Major depression is not the only variety of depressive disorder. Dysthymia, or persistent depressive disorder, is yet another, and while its symptoms aren’t as acute or debilitating as those of major depression, dysthymia is still a life-altering mental health condition. Spontaneous remission of dysthymia is unlikely, and the best way to avoid significant problems down the road is to seek treatment for depression whenever symptoms occur, regardless of their strength and intensity.
What Is Dysthymia?
Depression is always serious but not always disabling. People who suffer from persistent depressive disorder, or dysthymia, experience the typical symptoms of depression, but in a relatively manageable form.
Under the influence of dysthymia, men and women experience persistent, long-term symptoms of low-grade depression that can linger indefinitely. Through at least the first few months of the illness, they may be able to meet most if not all of their personal, financial, and familial obligations. Unless they choose to share what they’re feeling, friends and family members may never suspect anything is wrong—and if they do suspect, they are unlikely to identify depression as the culprit.
Over time, however, dysthymia takes its toll. Even in low-grade form depression is still depression, and happiness and contentment will be impossible to find as long as a person is trapped by the feelings of emptiness and meaninglessness that dysthymia causes. If treatment for persistent depressive disorder is not provided—and people suffering from dysthymia often fail to realize they need help—the condition can cause a host of life problems that leave sufferers struggling to hang on.
Facts and Statistics
Major depression affects more than 16 million adults in the United States. But many people don’t realize there is such a thing as high-functioning depression, which is yet another name for dysthymia.
While dysthymia isn’t as common as major depressive disorder, it still touches the lives of approximately 3.5 million Americans each year, which represents about 1.5 percent of the adult population. The lifetime rate for persistent depressive disorder is about 3.6 percent, and those who experience the chronic, long-term symptoms of this disorder only seek treatment for their conditions about 60 percent of the time.
Even though dysthymia isn’t normally thought of as disabling, one-half of those who develop the disorder have it in an acute form, meaning it will cause difficulties if no help is provided.
Dysthymia Symptoms and Diagnosis
While the symptoms of persistent depressive disorder don’t reach the level of major depression, they are still quite similar in their makeup. People who’ve developed dysthymia will quickly realize that something is wrong, even if their closest companions only notice subtle changes.
Some of the common symptoms of dysthymia include:
- Low motivation
- Lack of energy
- Muted emotional responses
- Inability to take pleasure in favored hobbies or activities
- Detachment from friends and family life
- Feelings of unworthiness and shame
- Chronic anxiety
- Pessimism or fatalism about the future
- Overeating or eating too little
- Changes in sleeping habits, with at least some insomnia
- Poor focus, concentration, and memory
- Inability to complete tasks, or to complete them correctly or on time
- Impulsive actions, often including sudden changes in jobs or relationships
Dysthymia manifests as a vague yet persistent sense of unease and emptiness. Its symptoms may worsen over time, but even if they don’t they can be expected to last longer than symptoms of major depression should treatment not be provided.
Persistent depressive disorder may be diagnosed by a mental health practitioner if two of the following symptoms are detected:
- Feelings of despair, emptiness, and hopelessness
- Chronic feelings of self-doubt and poor self-esteem
- Changes in weight and appetite
- Changes in sleeping patterns
- Moodiness marked by frequent irritability
- Difficulties in focusing and concentrating
- Inhibitions or inconsistencies in decision-making
Low-grade depression can be hard to identify, and professionals must rely on the complete and honest testimony of their patients to diagnose this elusive disorder. To a certain extent dysthymia mimics major depression, but without the dramatic interruptions in functioning or profoundly overwhelming feelings of sadness that make the latter condition easier to spot.
Major depression can be diagnosed if symptoms persist for as little as two weeks, but dysthymia must be present for two years or more, with no symptom-free periods lasting for more than two months, before it can be classified as a true mental health condition.
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Causes and Risk Factors for Dysthymia
Everyone is potentially at risk for chronic, low-intensity depression. This condition is largely a response to troubling, confusing, stressful, disappointing, or traumatic life experiences, and the chances of developing dysthymia are greater if the feelings associated with such experiences are not addressed in therapy at the time they first arise.
