Persistent Depressive Disorder (Dysthymia)



Let’s talk about Persistent Depressive Disorder shall we. The medical name for this condition is Dysthymia. More than 3 million cases are reported annually in the U.S alone. It can creep up on you, so let’s find out what it is, how it develops, and where to get help.


In this article we’ll cover:

  • What is Dysthymia?

  • Anxious vs. Anergic Dysthymia

  • Risk factors

  • Major Depression vs. Persistent Depressive Disorder

  • Understanding Double Depression

  • Diagnostic criteria for Dysthymia

  • Treatment


What is Dysthymia?


Originating from the ancient Greek word dusthumía, dysthymia literally means “despondency, despair, or ill-temper”. That said, we can glean from the definition person(s) suffering from Dysthymia can be seen as the embodiment of depressive symptoms.


Typically, symptoms of this mild form of chronic depression are experienced for at least 2 years in adults and 1 year in children and adolescents. For more information on depressive symptoms read Complex PTSD Symptoms Pt 2: True Blues where I go into how symptoms can effect the mind and body.




Anxious vs. Anergic Dysthymia


While researching this topic I found a number of articles suggesting 2 sub types of Dysthymia based on the proposed endophenotypes of dysthymia .The version I’ve provided has in-article links like this one if you would like to go further.


Below you will find a simplified list of the proposed symptoms for each sub type:


Anxious Dysthymia Symptoms

Anergic (without anxiety) Dysthymia Symptoms

  • Low energy

  • Hypersomnia (Excessive Tiredness)

  • Anhedonia (the reduced ability to experience pleasure)


Risk factors


According to the DSM-5 Persistent Depressive Disorder is now classified as a depressive disorder which typically begins early in life. Early onset (before the age of 21) is associated with higher risk for coexisting personality disorders. In some cases symptoms may develop rapidly later in life if a person negatively triggered.


Common Risk Factors Include:

  • Family history of depressive disorders

  • Traumatic or stressful life events

  • Building a habit of persistent self-loathing and pessimism

  • Having a history of mental or personality disorders

Major Depression vs. Persistent Depressive Disorder


Trying to distinguish the difference between Dysthymia and Major Depression can be confusing. Major Depression is considered to be a more severe case of depression because of its potency. A major depressive episode can last two weeks or longer.


On the other hand, Dysthymia (mild, chronic depression) is considered a serious depressive disorder due to its longevity and insidious nature. Persistent Depressive Disorder symptoms can last for years at a time eventually becoming inseparable from one’s identity. Some people live with Dysthymia for over 10 years before seeking treatment because they view their symptoms as normal.



Understanding Double Depression


Double depression is the coexistence of Major Depressive Disorder (MDD) and Persistent Depressive Disorder (PDD). More than half of the people with Dysthymia have had a major depressive episode and go on to experience the chronic low-grade depression they have grown accustomed to after recovery.



Diagnostic criteria for Dysthymia


The specific DSM-5 Criteria for persistent depressive disorder (dysthymia) are as follows:


A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.


In children and adolescents, mood may be irritable and duration must be at least 1 year.


B. Presence, while depressed, of two (or more) of the following:

  • Poor appetite or overeating

  • Insomnia or hypersomnia

  • Low energy or fatigue

  • Low self-esteem

  • Poor concentration and/or difficulty making decisions

  • Feelings of hopelessness

C. During the 2-year period (1 year for children and adolescents) of the disturbance, the individual has never been without symptoms in Criteria A and B for more than 2 months at a time.


D.Criteria for major depressive disorder may be continuously present for 2 years.


E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.


F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.


G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).


H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.




Treatment


If you suspect you may have Persistent Depressive Disorder, or members of your inner circle have vocalized their concern it may be time to seek treatment. The first criteria for this diagnosis includes the observation of others for a reason. The symptoms are subtle but treatment is straightforward.


Your physician may refer you to a Psychotherapist for talk therapy or prescribe antidepressants depending on the severity of your symptoms. Bear in mind, proper treatment can curb the intensity of your depressive states and go a long way in preventing major depressive episodes.


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