Dysthymia: causes, symptoms, and treatments

Dysthymia is a mental and behavioral disorder characterized by a long-lasting duration and an early and gradual onset. It is a milder but more persistent form of depression than major depressive disorder (MDD).

The causes of dysthymia include environmental, psychological, and genetic factors.

The symptoms of dysthymia are lasting low mood, poor concentration, difficulty making decisions, less energy, fatigue, feeling hopeless, weight and/or appetite changes, sleep problems, and low self-esteem.

The available treatments for dysthymic disorder are medications and therapy.

What is dysthymia?

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dysthymia or dysthymic disorder, now known as persistent depressive disorder (PDD), is defined as a type of long-term depression that combines DSM-IV-defined chronic major depressive disorder and dysthymic disorder.

Just like with depression, having dysthymic disorder may also cause someone to be less interested in engaging in activities they once enjoyed and to lose motivation in getting things done.

What is the other term for dysthymia?

The other term for dysthymia is persistent depressive disorder. In fact, persistent depressive disorder (PDD) is the recently updated term for dysthymia, as listed in the DSM-5.

PDD consists of fewer and less intense symptoms than those of major depression, but they last longer.

When does dysthymia start?

Dysthymia starts early and subtly during childhood, teenage years, or early adulthood, and may persist for a long time, usually longer than five years. It can be initially difficult to recognize because its symptoms may feel normal to the affected person due to the less severe and prolonged nature of dysthymia.

Individuals diagnosed before the age of 21 are considered to have early-onset dysthymia, while those who have dysthymia that manifested after the age of 21 are referred to as having late-onset dysthymia, according to a 2011 study by Junko Ishizaki and Masaru Mimura on the diagnosis and treatment of dysthymia and apathy published in Depression Research and Treatment.

Where is dysthymia most common?

Dysthymia is a worldwide condition that can occur everywhere. It is not localized to any one place. It’s crucial to keep in mind that different nations and cultures may have varied rates of dysthymia diagnosis and treatment.

Reasons for this may include a lack of awareness, of resources, or of acceptance for those with mental health issues.

How common is dysthymia?

Dysthymia is a common condition that globally affects approximately 105 million people a year (1.5% of the population), as indicated in a 2018 study by Sharma et al., published in the Journal of Psychiatric Nursing. It occurs just as frequently as major depression. It is also possible that a third of those receiving psychotherapy may have dysthymic disorder.

Furthermore, according to an article entitled, “Dysthymia” from Harvard Health Publishing (HHP), in the United States, the lifetime prevalence rate of dysthymia appears to range from 3 to 6%.

What are the causes of dysthymia?

The causes of dysthymia may involve different factors that contribute to the development of the condition. The causes of dysthymia are listed below.

• Environment
• Psychological
• Genetic factors

1. Environment

The environmental factors of dysthymia are referred to as the place where we live, work, or certain behaviors that may influence how we respond to stress and consequently increase our risk of developing an illness or disease.

The environment may become a cause of the onset of persistent depressive disorder symptoms through experiencing traumatic life events, such as the death of a loved one, financial struggles, or even high levels of stress.

Environmental factors are considered one of the causes of dysthymia because they may give rise to events or circumstances that trigger the condition in some people.

2. Psychological

Psychological factors are aspects of an individual’s personality that either restrict or facilitate their thought processes. They may render simple or complex tasks extremely difficult or very easy.

Psychological influences may become a cause of dysthymia when one has personality traits that can increase their likelihood of developing the disorder, including poor self-esteem, extreme self-criticism, and catastrophic thinking.

Psychological factors are also regarded as a cause of PDD because they affect the way a person copes with stress, how they behave, and their habits, all of which play a big part in their overall health.

3. Genetic factors

Genetic factors describe how genes influence each person’s behavioral and psychological traits, such as intellectual capacity, personality, and susceptibility to mental disease.

Genes can possibly become a cause of dysthymia if an individual has a genetic predisposition to the condition, which means they may have a family history of persistent depressive disorder or other depressive disorders.

Genes are also considered one of the causes of dysthymic disorder because they shape our traits, determine our temperament, and ultimately modify our personalities and behaviors.

What are the symptoms of dysthymia?

The symptoms of dysthymia are less severe but longer lasting than those of major depression. The symptoms of dysthymia are listed below.

• Lasting sad, anxious, or “empty” mood
• Less ability to concentrate, think, and/or make decisions
• Less energy
• Fatigue
• Feeling hopeless
• Weight and/or appetite changes due to over- or under-eating
• Changes in sleep patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much
• Low self-esteem

1. Lasting sad, anxious, or “empty” mood

The lasting sad or empty mood commonly experienced in dysthymia involves the feeling of being down or depressed for the majority of each day, most days, which can last for at least two years or more.