Some of the specific risk factors for persistent depressive disorder include:
- Family history of depression or other types of mental illness. Genetic factors play some role in creating this connection, but home environmental influences during childhood and adolescence are implicated as well.
- Exposure to trauma or neglect. The chances for depression increase significantly for those who experience abuse of some kind during childhood, but traumatic exposures later in life can also predispose a person to dysthymia or major depressive disorder.
- Negative personality traits. People who lack self-confidence and self-esteem and are generally pessimistic or fatalistic are likely to develop some form of depression.
- Stressful lifestyle. Bodies and minds under constant stress and emotional duress may eventually break down, and depression is one possible consequence of stress if it is prolonged.
- Previous history of mental health problems. Anxiety disorders are frequently diagnosed in people with depression, and those who suffer from anxiety are likely to experience depression symptoms eventually.
Dysthymia is linked to neurological changes that affect mood management and emotional balance. Over time, brains can be reprogrammed to respond to stress and anxiety more constructively, which is an important remedy for depressive disorders.
There is a strong connection between mood disorders and anxiety disorders. Research has revealed that as many as 70 percent of people with major depression or dysthymia have a co-occurring anxiety disorder, while up to 60 percent of anxiety disorder sufferers will also battle depression.
The frequent comorbidity of anxiety and depression is common knowledge, but what is less well-known is the striking association between personality disorders and depression. Perhaps because of the relationship troubles and social turmoil people with personality disorders often face, they are highly vulnerable to depression—and to dysthymia in particular.
Among men and women who’ve been diagnosed with persistent depressive disorder, an astounding 85.7 percent in one study also demonstrated symptoms consistent with at least one personality disorder. Borderline personality disorder was the condition most commonly diagnosed in these individuals, with a 20-percent occurrence rate, and the relationship between borderline traits and depression has been found to hold across cultures and nationalities.
Even though dysthymia and major depression are separate disorders, in some instances there can be overlap. Some people diagnosed with persistent depressive disorder will develop a limited number of severe symptoms that are more characteristic of major depression than dysthymia, and these individuals may be re-diagnosed with double depression, a complex condition that could require intensive therapy.
The frequent co-occurrence of other health conditions is one of the main reasons why people suffering from the symptoms of dysthymia should seek evaluation and treatment, even if they are still able to function. With multiple mental health disorders they won’t be able to function indefinitely, and the sooner they seek help the better their chances of making a full and successful recovery.
Dysthymia Treatment and Prognosis
Unfortunately, many people learn to live with dysthymia. They may see it as an unavoidable consequence of modern life, or they may convince themselves that superficial changes will eventually make their feelings of sadness and emptiness disappear.
But dysthymia is a chronic mental health condition that seldom vanishes on its own. Left unchecked, it will limit achievement and undermine contentment, while slowly eroding a person’s sense of confidence and self-worth. Without treatment, people who suffer from dysthymia will be unable to maintain their emotional and psychological equilibrium, and their capacity to learn, develop, accomplish, and prosper may be severely restricted over the long haul.
The failure of many people with dysthymia to seek help prevents health and happiness, since this condition is highly amenable to treatment. Like major depressive disorder, persistent depressive disorder responds well to a combination of psychotherapy and medication, offered in a structured outpatient or inpatient treatment program at a licensed a mental health treatment facility.
While in treatment, clients attend daily therapy sessions in individual, group, and/or family formats, where all the underlying issues involved in their depression can be identified and discussed. Various antidepressant medications may be administered for the symptoms of depression, and the mixture of talk therapy with medicinal intervention can dramatically decrease the frequency and intensity of those symptoms over the course of a 30- to 90-day inpatient or outpatient treatment program.
Outpatient programs are often the first choice for dysthymia, but residential inpatient programs are a superior choice for those who have comorbid conditions that require additional treatment services. Aftercare services are also vital to help recovering depression sufferers stay focused on healing, and that is especially true if they have been diagnosed with co-occurring anxiety disorders, personality disorders, or substance use disorders.
Dysthymia should not be accepted as normal or dismissed as a small concern. Depression is always unwelcome, and no one who experiences it in any form should be content to suffer through it in silence.