What is persistent depressive disorder (dysthymia)?
Persistent depressive disorder, also called dysthymia, is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.
If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.
How common is persistent depressive disorder (dysthymia)?
Please discuss with your doctor for further information.
What are the symptoms of persistent depressive disorder (dysthymia)?
The common symptoms of persistent depressive disorder (dysthymia) are:
- Loss of interest in daily activities
- Sadness, emptiness or feeling down
- Tiredness and lack of energy
- Low self-esteem, self-criticism or feeling incapable
- Trouble concentrating and trouble making decisions
- Irritability or excessive anger
- Decreased activity, effectiveness and productivity
- Avoidance of social activities
- Feelings of guilt and worries over the past
- Poor appetite or overeating
- Sleep problems
In children, symptoms of persistent depressive disorder may include depressed mood and irritability.
Persistent depressive disorder symptoms usually come and go over a period of years, and their intensity can change over time. But typically symptoms don’t disappear for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
Because these feelings have gone on for such a long time, you may think they’ll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.
Talk to your primary care doctor about your symptoms. Or seek help directly from a mental health provider. If you’re reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it’s a friend or loved one, a teacher, a faith leader, or someone else you trust.
If you think you may hurt yourself or attempt suicide, call your local emergency number immediately.
What causes persistent depressive disorder (dysthymia)?
The exact cause of persistent depressive disorder isn’t known. As with major depression, it may involve more than one cause, such as:
- Biological differences.People with persistent depressive disorder may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
- Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
- Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
- Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people.
What increases my risk for persistent depressive disorder (dysthymia)?
There are many risk factors for persistent depressive disorder (dysthymia), such as:
- Having a first-degree relative with major depressive disorder or other depressive disorders
- Traumatic or stressful life events, such as the loss of a loved one or financial problems
- Personality traits that include negativity, such as low self-esteem and being too dependent, self-critical or pessimistic
- History of other mental health disorders, such as a personality disorder
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is persistent depressive disorder (dysthymia) diagnosed?
Your health care provider will take a history of your mood and other mental health symptoms. The provider may also check your blood and urine to rule out medical causes of depression.
How is persistent depressive disorder (dysthymia) treated?
The two main treatments for persistent depressive disorder are medications and talk therapy (psychotherapy). The treatment approach your doctor recommends depends on factors such as:
- Severity of your symptoms
- Your desire to address emotional or situational issues affecting your life
- Your personal preferences
- Previous treatment methods
- Your ability to tolerate medications
- Other emotional problems you may have
Psychotherapy may be the first recommendation for children and adolescents with persistent depressive disorder, but that depends on the individual. Sometimes antidepressants are also needed.
The types of antidepressants most commonly used to treat persistent depressive disorder include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Talk with your doctor or pharmacist about possible side effects.
Finding the right medication
You may need to try several medications or a combination before you find one that works. This requires patience, as some medications take several weeks or longer for full effect and for side effects to ease as your body adjusts.
Don’t stop taking an antidepressant without talking to your doctor — your doctor can help you gradually and safely decrease your dose. Stopping treatment abruptly or missing several doses may cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression.
When you have persistent depressive disorder, you may need to take antidepressants long term to keep symptoms under control.
Antidepressants and pregnancy
If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.
FDA alert on antidepressants
Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the most serious warning for prescriptions.
In some cases, children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So watch them for possible worsening depression and contact the doctor right away if this occurs, or get emergency help if suicidal behaviors occur.
Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy or psychological counseling.
Different types of psychotherapy, such as cognitive behavioral therapy, can be effective for persistent depressive disorder. You and your therapist can discuss which type of therapy is right for you, your goals for therapy and other issues, such as the length of treatment.
Psychotherapy can help you:
- Adjust to a crisis or other current difficulty
- Identify issues that contribute to your depression and change behaviors that make it worse
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Find better ways to cope and solve problems
- Explore relationships and experiences, and develop positive interactions with others
- Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
- Learn to set realistic goals for your life
Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren’t a substitute for medical care.
For example, the herbal supplement called St. John’s wort is not approved by the Food and Drug Administration (FDA) to treat depression in the U.S., though it’s a popular depression treatment in Europe. It may help improve mild or moderate depression, but the overall evidence is not conclusive.
St. John’s wort can interfere with a number of medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John’s wort while taking antidepressants because the combination can cause serious side effects.
FDA doesn’t monitor supplements
Dietary supplements aren’t approved and monitored by the FDA the same way medications are. You can’t always be certain of what you’re getting and whether it’s safe. Also, because some herbal and other dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider before taking any supplements.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage persistent depressive disorder (dysthymia)?
The following lifestyles and home remedies might help you cope with persistent depressive disorder (dysthymia):
- Stick to your treatment plan. Don’t skip psychotherapy sessions or appointments, and even if you’re feeling well, don’t skip your medications. Give yourself time to improve gradually.
- Learn about persistent depressive disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about the disorder to help them understand and support you.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms get worse or return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
- Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you’re having trouble sleeping, talk to your doctor about what you can do.
- Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression-related symptoms, but in the long run they generally worsen depression and make it harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug abuse.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Persistent depressive disorder. https://medlineplus.gov/ency/article/000918.htm. Accessed July 5, 2017.
Persistent depressive disorder (dysthymia). http://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/home/ovc-20166590. Accessed July 5, 2017.
Review Date: July 6, 2017 | Last Modified: September 13, 2019