive working relationship between you and your mental health professional, increasing your understanding of yourself and your condition, and teaching you how to become more flexible in approaching problems can greatly increase the chance of recovery.
The most successful approaches involve various forms of psychotherapy, or talk therapy. Some of the most effective are:
- Cognitive behavioral therapy (CBT): CBT is generally a short-term treatment, but one that can be highly effective in people with dysthymia. By addressing ongoing problems, finding more effective coping strategies, and developing new ways of processing feelings, thoughts, and behaviors, CBT can help individuals learn new and more effective ways of coping with dysthymia triggers.
- Interpersonal therapy (IPT): This type of therapy focuses on an individual’s relationships with other people, including family members and friends, and works to improve interpersonal skills, thus reducing symptoms of dysthymia related to difficult relationships and communication issues.
- Cognitive behavioral analysis system of psychotherapy (CBASP): CBASP is an integrative therapy that combines aspects of cognitive, behavioral, interpersonal, and psychodynamic therapies. During CBASP, individuals learn how to recognize the consequences of their behavior on others (and change it) and how to examine past traumatic experiences and heal from them. In addition, they’re taught social problem-solving skills, including assertiveness training, the goal of which is to learn new ways of responding to everyday problems.
Although CBASP was specifically designed for use in adults, both CBT and IPT have been shown to be effective in teens. And a relatively new type of therapy called family-focused treatment for childhood depression (FFT-CD) has shown promise in children aged 7 to 14.
FFT-CD is a 15-session family treatment that’s designed to enhance support within families by decreasing criticism and increasing supportive interactions. FFT-CD also helps children strengthen their communication and problem-solving skills and encourages participation in previously pleasurable activities.
Like major depressive disorder, treatment for dysthymia also usually includes antidepressant medications. The most commonly prescribed medications for dysthymic disorder are tricyclic antidepressants like imipramine (Tofranil), selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft), and serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor).
Because every individual is different, it may take some patience to find the medication or combination of medications that works for you. It can also take several weeks for certain drugs to take effect, and some people may experience unwanted side effects, such as nausea, dry mouth, weight gain, drowsiness, or reduced sex drive.
Beyond structured therapy and medication, certain lifestyle changes can help individuals with dysthymia manage symptoms. For example, getting adequate sleep, exercising regularly, limiting alcohol consumption, avoiding illicit drug use, using amino acids to help balance brain chemicals, and eating a healthy diet—including limiting sugar and caffeine and increasing consumption of green leafy vegetables, whole grains, and omega-3 fatty acids—can all help support mental health.
If you have dysthymia, you may feel like it’s been a part of you so long that things will never be any different, but as we’ve seen, there are a number of treatments that can help lift the cloud of dysthymia. So if you’re struggling with the symptoms of this chronic depressive disorder, don’t hesitate to seek the medical advice of a qualified mental health professional.