Chronic Depression: What Is Dysthymia and How It Differs

Sometimes low mood does not come in waves but drags on for years: a person wakes up without joy, does routine tasks by force, and no longer remembers what their mood used to be like. This condition is called chronic depression, and it has its own name — dysthymia.

What chronic depression and dysthymia are

Depression is a persistently low mood that lasts for weeks or months and affects daily life. Dysthymia, or dysthymic disorder, is a chronic mood disorder with the same cognitive and physical problems as depression, but less severe and longer lasting. In the American DSM-5 classification it is called persistent depressive disorder, in ICD-11 — dysthymic disorder. The term appeared as a replacement for the concept of "neurotic depression."

How prolonged depression differs from ordinary depression

In major depressive disorder, symptoms affect daily activities and last at least two weeks. In dysthymia they are milder but last much longer: a diagnosis is possible only if the disorder continues for at least two years. Periods of normal mood during this time last less than a few weeks.

Because the symptoms are mild, prolonged depression is easily mistaken for a personality trait or constant fatigue. For years a person explains to themselves that they are simply "like that" and does not seek help.

What signs occur in dysthymia

The basis is low mood most of the time, low self-esteem, and a reduced ability to experience pleasure. At least two of the following signs are added to this:

• reduced appetite or overeating;
• insomnia or, conversely, sleeping too long;
• fatigue and lack of energy;
• low self-esteem, difficulty concentrating and making decisions;
• pessimism or a sense of hopelessness.

Sometimes physical complaints come to the fore: general poor well-being, palpitations, shortness of breath, tearfulness, sleep with frequent awakenings. Mood is only mildly low, while anxiety is more pronounced.

Why depression becomes "eternal": possible causes

Among the causes cited are genetic, biological, environmental, and psychological factors. The risk is higher if a close relative lives with depression or another mental disorder, and also after trauma or stressful events. Dysthymia more often begins at a young age, and early onset, before age 21, is associated with more frequent relapses. If the disorder began in childhood, a person considers their symptoms a personality trait and does not tell doctors or loved ones about them.

After three years without treatment, more pronounced depression may be added to dysthymia — this picture is called double depression, and it occurs during a lifetime in more than two-thirds of people with dysthymia. At least 75% of them also have a chronic somatic disease or another psychological disorder.

How a doctor makes the diagnosis

The conversation begins with questions about symptoms and family history. Then an examination and tests are possible to rule out other causes: some medications, viral infections, and thyroid diseases produce a similar picture. A mental status assessment is conducted separately. The basis for the diagnosis is a mood that remains low for two years or longer, with intervals of normal mood shorter than a few weeks. The picture is complicated by the fact that dysthymia often occurs together with other disorders, and then the correct diagnosis is often made many years after onset.

Why a long course is dangerous and when to see a doctor

People with dysthymia more often face major depressive disorder, anxiety states, and alcohol or drug dependence. Years of low mood affect work, study, and relationships. It makes sense to see a family doctor or psychiatrist if low mood persists for months and years, joy almost never returns, and sleep, appetite, and concentration changed long ago. If thoughts of death or suicide appear, but there is no immediate threat to life, this is also a reason to talk to a doctor as soon as possible. Dysthymia itself does not require urgency, but a conversation about it with a doctor is possible at any convenient moment.

Dysthymia by itself is not a reason to call an ambulance; 103/112 — if there is an immediate threat to life: a person is trying to harm themselves or has attempted suicide.

This is reference material, and it does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer