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Persistent Depressive Disorder (Dysthymia)

Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA

In persistent depressive disorder or dysthymia, a person has a depressed mood for most of the day for more days than not for at least two years. If the patient is a child or teen, symptoms only need to be happening for one year. People with this condition describe their mood as sad or 'down in the dumps.' They experience at least two of the six typical symptoms of MDD such as changes in appetite, changes in sleep patterns, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.

With this condition, an individual usually starts experiencing symptoms early in life. In this case, it might be a part of their personality and may be difficult to recognize. Because of its long-term nature, it has a higher likelihood to occur with personality disorders and substance use disorders.

The risk factors for persistent depressive disorder are the same as for major depressive disorder. This includes the combination of mental, physical, and emotional traits of a person - their personality/temperament, environment, or genetics.

Like major depressive disorder, dysthymia also has genetic risk factors and runs in families. People who have a parent, brother or sister with major depressive disorder are 2 to 4 times more likely to develop the disorder themselves than those in the general population. Approximately, 40% of those with MDD have a genetic link to the disorder. This holds true for those who go on to develop persistent depressive disorder.

There are also disorders or medical conditions that can increase the risk for developing the condition or making it worse. Examples include substance use, anxiety disorders, and borderline personality disorder. In these situations, treatment and outcome depends on finding the true cause of persistent depressive disorder. Long-term or disabling medical conditions such as diabetes, morbid obesity and heart disease are also risk factors for persistent depressive disorder.

Environmental risk factors include major losses such as parental loss or separation. Recovery from persistent depressive disorder can be predicted from:

  • Temperamental factors - a person with a negative outlook will have a longer recovery than someone who has a positive outlook on life;
  • Neuroticism - if a person with dysthymia also experiences a long-term tendency to be in a negative emotional state;
  • More severe symptoms of depression - if a person's depressive symptoms are more severe;
  • Functioning - if a person has difficulty performing their daily activities such as being able to get out of bed, getting ready for the day, and handling school, work, relationships, and other commitments;
  • Anxiety or antisocial behaviors.

The more severe a person's symptoms, the more difficult or longer the recovery. A person with persistent depressive disorder can experience a wide variety of problems. For example, they may be able to get out of bed in the morning, groom themselves and get to school or work, but have a hard time performing any of the tasks associated with being at school or work. In the most severe cases, a person may not even be able to get out of bed, or they may get out of bed, but not able to move beyond the getting ready to leave the house stage. The effects on daily functioning vary widely based on how severe the symptoms are.

This condition often occurs along with other mental health issues, especially anxiety disorders and substance use disorders. Those who develop this condition at an earlier age often have a personality disorder as well.

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