Dysthymia is a milder but more long-lasting form of depressive disorder.
Feelings of low mood, worthlessness, distractibility, and other symptoms accompany a person’s life every day, for months or even years.

Dysthymia does not lead to significant impairment in functioning or autonomy, but people with dysthymia are unable to fully experience joy, happiness, or enjoy their lives. These individuals may attribute their emotional state to their personality, while in reality, dysthymia is a fully treatable mental disorder—not a personality trait.

 

What is Dysthymia?

Persistent depressive disorder (dysthymia) is characterized by chronic depression (lasting two years or more), present most of the day, more days than not.
In children and adolescents, depression may manifest as irritability.
Depressed mood is accompanied by a noticeable decrease in interest or pleasure in activities, reduced concentration, distractibility, and feelings of worthlessness. Anxiety, guilt, hopelessness about the future, changes in appetite and sleep, or fatigue may also be present.

According to research, at least three-quarters of people with dysthymia also have a chronic physical illness or another mental disorder, such as one of the anxiety disorders, cyclothymia, or substance use disorders.
The most common co-occurrence is with major depressive disorder (up to 75%).
This combination, often called “double depression,” is harder to treat than regular depression, as individuals may perceive major depressive symptoms as uncontrollable or inevitable. This, of course, delays help-seeking. Moreover, treatment may be less effective if only the symptoms of major depression are addressed, while dysthymic symptoms are overlooked.

Dysthymia affects approximately 4.5–5% of the world’s population and is more common in women.
The onset typically occurs during adolescence.

While the biological causes of dysthymia are not considered primary, the disorder’s development is likely due to a complex set of factors. Some evidence supports a genetic predisposition to dysthymia. Other contributing factors include stress, social isolation, and a lack of social support.

Impact on Life

The chronic and subtle nature of dysthymia often leads people to be unaware they have a disorder.
Individuals with dysthymia often cannot recall a time when they felt differently.
As a result, they may believe that the signs of depression are traits of their personality, temperament, or worldview. They may hide their symptoms and avoid discussing their emotions with professionals, family, or friends. This can lead to feelings of loneliness and abandonment.

Mild dysthymia can cause a person to protect themselves from stress and potential failure by avoiding fully engaging in life. In more severe cases, the person may withdraw from daily activities altogether, as they derive no pleasure from regular pastimes, and a pessimistic outlook on the future hinders motivation.

Additionally, dysthymia often co-occurs with other psychological disorders, which may mask dysthymia or worsen the overall condition.

Treatment

The best outcomes in the treatment of dysthymic disorder are achieved through a combination of psychotherapy and pharmacotherapy. The treatment indications are the same as for major depressive disorder—antidepressants (mainly Selective Serotonin Reuptake Inhibitors (SSRIs)) and Cognitive Behavioral Therapy (CBT).
The overall level of treatment effectiveness is slightly lower compared to non-chronic depression, and treatment-resistant cases are more likely. In such cases, the use of additional interventions is often recommended. These may include lithium, thyroid hormone supplements, stimulants, and other medications.

Among psychotherapeutic methods, Dialectical Behavior Therapy (DBT) may also be used. It focuses on teaching problem-solving techniques and acceptance strategies. Behavioral Activation can also be effective in overcoming avoidant and isolating behaviors.
Additionally, for individuals who also experience seasonal affective disorder, light therapy may help enhance the therapeutic effect.

When living with a chronic mental illness for a long time, relief or recovery may seem impossible. However, dysthymia is a treatable condition, and with consistent treatment and the necessary support, it is entirely possible to restore mental health and live a happier and more fulfilling life.