Depression comes in many different forms.\u00a0 One type that is quite common but not often discussed is a type of depression known as dysthymia.\u00a0 Dysthymia (also called dysthymic disorder) is a milder form of depression than major depression that affects nearly 11 million adults in the U.S. Whereas the symptoms of major depression need to last only 2 weeks in order to meet the criteria for a diagnosis, dysthymia is a chronic disorder.\u00a0 The symptoms must last for at least 2 years.\u00a0 For many people, however, the symptoms last for many years \u2013 even decades - if not treated.\u00a0 Unfortunately, many people with dysthymia don\u2019t seek treatment because the symptoms don\u2019t seem serious enough to them or they\u2019ve been that way for so long that it feels normal. Although the symptoms of major depressive disorder are more intense and can be disabling, dysthymic disorder can be particularly challenging because it can last for many years.\u00a0 This takes a toll on those who have it, often making life feel like a constant challenge.\u00a0 It\u2019s difficult to function or feel your best when you struggle with low self-esteem, lack of motivation, or a pessimistic outlook on life.\u00a0 In fact, although the day-to-day symptoms are mild compared to major depression, the chronic nature of the disorder can lead to thoughts of suicide. Symptoms Dysthymic disorder and major depressive disorder share many symptoms.\u00a0 The primary difference is that, with dysthymia, they are less intense.\u00a0 The primary symptom in adults is a chronically depressed mood, lasting for at least two years.\u00a0 This is typically described as feeling sad or down. To meet the criteria for a diagnosis of dysthymic disorder, two of the following 6 symptoms must also be present while feeling depressed: \tInsomnia or hypersomnia (excessive sleep) \tPoor appetite or overeating \tLow self-esteem \tFatigue or low energy \tDifficulties concentrating or making decisions \tFeelings of hopelessness Other symptoms often include: \tFeelings of emptiness \tApathy\u00a0 \/ loss of interest in day-to-day activities \tDifficulties enjoying life \tFeelings of helplessness \tSocial withdrawal or isolation \tFrequent self-criticism \tPersistent physical symptoms (e.g. problems with digestion, aches, headaches) that don\u2019t improve despite treatment \tThoughts of suicide Children with dysthymia may exhibit irritability rather than a depressed mood, and the symptoms need to last only 1 year.\u00a0 They may perform poorly in school and struggle socially.\u00a0 They tend to have a negative outlook as well. Causes As with most mental health disorders, the exact cause of dysthymia remains a mystery.\u00a0 However, it is most likely a combination of the following factors: Genetics:\u00a0 Dysthymia is more likely to develop when there is a family history of major depression or dysthymia. Biochemistry:\u00a0 As with other types of depression, dysthymia is likely caused in part by an imbalance of brain chemicals \u2013 neurotransmitters, such as serotonin \u2013 that help regulate mood. Environmental factors:\u00a0 Highly stressful events may trigger or contribute to the development of dysthymia.\u00a0 These may include things like the death of a loved one, work stress, or ongoing financial difficulties. Associated problems: Individuals with dysthymia often experience other problems as a result, including substance abuse, relationship and family problems, poor work or school performance, low productivity, and a decreased quality of life.\u00a0 They often become socially isolated.\u00a0 The risk for developing major depression is also increased for those with dysthymia.\u00a0 When both disorders occur at the same time, it is often referred to as \u201cdouble depression\u201d.\u00a0 The long term nature of this disorder can ultimately trigger thoughts of suicide and suicidal behavior. Diagnosis There are no tests for dysthymia.\u00a0 Usually, the diagnosis is made by a mental health professional who recognizes the chronic pattern of symptoms.\u00a0 Other potential causes for the symptoms must be ruled out, including a health condition (e.g. hypothyroidism), a medication, or ongoing substance abuse.\u00a0 A diagnosis is not made unless the symptoms cause significant distress or create problems in important aspects of life such as work or school performance, personal relationships, or social functioning. Treatment There are two types of depression treatment that are generally recommended for dysthymic disorder:\u00a0 psychotherapy and medication. Psychotherapy While many types of psychotherapy may be beneficial, cognitive behavioral therapy (CBT) is one of the most effective types of psychotherapy for depression, including dysthymia.\u00a0 A skilled cognitive behavioral therapist can help individuals with dysthymia identify and change negative thought patterns.