# Dysthymia - Dysthymic Disorder



## David Baxter PhD

Dysthymia (dysthymic disorder)
By Mayo Clinic Staff 
Aug. 26, 2008 

Dysthymia is a mild but chronic form of depression. Dysthymia symptoms usually last for at least two years, and often much longer than that, especially when the condition starts in childhood. 

Although the symptoms of dysthymia may be less intense than those of depression, dysthymia can actually affect your life more seriously because it lasts so long. With dysthymia, you may lose interest in normal daily activities, feel hopeless, lack productivity and have a low self-esteem. In general, dysthymia prevents you from living life to its fullest, and your overall quality of life may be low. Dysthymia is also known as dysthymic disorder and sometimes as chronic depression and minor depression. 

*Symptoms*
Signs and symptoms of dysthymia include: 


Loss of interest in daily activities 
Feeling sad or down 
Poor appetite 
Overeating 
Hopelessness 
Sleep problems 
Lack of energy 
Fatigue 
Low self-esteem 
Trouble concentrating 
Trouble making decisions 
Self-criticism 
Irritability 
Excessive anger 
Decreased productivity 
Avoiding social activities 
Feelings of guilt
Dysthymia symptoms typically come and go over a period of years, and their intensity can change over time, too. But in general, you may find it hard to be upbeat even on happy occasions ? you may be characterized as having a gloomy personality. 

*When to see a doctor*
It's perfectly normal to feel sad or upset sometimes, or to be unhappy with stressful situations in your life. But with dysthymia, these feelings last for years and interfere with your relationships, work and daily activities. 

If you have any symptoms of dysthymia, seek medical help as soon as possible. Dysthymia usually doesn't get better on its own, and it may even get worse if left untreated. In fact, if not effectively treated, dysthymia commonly progresses into depression (major depression). When you have both dysthymia and depression, it's known as double depression. 

If you have a primary care doctor, talk to him or her about your symptoms. Or seek help directly from a mental health provider. If you're reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it's a friend or loved one, a teacher, a faith leader or someone else you trust. 

*Causes*
It's not known specifically what causes dysthymia. Researchers believe that dysthymia has similar origins as depression, including: 


_Biochemical_. Some evidence from imaging studies indicates that people with depression have physical changes in their brains, and this may be true of dysthymia, too. The significance of these changes is still uncertain but may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in causing dysthymia. 
_Genes_. Some studies show that depression is more common in people whose biological family members also have the condition, and this also appears to be the case with dysthymia. Researchers are trying to find genes that may contribute to causing dysthymia. 
_Environment_. Again, as with depression, environment may contribute to dysthymia. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems and high stress.
*Risk factors*
Although it's not clear exactly how many people may have dysthymia, evidence suggests that it's more common than is depression. That may be because dysthymia tends to start earlier in life ? often in childhood or during the teenage years ? and lasts longer than does depression. When dysthymia starts on or before age 21, it's called early-onset dysthymia. When it starts after that, it's called late-onset dysthymia. 

Although the precise cause of dysthymia isn't known, researchers have identified certain factors that appear to increase the risk of developing or triggering dysthymia, including: 


Having biological relatives with depression 
Having biological relatives with dysthymia 
Being female 
Stressful life events 
Having a chronic medical condition
*Complications*
Complications that dysthymia may cause or be associated with include: 


Reduced quality of life 
Major depression 
Suicidal behavior 
Substance abuse 
Relationship difficulties 
Family conflicts 
Social isolation 
School and work problems 
Decreased productivity
*Preparing for your appointment*
In some cases, a health care provider or other professional may ask you about your mood. Your doctor may bring it up during a routine medical appointment if you seem to be sad or down, for instance. Or you may decide to schedule an appointment with your family doctor or general practitioner to talk about your concerns. In either case, because dysthymia often requires specialized mental health care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment. In other cases, you may seek out a mental health provider on your own first. 

*What you can do*
Being an active participant in your care can help your efforts to recover from dysthymia. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These may include: 


Why can't I get over dysthymia on my own? 
How do you treat dysthymia? 
Will psychotherapy help? 
Are there medications that might help? 
How often will we meet? 
How long will treatment take? 
What can I do to help myself? 
Are there any brochures or other printed material that I can take home with me? 
What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask, don't hesitate to ask questions during your appointment when you don't understand something. 

