Dysthymia - Mild Form of Chronic Depression

What is Dysthymia?

Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression. With dysthymia, the depression symptoms can linger for a long period of time, perhaps two years or longer. Those who suffer from dysthymia are usually able to function adequately but might seem consistently unhappy.

In other words, Dysthymia is a common type of a low-grade depression. Harvard Health Publications states that, “the Greek word dysthymia means ‘bad state of mind’ or ‘ill humor’. As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer.

At least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism.

Dysthymia “affects approximately 3% of the population and is associated with significant functional impairment. According to the National Institute of Mental Health, approximately 10.9 million Americans aged 18 and older are affected by dysthymia. While not disabling like major depression, dysthymia can keep you from feeling your best and functioning optimally. Dysthymia can begin in childhood or in adulthood and seems to be more common in women.

What Causes Dysthymia?

Experts are not sure what causes dysthymia. This form of chronic depression is thought to be related to brain changes that involve serotonin, a chemical or neurotransmitter that aids your brain in coping with emotions. Major life stressors, chronic illness, medications, and relationship or work problems may also increase the chances of dysthymia.

What Are the Signs and Symptoms of Dysthymia?

The symptoms of dysthymia are the same as those of major depression but not as intense and include the following:

• Persistent sad or empty feeling.
• Difficulty sleeping (sleeping too much or too little).
• Insomnia (early morning awakening).
• Feelings of helplessness, hopelessness, and worthlessness.
• Excessive shyness.
• Feelings of guilt.
• Loss of interest or the ability to enjoy oneself.
• Social withdrawal.
• Loss of energy or fatigue.
• Difficulty concentrating, thinking or making decisions.
• Poor school/work performance.
• Changes in appetite (overeating or loss of appetite).
• Observable mental and physical sluggishness.
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
• Irritable hostility.
• Constant conflicts with family and friends.
• Thoughts of death or suicide.

Diagnostic criteria

The essential symptom involves the individual feeling depressed almost daily for at least two years, but without the criteria necessary for a major depression. Low energy, disturbances in sleep or in appetite, and low self-esteem typically contribute to the clinical picture as well. Sufferers have often experienced dysthymia for many years before it is diagnosed. People around them come to believe that the sufferer is 'just a moody person'. Note the following diagnostic criteria, offered by The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association:

1. During a majority of days for 2 years or more, the patient reports depressed mood or appears depressed to others for most of the day.

2. When depressed, the patient has 2 or more of:
  • Appetite decreased or increased.
  • Sleep decreased or increased.
  • Fatigue or low energy.
  • Poor self-image.
  • Decreased concentration and decisiveness.
  • Feels hopeless or pessimistic.
  • Excessive muscle pain, particularly upper back, and feet.
3. During this 2 year period, the above symptoms are never absent longer than 2 consecutive months.

4. During the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.

5. The patient has not had any Manic, Hypomanic or Mixed Episodes.

6. The patient has never fulfilled criteria for Cyclothymic Disorder.

7. The disorder does not exist solely in the context of a chronic psychosis (such as Schizophrenia or Delusional Disorder).

8. The symptoms are often not directly caused by a general medical condition or the use of substances, including prescription medications.

9. In contrast to major depression, these symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000). People suffering from dysthymia are usually well capable of coping with their everyday lives (usually by following particular routines that provide certainty).

In children and adolescents, mood can be irritable and duration must be at least 1 year, in contrast to 2 years needed for diagnosis in adults.

Treatments for Dysthymia


In multiple clinical studies, both Prozac and Tofranil have been shown to be effective treatments for Dysthymia. The response rate to antidepressant therapy is usually around 62%; whereas the response rate to placebo therapy ranges from 19% to 44%.


• Psychotherapy or cognitive therapy (also known as "talk therapy") is used to alter people's self-defeating thoughts.
• Behavioral therapy may help people learn how to act in a more "positive approach" to life and to communicate better with friends, family, and co-workers.

Psychotherapy is used to treat this depression in several ways. First, supportive counseling can help to ease the pain, and can address the feelings of hopelessness. Second, cognitive therapy is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to learn how to accept the life problems that cannot be changed. Third, problem solving therapy is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression. Behavioral therapy can help you to develop better coping skills, and interpersonal therapy can assist in resolving relationship conflicts.

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