Dysthymic Disorder (Persistent Depressive Disorder)
Dysthymic Disorder is characterized by an almost daily depressed mood (i.e., sadness, irritability) for at least 2 years. While depressed, it is quite common to have less appetite than normal or experience an increase in appetite. That said, extreme fluctuations in appetite are rather uncommon.
Many people with dysthymia experience insomnia. People have difficulty falling asleep initially or resuming sleep after waking up in the night and often wake-up earlier than desired in the morning. The person may experience a lack of motivation or energy and feel fatigued throughout the day.
The individual may have difficulty concentrating or making decisions. Low self-esteem is also a familiar complaint of individuals with Dysthymic Disorder which is often experienced as recurrent negative thinking about oneself, the world, and their future. In turn, chronic feelings of hopelessness are quite common, though often not severe enough to cause the person to feel suicidal. However, if you are considering suicide visit your family physician or local emergency department immediately or call your local Distress Line.
Although the symptoms of dysthymia cause a great deal of distress and often interfere with academic, occupational, or social functioning, many people continue to manage their daily lives. However, most individuals use up a great deal of their energy with work, leaving little energy to maintain relationships and other activities. Some individuals will devote themselves almost entirely to work in order to avoid dealing with the overwhelming depression they experience outside of work.
It is important to note that the symptoms of Dysthymic Disorder usually last longer and are less severe than those of a Major Depressive Disorder. Due to the chronic nature of dysthymia, however, people often have difficulty recalling a time when they did not feel depressed.
It is possible to be diagnosed with both Major Depressive Disorder and Dysthymic Disorder, but the symptoms of dysthymia must have been present for least 2 years prior to the first Major Depressive Episode. Alternatively, the person must be in full remission from a Major Depressive Disorder (i.e., 2 months without symptoms) prior to the onset of Dysthymic Disorder. Dysthymia is also a risk factor for Major Depressive Disorder. Approximately 3 out of 4 individuals with Dysthymic Disorder will go on to develop Major Depressive Disorder. Symptoms of dysthymia are commonly present at an early age. Those who experience Dysthymic Disorder prior to age 21 are more likely to experience Major Depressive Episodes as well. If untreated, a return to low-grade dysthymic depression upon recovery from a Major Depressive Episode is often the rule which further emphasizes the need for treatment.
Fewer individuals experience the onset of dysthymia after age 21. Some individuals with a dysthymic condition have long-standing personality problems (i.e., habitual and ineffective ways of approaching life), resulting in interpersonal difficulties that contribute to their chronically depressed state. Approximately 6% of the population will develop Dysthymic Disorder at some point in their lives.
There are a number of Physical Conditions that can cause symptoms similar to dysthymia. Consult with a physician that you trust in order to have a full medical examination prior to concluding that what you are experiencing is depression without any physical basis.
Treatment:
Current research indicates that depression can be treated effectively with medications or psychotherapy. However, some forms of psychotherapy appear to have a lower rate of relapse than medications. In particular, individuals who have gone through Cognitive Behavior Therapy (CBT) appear less likely to experience subsequent depressive episodes. People are taught how to change the negative thoughts and beliefs that impact their perceptions of themselves, others, and the world around them. Often these thoughts are tied to past negative experiences, but occur in the present as a result of current experiences. However, the person is usually much harsher with him or herself than the situation warrants. CBT also involves teaching the person to approach life in a way that will reduce symptoms and get them back to doing the things that they enjoyed when not depressed.