\u00a0 These thought patterns often fuel the depressive symptoms, particularly low self-esteem, hopelessness, pessimism, and self-criticism. With dysthymia, these thought patterns have become deeply ingrained and can be difficult to change without the help of a trained therapist. Psychotherapy can also help people develop healthy coping skills, learn to manage stress more effectively, learn good decision-making skills, overcome self-defeating behaviors, and create a support network.\u00a0 Each of these things can help to significantly reduce symptoms and help individuals live a happier, more productive life. Medication Medication is not always necessary with dysthymic disorder.\u00a0 However, in some cases it may be a beneficial treatment when used in combination with psychotherapy.\u00a0 Generally, medication alone is not a good treatment for depression because once stopped, the symptoms often return.\u00a0 Since dysthymia is a chronic condition, medications usually need to be taken long term. Antidepressant medications are typically prescribed for dysthymic disorder.\u00a0 There are different types of antidepressants available. The two types most frequently prescribed are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors).\u00a0 This is because their side effects tend to be milder than those of other types of antidepressants.\u00a0 They can be very effective, but as with all medications, they don\u2019t work for everyone. SSRIs\u2013 Medications in this category include Paxil, Zoloft, Prozac, Celexa, and Lexapro. SNRIs \u2013Medications in this category include Effexor, Pristiq, and Cymbalta. TCAs (tricyclic antidepressants) \u2013 These include Elavil, Anafranil, Tofranil, and Sinequan NDRIs (norepinephrine and dopamine reuptake inhibitors) \u2013 These include Remeron and Wellbutrin. MAOIs (monoamine oxidase inhibitors) \u2013 These include Nardil and Parnate. When it comes to medication, there is often a period of trial and error before finding a medication that is not only effective, but also has tolerable side effects.\u00a0 The benefits must always outweigh the costs.\u00a0 With most antidepressants, the full effects are not experienced for several weeks.\u00a0 Discontinuing any medication should always be done under a doctor\u2019s supervision.\u00a0 Stopping some medications suddenly can cause unpleasant side effects or withdrawal symptoms. Common antidepressant side effects include sleep disturbance, weight loss or gain, problems with sexual performance or decreased libido, and dry mouth.\u00a0 Unlike other antidepressants, MAOIs can have serious (and potentially fatal) interactions with certain foods, beverages, and other medications.\u00a0 They are usually the last choice because of the serious restrictions involved when taking them. In order for treatment to be effective, it\u2019s very important to stick with it.\u00a0 Although it can be tempting to skip a therapy session or medication dose, doing so will only defeat their purpose.\u00a0 In most cases, the symptoms will return if treatment is stopped prematurely. Other remedies and lifestyle changes that may help In addition to psychotherapy and medication, there are other things you can do to help reduce the symptoms of dysthymia.\u00a0 These include: Exercise regularly.\u00a0 Numerous studies have shown that regular exercise \u2013 particularly aerobic types of exercise (e.g. running, biking, swimming) \u2013 helps reduce symptoms of depression.\u00a0 It also helps to improve sleep, increase confidence, and improve self-esteem. Stay away from street drugs, medications that aren\u2019t prescribed, and alcohol.\u00a0 It can be tempting to self-medicate with substances when you feel sad or down.\u00a0 Unfortunately, they won\u2019t help your depression and often make it worse. They can also interfere with your treatment.\u00a0 If you have a problem with substance abuse talk to your doctor or therapist about treatment. Educate yourself.\u00a0 Learning everything you can about your disorder.\u00a0 This will help you understand it better, and hopefully keep you motivated with regards to your treatment.\u00a0 It will also help you understand that it\u2019s not your fault or a sign of weakness that you struggle with depression.\u00a0 Find a type of exercise you enjoy and do it consistently, even if you don\u2019t feel like it.\u00a0 Find an exercise buddy to make it more fun and keep you motivated. Develop a good support system. People with dysthymia and other types of depression often withdraw socially.\u00a0 Over time, they can become very isolated.\u00a0 This often makes their symptoms worse.\u00a0 Make a commitment to develop a network of people who are positive and supportive. Make an effort to spend time regularly with people you enjoy.