Depressive disorders, illnesses that involve the body, mood, and thoughts, affect the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Without treatment, symptoms may last for weeks, months, or years, but most people can benefit from appropriate treatment.
Depressive disorders come in different forms. Dysthymia, which is less severe than major depression, entails long-term, chronic symptoms. These symptoms do not disable a person, but keep him or her from functioning well or from feeling good.
There is a significant impact of dysthymia on the people who have it, their families, and society. People with this form of mild depression are twice as likely to develop dementia. They may be unproductive and unable to care for themselves or others.
Dysthymia, which occurs by itself or in conjunction with other mood or psychiatric disorders, puts people at higher risk for anxiety and substance use disorders than major depression. More than half of people who suffer from dysthymia experience at least one episode of major depression. This condition is called double depression. In each year in the U.S., dysthymia is projected to affect 0.5% of people. As in major depression, dysthymia occurs twice as often in women as in men.
Other researchers say that dysthymia affects 3% to 6% of the population and as many as one-third of people who receive outpatient mental-health services in the United States. While older individuals are less likely to develop major depression than younger people, senior citizens appear to be more at risk for developing less severe but chronic dysthymia. Unlike the prevalence of major depression in ethnic groups in the United States, dysthymia is more common in African-Americans than in Caucasians and some Hispanic-Americans in most age groups. In the elderly, older, non-Hispanic Caucasians are thought to experience dysthymia and other depressive disorders more frequently than African-American and Asian people but with equal frequency to older Latino people. Dysthymia usually occurs along with other disorders, most often with major depression, anxiety, personality, or somatic symptom and related disorders, and alcohol or other drug abuse.
While dysthymia, also known as persistent depressive disorder (PDD), low-grade depression, or persistent mild depression, is less severe than major depression, it is more chronic. PDD, which has many symptoms in common with other kinds of clinical depression, is a less severe but more enduring form of major depression. Usually experienced for two years or more, PDD is identified by a depressed mood that is felt most of the time.
The primary symptom of dysthymia is “low, dark, or sad mood that occurs for most of the day, for more days than not, for at least two years,” according to Psychology Today. Children and adolescents suffering from dysthymia might be more irritable than depressed. Other symptoms may include insomnia or excessive sleep, low energy or fatigue, low self-esteem, poor appetite or overeating, poor concentration or indecisiveness, and feelings of hopelessness.
PDD usually does not include the severe symptoms of major depression, such as anhedonia (inability to feel pleasure), psychomotor symptoms (particularly lethargy or agitation), and thoughts of death or suicide. Symptoms, which are not a direct result of a general medical condition or substance usage, often result in impaired functioning in work, social, or personal situations.
Dysthymia is often characterized by fatigue, low energy, low self-esteem, and changes in appetite or sleep. Despite potential brief periods of normal mood, symptoms last at least two years at a time in adults and more than one year at a time in children and adolescents.
To meet criteria for the diagnosis of PDD, a person must experience depression, which can manifest itself as a loss of interest or general discontent (irritability or excessive anger in children and adolescents) most of every day, more days than not for at least two years in a row in adults, and one year for children and teens. Someone with PDD will not experience more than a two-month symptom-free period during the illness and must experience at least two of the following:
- Loss of appetite or excessive hunger
- Insomnia or excess sleepiness
- Fatigue or other physical symptoms
- Slowness in activity and thought
- Low self-esteem/feelings of inadequacy
- Lack of concentration or making decisions
A person with PDD can also have major depression, but does not suffer from cyclothymia, never has the mania or hypomania of bipolar disorder, and does not have symptoms that are better explained by another mental-health problem, the effects of a medication, drug of abuse, or medical condition.
Dysthymia is a mild but long-lasting type of depression that makes a person feel inadequate and hopeless. The condition affects productivity in work or school, enjoyment of life’s normal and special activities, and the ability to have relationships. People with dysthymia are usually chronic complainers who seem to find negatives in every situation.
Causes of Persistent Mild Depression
Persistent mild depression seems to be the result of a combination of genetic, biochemical, environmental, and psychological factors, along with chronic stress and trauma. Stress can influence a person’s ability to regulate mood and minimize the effect of mild sadness. Social situations, such as isolation and lack of social support, add to the development of PDD. Lack of social support is a major concern, because depression often makes people who could provide support uncomfortable, increasing isolation and exacerbating symptoms. Trauma, loss of a loved one, a difficult relationship, or any stressful situation can trigger PDD. Additional episodes can occur even without an apparent reason. In the case of older people, PDD might be triggered by illness, cognitive decline, bereavement, and physical disability.
Depressive illnesses are disorders of the brain that are a function of an imbalance in neurotransmitters, chemicals that brain cells use to communicate. While brain-imaging technologies, such as magnetic resonance imaging (MRI), show that the brains of people with depression look different from those of people without depression, they do not explain why the depression has occurred.
Different segments of the brain of people with dysthymia respond differently to negative emotions such as fear and sadness, and to physical sensations, as compared with the brains of people without the disorder. People who develop PDD usually have a family member who also has PDD, major depression, or a personality disorder. Major stress during childhood or adulthood—neglect, abuse, or community violence without support—can trigger PDD.
People with PDD can attempt to make lifestyle changes and use home/natural remedies for relieving or coping with the condition. Lifestyle changes may include getting adequate sleep, creating a healthy diet, exercising regularly, developing small goals, limiting alcohol consumption, and refraining from abusing other drugs. Homeopathic remedies include St. John’s wort and SAM-e, but people who have PDD should consult a physician before taking them.
According to the Johns Hopkins School of Medicine, dysthymia treatment might include medicine, therapy, or both. Many medicines are used to treat depression. It usually takes 4 to 6 weeks for antidepressants to have appropriate impact on patients. They need to keep taking the medications, consult the healthcare provider before stopping, and consider adding or switching medicines on the advice or a physician.
The most prevalent medications include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft), or one of the newer dual-action antidepressants like venlafaxine (Effexor). There are also tricyclic antidepressants like imipramine (Tofranil). Some antidepressant drugs have side effects. SSRIs can cause stomach upset, mild insomnia, and reduced sex drive in some patients.
Cognitive behavioral or interpersonal therapy may help people to change distorted views of themselves and their environment. Such therapy can help to improve relationship skills and identify and manage stressors.
Curious if you or someone you love has dysthymia? If you answer “yes” to several questions on this dysthymia test, you may want to consider seeking treatment.