Whereas a major depressive episode is an experience that ruptures the fabric of a person’s life, taking them from being okay to a space of dark depression (see my article Am I depressed? What the DSMV Says), there is a much more insidious condition that literally sucks the joy out of life. Dysthymic Disorder (DD), a sub-category of the DSM-V’s Pervasive Depressive Disorder, is characterized by a consistent experience of life from a depressed space. By way of analogy, a regular person sees the world in full color and when they slump into a depression, it’s as if the world loses its color and is transformed to dull greys, blacks and whites. For the person suffering from DD it’s as if their world never had any color to begin with. While DD is less severe than a major depressive episode, it is a chronic and persistent condition that can almost be thought of as “part of the personality” of the sufferer.
In adults the primary symptoms of DD are consistently negative feelings and mood almost every day for a period of at least 2 years. Someone with DD might describe themselves as having been “depressed for as long as I can remember”. According to the DSMV this lowered, sad mood is accompanied by at least two of the following symptoms: sleep disturbances, reduced energy or fatigue, lowered self-esteem, feelings of hopelessness, disturbances in appetite and problems with concentration. People with DD have a negative self-image, a negative perception of others, their life and their future prospects. They have an increased risk of suicide and struggle to problem-solve.
In contrast to normal sadness or unhappiness which lifts when circumstances change or a person adjusts to life’s challenges, DD is persistent. The chronic negative outlook disrupts the trajectory of people’s lives on a long-term basis. A negative mind-set increases the likelihood of negative experiences which in turn reinforces the negative mind-set. DD sufferers are at high risk of a major depressive episode during the course of their lives. As people with DD age the impact of the disorder is felt more strongly with increased risk of social isolation, incapacity to care for themselves and medical conditions.
While DD is often considered a long-term or chronic condition, there are a number of steps sufferers can take to improve their situation. DD sufferers need to be very sensitive to their physical health and well-being. Ensuring enough sleep, healthy eating and exercise are all essential to maintaining a tolerable equilibrium. Avoiding drugs and alcohol are also a key aspect of managing the condition. Antidepressant medication forms part of the treatment approach for DD sufferer with some relief of symptoms within one or two months of commencing treatment. Psychotherapy either in person or online in the form of supportive therapy with a cognitive-behavioral focus is also helpful as are support groups or group therapy with other DD sufferers. Therapy focuses on managing the psychological effects of general life consequences of struggling with chronic, low-grade depression as well as equipping patients with skills to manage their negative thought processes, improve their social relationships and navigate life demands more effectively. It is likely that a combination of medication and psychotherapy would offer increased benefits in terms of recovery or at the very least more effective management of symptoms.
People with untreated chronic low-grade depression or DD are thus likely to struggle across their life-span with a significant negative impact on relationships and work. As the symptoms are less severe than clinical depression and more long-term, DD sufferers become accustomed to their symptoms and hence there is a real risk, to quote Pink Floyd, of “hanging on in quiet desperation.” So if you feel that you can relate to the condition described in this article, contact a health professional for a proper diagnosis and ensure you seek the appropriate treatment.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
Q and A about Dysthymic Disorder (Chronic Depression. Downloaded on 6 February 2017.