Feelings of emptiness become a symptom of PDD when it starts to affect many aspects of one’s life, and may even make it hard for them to find enjoyment in anything.

A lasting sad or empty mood is also considered an indication of dysthymic disorder because it lasts for a long time and impairs important areas of daily functioning.

Identifying feelings of sadness and emptiness in a person is possible by watching out for warning signs, including constant feelings of sadness that last for more than two weeks, irritability, feelings of worthlessness, obsessive thoughts of death, and suicidal thoughts or actions.

2. Less ability to concentrate, think, and/or make decisions

Poor concentration, slowed thinking, and indecisiveness are symptoms that prove how persistent depressive disorder impairs one’s attention, cognitive abilities, and memory.

These dysthymia symptoms become an indication of the disorder by adversely affecting one’s ability to think and their mental processing speed. Impairments in concentration and memory are also regarded as signs of dysthymia because they are often associated with the illness.

Difficulty focusing, thinking, and making decisions can be recognized by looking out for their signs, including restlessness, inability to perform routine activities, mental cloudiness, excessive daydreaming, trouble staying alert, slow processing of information, becoming stressed when making decisions, and preferring someone else makes the decision.

3. Less energy

Less energy means that energy levels tend to decline in people with dysthymia. There are significant links between dysthymia and low energy, as one may fuel the other, and vice versa.

Low energy becomes a symptom of PDD when it makes an individual feel so tired that they do not even attempt to engage in any activity, regardless of the difficulty or required effort.

It is also considered a sign of dysthymia because the condition itself affects the brain’s neurotransmitters in charge of regulating how alert and awake people feel.

Finally, low energy can be identified by observing its most common symptoms, including inability to stay awake or alert, slowed reflexes or responses, constant feelings of exhaustion, lack of motivation, and moodiness.

4. Fatigue

An ongoing feeling of weakness or exhaustion is known as fatigue, which can be either physical, mental, or a combination of both. It is a common symptom of depression and can make someone feel so lethargic that even seemingly simple actions, like cleaning your face, seem impossible.

Fatigue becomes a symptom of dysthymia when it makes day-to-day functioning more difficult for the affected person, impairs their ability to work or learn, damages relationships, and increases their visits to the doctor’s office.

Severe fatigue is also regarded as a sign of persistent depressive disorder because it is a common occurrence among people with the condition.

Fatigue can be identified in an individual by looking for its signs, including weakness, muscle aches, whole body exhaustion, trouble concentrating, lack of motivation, and malaise or a general feeling of discomfort.

5. Feeling hopeless

Feeling hopeless is an emotion characterized by a lack of hope, optimism, or belief that life can be better than it is. Hopelessness could lead someone to withdraw from life and avoid engaging in their favorite activities or spending time with the people they care about.

It becomes an indication of dysthymia when it makes someone lose motivation to try to change their lives, simply because they could not imagine how it could still change for the better.

Feelings of hopelessness are regarded as one of the signs of PDD because it is mostly associated with depression and its other forms.

A hopeless mindset can be recognized by noticing its accompanying symptoms, including fear, despair, sorrow, and a pessimistic view of the future.

6. Weight and/or appetite changes due to over- or under-eating

Changes in weight and/or appetite refer to changes in one’s body mass and desire to eat food. While some individuals may have an increased appetite, others may experience loss of appetite.

Weight and/or appetite changes become a symptom of dysthymia when they result from the affected person’s tendency to under- or overeat in response to unpleasant emotions.

These changes are also considered signs of PDD because many of the brain areas involved in food-related appetitive reactions have also been linked to the condition.

Changes in appetite and/or weight can be recognized in someone who is experiencing a dysthymic mood by looking at its signs, such as weight loss or gain, over- or under-eating, having little to no interest in food, and irritability.

7. Changes in sleep patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much

Changes in sleep patterns are defined as changes to the biological rhythm that tells the body when to wake up and go to sleep. These changes can cause a person to be uncomfortable when trying to sleep, have trouble falling and/or staying asleep, oversleep, or wake very early in the morning.

Sleep abnormalities become a symptom of dysthymia when they disrupt both homeostatic and circadian drives to sleep, according to a 2008 study on sleep disorders as core symptoms of depression published in the Dialogues in Clinical Neuroscience.

Changes in sleeping habits are also considered a sign of dysthymic disorder because the two are closely linked. For instance, an article entitled, “Depression and Sleep: Understanding the Connection” from Johns Hopkins Medicine explains that those who experience insomnia may be ten times more likely to develop depression than those who obtain a decent night’s sleep, while 75% of those who suffer from depression have problems sleeping or staying asleep.