*What to expect from your doctor*
During your appointment, your doctor is likely to ask you a number of questions about your mood, thoughts and behavior. Your doctor may ask such questions as: 


When did you first notice symptoms? 
How is your daily life affected by your symptoms? 
What other treatment have you had? 
What have you tried on your own to feel better? 
What things make you feel worse? 
Have any relatives had dysthymia, depression or another mental illness? 
What do you hope to gain from treatment?
*Tests and diagnosis*
When doctors suspect someone has dysthymia, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include: 


_Physical exam_. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen. 
_Laboratory tests_. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function. 
_Psychological evaluation_. A doctor or mental health provider talks to you about your thoughts, feelings and behavior patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar issues in the past. You also discuss any thoughts you may have of suicide or self-harm. You may also be asked to fill out questionnaires about your mood and state of mind.
*Checking for other conditions*
Several other conditions have symptoms that may resemble the symptoms of dysthymia, including feeling sad or down, loss of interest in daily activities, and problems sleeping. Your doctor or mental health provider's evaluation will help determine if you have dysthymia or another condition that can affect your mood, such as: 


Adjustment disorder 
Bipolar disorder 
Depression 
Personality disorders 
Seasonal affective disorder 
Substance abuse disorder
*Diagnostic criteria for dysthymia*
Dysthymia is distinguished from these other conditions by its symptoms and their severity. To be diagnosed with dysthymia, you must meet the symptom criteria spelled out in the _Diagnostic and Statistical Manual of Mental Disorders (DSM)_. This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. 

*Main criterion*
The main criterion to be diagnosed with dysthymia is: 


Having a depressed mood most of the time for two or more years (in children, the duration must be at least one year, and their mood can be irritable rather than depressed).
*Additional criteria*
In addition to that, you must have at least two of these symptoms, and they must cause you distress or interfere with your ability to function in your daily life: 


Poor appetite or overeating 
Sleep problems 
Fatigue or lack of energy 
Low self-esteem 
Hopelessness 
Poor concentration 
Trouble making decisions
Make sure you understand if you have been diagnosed with dysthymia or another condition so that you can learn more about your specific situation and get appropriate treatment. 

*Treatments and drugs*
*Treatment options: Medications and psychotherapy*
The two main treatments for dysthymia are: 


Medications 
Psychotherapy
There's no clear evidence that either of these treatments is better than the other. There is some evidence, though, that using a combination of medications and psychotherapy may be slightly more effective in treating dysthymia than using only medications or only psychotherapy. 

Which treatment approach you take depends on such factors as: 


The severity of your dysthymia symptoms 
Your desire to address emotional or situational issues affecting your life 
Your personal preferences 
Previous treatment methods 
Your ability to tolerate medications 
Whether you're pregnant or breast-feeding 
The availability of mental health services in your community 
Your health insurance coverage
*Medications for dysthymia*
The psychiatric medications most commonly used to treat dysthymia are the same kinds used to treat depression. They include: 


Selective serotonin reuptake inhibitors (SSRIs) 
Serotonin and norepinephrine reuptake inhibitors (SNRIs) 
Norepinephrine and dopamine reuptake inhibitors (NDRIs) 
Combined reuptake inhibitors and receptor blockers 
Tetracyclic antidepressants 
Tricyclic antidepressants (TCAs) 
Monoamine oxidase inhibitors (MAOIs)
SSRIs are often the antidepressant of choice because, in general, they work well and their side effects are more tolerable. MAOIs are usually last choices because they can have serious side effects and require strict dietary restrictions because of rare but potentially fatal interactions. Which one is best for you depends on your individual situation. When you have dysthymia, you may need to take antidepressants long term to keep symptoms under control. 

The Food and Drug Administration (FDA) requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications. The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants. 

*Psychotherapy for dysthymia*
Psychotherapy can help you learn about your condition and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy coping skills and stress management. Psychotherapy can be especially helpful if: 


You need help learning to make decisions 
You have self-defeating behavior patterns 
You also have other mental illnesses, such as an anxiety disorder 
You have a history of traumatic life experiences
*Types of psychotherapy*
Several types of psychotherapy may be helpful for dysthymia, including: 


Cognitive behavioral therapy 
Interpersonal therapy 
Cognitive therapy 
Behavior therapy
You and your therapist can talk about which type of therapy is right for you, your goals for therapy, and other issues, such as the number of sessions and length of treatment. 

Lifestyle and home remedies
Dysthymia generally isn't an illness that you can treat on your own. But you can do some things for yourself that build on your treatment plan. In addition to professional treatment, follow these lifestyle and self-care steps for dysthymia: 


_Stick to your treatment plan_. Don't skip therapy sessions, even if you don't feel like going. 
_Take your medications as directed_. Even if you're feeling well, resist any temptation to skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms. 
Learn about dysthymia_. Education about your condition can empower you _and motivate you to stick to your treatment plan. 
_Pay attention to warning signs_. Work with your doctor or therapist to learn what might trigger your dysthymia symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends in watching for warning signs. 
_Get active._ Physical activity and exercise have been shown to reduce symptoms in depression-related conditions. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy. 
_Avoid drugs and alcohol_. Alcohol and illicit drugs can worsen depression-related symptoms.
*Alternative medicine*
You may be interested in trying to relieve dysthymia symptoms with complementary or alternative medicine strategies. These may include nutritional and dietary supplements and mind-body techniques. 

