Dysthymia: Persistent depressive disorder

A persistent depressive disorder (old term: dysthymia) is a chronic mental illness in which the mood of a patient is regularly low. The patient experiences the same cognitive and physical problems as with normal depression, with less severe but longer-lasting symptoms that last for at least two years (one year for children and adolescents). Because dysthymia is a chronic condition, patients experience symptoms for many years before the doctor (possibly) makes a diagnosis. Treatment usually consists of a combination of psychotherapy and medication. Furthermore, the condition increases the risk of a double depression. Other complications may also occur. Early diagnosis prevents worsening of the signs and possible complications.
  • Epidemiology
  • Causes of dysthymia
  • Risk factors of persistent depressive disorder
  • Symptoms
  • Diagnosis and investigations
  • Therapy
  • Medication
  • Psychotherapy
  • Prognosis of mental illness
  • Complications of form of depression
  • Prevention


Dysthymia occurs worldwide in around 105 million patients per year. A persistent depressive disorder is slightly more common in women than in men.

Causes of dysthymia

There are no known causes of a persistent depressive disorder. Possibly there is a genetic predisposition for this form of depression. Changes in certain brain structures may also play a role in the development of the mental disorder. These brain regions work in a different way. Other factors related to dysthymia are stress, social isolation and a lack of social support.
Alcohol abuse is linked to a persistent depressive disorder / Source: Jarmoluk, Pixabay

Risk factors of persistent depressive disorder

At least three-quarters of patients with dysthymia also have a chronic physical illness or other psychiatric disorder such as:
  • cyclothymia (fluctuations in hypomania and mild depression)
  • an anxiety disorder
  • a major depression
  • a personality disorder
  • a somatoform disorder
  • substance abuse such as alcoholism and drug addiction

Early onset (diagnosis before the age of 21) is often associated with more frequent recurrences, psychiatric hospital admissions, and more common conditions. In the elderly who suffer from dysthymia, the psychological symptoms are often associated with medical conditions and / or stressful events and losses in life and. Patients with dysthymia usually also experience an episode of major depression at some point in life.


A persistent depressive disorder may start early in life, even in childhood. There may be ups and downs in the mood, but lower moods dominate and persist. Patients with dysthymia therefore experience a longer period of depressive mood combined with at least two other symptoms, such as:
  • concentration problems
  • a negative self-image
  • food changes (eat less or eat more)
  • hopelessness or pessimism
  • difficult to make decisions / indecision
  • insomnia or sleepiness
  • tiredness or little energy
  • low self esteem

With mild symptoms of a persistent depressive disorder, patients withdraw from situations of stress and situations where there is a chance that they will fail. In more severe cases of dysthymia, patients withdraw from daily activities. They will usually have little pleasure with the usual activities and activities. Suicidal behavior is also a special problem in patients with dysthymia.

Diagnosis and investigations

The diagnosis of dysthymia is difficult because the symptoms are subtle and patients can often hide them in social situations, making it a challenge for others to detect symptoms and patients have been walking around with the disease for years. In addition, dysthymia often appears together with other mental disorders, making it difficult for the physician to identify dysthymia, especially as there is often an overlap in the symptoms of the disorders. It is vital that a doctor looks for signs of major depression, panic disorder, generalized anxiety disorder (constant, irrational anxiety and worry), alcohol and substance abuse, and personality disorder. The 'Diagnostic and Statistical Manual of Mental Disorders IV' (DSM-IV) contains the diagnostic criteria of a dysthymic disorder. The essential symptom is that the patient feels depressed for most days and parts of the day for at least two years (this is one year for children and adolescents). Low energy, sleep disorders, changes in appetite and low self-esteem generally also contribute to the clinical picture.


Patients often seek treatment because they experience more stress or have personal problems that may be related to the situation. The patient often suspects that the chronic symptoms belong to his character and usually does not seek help for this. A combination treatment of antidepressants and psychotherapy is the most effective treatment for patients diagnosed with dysthymia. This combination is often the preferred treatment method for patients with dysthymia.
Medications relieve the symptoms / Source: Stevepb, Pixabay


The doctor usually first prescribes SSRIs (selective serotonin reuptake inhibitors, a type of antidepressant). These drugs usually have fewer side effects compared to the irreversible monoamine oxidase inhibitors (MAOs) or tricyclic antidepressants. It often takes an average of six to eight weeks for the patient to feel the therapeutic effects of these drugs. Moreover, it is possible that a patient must try out different brands of medication before they find the medication that is suitable for them.


Psychotherapy such as cognitive behavioral therapy is often effective in the treatment of dysthymia. This causes the symptoms to disappear over time. Other forms of psychotherapy (such as psychodynamic psychotherapy, interpersonal psychotherapy) may also be effective in treating the condition. Furthermore, it is useful that patients with persistent depressive disorder develop better coping skills, look for the cause of symptoms, and work on changing wrong beliefs (such as when patients find themselves worthless). Group psychotherapy, self-help and / or support groups may also be effective treatments for dysthymia. As a result, patients work on self-esteem, self-confidence, relationship problems / patterns, assertiveness skills, cognitive restructuring, and so on.

Prognosis of mental illness

Thanks to the treatment, the prospects for a patient with this condition are excellent. The duration and intensity of the symptoms is often considerably reduced. The symptoms disappear completely in many patients. Without treatment, the risk is greater that the disease persists, the patient probably has a reduced quality of life and he has an increased risk of developing a major depression. Even if the treatment is successful, maintenance treatment is often needed to prevent the symptoms from returning. Other patients continue to show some symptoms even with treatment.

Complications of form of depression

Patients with a persistent depressive disorder have a more than average chance of developing a major depression. When an intense episode of depression occurs on top of dysthymia, there is a 'double depression'. This is difficult to treat because patients accept these important depressive symptoms as a natural part of their personality or as a part of their life that is beyond their control. If such patients nevertheless seek treatment, it may not be very effective. Patients with double depression report significantly higher levels of hopelessness. Cognitive behavioral therapy may be effective in treating patients with double depression to help change negative thinking patterns and give patients a new way to see themselves and their environment. The best way to prevent double depression is to treat the dysthymia. Finally, dysthymia increases the risk of suicide.


A combination of antidepressants and cognitive therapies is useful to prevent severe depressive symptoms. In addition, exercise, a healthy and varied diet and good sleep hygiene (for example, improving sleep patterns) are useful for preventing dysthymic symptoms and also to prevent the symptoms from getting worse.

Video: What is Dysthymia - Persistent Depressive Disorder - Mental Health with Kati Morton. Kati Morton (February 2020).

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