Understanding Dysthymia

JAN. 17, 2018

By Luna Greenstein


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.


Laura Greenstein is communications manager at NAMI.


SEP, 25, 2018 02:44:49 PM
Some of the comments here almost make me cry in relief. Not because I want anyone else suffering, but I just feel less alone. Even with the psychiatrist I feel like I put on a mask, and it's even worse with friends. I wonder if this is what causes social angst? Just feel so uncheerful and cynical and sad and it's so hard to be around happy people, but also I am jealous of their freedom. Sorry if this is boring. I am always scared my depression/dysthymia is going to drive people away if I talk about it.

SEP, 16, 2018 09:53:53 AM
PDD sure feels like me, as well, with a dash of social anxiety disorder thrown in for grins. I’m having a career year in a business development role with tons of social interaction required and I have a very supportive wife and three healthy boys who all seem happy for the most part. Despite all of that, I can’t find real contentment or enjoyment in any of my favorite activities, struggle mightily to get myself out there in social settings and therefore am dealing with very low self esteem and hopelessness.

I’ve been on numerous meds for 20 years and am on my 3rd in the past year. Stepping up each new one only to see no results and then stepping back down seems to take an eternity - makes you feel like life is passing you by.

My overactive, questioning brain has also led me to have major doubts about my faith, which has been a big part of my life since high school. I want so bad to experience the joy, contentment and love of life that I did often experience earlier in life, but it’s simply not possible these days. Even getting to a more neutral “Life’s not wonderful, but it’s ok”, would be nice.

SEP, 15, 2018 07:58:56 PM
I’ve had depression/dysthymia since I was a kid bc I had a really rough past being both physically and emotionally abused by a mentally unstable mom almost everyday ever since I was a toddler. She then sent me away to a different country and would not take me back threatening my dad with divorce and suicide if he did . Somehow I’ve been able to stay positive throughout most of my life but the depression is always lingering coupled with an avoidant personality not feeling like hanging out with friends at times and just wanting to be alone esp if my mood is low . Now 36, single and living alone brings some additional challenges with respect to this problem. Lately I’ve been taking a break from my self-employment and find myself laying in bed most of the time, not really feeling depressed but somehow I feel more comfortable and less alone underneath my comforter. On top of that I have a certain addictioj issue. Thanks for this blog I feel like I am not alone in battling this disease and there is hope out there. By the way I recently stumbled upon articles on EFT tapping look it up it’s been known to cure depression and ptsd. Good luck to everyone on their recovery, cheers and stay strong.

AUG, 30, 2018 10:20:41 PM
I have suffered from depression for over 20 years, been in and out of counseling, on and off medication, never really finding anything that seemed to fit or truly help. It's been very discouraging and I honestly wonder if I'll ever find any real help. It's been very easy to blame myself throughout all of this, which I know only makes it worse, but the frustration and shame has always overwhelmed me and I really don't know where to turn. I was never diagnosed with dysthymia--in fact, in spite of all the counselors and doctors I've seen, not one has ever sat me down and said anything like "based on the symptoms you're describing, I'm diagnosing you with _____," which would actually be reassuring but has never happened--but reading the description of the condition on this site, as well as several others, I'm extremely confident that this is exactly what's been plaguing me since I was a teenager. What to do with that information, well, it's still unclear. I'd rather not rant about the hopelessness of it all, which won't do myself or anybody else reading this any good.

Depression/dysthymia stole away my youth and derailed my career and has taken away my capacity to experience joy and left me with nothing but shame and fear of what people would think of me if they actually knew how I felt all the time. I still have hope that I'll get better, that I'll ever be eligible for treatment or that I'll ever be able to afford it. But mental illness is still not taken seriously in this country and neither politicians nor the healthcare industry have the slightest amount of compassion for anyone who's trying to deal with it. I want to believe that I have a future without this feeling, that I will someday feel a sense of happiness and joy that isn't a muted, foggy version of the real thing.

I truly wish you all the best in your own struggles with this experience.

