# Understanding Dysthymia



## David Baxter PhD (Feb 4, 2018)

*Understanding Dysthymia*
By Laura Greenstein, _NAMI: National Alliance on Mental Illness_
Jan. 17, 2018

If someone mentioned that they have depression, most people would  likely have some idea of what that means. They might imagine a person  feeling tired, gloomy or empty. They might even know some of the  accompanying symptoms such as changes in weight or sleep patterns. But  what many people don’t know is that there are actually different types  of depression.

  The most common form is major depressive disorder, which affects about 16 million adults in the U.S. This is what most people associate with the term “depression.” Other forms  include depression with a seasonal pattern, which usually occurs in late fall and winter; postpartum depression, affecting women after childbirth; and dysthymia, which is a long-term form of depression that lasts for years.

   All forms of depression have similar symptoms: issues with sleep, low  energy, low self-esteem, poor concentration, difficulty making  decisions, feelings of hopelessness. What _distinguishes_ them is timing and consistency of symptoms. And the primary distinction with dysthymia (also known as persistent depressive disorder) is that it’s the only depressive disorder where symptoms are present for at least two years, and typically longer.

*What is Dysthymia Like?*
  While someone with major depressive disorder will typically “cycle”  through episodes of feeling severely depressed and then be symptom-free  for periods of time, dysthymia presents with persistent symptoms for  years.

  An episode of depression usually represents a break from someone’s  normal life and outlook, while dysthymia is often embedded into a  person’s life and outlook because they experience symptoms for such  prolonged periods of time. In fact, an adult must experience depression  for at least a two-year period to receive a diagnosis (one year for  children and teenagers).

  Dysthymia often has an early and subtle onset during childhood,  adolescence or early adulthood. However, it can be challenging to detect  because its less severe and lingering nature can make the condition  feel “normal” for that person.

  Also making it a challenge to diagnose is the fact that about 75%  of people with dysthymia will also experience a major depressive  episode. This is referred to as “double depression.” After the major  episode ends, most people will return to their usual dysthymia symptoms  and feelings, rather than feel symptom-free.

*What Can I Do?*
  If you think you may have dysthymia, it’s essential to seek help.  Seeing a mental health professional is the first step to recovery.  Taking the time to go to therapy is an investment in your health and  well-being; the condition will not go away on its own. Typically, a  combination of both psychotherapy and medication leads to the best outcomes.

  Further, according to a study  that followed people experiencing dysthymia for nine years, one of the  most important factors of recovery is having confidence in your health  care providers. This may mean trying out different therapists and  psychiatrists until you find one that best fits your needs.

  The study also notes that participants who recovered felt like they  gained “tools to handle life,” including understanding themselves and  their condition, having self-acceptance and self-compassion and focusing  on solving problems that create distress.

  Learning these tools and preparing yourself to handle difficult  symptoms requires patience. It can be challenging to have hope for  recovery when depression is your norm—when feeling good seems more like a  memory than a possibility. But recovery _is_ possible. It takes effort and commitment, but you deserve to feel better.


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## GaryQ (Feb 4, 2018)

David, can you help me understand more about the distinctions between dysthymia/MDD?

IF I understand the description from this article, having been in a pretty much constant depressed state for years now with episodes of major depression would that be considered my condition being dysthymia with episodes of MD?

I thought MDD was being in a pretty constant depressed state. This seems to describe MD as episodal rather than a prolonged depressed state.

I know I should talk to my doctor about it but his focus is on keeping me alive more than figuring out what labels to put on my disorders and the psychiatrist I saw about a year ago doesn't seem to have the competency to properly diagnose anything else than calling everything a personality disorder. The only half decent info he had was from a previous psychiatrist that I saw years back but who has long since retired. And the others I have seen blame my depression and symptoms on being medication side effects. 

Trying to understand and grasp the reason for being in this state is depressing in itself. 
Maybe I just have to learn to simply accept things as they are and not add extra pressure and stress on myself by trying to figure out what the heck is wrong with me...

Thanks,
Gary


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## David Baxter PhD (Feb 4, 2018)

No. 

Dysthymia is basically low level depression that doesn't meet the criteria for Major Depressive Episode:



> Emotional depression that persists for years, usually with no more than moderate intensity, characterizes this depressive disorder.
> 
> *DSM IV-TR Criteria*
> 
> ...



If you experience at least one Major Depressive Episode, you can still have periods where you don't meet the criteria for MDD. Once you experience a second Major Depressive Epiosode, your diagnosis wiuld be *Major Depressive Disorder, Recurrent*.



> *DSM IV-TR Criteria*
> 
> A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either
> 
> ...


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## Michelle M (Feb 12, 2018)

l would like to know if this is Heriditary??   My Mother had MDD and my sister has MDD as well as Bi - polar, so is there a chance my children might suffer from Depression also?? l know after the loss of my child,  l did suffer a Mdd but l have since been diagnosed with Dysthemia.  lt is my son, that has always worried me as he always seemed sad and was bullied at school.  l did mention to the Dr. l was worried he might have anxiety but also looked depressed and she told me,  he would grow out of it..  That is why l wanted to know if any forms of Depression could be passed to children.  Thanks


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## David Baxter PhD (Feb 13, 2018)

The answer is yes, there is a genetic basis to almost any mental disorder so vulnerability may be passed on to your children.

But that doesn't mean that they will necessarily inherit any mental disorders.

For one thing, they are not inheriting only your genetic material but also that of their father which may at least partially offset the risk they inherit from you.

Additionally, whether someone exhibits the full symptoms of a disorder often seems to depend on an interaction between genes and experience in the world. For example, there have been numerous studies of schizophrenia using identical twins, who have the same genetic material. When one twin develops schizophrenia, this significantly increase the possibility that the other twin will also develop schizophrenia, confirming the genetic factor. But the risk for the non-schizophrenic does not jump to 100% but rather only to about 50%, so the twin without schizophrenia still has a 50% chance of NOT developing the illness.

A similar risk picture applies to your children or siblings, except since they can have quite different genetic makeup the effect is even smaller.


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## Michelle M (Feb 13, 2018)

Okay,  l understand but there is mental illness on the Father's side as well as Alcoholism,  so that would increase the mental illness up a bit and 50% for becoming alcoholics,  especially if the Father was supplying them with Alcohol at 14 + years before the age of 25,  when the brain is fully formed.
The Father's family , as well as the Father were extremely Dysfunctional and it carried down to our family and the children were shutting me out of their lives as they were being rewarded with Alcohol and money.


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## David Baxter PhD (Feb 14, 2018)

As I said above, they may have inherited vulnerabilities but they are not doomed. Only time will tell.


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## Michelle M (Feb 14, 2018)

lol,  Thank you for the info....Good to know they may not continue on past behaviours of other family members..l had to giggle when you told me they were not "doomed".  l did not realize how my messages were sounding,  but l do really appreciate your quick response!


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## David Baxter PhD (Feb 14, 2018)

I couldn't think of another word in the moment. I just meant there is no guarantee one way or another.


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