Dysthymia [Persistent Depressive Disorder]: Symptoms, Causes, Treatment & 6 Coping Strategy

Jun 5, 202410 min
A man with Low Grade Chronic Mood

Dysthymia - The Low Grade Chronic Mood Disorder

Dysthymia, also known as Persistent Depressive Disorder (PDD), is a mood disorder characterized by long-term, low-grade depression.  Unlike major depression, which can be intense but acute, dysthymia is more chronic and prolongs for at least two years (one year in the case of adolescents and children), subtly impacting daily life.

The symptoms of dysthymia consist of a depressed mood along with at least two more symptoms like loss or increased appetite; changes in sleep patterns; fatigue/ low energy, difficulty concentrating; low self-esteem, etc.

As Dysthymia is a chronic disease, most people experiencing it often go undiagnosed as they feel that this state is more of their personality than a mood state or a mental health condition

Dysthymia is a poorly understood condition (StatsPerls, 2023). Researchers have constantly evolved the definitions, symptoms, and classification of this condition. 

What does Dysthymia Feel like?

Dysthymia can feel like being in a musical concert, instead of the usual bright lights and booming music, everything seems to be blunted and dull. The colors seem duller, the music sounds distant, and even jumping around feels like a chore. That's the experience for many with dysthymia. While not as debilitating as major depression, the persistent low mood, lack of motivation, and feelings of hopelessness can significantly impact daily activities, work, and relationships

Dysthymia could also feel like showing up to work, but with no motivation and interest. The deadlines approach, but no will to work on them, the tasks that were once a piece of cake now feel like moving mountains. You might find yourself struggling to concentrate or feeling constantly drained, making it hard to give your best effort. People who experience Dysthymia, often say that they feel “down in the dumps”, they also tend to report that they have always been like that. 

Know the Major Differences Between MDD and Dysthymia

Is Dysthymia a Personality Disorder? 

In the past, dysthymia was categorized as a personality disorder, implying a fixed and unchanging state. However, this view is evolving (Freeman, 1994). Today, dysthymia is increasingly understood as a treatable and temporary condition. This shift empowers individuals seeking help and emphasizes the possibility of recovery.

7 Most Common Signs and Symptoms of Dysthymia:

While symptoms of Dysthymia are common to those of Major Depression Disorder, the individual with dysthymia experiences a depressed mood that occurs for most days, on more days than not for at least 2 years. Apart from depressed mood, the individuals need to experience at least 2 of the following symptoms:

  • Changes in appetite: Overeating or undereating.
  • Sleep disturbances: Difficulty sleeping (insomnia) or sleeping too much (hypersomnia).
  • Low energy or fatigue: Feeling constantly drained and lacking the motivation to engage in daily activities.
  • Low self-esteem: A persistent sense of worthlessness or self-criticism.
  • Difficulty concentrating or making decisions: Feeling mentally foggy and lacking clarity.
  • Feelings of hopelessness: A pervasive belief that things won't get better and a sense of helplessness.
  • Irritability: This is especially common in children and adolescents with dysthymia.

3 Main Causes of Dysthymia

The exact cause of Dysthymia is not known. Experts who study depression believe it's not caused by just one thing, but rather a combination of factors. A generally accepted conceptualization of depressive disorder comes from the bio-psycho-social model. Here's the breakdown explaining this model:

Biological:

This includes things like brain chemistry and genetics. Imbalances in brain chemicals or a family history of depression can increase the risk. Scientists believe that the low levels of serotonin, and disturbances in epinephrine, norepinephrine, and glutamate could also play a role. If someone in your close family has dysthymia, you might be more likely to get it too. The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder (Harvard, 2014). 

Social:

Life events like stress, trauma, or social isolation can contribute to dysthymia. Going through difficult or stressful experiences, especially for a long time, can take a toll on your mood. This could be anything from chronic health problems or financial worries to bullying or a difficult relationship. Traumatic events, whether in childhood or later in life, can also increase the risk of developing dysthymia. Feeling isolated or alone, without a strong social support network, can make it harder to cope with challenges and bounce back from setbacks. All these factors can contribute to a low mood that lingers and disrupts daily life, which is characteristic of dysthymia.

Psychological:

Negative thinking patterns can impact our self-image and self-esteem. A negative view of self and/or of the world can lead to feelings of hopelessness and worthlessness. This could lead to a further dip in one’s mood and energy levels. Furthermore, a lack of adaptive coping skills and an inability to manage one’s difficult emotions could also lead to persistent low affect.

Thinking of dysthymia as a mix of these factors helps us understand why it affects people differently and how treatment can involve addressing all these areas.

At what age does Dysthymia Start?