AUG, 09, 2018 06:53:14 AM
I was first diagnosed with dysthymia over ten years ago by a fantastic doctor who helped me understand what I had been dealing with for years. Sadly I moved away from her and have never again found a doctor who can adequately help me. In fact, more often than not, I am shamed by my doctors and made to feel I have a character issue. I’m a christian missionary and am so tired of the stigma and lack of support. Just yesterday, when seeking help for back pain problems, my doctor (who knows nothing of my history and disbelieves my diagnosis) told me that my back pain is just another sign of the problems with my soul. No joke. So demoralizing and so wrong! And the impetus for searching for online support and understanding. I’m thankful for this post.

AUG, 08, 2018 07:41:13 PM
I don't know if I have ever been truly "happy" for more than a few minutes. I feel alone, sad, and helpless all the time. When going through episodes of MDD it's a struggle to keep myself alive. Reading some of these posts about people going through this their whole life makes me wonder what the point is. I hope there's a solution before more people die the slow death of loneliness.

AUG, 06, 2018 04:32:58 PM
I just found out about dysthymia yesterday. I knew I was depressed but I always hear people talk about depression like a phase and then they're back to normal. But I knew my condition was always there no matter if I was laughing and joking or struggling to get up and shower and start my day. I grew up in poor and bleak conditions with my family since birth, but I remember myself getting more and more depressed as I got older, specifically around 14. Now here I am at 26 and just feeling more hopeless and exhausted than ever. My relationship with the one person that helped me escape sadness at times is over and ever since the break up, I feel like I've been spiralling downward at a fast pace. I'm back with my family who are all depressed as well whether they know it or not, and its just not a healthy environment. I know it's not healthy to depend on someone else to be my happiness, I need to be my own source of happiness. I'm finally seeking the help I need.

JUN, 25, 2018 12:28:28 PM
Wendy Barton
Hi fellow sufferers,
I was diagnosed with dysthymia in 1998 but I feel I started having it much earlier beginning at age 21 but was treated until years later. I was married to a narcissist/sociopath for 30 years but thought everything was all my fault as he made me feel that way and always accused me of being crazy when he was really the crazy one. I am still dealing with my disorder and have been in therapy on and off since 1998. Sometimes I feel better but then always go back to baseline. I have had a very difficult time since my divorce both mentally and emotionally. My son had problems too and tried to take his own life but by the grace of God is alive and well today. My ex-husband is still the same and continues to try and play his sick games with both of us. Thank you for this site as I have felt alone in this for a long time. If anyone else is dealing with a narcissist I recommend the book Lovers of Ourselves by David Juroe. It will help you understand why you may have developed your depression if you are around person like this. I am a Christian and pray for those who suffer like myself.

JUN, 23, 2018 02:54:48 PM
I think I lived with someone who has dysthymia for several decades. The relationship ended because alcohol abuse became the primary "medication". My ignorance (& the doctors and therapists ignorance) about this disorder has me feeling a lot of regrets. My message is when depression is diagnosed, the caregivers need to involve the spouses.

JUN, 20, 2018 05:09:50 PM
Laurel Duerwachter
Relieved to know that this is common. I've been on antidepressants for years and they keep me functional but that's about it.

JUN, 14, 2018 11:31:53 AM
OMGosh! This is me exactly. I have been depressed for as long as I can remember. I can remember holding my father’s hand in a parking lot and wanting to let go and have a car run over me. I was probably only 4-5 years old. So many people tell me they “had” depression. I never understood that and wondered why mine just never went away. I’m always low, low energy, low mood, low everything. Being down is my normal. I have noticed that it is important to get out and be with other people or I start to “close in on myself” and never get out of bed. I also have generalized anxiety disorder. I’m wondering if those suffering with dysthymia also suffer with horrible nightmares? Or maybe that is a result of my anxiety. Thank you so much for this article. I’ll be discussing this with my doctor the at my next appointment..

JUN, 08, 2018 04:37:27 PM
I have lived my entire life depressed, I find it hard to even get out of bed most days, I can sleep 24-48 hrs at a stretch with out even getting up to eat. I didn't even no that what I had was Dysthymia, I thought it was just a bi-polar thing. I found out today when my Dr allowed me access to my medical files.

I also suffer from Agoraphobia which even to the h makes things even worse on me. I have to fight my self to go out even to the Dr. I am currently on meds but they do little to help with my Agoraphobia, they barely help with my depression. I do try so hard to be normal, but I don't even no what "NORMAL" is.

