You've likely heard the term “depression” quite a few times in your life, but have you heard the term “dysthymia?” Also known as persistent depressive disorder (PDD), dysthymia can impact your relationships with family and friends, your work experience, your personal life, your physical health, and even your ability to accomplish daily activities. This article explores these mental health disorders from a medical standpoint to help you learn more about dysthymia and each type of depression.
Dysthymia is actually a type of depression, but it’s considered milder than mental health conditions such as major depressive disorder. That doesn’t mean that dysthymia isn’t a serious chronic condition or that the symptoms, such as depressed mood, aren’t challenging to cope with. However, dysthymia will generally have fewer intense side effects and symptoms than those with other types of depression will face.
For a dysthymia diagnosis, symptoms must be ongoing for at least two years. PDD symptoms are generally milder, but last longer than Major Depression.
As the American Psychological Association explains, depression is not just feeling sadness at times, but rather “extreme sadness or despair that lasts more than days.” It is also the most common mental disorder.
While there are several types of depression, the term is most commonly used to describe major depressive disorder. This is the more extensive and more severe form of what is considered clinical depression. It tends to create physical and emotional symptoms for individuals and it can interfere with work, family, friends, social life, and personal relationships. In extreme cases, it can lead to suicide or attempted suicide.
If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 988, and is available 24/7.
Dysthymia Vs. Depression
The first major difference between major depressive disorder and dysthymia is that they interact with mood in slightly different ways. Both those diagnosed with dysthymia and those with major depressive disorder will have times where they feel depressed. However, those with major depressive disorder will also have times where they do not experience depression. Those with dysthymia will generally experience depression at all times and will not have periods where they feel “normal.”
The second major difference is that major depressive disorder and dysthymia require different amounts of time to be diagnosed. Someone who is experiencing major depressive disorder must have symptoms for at least a period of two weeks in order to be diagnosed. Someone who is experiencing dysthymia or persistent depressive disorder must have symptoms for at least a period of two years in order to be diagnosed. These periods of time allow the mental health professional to tell whether the symptoms are persistent or not. It is possible for a major depressive disorder diagnosis to lead to a persistent depressive disorder diagnosis as time continues.
The intensity of the symptoms is different between major depressive disorder and dysthymia as well. Whereas someone with major depressive disorder will generally have more severity to their symptoms, someone with persistent depressive disorder will have milder, but more persistent symptoms. This means that the symptoms associated with persistent depressive disorder may not be as debilitating or as intense, but they last longer. Someone with major depressive disorder may have more intense outbursts, but the symptoms will come and go over time. This isn't to say that either one is easier to handle, but that they are different.
Dysthymia & Depression Symptoms
Both PDD and major depressive disorder have the same symptoms, just for different lengths of time and intensities. These may include:
- Anger and frustration at small inconveniences
- Loss of interest in normal daily activities, including sports and hobbies
- Increase or decrease in sleep
- Lack of energy for even simple tasks
- Increase or decrease in appetite
- Increase or decrease in weight
- Feelings of sadness, emptiness or hopelessness
- Feelings of guilt or worthlessness
- Difficulty concentrating, making decisions, or remembering things
Because of the way that these two types of depression are defined, they are considered separate disorders, and therefore can also occur concurrently. Someone who has been diagnosed with persistent depressive disorder, for example, may have a major depressive episode that then leads to a diagnosis of major depressive disorder as well. When this happens, the clinical world refers to it as “double depression.”
It is important that you communicate with your mental health professional about what you are experiencing and when so they can help you work through your symptoms and get the proper treatment for all of them.
Dysthymia & Depression Treatment
Although the two disorders are different, their treatments are generally similar. Depression of all types typically uses a combination of two different types of treatment: psychotherapy and medication. For each individual, the specific treatments used will vary slightly.
The two most common types of therapy used to help treat depression are behavioral activation (BA) and cognitive behavioral therapy (CBT). Each of these focuses on the way that you feel and the way that your thought patterns can be adjusted to create positive changes in your moods or behaviors. They both have shown great success in treating patients with depression to make dramatic changes by helping them recognize their own influence, and control, over their thoughts and behaviors.