Sleep issues may be identified in an individual by closely observing its signs, including difficulty falling asleep or staying asleep, excessive daytime sleepiness, poor work or school performance, increased movement during sleep, difficulty initiating or maintaining sleep, and inability to meet social obligations.

8. Low self-esteem

Struggling with low self-esteem means a person continually worries about making mistakes or disappointing other people. They also lack confidence in who they are and what they are capable of, as stated by an article entitled, “Signs of Low Self-Esteem” published in WebMD.

Low self-esteem becomes one of the dysthymia symptoms when it negatively affects how they see themselves and tends to knock down their confidence further.

It is also considered a sign of the condition because poor self-esteem and dysthymia frequently coexist and reinforce one another.

Low self-esteem can be recognized in an individual by looking at its common markers, such as overly critical and negative self-talk, being passive about sharing their opinion, neglecting self-care, assigning blame to oneself, difficulty prioritizing their own needs, and trouble asking for help.

Who is at risk for dysthymia?

Individuals who have a family history of major depression or other depressive disorders, those who were exposed to trauma, and women seem to have a greater risk of developing dysthymia.

The condition tends to run in families, and those who have a blood relative diagnosed with related depressive disorders may have an increased likelihood of developing persistent depressive disorder themselves.

Individuals who experienced, or witnessed, trauma may also develop dysthymia due to the high levels of stress brought by their traumatic experiences.

Finally, dysthymic disorder is more common in women, as is the case with major depression. This vulnerability to depression may be explained by certain factors, such as differences in physical strength and personality traits, as stated by a study about why depression is more prevalent in women, published in 2015 in the Journal of Psychiatry & Neuroscience.

What can I expect from dysthymia?

If you have dysthymia, you can expect to have a low mood most of the time, on most days, in a span of two years or more. Most of the things you used to appreciate might no longer excite you as much. Hobbies, social relationships, and formerly rewarding events may become less enticing or uninteresting.

The symptoms of dysthymia may be fewer and milder than those of major depressive disorder, but they tend to last much longer. That said, as with other forms of depression, dysthymia can significantly impair one’s quality of life.

How is dysthymia diagnosed?

Dysthymia may be diagnosed by conducting a physical exam, performing lab tests, or doing a psychological evaluation. Your healthcare provider may initially conduct a physical exam to check your medical history and determine if your symptoms are connected to another physical health issue.

They may also perform lab tests to rule out any medical conditions that could produce dysthymia symptoms. If your provider believes you may have persistent depressive disorder, they will refer you to a mental health professional who may have you undergo a psychological evaluation. This may involve answering a questionnaire or discussing your thoughts, feelings, and behavior.

Finally, they may use the diagnostic criteria for dysthymia stated in the DSM-5, which includes a persistent depressed mood for most of the day, most days, for at least two years in adults or for at least one year in teens and children (which can show up as irritation). They should also be unable to remain symptom-free for more than two months.

These also need to be accompanied by at least two or more of the most common markers of dysthymia, including poor attention or indecision, low energy or weariness, hopelessness, poor appetite or overeating, excessive sleeping or insomnia, and low self-esteem.

What are the available treatments for dysthymia?

The treatments for dysthymia usually involve combination treatment. The available treatments for dysthymia are listed below.

• Medicine
• Therapy

1. Medicine

Medicine refers to a legal drug used to treat, prevent, or relieve the signs and symptoms of illnesses or abnormal conditions, according to the National Cancer Institute’s Dictionary of Cancer Terms.

Dysthymia is commonly treated with antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin and norepinephrine reuptake inhibitors (SNRIs).

Antidepressants help treat dysthymic disorder by increasing the brain’s neurotransmitter activity, which helps in improving mood and emotion.

Dysthymia medication is also an integral part of the treatment for PDD because they help lessen the symptoms of the condition.

A 2011 study on the diagnosis and treatment of dysthymia and apathy published in Depression Research and Treatment states that the use of medications such as SSRIs, SNRIs, and TCAs for the treatment of dysthymia has a favorable outcome.

Finally, antidepressants frequently take 4 to 6 weeks to fully take action. Even if the medication first doesn’t seem to be working, it’s crucial to continue taking it.

2. Therapy

Therapy refers to the process of consulting with a therapist to address problematic thoughts, feelings, behaviors, and/or somatic reactions (body sensations). A form of psychotherapy called cognitive behavioral therapy (CBT) is commonly used to treat PDD.

CBT helps treat dysthymia by educating patients about their illness and helping them learn techniques for managing their symptoms such as low mood, anxiety, and stress.

One of the most popular forms of treatment for the disorder is therapy because it helps patients connect dots and identify patterns they may not have previously noticed. As a result, individuals are more likely to identify personal changes that they would like to undertake.