MAY, 07, 2018 08:03:42 PM
I am 85 and I’ve had dysthymia as long as I can remember but not knowing
it had a name. Since the mid 90’ s i’ve been taking Paxil for the depression.
Surprisingly it has been more effective for anxiety disorder. This has been an
extremely hard way to live . It can make you stronger if allowed to. I’ve been a
life long Christian thankfully !! Thanks.

MAY, 04, 2018 07:23:34 PM
Hi everyone- I just recently was diagnosed with dysthymia and generalized anxiety disorder. Apparently Ive had it for a while but I just found out. A lot of it has to do with my abusive mother. It’s very difficult to even get out of bed sometimes; even brush my hair. But I feel like it’s getting better. I just finished up my junior year of college and I’m graduating next year; then I’ll be away from my mom. So that’s exciting. I think then, I’ll actually begin to heal. It’s hard to find support groups with depression, especially with this form I feel. People seem to understand but it’s still difficult to see that it lasts a while. Thanks for writing this, though. I feel comforted that I’m not the only one

FEB, 11, 2018 12:14:04 AM
Christopher P O'Sullivan
Great information

FEB, 05, 2018 04:21:14 PM
I have suffered from depression since I have a conscious memory. My first suicide attempt was at 4 or 5 years old. My depression became the norm to me and I had several major depressive episodes through my life. It is exhausting. Unfortunately, my care or access to services is limited. I am trying to make the best of the services I have access to. Even though I have to live with this disorder, I still love life. I have good, bad and horrible days. Every day is a battle, getting out of bed is some days almost impossible, but here I am. The hardest thing to deal with is the lack of support from the medical insurance I have, from family and inner circle. Dysthymia or persistent depressive disorder is a hard concept for people to understand. I am glad I found this site, it helps me make sense of my feelings. I do agree that mental illness does not define us. The way I see it, in a way it makes us stronger because we face all the ups and downs that life brings already with an extra heavy back in our shoulders. Thank you for your comments and bringing some light to my very dark tunnel.

FEB, 04, 2018 11:50:45 PM
Rory gohn
Absolutely a great article!! Explains me and my condition, totally.helps me to feel not alone also.

JAN, 31, 2018 10:50:35 PM
Thanks for the insight. It helps me feel not alone.

JAN, 31, 2018 01:18:43 AM
Philip A
I have never commented on anything online before, but being 24, I am nothing short of proud that this diagnosis is brought to light (as I also have MDD and GAD).

My generation seems to throw the term "depressed" and "depression" a lot, especially when someone is normally just negative or pessimistic. As the post mentions, there are different types: MDD and PDD. Others have mentioned that MDD happens in episodes, while PDD sticks around. I am relieved to know that others understand that nuance.

Thank you, NAMI, for bringing this cousin of MDD to light. We need to remember that these conditions do not define who we are: it is a part of us, like our eye color, but the labels do not limit us as humans. #stigmafree

JAN, 31, 2018 01:17:37 AM
Philip A
I have never commented on anything online before, but being 24, I am nothing short of proud that this diagnosis is brought to light (as I also have MDD and GAD).

My generation seems to throw the term "depressed" and "depression" a lot, especially when someone is normally just negative or pessimistic. As the post mentions, there are different types: MDD and PDD. Others have mentioned that MDD happens in episodes, while PDD sticks around. I am relieved to know that others understand that nuance.

Thank you, NAMI, for bringing this cousin of MDD to light. We need to remember that these conditions do not define who we are: it is a part of us, like our eye color, but the labels do not limit us as humans. #stigmafree

JAN, 21, 2018 11:57:34 AM
I have had dysthymia since I was around 4, maybe a bit older. It truly *****s. Everyday is a struggle for me. I force myself out of bed, head to work, and come home to my family. I also suffer from anxiety. Thank you for this article. I haven’t reasearched this much but perhaps it will help if I do. I just feel like another statistic.

JAN, 18, 2018 02:22:52 PM
Beth Almeida
I have never heard of dysthymia until just now. I was diagnosed as bipolar at 14 or 15 and then at 27, I think, I was told I had major depressive disorder with anxiety and borderline agoraphobia. The anxiety and agoraphobia, I understood, but I knew that people with major depressive disorder could feel better sometimes. I was and am in a constant state of depression. No ups, just down.
I'm going to mention this to my doctor.

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