Keep in mind that nutritional and dietary products aren't regulated. The FDA doesn't test them for safety, purity or effectiveness. You can't always be sure of what you're getting and if it's safe. Also, be aware that herbal and dietary supplements can interfere with the way certain prescription medications work or can cause dangerous interactions that can harm your health. Talk to your doctors and other health care providers before taking any herbal or dietary supplements. 

While some researchers are studying the effectiveness of complementary and alternative medicine, the jury's still out. Make certain you understand possible risks as well as benefits before pursuing them. Complementary and alternative treatments generally aren't a good substitute for traditional medical care. 

*Nutritional and dietary supplements*
Here's a look at some nutritional supplements commonly used for dysthymia and major depression: 


_St. John's wort_. Known scientifically as Hypericum perforatum, this is an herb that's been used for centuries to treat a variety of ills, including depression-related disorders. It's not approved by the FDA to treat dysthymia or other forms of depression in the United States. Rather, it's classified as a dietary supplement. However, it's a popular depression treatment in Europe. Some studies show it may be helpful if you have mild or moderate depression, such as dysthymia, but overall evidence is inconclusive. 
_SAMe_. Pronounced "sammy," this is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosyl-methionine. It's not approved by the FDA to treat depression-related conditions in the United States. Rather, it's classified as a dietary supplement. However, it's used in Europe as a prescription drug to treat depression. 
_Omega-3 fatty acids_. These are polyunsaturated fats found mostly in seafood. Good sources of omega-3s include fatty, cold-water fish, such as salmon, mackerel and herring. Flaxseed, flax oil and walnuts also contain omega-3 fatty acids, and small amounts are found in soybean and canola oils.
*Mind-body connections*
The connection between mind and body has been studied for centuries. And some people with dysthymia may experience physical symptoms, including fatigue, backache, or vague aches and pains. 

Mind-body techniques are thought to strengthen the communication between your mind and your body. Complementary and alternative medicine practitioners say that these two systems must be in harmony for you to stay healthy or to heal. 

Mind-body techniques used to improve dysthymia symptoms can include: 


Acupuncture 
Yoga 
Meditation 
Guided imagery 
Massage therapy
As with dietary supplements, take care in using these techniques. Although they may pose less of a risk, relying solely on these to treat dysthymia may not be effective enough. If you try mind-body techniques first to treat your dysthymia but your symptoms worsen or don't improve, be sure to consult your health care providers. 

*Coping and support*
Coping with dysthymia can be challenging since it can have such a strong hold on your life. Dysthymia makes it hard to engage in the behavior and activities that may help you feel better. Talk to your doctor or therapist about improving your coping skills, and consider these tips to cope with dysthymia: 


Simplify your life. Cut back on obligations when possible, and set reasonable schedules for goals. 
Write in a journal to express pain, anger, fear or other emotions. 
Read reputable self-help books and consider talking about them to your doctor or therapist. 
Don't become isolated. Try to participate in normal activities and get together with family or friends regularly. 
Take care of yourself by eating a healthy diet and getting sufficient sleep. 
Join a support group for people with depression-related conditions so that you can connect to others facing similar challenges. 
Stay focused on your goals. Recovery from dysthymia is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals. 
Learn relaxation and stress management. Try such stress reduction techniques as meditation, yoga or tai chi. 
Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.
*Prevention*
There's no sure way to prevent dysthymia. Because dysthymia often starts in childhood, identifying children at risk of the condition may be of some benefit, though, by encouraging early treatment. Also, taking steps to control stress, to increase your resilience and to boost low self-esteem may help ward off dysthymia symptoms. Friendship and social support, especially in times of crisis, can help you weather rough spells. Also, treatment at the earliest sign of a problem can help prevent dysthymia from worsening. Long-term maintenance treatment also may help prevent a relapse of dysthymia symptoms.


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## suewatters1

Very Good article that describes me perfectly. I have been feeling this way since I was in grade school.

Sue


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## Lida

Why should this be seen as an illness? Why is this not just a normal human variant like brown eyes or being short? And if this is an illness then what about people who are chronically happy, we all know people like that.


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## SunMnStrz

Ah yes... thank you so much for posting this article, describes me quite well unfortunately.


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