BetterHelp is one place you can find the type of help that you're seeking. With BetterHelp, you're getting a complete online service that will connect you with the mental health professionals you need. Because everything is online, you can connect from anywhere in the country that has an internet connection. This gives you the freedom to attend a session from the comfort of your own home.
Research finds that online therapy can be as effective for individuals with depression as in-person counseling. A medically reviewed study published in the Journal of Medical Internet Research found that patients receiving CBT therapy via video chat experienced reductions in depression symptoms, indicating that online therapy for depression can produce “sustained and clinically meaningful improvements.” In another literature review, internet-based cognitive behavioral therapy was shown to be a cost-effective option for patients with depression, and was particularly helpful for those who lived in more rural areas.
A number of different types of antidepressant medications have shown success in treating depression. They may be used in conjunction with talk therapy or modalities such as cognitive behavioral therapy. In general, some of the following types of medication are used to treat depression:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
The specific medication and dosage prescribed will vary from patient to patient. It's important to talk with your mental health professional about the different options to see what you could be doing to help yourself as well.
With BetterHelp, you also aren’t limited by the mental health professionals who are available in your area, giving you more freedom to choose someone you trust and with whom you feel comfortable. Not only that, it allows you to review far more information and qualifications before you narrow down your choice. There's no reason to settle for a therapist with whom you aren't entirely comfortable. Through BetterHelp, you don’t have to.
FAQs On Dysthymia
Is dysthymia a personality disorder?
No. But at one time, the disorder that is now called persistent depressive disorder was called"depressive personality." This name indicated the prior belief that depression was just a part of who someone with persistent depressive disorder was, likely because the depression lasts so long. However, modern experts have a different understanding of persistent depressive disorder now. Instead of a personality disorder, dysthymia is seen today as a depressive disorder. The main difference is that dysthymia doesn't necessarily last for a lifetime. On the other hand, while treatment can help people manage their personality disorder, that type of disorder isn't likely to ever go away completely.
It is true that some experts have pushed to reintroduce the label of depressive personality disorder. If so, this personality disorder would probably include symptoms like strong tendencies to be self-critical, critical of others, have guilty feelings, and be pessimistic, gloomy, and brooding. But this is different from persistent depressive disorder, too, because this personality disorder would not include loss of interest or physical symptoms as dysthymia does.
Which antidepressant is best for dysthymia?
According to an article published by the National Institute of Mental Health, selective serotonin reuptake inhibitors are often the best choice for people with persistent depressive disorder. SSRIs are not only quite effective for most people with this depressive disorder, but most people also tolerate them well.
However, not everyone thrives on the same medication. For example, SSRIs aren't very effective in reducing anhedonia in elderly people. And anyone of any age may need a different medication. Other choices for dysthymia include serotonin norepinephrine reuptake inhibitors (SSNRIs) and tricyclic antidepressants.
Can dysthymia be cured?
Yes, in the following sense. To cure simply means to relieve the symptoms of a condition, such as physical or mental illness With a combination of medications and psychotherapy, people can find relief from the symptoms of persistent depressive disorder.
Now, that doesn't mean that if the symptoms go away, they will never come back. Think of cancer. Someone with cancer can receive treatments, and the symptoms and all the signs of cancer can be gone. Yet, they might still have cancer again at some point. The same is true of any depressive disorder. Treatment may put an end to your symptoms of persistent depressive disorder, but it can still return in the future. For example, you may begin to notice yourself feeling sad and having a poor appetite or overeating. If so, don't wait for other dysthymia symptoms to start. Instead, it's always a good idea to stay alert to warning signs of a depressive disorder. Then, find a doctor, and get help if you begin to notice they're returning.
What is the difference between PDD and MDD?
