Dysthymia (Persistent Depressive Disorder): Signs, Symptoms, Treatment And Prevention

Persistent depressive disorder, also called dysthymia or dysthymic depression, is a chronic form of mild to moderate depression — though its symptoms are typically milder than those of its most common "cousin" major depressive disorder, they last much longer.

Persistent depressive disorder can also be diagnosed in adolescents, in which case the symptoms need to have lasted at least one year rather than two, as well older adults — who often have a history of major depressive disorder and whose persistent depressive disorder tends to be triggered by some kind of stress or loss. 

Persistent depressive disorder: The signs and symptoms

The symptoms seen in major depressive disorder (classic depression) apply to dysthymia too, but because they've gone on for so long, they're harder to recognize — if you have dysthymia, you may not see yourself as depressed, in part because the way you're feeling is "business as usual" for you. Despite the fact that folks with persistent depressive disorder often do have "good months" during which their symptoms lift, the depression returns afterwards.

Whereas diagnostic tests for major depressive disorder tend to focus on the way in which your mood, self worth, and behaviors have changed, people with dysthymia may benefit more from simply looking at whether the symptoms apply to them. These include:

• A lack of interest in daily tasks — being demotivated or finding it hard to get things done
• Feelings of low self esteem, hopelessness, worthlessness, pessimism, irritability, sadness, and being "down"
• Fatigue and a lack of energy
• Disordered sleep — finding it hard to go to sleep or stay asleep, or oversleeping
• Having a low appetite or overeating
• Trouble concentrating and making decisions

What causes dysthymia?

The exact causes of dysthymia remain unknown, and may also differ from person to person. It is, however, almost certain that multiple factors contribute to the development of persistent depressive disorder:

• Genetics — people who have immediate relatives with dysthymia appear to be more likely to develop it themselves, and the cause is likely to be at least partially genetic.
• Brain imbalances — as with other forms of depression, neurotransmitters are implicated.
• Stress and trauma — people who have been subject to a lot of stress, or who have experienced trauma, may be more likely to develop dysthymia. This is especially true in older people who are diagnosed with the condition. 

Because the cause of persistent depressive disorder isn't well understood yet, and there isn't a reliable way to predict who is at risk, targeted preventative measures aren't yet possible. General steps that promote emotional and physical wellbeing — like participating in enjoyable and meaningful activities, finding effective ways to relieve stress, regular physical exercise, and having a strong social support network — may help prevent any kind of depression, though. 

How is persistent depressive disorder treated?

It's not uncommon for people with dysthymia to also suffer from other mood disorders or to have other medical conditions, which influences the treatment plan. Interestingly, it appears that antidepressants are the most effective form of treatment for folks who have only dysthymia — and they, rather than talk therapy, should be consider the first step towards recovery. Among the antidepressants people with persistent depressive disorder may be offered are:

• Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft)
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), for example desvenlafaxine (Pristiq) and duloxetine (Cymbalta)
• Tricyclic antidepressants (TCAs), which include amitriptyline (Elavil) and amoxapine (Asendin)

Once you settle in to your antidepressants and start to notice a difference, talk therapy can also play a very useful role in recovery. Cognitive behavioral therapy, a targeted and short-term therapy that helps you analyze and change your thought patterns, is often used. Interpersonal therapy, in which you and your therapist look at your relationships with other people and the world around you, can be helpful as well. 

Additionally, St John's wort, a herbal remedy, has been shown to be pretty effective in treating mild depression. It may be an option for you, but because it can interact with prescription antidepressants, you shouldn't combine it with one of those. Talk to your doctor if you are interested in St John's wort.