What Is It?

Dysthymia, also called dysthymic disorder, is a form of depression. It is less severe than major depression, but usually lasts longer. Many people with this type of depression describe having been depressed as long as they can remember, or they feel they are going in and out of depression all the time.

The symptoms of dysthymia are similar to those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, a decrease in pleasure, and a loss of energy. They feel relatively unmotivated and disengaged from the world. Appetite and weight can be increased or decreased. The person may sleep too much or have trouble sleeping. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a poor self-image.

Symptoms can grow into a full-blown episode of major depression. This situation is sometimes called "double depression" because a second problem (the major depressive episode) is superimposed on the usual feelings of low mood. People with dysthymia have a greater-than-average chance of developing major depression.

While major depression often occurs episodically, dysthymia is more constant, lasting for long periods, sometimes starting in childhood. As a result, a person with dysthymia tends to believe that depression is part of his or her character. The person with dysthymia may not even think to talk about this depression with doctors, family members or friends.

Dysthymia, like major depression, tends to run in families. It is two to three times more common in women than in men. Some people with dysthymia have experienced a major loss in childhood, such as the death of a parent. Others describe being under chronic stress. But it is often hard to know whether people with dysthymia are under more stress than other people or if the dysthymia causes them to perceive more stress than others do.

Symptoms

The main symptom of dysthymia is a long-lasting low or sad mood. People with dysthymia also can be irritable. Other symptoms include:

  • Increased or decreased appetite or weight

  • Lack of sleep or sleeping too much

  • Fatigue or low energy

  • Low self-esteem

  • Difficulty concentrating

  • Indecisiveness

  • Hopelessness or pessimism

Diagnosis

Many primary care doctors can recognize when one of their patients has some form of depression. But the specific diagnosis of dysthymia is usually made by a mental health professional after a full evaluation. Clinicians diagnose the depression as dysthymia when a person has had low mood, along with some of the other symptoms, for two years or more. (But it is not necessary to wait for two years before getting help! Someone who has symptoms for less than two years may still be treated for any persistent or distressing symptoms.)

Since many people with this disorder are embarrassed or ashamed to be labeled "depressed," they may be reluctant to raise the subject with a clinician.

The symptoms persist over time and are related to symptoms of other mood disorders such as major depression, bipolar disorder (in which a person has depressive episodes and periods of elevated mood called manic episodes) and cyclothymic disorder (a milder form of bipolar disorder).

There are no laboratory tests to diagnose dysthymia. (However, a doctor may order tests to investigate conditions such as thyroid disease or anemia.)

Expected Duration

Dysthymia can start early in life, even in childhood. There can be ups and downs in mood, but lower moods dominate and are persistent. Treatment can reduce how long it lasts and the intensity of the symptoms.

Prevention

There is no known way to prevent dysthymia.

Treatment

The best treatment is a combination of psychotherapy and medication.

Psychotherapy

The most helpful type of psychotherapy for you depends on a number of factors, including the nature of any stressful events, the availability of family and other social support, and personal preference. Therapy should include education about depression. Support is essential. Cognitive behavioral therapy is designed to examine and help correct faulty, self-critical thought patterns. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms.

Medication

People with dysthymia who think that "feeling blue" is just part of their life may be surprised to learn that antidepressant medication can be very helpful. The most commonly prescribed antidepressants for this disorder are the selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). Common side effects are nausea and problems with sexual functioning. Anxiety may increase in the early stages of treatment and lead to apathy in the long run. Based on concerns that these drugs can cause the onset of suicidal thinking, the U.S. Food and Drug Administration required antidepressant manufacturers to put prominent warning labels on their products.

The scientific community has not found that antidepressants increase suicide risk in the population as a whole. In fact, the risk of leaving depression untreated is far greater than the risk of treatment with an antidepressant. But a small number of people using the medications do feel strikingly worse rather than better when they take them. You should therefore keep all follow-up appointments and immediately report any troubling changes to your doctor.

Other antidepressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron) and duloxetine (Cymbalta). Older antidepressants – tricyclic antidepressants and monoamine inhibitors – are still in use and can be very effective for those who do not respond to the newer treatments.

It usually takes two to six weeks of antidepressant use to see improvement. The dose usually must be adjusted to find the right dose for you. Often it will take up to a few months for the full positive effect to be seen.

Also, the first medication may not work for you. You may need to try a few different antidepressants before finding one that provides relief.

Sometimes, two different antidepressant medications are prescribed together, or your doctor may combine a mood stabilizer or antianxiety medication with an antidepressant.

When To Call a Professional

Contact a health care professional if you suspect that you or a loved one has this disorder.

Prognosis

With treatment, the outlook for someone with this disorder is excellent. The duration and intensity of symptoms is often diminished significantly. In many people, the symptoms go away completely. Without treatment, the illness is more likely to persist, the person is likely to have a reduced quality of life and has an increased risk of developing major depression.

Even when treatment is successful, maintenance treatment often is required to prevent symptoms from returning.

Additional Info

National Institute of Mental Health Science Writing, Press, and Dissemination Branch 6001 Executive Blvd. Room 8184, MSC 9663 Bethesda, MD 20892-9663 Phone: 301-443-4513 Toll-Free: 1-866-615-6464 TTY: 301-443-8431 Fax: 301-443-4279 http://www.nimh.nih.gov/

National Alliance for the Mentally Ill Colonial Place Three 2107 Wilson Blvd. Suite 300 Arlington, VA 22201-3042 Phone: 703-524-7600 Toll-Free: 1-800-950-6264 TTY: 703-516-7227 Fax: 703-524-9094 http://www.nami.org/

National Mental Health Association 2000 N. Beauregard St., 6th Floor Alexandria, VA 22311 Phone: 703-684-7722 Toll-Free: 1-800-969-6642 TTY: 1-800-433-5959 Fax: 703-684-5968 http://www.nmha.org/

American Psychiatric Association 1000 Wilson Blvd. Suite 1825 Arlington, VA 22209-3901 Phone: 703-907-7300 Toll-Free: 1-888-357-7924 Web site: http://www.psych.org/ Public information site: http://www.healthyminds.org/

American Psychological Association 750 First St., NE Washington, DC 20002-4242 Phone: 202-336-5500 Toll-Free: 1-800-374-2721 TTY: 202-336-6123 http://www.apa.org/

Last Annual Review Date: 2011-01-13T00:00:00-07:00 Copyright: Medical content reviewed by the Faculty of the Harvard Medical School. Copyright © 2010 by Harvard University. All rights reserved. Used with permission of StayWell.

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Married women are more likely to be depressed than unmarried women. But it's the opposite with men: Unmarried men are more likely to be depressed than married men.