Dysthymia

Dysthymia: Depression Symptoms Guide

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Dysthymia.

Dysthymia is a type of unipolar disorder, also referred to as chronic depression, dysthymic disorder, and sometimes misleadingly as ‘minor depression’, as the effects of dysthymia are not ‘minor’, and can be extremely debilitating.

Unlike major depressive disorder which tends to develop rapidly and dramatically, dysthymia is described as a ‘low grade’ depression. The symptoms of dysthymia tend to infiltrate in such a way that most sufferers of the illness cannot identify when they first became depressed.^[1]

Dysthymia is also a very long-lasting form of depression — persisting for no less than two years by definition of its diagnosis.

Dysthymia is approximately as common as major depressive disorder, though it tends to occur earlier in life, and more than 50% of dysthymia sufferers will eventually have an episode of major depression as well. Like major depression, dysthymia is more common in women than in men.^[1]

Symptoms

Some of the symptoms of dysthymia are shared with major depressive disorder, though dysthymia generally does not cause anhedonia, nor involve psychomotor agitation or psychomotor retardation. Other symptoms may include:

Feelings of hopelessness.
Low self-esteem.
Poor concentration or difficulty making decisions.
Low levels of energy.
Increased or decreased appetite.
Insomnia or hypersomnia.
Suicidal thoughts.
Irritability.

Dysthymia sufferers are often able to continue to function in work and social situations, but frequently feel distressed, overburdened and unhappy.

Diagnosis

The chronic but low grade symptoms of dysthymia can make the illness difficult to diagnose. Many sufferers have lived with dysthymia for several years, and simply consider it part of their personality. As a result, the sufferer may not even discuss their feelings and symptoms with their doctor, family or friends. Numerous sufferers of dysthymia are simply never diagnosed, or treated for their illness.

According to the DSM-IV-TR^[2], a diagnosis of dysthymia can be made when:

The patient experiences a depressed mood for most of the day, for more days than not, for at least two years (in children and adolescents this duration is one year, and the mood can be irritability instead of depression).
The depression is accompanied by at least two of the symptoms listed above.
The patient has not been symptom-free for two or more months during the two year period.
No major depressive episode has occurred during the first 2 years of the disturbance, ascertaining that the condition should not be diagnosed as major depressive disorder instead.

(Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of major depressive disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode).
There has never been a Manic Episode, a Mixed Episode, or hypomania, and criteria have never been met for Cyclothymic Disorder.
The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning.^[2]

Getting Help

Perhaps the most important step in getting help for dysthymia is realising and accepting that you may be suffering from the condition. Due to dysthymia’s low grade profile, years of living with the illness may have convinced you that you’re just an unhappy or worthless person — but you’re not.

Chances are that if you feel this way, you need to speak with your doctor, psychologist or psychiatrist about these thoughts and feelings. Once diagnosed, dysthymia can be treated effectively with psychotherapy (counseling), medications such as antidepressants, or a combination of both.

If you believe you know someone who may be suffering from dysthymia, try talking to them about it. Approach the subject tactfully and perhaps provide them with some information on the condition. Remember, they may not know dysthymia even exists, let-alone that the illness may be seriously affecting and reducing the quality of their life.