Persistent Depressive Disorder (272)

Dysthymia • Depressive Neurosis • Dysthymic disorder

The Facts

Persistent depressive disorder, also known as dysthymia, is a mood or affective disorder. It is a chronic, mild depression that lasts for a long period of time (at least 2 years). The word dysthymia comes from Greek roots meaning "ill-humour." Persistent depressive disorder has less of the mental and physical symptoms that a person with major depressive disorder experiences.

The condition usually starts in early adulthood, and the disorder can last for years or even decades. Later onset is usually associated with bereavement or obvious stress, and often follows on the heels of a more extreme depressive episode. Women are twice as likely as men to suffer from persistent depressive disorder, in a similar ratio to that seen with major depression.

In the past, persistent depressive disorder had several other names: dysthymia, depressive neurosis, neurotic depression, depressive personality disorder, and persistent anxiety depression.

Causes (1-4)

The exact cause of persistent depressive disorder is not known, but a combination of factors are thought to play a role in its development. Heredity (genetics) can play a role, and people with family members who have depression are more likely to develop persistent depressive disorder, especially when it starts early in life (teens to early 20s).

Changes in neurotransmitters (chemical messengers) in the brain may also precipitate persistent depressive disorder. Chronic stress or medical illness, social isolation, and thoughts and perceptions about the world, can all influence the development of persistent depressive disorder. Other mental health conditions (e.g., borderline personality disorder) can also increase the risk of its development.

Symptoms and Complications (5-6)

Signs that a person may be suffering from persistent depressive disorder include:

• depressed mood for prolonged periods
• low self-esteem
• low energy, tiredness
• sleep irregularities
• changes in appetite
• poor concentration
• hopelessness

The severity of these symptoms varies and depends on the individual. Some people can still deal with the basic demands of life, while others undergo significant distress, making it difficult to cope with work, school, or social situations.

Making the Diagnosis (5-7)

A doctor will diagnose a person with persistent depressive disorder when they have a chronically depressed mood for most days for at least 2 years. For children and adolescents, the mood may be irritability that lasts for more than 1 year. The person must also not go for more than 2 months without experiencing 2 or more of the following:

• low self-esteem
• low energy, tiredness
• sleep irregularities
• changes in appetite
• poor concentration
• hopelessness

During those 2 years, there will have been no major depressive episodes, though there might have been a bout with major depression in the past that has since resolved. A doctor will also want to confirm that symptoms aren't a result of a substance use problem or due to other medical or mental health conditions such as thyroid problems, anemia, or anxiety.

Recognizing and diagnosing persistent depressive disorder  isn't always simple. People with the condition may not think of themselves as depressed, and they often visit doctors with physical rather than psychological complaints. Mental health professionals aren't always consulted until more obvious symptoms are noticed. When persistent depressive disorder goes undiagnosed, there's a danger that it can lead to substance abuse or even suicide.

Treatment and Prevention (8-13)

Persistent depressive disorder is treated with a similar approach to that used for depression – with medication and psychotherapy. The most effective treatment is a combination of strategies.

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine*, citalopram, fluvoxamine, paroxetine, sertraline), may be used in the treatment of persistent depressive disorder.

Short-term psychotherapeutic approaches to treating persistent depressive disorder are quite effective at treating the symptoms of depression. Effective psychotherapies include cognitive behavioural psychotherapy, interpersonal psychotherapy, and peer support.

• Cognitive behavioural therapy (CBT) helps people understand how their thoughts affect feelings, and how feelings affect behaviour.
• Interpersonal therapy (IPT) involves focusing on problems with a person's relationships with others.
• Group therapy may also be used to help manage dysthymia.

The herbal preparation St. John's wort may also be helpful for mild depression. Although several studies have shown some benefit, results have been inconsistent. Caution must be advised before people self-medicate to treat persistent depressive disorder. Just because a remedy is available without prescription and is herbal doesn't mean that it's safe. Adverse reactions to and drug interactions with herbal remedies are increasingly reported. Before turning to St. John's wort or other self-medication to treat dysthymia, it's vital to discuss this option first with a doctor or pharmacist.

It is an unfortunate myth that dysthymia is not a treatable medical condition. It is treatable and many people do recover with treatment.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

[references]

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