Depression comes in many different forms. One type that is quite common but not often discussed is a type of depression known as dysthymia. 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. The symptoms must last for at least 2 years. For many people, however, the symptoms last for many years – even decades – if not treated. Unfortunately, many people with dysthymia don’t seek treatment because the symptoms don’t seem serious enough to them or they’ve 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. This takes a toll on those who have it, often making life feel like a constant challenge. It’s difficult to function or feel your best when you struggle with low self-esteem, lack of motivation, or a pessimistic outlook on life. 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.
Dysthymic disorder and major depressive disorder share many symptoms. The primary difference is that, with dysthymia, they are less intense. The primary symptom in adults is a chronically depressed mood, lasting for at least two years. 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:
- Insomnia or hypersomnia (excessive sleep)
- Poor appetite or overeating
- Low self-esteem
- Fatigue or low energy
- Difficulties concentrating or making decisions
- Feelings of hopelessness
Other symptoms often include:
- Feelings of emptiness
- Apathy / loss of interest in day-to-day activities
- Difficulties enjoying life
- Feelings of helplessness
- Social withdrawal or isolation
- Frequent self-criticism
- Persistent physical symptoms (e.g. problems with digestion, aches, headaches) that don’t improve despite treatment
- Thoughts of suicide
Children with dysthymia may exhibit irritability rather than a depressed mood, and the symptoms need to last only 1 year. They may perform poorly in school and struggle socially. They tend to have a negative outlook as well.
As with most mental health disorders, the exact cause of dysthymia remains a mystery. However, it is most likely a combination of the following factors:
Genetics: Dysthymia is more likely to develop when there is a family history of major depression or dysthymia.
Biochemistry: As with other types of depression, dysthymia is likely caused in part by an imbalance of brain chemicals – neurotransmitters, such as serotonin – that help regulate mood.
Environmental factors: Highly stressful events may trigger or contribute to the development of dysthymia. These may include things like the death of a loved one, work stress, or ongoing financial difficulties.
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. They often become socially isolated. The risk for developing major depression is also increased for those with dysthymia. When both disorders occur at the same time, it is often referred to as “double depression”. The long term nature of this disorder can ultimately trigger thoughts of suicide and suicidal behavior.
There are no tests for dysthymia. Usually, the diagnosis is made by a mental health professional who recognizes the chronic pattern of symptoms. Other potential causes for the symptoms must be ruled out, including a health condition (e.g. hypothyroidism), a medication, or ongoing substance abuse. 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.
There are two types of depression treatment that are generally recommended for dysthymic disorder: psychotherapy and medication.
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. A skilled cognitive behavioral therapist can help individuals with dysthymia identify and change negative thought patterns. 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. Each of these things can help to significantly reduce symptoms and help individuals live a happier, more productive life.
Medication is not always necessary with dysthymic disorder. However, in some cases it may be a beneficial treatment when used in combination with psychotherapy. Generally, medication alone is not a good treatment for depression because once stopped, the symptoms often return. Since dysthymia is a chronic condition, medications usually need to be taken long term.
Antidepressant medications are typically prescribed for dysthymic disorder. 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). This is because their side effects tend to be milder than those of other types of antidepressants. They can be very effective, but as with all medications, they don’t work for everyone.
SSRIs– Medications in this category include Paxil, Zoloft, Prozac, Celexa, and Lexapro.
SNRIs –Medications in this category include Effexor, Pristiq, and Cymbalta.
TCAs (tricyclic antidepressants) – These include Elavil, Anafranil, Tofranil, and Sinequan
NDRIs (norepinephrine and dopamine reuptake inhibitors) – These include Remeron and Wellbutrin.
MAOIs (monoamine oxidase inhibitors) – 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. The benefits must always outweigh the costs. With most antidepressants, the full effects are not experienced for several weeks. Discontinuing any medication should always be done under a doctor’s supervision. 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. Unlike other antidepressants, MAOIs can have serious (and potentially fatal) interactions with certain foods, beverages, and other medications. They are usually the last choice because of the serious restrictions involved when taking them.
In order for treatment to be effective, it’s very important to stick with it. Although it can be tempting to skip a therapy session or medication dose, doing so will only defeat their purpose. 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. These include:
Exercise regularly. Numerous studies have shown that regular exercise – particularly aerobic types of exercise (e.g. running, biking, swimming) – helps reduce symptoms of depression. It also helps to improve sleep, increase confidence, and improve self-esteem.
Stay away from street drugs, medications that aren’t prescribed, and alcohol. It can be tempting to self-medicate with substances when you feel sad or down. Unfortunately, they won’t help your depression and often make it worse. They can also interfere with your treatment. If you have a problem with substance abuse talk to your doctor or therapist about treatment.
Educate yourself. Learning everything you can about your disorder. This will help you understand it better, and hopefully keep you motivated with regards to your treatment. It will also help you understand that it’s not your fault or a sign of weakness that you struggle with depression. Find a type of exercise you enjoy and do it consistently, even if you don’t feel like it. 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. Over time, they can become very isolated. This often makes their symptoms worse. 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.