Dysthymia: Why always being a little depressed is worth taking seriously 

Everyone feels a little blue sometimes. But what if that low mood seems to be the daily norm?

You might assume you’re someone who just naturally has poor self-esteem or a negative outlook on life. But you might actually have a mood disorder called dysthymia.

Also known as persistent depressive disorder, the condition is a mild to moderate form of chronic depression. Anywhere from 3% to 6% of Americans have dysthymia, according to various studies. That number is higher among folks who are receiving psychotherapy.

Dysthymia can weigh on you and cause you to lose interest in your regular daily activities. It may even sap enjoyment from things that should be fun, such as getting together with friends. And it can make you less productive, even when you’re accomplishing tasks.

It can also be accompanied by other distressing emotions. These feelings may include hopelessness, irritability and sadness. You may also experience low self-esteem, social avoidance, fatigue and guilt.

The bottom line: Dysthymia is a commonly treated condition. And people who seek help for it almost always experience some improvement.

Dysthymia vs. depression: What’s the difference?

In adults, dysthymia is a persistent low mood that is experienced most days of the week for at least 2 years, says Peggy Scallon, MD, a psychiatrist. She is the medical director of Focus Depression Recovery Adolescent Residential Care at Rogers Behavioral Health, a nonprofit treatment center in Oconomowoc, Wisconsin. In children and adolescents, dysthymia can be diagnosed after a year.

That doesn’t mean you should wait 2 whole years before seeking help. Always report any change in mood to your health care provider. The time frame is part of the diagnosis that helps health care providers determine what the next treatment steps should be.

The main differences between dysthymia and major depressive disorder are how long the symptoms last and how severe they are. With dysthymia, symptoms occur almost daily for months or years. They are usually low-grade or moderate. People with dysthymia may be functioning in their lives. But they may not feel a lot of joy or happiness in what they’re doing, experiencing or accomplishing.

With major depression, symptoms can cycle. Sometimes you have them, sometimes you don’t. They also feel more intense and can significantly interfere with daily life. It can feel difficult or even impossible to do basic things, such as exercise, make dinner or even get out of bed. (Learn more about depression here.)

To be diagnosed with dysthymia, you have to experience 2 or more of the following 6 symptoms for a 2-year period:

• Poor appetite or overeating
• Insomnia or hypersomnia (oversleeping)
• Low energy or fatigue
• Low self-esteem, feeling unworthy or inadequate a lot of the time
• Poor concentration
• Having a hard time making decisions
• Feelings of hopelessness

If your symptoms go away for more than 2 months at a time, you’re considered to be in remission from dysthymia, Dr. Scallon says. But if you’re in remission and still have symptoms that affect your daily life, talk with a doctor or mental health professional. You might be suffering from another mood disorder that needs attention.

Living with dysthymia can be confusing and frustrating. Some people assume that their symptoms are just a part of their personality. They can’t remember feeling any differently. But dysthymia is a treatable mood disorder, not a personality type.

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What causes dysthymia?

The exact causes of dysthymic disorder are unknown, but there are some possible theories. And sometimes more than one cause may be involved.

Some causes of dysthymia may include:

Physical differences in the brain. Some people’s brains may develop differently in ways that can affect their emotions. The areas that regulate mood may be smaller or have fewer nerve connections, for instance. Researchers are still learning more about these possible causes.

Brain chemistry. Neurotransmitters may play a role in dysthymia and major depression. These are chemicals that carry signals between brain cells. The neurotransmitters serotonin and norepinephrine are likely involved. But recent research finds that two common neurotransmitters involved in emotional regulation, glutamate and GABA, may also cause symptoms of depression. That’s according to scientists at Yale University in New Haven, Connecticut.

Genes. People with relatives who have depression may have a higher risk of developing depression themselves.

Chronic stress. Continual, daily stress is more likely to trigger dysthymia than a major one-time stressful event, such as a job loss or a death. Constantly feeling overwhelmed and believing that there’s no way to change the situation takes a toll.

People who live in poverty or have very dissatisfying jobs may be at a higher risk for dysthymia. The same is true for people who live with physical or emotional abuse.

Regardless of the cause, there are many forms of treatment.

How is dysthymia treated?

Dysthymia is usually treated the same way as major depression. People with dysthymia can’t snap out of it and suddenly get better. Treatment is important to recovery.

Medication and therapy are the most common methods of easing symptoms and feeling better. Therapy can be key to treating dysthymia because it teaches you coping skills. Plus, it empowers you to make the changes that will help you feel better. (Looking for a new therapist? Start here.)

Common therapy options for dysthymia include:

Cognitive behavioral therapy (CBT). This approach focuses on how your thoughts and beliefs influence your moods and actions. For example, CBT can help you identify and change harmful thinking patterns that may lead you into a negative thought spiral.

A common negative thought pattern is catastrophizing: convincing yourself that an event will have major negative consequences without any proof of it. For instance, if a colleague is 15 minutes late to lunch, you may think it means they’ve been in a car accident — or that they dislike you and are blowing you off.

Dialectical behavioral therapy (DBT). DBT uses problem-solving methods and acceptance strategies. For example, you’re taught to identify and accept difficult feelings but also to make changes to handle those emotions. This approach considers all of the mood disorders and mental health conditions you might have and how they impact one another.

Behavioral activation. This practice teaches people to move away from behaviors of avoidance and isolation. These are two behaviors that can actually make your depressive symptoms worse, Dr. Scallon says.

Dr. Scallon especially recommends behavioral activation. “It’s about changing your behavior and then having your mood follow,” she says. “Rather than waiting for inspiration, you force yourself to get up and do it. At the end, you tend to feel better, or at least have a feeling of accomplishment.”

Learn more about how to prep for your first therapy session here.

Your doctor or therapist may also recommend medication in addition to therapy. Commonly prescribed medications include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac^®) and sertraline (Zoloft^®).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor^®) and duloxetine (Cymbalta^®).
• Atypical antidepressants. These include bupropion (Wellbutrin^®) and mirtazapine (Remeron^®).

Long-lasting conditions can feel impossible to beat. But dysthymia is one that can absolutely be managed and treated. Once you have the support you need, you’ll be well on your way to getting back on track and feeling better — for good.

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Additional sources:
Prevalence of major depressive disorder and dysthymia: Journal of Clinical Psychiatry 2010. “The Epidemiology of Chronic Major Depressive Disorder and Dysthymic Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions”
Symptoms and causes of dysthymia: Mayo Clinic. Persistent Depressive Disorder (Dysthymia): Symptoms & Causes. Johns Hopkins Medicine. Dysthymia.
Diagnosis and treatment: Mayo Clinic. Persistent Depressive Disorder (Dysthymia), Diagnosis and Treatment.
Depression and the brain: Yale Medicine. 2021 How Depression Affects the Brain.
Facts on depression: American Psychiatric Association. What is Depression?
Psychotherapy: National Alliance on Mental Illness. Psychotherapy
Behavioral activation: Mayo Clinic. Depression Treatment Behavioral Activation
Medication: Mayo Clinic. Antidepressants: Selecting One That’s Right For You