Dysthymia/ PDD often starts early in life: Unlike major depression which can hit at any time, PDD frequently develops in childhood, during the teenage years, or early adulthood (DSM -5). It's insidious, meaning it creeps up slowly over time. You might not even notice it at first, but over time it can start to affect your mood and energy levels in a significant way. Studies suggest that dysthymia is not triggered by one specific stressful event, but rather by ongoing challenges. As you get older, physical health problems, memory loss, or losing a loved one can also increase the risk of dysthymia. In men, low testosterone levels might be a factor too (Harvard, 2014).

How is Dysthymia Diagnosed?

There are no lab tests that are required for a diagnosis of this condition. If you identify with the signs and symptoms of Dysthymia, consult a mental health professional (MHP) for assessment and diagnosis. A thorough assessment helps to understand the nature of the depressive symptoms. 

A psychiatrist or a psychologist would take a detailed history of the presenting symptoms and its severity and duration. They may ask open questions about your mood, energy levels, changes in sleep, appetite, motivational levels along with recent or chronic stressors, etc. to understand your condition better. Usually, a psychometric assessment or a rating scale is filled for screening of mood disorders. The mental health professional might also recommend some medical tests to rule out any other condition that might be causing the symptoms. 

Treatment for Dysthymia: The Path to Recovery

The treatment for Dysthymia is similar to that of Major Depressive Disorder. The most effective treatment for Dysthymia combines medications and psychotherapy, or counseling. Studies report that the combination of medications and psychotherapy is more effective than either of the treatments alone. 

Psychotherapy: 

Psychotherapy also known as talk therapy, psychotherapy is beneficial to help understand one’s emotions, thoughts, and behaviors. It can help individuals identify negative thought patterns and develop coping mechanisms to manage dysthymia symptoms. There are different psychotherapeutic approaches that can be utilized for the treatment of dysthymia. However, Cognitive-behavioral therapy (CBT) and Interpersonal Therapy are the most common and evidence-based therapeutic approaches utilized for treating mood disorders. Additionally, The cognitive-behavioral analysis system of psychotherapy (CBASP) is a newer modality and the only psychotherapy specifically developed for the management of chronic depression, but it has yet to become the standard of care (Furukawa,2018). 

Medication: 

Antidepressant medications can help regulate brain chemistry and improve mood and energy levels. If your doctor decides medication is a good option for your dysthymia, they'll likely prescribe a type of medication called an SSRI (selective serotonin reuptake inhibitor) first. SSRIs are generally well-tolerated and effective in treating dysthymia.

Who's More Likely to Get Stuck in the Fog: Risk Factors for Dysthymia

Dysthymia, that low-grade chronic depression, can impact anyone. But certain factors can make you more susceptible. Here's a breakdown of the key risk categories:

Early onset of Depression can lead to the development of a more chronic form of depression.

Temperamental Traits:

  • Negative outlook: People who tend to have a negative or pessimistic approach or are high on neuroticism are more prone to develop dysthymia or chronic low mood.
  • Overall Functioning: How well you manage your daily life is also a predictor of this condition. Difficulty functioning at work, school, or in relationships can indicate a poorer prognosis.
  • Co-existing conditions: Having Borderline Personality Disorder, Anxiety disorders, or substance use can worsen dysthymia's impact.

Environmental Factors:

  • Tough Childhood: Experiencing parental loss, separation, or a generally difficult childhood can increase the risk of developing dysthymia/ persistent depressive disorder later in life.

Genetic and Physiological Factors:

  • A family history of depression, bipolar disorder, and recurrent depression might make you more susceptible to the development of Persistent Depressive Disorder/ Dysthymia. Studies suggest a genetic link but the exact role of genes is still being explored.
  • Sleep Issues: Potential sleep problems might be linked to dysthymia, however, studies have suggested that people with persistent depressive disorder tend to have shorter REM cycles. 

It is important to remember that while these are risk factors that can make you prone to depressive disorders, these factors don’t necessarily guarantee a diagnosis of dysthymia. 

6 Coping Strategies for Dysthymia

Living with Dysthymia can feel like walking through dense fog that doesn't seem to uplift. Yet, it is treatable, and with professional help and support one can manage it and reclaim one’s zest for life.

Here are some ways that can help you cope efficiently with Dysthymia. 

1.Seek Therapy

Talk therapy is one of the most efficient ways to understand one’s thoughts, beliefs, emotions, and behaviors. Therapy is instrumental in generating insight into one’s core beliefs, behavioral patterns, and coping style.

Therapy can help not only gain knowledge and insight into one’s life but also to establish goals that help people thrive in their life.

People with Dysthymia can benefit from therapy by identifying risk factors based on their personal history, learning adaptive coping skills, and uplifting the depressive fog. 