PDD, or persistent depressive disorder, is typically longer lasting than MDD, or major depression. To get a diagnosis of major depression, you would have depressed mood, decreased interest, and other symptoms during the same two-week period, although major depression episodes often last several months. For a diagnosis of persistent depressive disorder, on the other hand, you would have symptoms like depressed mood, loss of enjoyment, and other signs of depression for most of the day, more days than not, for at least two years. In other words, while major depression is an acute disorder, PDD is a chronic form that lasts for a long time.
As for severity, major depression has symptoms that are more severe than persistent depressive disorder. Major depression is more disabling. But that doesn't mean that PDD is mild. It can be extremely distressing and disrupt your work, family, and social life.
Sometimes, people can have both PDD and MDD. This happens when someone has persistent dysthymia symptoms in the long term, but then at some point, they have a more acute depressive episode. This is called double depression because the person has both the chronic form and an acute, severe episode of depressive disorder.
Dysthymia symptoms include:
- Depressed or sad mood
- Loss of pleasure in things once enjoyed
- Weight loss or weight gain of more than 5% in a month
- Increased appetite or overeating, or decreased appetite and undereating
- Insomnia or oversleeping
- Restlessness or feeling run-down
- Lack of energy or fatigue
- Feelings of hopelessness, worthlessness, or guilt
- Problems making decisions or concentrating
- Thoughts of death or suicide
These same symptoms are present in both mental health conditions. It's the severity and intensity of the symptoms that are different in major and persistent depressive disorder. It's important to get help if you suspect you have either of these types of depression. If you notice these warning signs of a depressive disorder, it's critical that you find a doctor who can tell you what kind of depression it is and offer effective treatments.
Risk factors for depressive disorder are the same for both persistent depressive disorder and MDD, as well as for nearly any other depressive disorder. They include, according to the institute of mental health:
- Personal history of depression
- Family history of depression
- Major life changes, stress, or trauma
- Some physical illness and medications
Both kinds of depressive disorder can also co-occur with other mental illnesses, such as anxiety disorders.
Is MDD worse than PDD?
No, not necessarily. Although major depressive episodes are acute and severe, the seemingly never-ending depressive symptoms that come with persistent depressive disorder can have more lasting effects on your life. Either depressive disorder is serious enough to warrant getting help. And either depressive disorder can have dire consequences for your health, relationships, career, and all aspects of your life. Even the lower-intensity persistent depressive disorder can lead to suicide, just like other depressive disorder can. The important thing is not whether MDD or persistent depressive disorder is worse but that both are bad enough to require attention from a mental health professional.
How long does dysthymia last?
Dysthymia, or persistent depressive disorder, is a long-term form of depression. People with dysthymia have depression symptoms most of the time for at least two years. And persistent depressive disorder can last even longer, especially if you don't get treatment for it.
Is dysthymia a form of bipolar?
No. These two conditions can't happen together. The reason is that when you have persistent depressive disorder, you have consistent symptoms of depression for at least two years. But to be diagnosed with bipolar disorder, you have to have a manic or hypomanic episode. Since those two things can't be true at the same time, you can't have one and also have the other.
However, sometimes people who have chronic depression over a long period of time eventually have a manic or hypomanic episode. It isn't that the two disorders are happening at the same time. It's just that no one could recognize the bipolar disorder until the depressive symptoms gave way to mania or hypomania. After that happened, the diagnosis would change to bipolar.
How do you deal with dysthymia?
You deal with persistent depressive disorder much the same way as any other depressive disorder, although you may need to be in treatment for longer. Any kind of depression requires treatment, though. The institute of mental health recommends antidepressants and psychotherapy as the first-line treatments for a depressive disorder. If those treatments aren't helpful, sometimes brain stimulation therapies like ECT can help reduce the symptoms of a depressive disorder.
Other things you can do for yourself include:
- Avoiding substance abuse or getting help for it.
- Getting treatment for other health conditions
- Getting therapy for anxiety disorders
- Living a healthy lifestyle
- Getting enough sleep
- Developing a strong social support system
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