Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 23, 2016

A chronic form of depression, dysthymia is a depressed mood that lasts for two years or longer. It is common for people to experience episodic bouts of symptoms for years, but the symptoms can be alleviated with a combination of psychotherapy and psychiatric medication. It is also known by the term, persistent depressive disorder.


Definition & Facts

Dysthymia is a type of depression lasting for a minimum of two years. People who have the disorder may have bouts of major depression as well as times during which their symptoms are not as severe. According to the National Institute of Mental Health, dysthymia affects 1.5 percent of adults in the U.S. Of those cases, 49.7 percent are classified as being severe.

Commonly, the condition first appears when a person is still a child or a teenager. The symptoms of this chronic low-level depression are generally not characterized as being quite as severe as those associated with a diagnosis of major depressive disorder.

Symptoms & Complaints

The symptoms of persistent depressive disorder normally will intermittently appear and disappear over time, and the intensity of the symptoms may change. Commonly, the symptoms stay for at least two or more months each time they appear. The symptoms may substantially impair a person's ability to function and enjoy his or her activities of daily living and may include the following: 

Children who have persistent depressive disorder commonly show a chronically depressed mood combined with irritability. It is common for people who have dysthymia to believe that they will always feel the way they do because they have had their symptoms for such an extended period of time. It is important to seek help from a medical or mental health professional in order to address and treat the symptoms, however. People who are experiencing suicidal thoughts should immediately call 911. 


Medical professionals do not know what causes persistent depressive disorder. They believe that there may be more than one cause for the disorder. Some people who have the condition may have physical and structural changes in their brains. Others may develop the disorder because of changes in the biochemistry of their brains, especially with their neurotransmitters.

Finally, medical researchers believe that the tendency to have the disorder may be inherited by some people and associated with family history. Research has shown that people who have a blood relative who has persistent depressive disorder are more likely to also be diagnosed with it. Finally, the onset of the disorder may be triggered by a traumatic life event.

Diagnosis & Tests

A doctor who suspects that his or her patient has dysthymia may perform several exams. A physical examination may be necessary so that the doctor can rule out any medical problems that might be causing the depression. Doctors normally ask a number of probing questions about the patient's physical health as part of the exam, and lab tests are commonly ordered to check for metabolic problems such as hypothyroidism (an underactive thyroid gland) or other similar problem.

The doctor may also perform a psychological evaluation which involves the patient completing a questionnaire that is designed to help the doctor determine whether the patient has dysthymia or a different mood disorder. The diagnosis of persistent depressive disorder may be made when the patient suffers from the symptoms that are outlined in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.

Adults who have the disorder will experience a depressed mood occurring daily for two years or more. Children may be diagnosed if they have experienced daily depressed moods and irritability for at least a year.  

Treatment & Therapy

The primary treatment for dysthymia involves a combination of talk therapy and medication. A person's recommended treatment course will be dependent on his or her symptoms, personal preferences, ability to handle medications, other emotional issues and the desire to deal with situational or emotional problems. The medications that are most commonly prescribed are antidepressants and may include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, or tricyclic antidepressants.

People with the disorder normally need to take their prescribed medications for the long term in order to control their symptoms. The talk therapy component may involve a cognitive behavioral therapy (CBT) strategy. The therapist will determine the type of therapy that will be most appropriate for the individual. Therapy is designed to help people with the identification of the contributing issues in their lives that worsen their symptoms. It will also involve the identification of negative self-thoughts and will work to replace those ideas with positive ones. Identifying and developing effective coping skills is also a common component.

Some people take alternative medicines in an effort to self-treat their symptoms. It is important that people who do so discuss the choice with their doctors. Some herbal medications may interfere with other medications the person may also be on, and these over-the-counter supplements are not approved or monitored by the Food and Drug Administration. Popular ones such as St. John's Wort may interact with a number of prescription medications such as blood thinners, HIV medications and others. This makes it very important for people to talk to their doctors before they begin any regimen with over-the-counter herbal supplements. 

Prevention & Prophylaxis

People can do several things to try to prevent the symptoms from occurring. They can do activities that relieve stress such as yoga, Tai Chi, or meditation. Regular exercise has been shown to help boost mood and alleviate depressive symptoms.

Getting early treatment may help to stave off the symptoms before they become very severe. Since many people are diagnosed when they are still children, health care professionals work to identify children who have a higher risk of developing persistent depressive disorder in order to start early treatment.

People should also be unafraid to be open with the people with whom they are close when they are in crisis. Getting help when a person notices the first sign of the onset of symptoms can prevent them from getting worse, and long-term medication treatment for maintenance can help to prevent a reoccurrence.

Dysthymia may feel overwhelming to people who are experiencing the symptoms, leaving them feeling as if they will always feel depressed. With a proper diagnosis and treatment, people may be able to control their symptoms and move forward with their lives.