2.Medication Magic

Antidepressants could be game-changing, they can help to uplift your low mood and energy levels. Medications can also give momentum to utilize helpful coping strategies that you may otherwise find too difficult to initiate. The push that one receives from antidepressants for behavior activation can help create a chain reaction of an upward cycle.

3.Prioritize Sleep: 

Work on creating a nighttime routine that aids in quality and consistent sleep of at least 7-8 hours. Sleep is important for your mental and physical health. Working on establishing a consistent sleep cycle can do wonders for your mood disorder and avoiding unnecessary thoughts at night will help you get good quality sleep.

4.Move your Body to Boost your Mood: 

Exercise helps release endorphins which helps you uplift your mood. Ask a friend to help you get regular exercise. A brisk walk, A 15-minute dance schedule, and/or practicing Yoga Asanas can be a few ways through which your body can get the desired exercise. It is beneficial for both your physical fitness and uplifting your mood.

5.The Sunshine Advantage:

Sunlight exposure can improve mood and sleep. Aim for at least 15-20 minutes of natural sunlight daily, even during winter months. Low levels of Vitamin D are known to be linked with Depression. Since sunlight is a natural source of Vitamin D, go ahead and soak some sun.

6.Practice Gratitude

Make this a habit, at the end of the day, jot down 5 things that went well and 5 things that didn't go well that day. While you are focussing on both the good and the bad of the day. It helps you create a perspective about how life is full of ups and downs.  If you don’t want to write, share it with a friend, partner, parent, or buddy daily.

FAQs of Dysthymia

Can dysthymia cause brain fog?

Yes, Dysthymia can cause brain fog. Cognitive dysfunction such as difficulty concentrating, memory issues, and inability to maintain focus are all symptoms of depression. Dysthymia, a low-grade, chronic form of depression can also create brain fog. While the role and reason for the same is still under investigation, researchers suggest the role of low levels of serotonin to be responsible for brain fog.

Can postpartum depression (PPD) turn into dysthymia?

Experiencing Postpartum Depression can leave you more vulnerable to developing other forms of mood disorders including persistent depressive disorder. It could be due to changes in brain chemistry, ongoing stress, and emotional exhaustion with PPD can also lead to chronic feelings of worthlessness and low mood.

Does dysthymia affect memory?

Yes, Dysthymia can affect memory. A study reported that people with dysthymia had impairments in their memory and attention.  However, it is important to remember not everyone with dysthymia will face memory and attention issues. 

Does dysthymia cause suicidal thoughts?

Suicidal thoughts can be one of the symptoms of dysthymia.  Chronic low mood, hopelessness, and feelings of worthlessness associated with dysthymia can contribute to suicidal ideation. If you are experiencing suicidal ideation, know that you are not alone. Please reach out to loved ones and get help immediately. 

Conclusion

Dysthymia has been a misunderstood psychological condition. It has been initially seen as a personality disorder, deeming it as a life sentence. However, the research evidence suggests that it is a mood state rather than a permanent condition. Dysthymia is a treatable condition. With the right approach, you can break free from this condition and reclaim a brighter, more fulfilling life. If you suspect you might have dysthymia, reach out to a healthcare professional for diagnosis and treatment options. Don't hesitate to take the first step towards feeling your best again.

Citations

Freeman HL. Historical and nosological aspects of dysthymia. Acta Psychiatr Scand Suppl. 1994;383:7-11.

Furukawa TA, Efthimiou O, Weitz ES, Cipriani A, Keller MB, Kocsis JH, Klein DN, Michalak J, Salanti G, Cuijpers P, Schramm E. Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression. Psychother Psychosom. 2018;87(3):140-153.

Harris P, Allegri RF, Dillon C, Serrano CM, Loñ L, Villar V, Lopez Amalfara L, Butman J, Taragano FE. Cognición en distimia [Cognition in dysthymia]. Vertex. 2005 May-Jun;16(61):165-9. Spanish. PMID: 15957010.

Harvard (2014, March 9) Dysthymia 

Hölzel, L., Härter, M., Reese, C., & Kriston, L. (2011). Risk factors for chronic depression — A systematic review. Journal of Affective Disorders, 129(1-3), 1–13. doi:10.1016/j.jad.2010.03.025 

Hellerstein, D. J., & Eipper, J. W. (2013). Dysthymia and chronic depression. In J. J. Mann, P. J. McGrath, & S. P. Roose (Eds.), Clinical handbook for the management of mood disorders (pp. 20–36). Cambridge University Press. 

Patel RK, Rose GM. Persistent Depressive Disorder. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: 

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Mave
Clinical Psychologist