CBT is meant to help you “rewire” your thoughts. Many individuals with depression have distorted ways of thinking, which may become more ingrained if you have persistent depression, according to a 2021 article entitled, “Treating Persistent Depressive Disorder” from PsychCentral. This makes CBT an effective first-line treatment for the condition.

Lastly, according to an article entitled, “The Science behind How Long Therapy Takes,” from Talkspace, although the suggested number of sessions varies depending on the condition and the type of therapy, most psychotherapy patients say they feel better after three months.

Those with depression and anxiety see significant improvements after shorter and longer time periods, such as one to two months and three to four months.

What are the complications of dysthymia treatment?

The complications of dysthymia treatment refer to the adverse consequences that can occur in some patients as a result of certain treatment options.

They may involve unwanted events that can affect 5% to 20% of psychotherapy patients. They include symptom worsening and treatment failure, the onset of new symptoms, suicidality, work-related issues or stigmatization, alterations in the social network or relationship tensions, therapy reliance, or diminished self-efficacy, as stated on a 2014 study by German researchers Michael Linden and Marie-Luise Schermuly-Haupt published in World Psychiatry.

On the other hand, the complications of dysthymia medications include agitation, loss of appetite, dry mouth, digestive problems, dizziness, loss of libido, weight gain, excessive sweating, irregular heartbeat, and problems passing urine.

Can dysthymia be treated?

Yes, dysthymia can be treated with medicine, therapy, or a combination of the two. These treatment methods both work in reducing the symptoms of dysthymia, making it possible for individuals with the condition to live productive and enjoyable lives.

How to prevent having dysthymia?

There is no one proven way to prevent dysthymia. However, some strategies may help prevent or lessen its symptoms, such as exercising, proactively managing stress, reaching out to loved ones, getting help at the first indication of a problem, and receiving ongoing care.

First, engaging in physical activity or exercising is one of the most natural ways to improve mood and emotion. This is most likely a result of exercise increasing your brain’s tryptophan and serotonin levels. Both of these substances contribute to elevated mood.

Next, proactively managing stress can also be done by learning stress management techniques, such as meditation, yoga, progressive muscle relaxation, deep breathing, and tai chi. These relaxation techniques can help an individual cope with everyday life stressors, thus avoiding triggers and potential depressive episodes.

Third, reaching out to loved ones, such as family or friends, can foster a supportive environment. This could aid in reducing one’s sense of isolation and remind them that they are not alone.

Getting help at the first indication of a mental health problem is beneficial in the early detection of an illness, and consequent early intervention can aid in preventing the progression of symptoms.

Finally, receiving ongoing care or long-term treatment once a psychological disorder is diagnosed is important to lessen the chance of symptoms returning.

What is the difference between dysthymia and depression?

Dysthymia and depression share certain similarities. However, when comparing dysthymia vs. depression, the two conditions may differ in duration of symptoms, severity of symptoms, interference with daily functioning, frequency of episodes, and treatment response.

Dysthymia is a mood disorder marked by long-lasting, chronic symptoms that last at least two years in adults (or one year in children and teens). In contrast, depression or major depressive disorder symptoms might remain for at least two weeks, but can even last for a few months to several years.

Another difference between the two conditions is that dysthymia is usually linked with milder symptoms than major depressive disorder. Dysthymic individuals typically exhibit persistent feelings of hopelessness, low self-esteem, disinterest in formerly pleasurable activities, and an overall gloomy disposition.

However, major depression causes severe symptoms like extreme sadness, worthlessness, or guilt, weight and eating fluctuations, sleep issues, trouble concentrating, and frequent thoughts of death or suicide.

Dysthymic disorder and major depressive disorder also differ in how they interfere with one’s daily functioning. Despite persistent symptoms, dysthymia can allow people to maintain a pretty good level of functioning in their daily life. They might be able to carry on with their jobs, studies, and social lives, albeit with less pleasure.

Contrarily, major depressive illness frequently considerably reduces a person’s capacity to function in a variety of spheres of life, resulting in challenges with social interactions, self-care, and work or school performance.

The frequency of episodes may help distinguish PDD from MDD. Dysthymia is defined by a chronic and persistently depressed mood, with symptoms present throughout the majority of the two-year period. Even if the severity of the symptoms may change, episodes are not easily distinguished from one another.

However, in major depressive illness, people frequently go through distinct depressive episodes that are followed by intervals of normal or somewhat stable mood.

Lastly, the treatment response in each condition is different. When compared to major depressive illness, dysthymia may respond to treatment less well. While antidepressant medications and psychotherapy are effective treatments for both disorders, major depressive disorder frequently responds to therapy more visibly.

For dysthymia to reduce symptoms and enhance overall functioning, more prolonged and long-term therapies could be necessary.