What's Dysthymia?

Depressive disorders affect over 61 million adults throughout the United States. However, not everyone experiences depression in the same way or for the same length of time, and there are many depressive disorders one may be diagnosed with, including dysthymia. For example, when depression is mild to moderate for years and not marked by clear episodes, it can sometimes be easy to miss. To understand this type of depression, it may be valuable to learn about persistent depressive disorder, previously called dysthymia.

Dysthymia vs. Major depression

Under the Diagnostic and Statistical Manual of Mental Disorders' (DSM-5 depressive disorders category, there are several depressive disorders, including major depressive disorder (MDD), persistent depressive disorder (PDD), seasonal affective disorder, and postpartum depression, among others. To better understand dysthymic disorder, examining the difference between this condition and MDD can be helpful. 

Major depressive disorder (MDD)

Major depressive disorder (MDD) is a serious mood disorder marked by severe low mood and a loss of interest in previously enjoyed activities. To receive a diagnosis of MDD, an individual must have five or more symptoms, including a depressed mood or a loss of interest in pleasurable activities lasting for two weeks or more. 

According to the American Psychiatric Association, the characteristics of MDD include:

• A low or depressed mood
• Loss of interest in prior activities that brought enjoyment
• Changes in appetite 
• Sleep disturbances
• Fatigue or a lack of energy
• Feelings of guilt or worthlessness
• Difficulty concentrating
• Slowed thought and reduced physical movement 
• Thoughts of death or suicide

If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. The lifeline also offers an online chat for those with an internet connection.

Persistent depressive disorder (PDD)

Persistent depressive disorder (PDD) is a relatively new term. Previously, this disorder had been called dysthymic disorder or dysthymia. The dysthymia definition used by Harvard Health Publishing (based on the American Psychiatric Association’s definition) is a “depressed mood most of the time for at least two years, along with at least two of the following symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness.” The Diagnostic and Statistical Manual of Mental Disorders, DSM-5) now uses the term persistent depressive disorder.

This mental health condition is a long-term form of depression. An individual with persistent depressive disorder may feel persistent sadness, emptiness, or hopelessness and lose interest in daily activities. With persistent depressive disorder, these feelings can last for years. 

Persistent depressive disorder differs from major depressive disorder in two main ways, including the duration and severity of depressive symptoms. Persistent depressive disorder is not as severe as MDD but lasts over two years. Meanwhile, MDD is more severe but may last a shorter period, like two weeks or two months. 

The symptoms of persistent depressive disorder tend to be less severe and less intense than those experienced by individuals with MDD. However, persistent depressive disorder is a long-term disorder that can negatively impact the quality of life over an extended period. Additionally, someone with persistent depressive disorder can experience a major depressive episode while experiencing dysthymia. This diagnosis is referred to as double depression.

Dysthymia symptoms

Below are a few of the potential causes of PPD and its symptoms. 

What causes persistent depressive disorder?

One factor may not solely cause persistent depressive disorder for every person. However, some risk factors can contribute to an individual developing the condition, including but not limited to the following: 

• Brain chemistry
• A family history of the condition
• A personal history of other mental health conditions
• Trauma or major stressors
• Long-term physical illness
• Physical trauma to the brain

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Symptoms of persistent depressive disorder

While there may not be one cause of this form of chronic depression, it may be easier to identify the symptoms characteristic of persistent depressive disorder. By exploring these symptoms, you may get an idea of whether you or someone you love might be living with PDD and find ways to manage your symptoms. 

Cognitive symptoms may be more common in persistent depressive disorder. For example, low self-esteem and social withdrawal may be more prevalent than symptoms like irregular sleep and significant changes in appetite, which are more common in MDD.

Some of the symptoms of persistent depressive disorder can include: 

• Feelings of sadness or emptiness
• Loss of interest in previously enjoyed activities 
• Changes in appetite
• Difficulty sleeping 
• Fatigue 
• Feelings of low self-esteem
• Difficulty focusing
• Hopelessness
• Avoidance of social activities 
• Difficulty completing tasks
• Irritability or anger 
• Feeling guilty or worried about the past

Dysthymia treatments

Having persistent depressive disorder can sometimes be frustrating, but treatment options exist, including the following.  

Medication 

Besides therapy, certain medications may be used to treat persistent depressive disorder. Antidepressant medications are commonly used. If you want to explore medication options, it’s recommended that you find a doctor before starting, changing, or stopping medical treatments.

Lifestyle changes  

In addition to medical treatment, there are lifestyle changes an individual can try to cope with this condition. These can include:

• Getting regular exercise
• Avoiding substance use 
• Eating a balanced diet
• Cultivating a meditation practice

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Therapy

Talk therapy is a commonly recommended form of treatment for persistent depressive disorder. Two of the most common types of therapy for dysthymia are interpersonal therapy and cognitive behavioral therapy (CBT), which is often used for many mental health conditions, including anxiety disorders, mood disorders, and bipolar disorder. In therapy, individuals can discuss their emotions, thoughts, and behaviors and learn ways to cope with negative emotions healthily and manage symptoms. Talk therapy can give the individual the opportunity to set goals and regain a sense of control.

Some individuals with persistent depressive disorder may frequently feel fatigued and experience low energy, so the thought of leaving the house to seek therapy in an office setting may feel exhausting. In these cases, online therapy may be a convenient option. With online therapy through a platform like BetterHelp, you can speak with a licensed therapist from the comfort of your home without worrying about a commute or finding parking. In addition, you can choose between phone, video, or chat sessions based on your preferences. 

Research has shown that online therapy can be an effective option for reducing symptoms of depression. One study examined the effectiveness of an online therapy program for improving symptoms of depression and anxiety, and it found that the program delivered significant reductions in symptoms, comparable to those experienced by individuals in traditional in-office therapy.