Persistent depressive disorder, also called dysthymia (dis-THIE-me-uh), is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.
If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.
Because of the chronic nature of persistent depressive disorder, coping with depression symptoms can be challenging, but a combination of talk therapy (psychotherapy) and medication can be effective in treating this condition.
Persistent depressive disorder symptoms usually come and go over a period of years, and their intensity can change over time. But typically symptoms don't disappear for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression.
Symptoms of persistent depressive disorder can cause significant impairment and may include:
In children, symptoms of persistent depressive disorder may include depressed mood and irritability.
Because these feelings have gone on for such a long time, you may think they'll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.
Talk to your primary care doctor about your symptoms. Or seek help directly from a mental health professional. If you're reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it's a friend or loved one, a teacher, a faith leader, or someone else you trust.
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
The exact cause of persistent depressive disorder isn't known. As with major depression, it may involve more than one cause, such as:
Persistent depressive disorder often begins early — in childhood, the teen years or young adult life — and is chronic. Certain factors appear to increase the risk of developing or triggering persistent depressive disorder, including:
Conditions that may be linked with persistent depressive disorder include:
There's no sure way to prevent persistent depressive disorder. Because it often starts in childhood or during the teenage years, identifying children at risk of the condition may help them get early treatment.
Strategies that may help ward off symptoms include the following:
If your doctor suspects you have persistent depressive disorder, exams and tests may include:
For a diagnosis of persistent depressive disorder, the main indication for an adult differs somewhat from that of a child:
Symptoms caused by persistent depressive disorder can vary from person to person. When persistent depressive disorder starts before age 21, it's called early onset; if it starts at age 21 or older, it's called late onset.
The two main treatments for persistent depressive disorder are medications and talk therapy (psychotherapy). The treatment approach your doctor recommends depends on factors such as:
Psychotherapy may be the first recommendation for children and adolescents with persistent depressive disorder, but that depends on the individual. Sometimes antidepressants are also needed.
The types of antidepressants most commonly used to treat persistent depressive disorder include:
Talk with your doctor or pharmacist about possible side effects.
You may need to try several medications or a combination before you find one that works. This requires patience, as some medications take several weeks or longer for full effect and for side effects to ease as your body adjusts.
Don't stop taking an antidepressant without talking to your doctor — your doctor can help you gradually and safely decrease your dose. Stopping treatment abruptly or missing several doses may cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression.
When you have persistent depressive disorder, you may need to take antidepressants long term to keep symptoms under control
If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn baby or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.
Although antidepressants are generally safe when taken as directed, the FDA requires all antidepressants to carry a black box warning, the strictest warning for prescriptions. In some cases, children, teens and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.
Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when first beginning a new medication or with a change in dosage. If your teen has suicidal thoughts while taking an antidepressant, immediately contact your doctor or get emergency help.
Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological counseling.
Different types of psychotherapy, such as cognitive behavioral therapy, can be effective for persistent depressive disorder. You and your therapist can discuss which type of therapy is right for you, your goals for therapy and other issues, such as the length of treatment.
Psychotherapy can help you:
Persistent depressive disorder generally isn't a condition that you can treat on your own. But, in addition to professional treatment, these self-care steps can help:
Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for medical care.
For example, the herbal supplement called St. John's wort is not approved by the Food and Drug Administration (FDA) to treat depression in the U.S., though it's available. It may help improve mild or moderate depression, but the overall evidence is not conclusive.
St. John's wort can interfere with a number of medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John's wort while taking antidepressants because the combination can cause serious side effects.
Dietary supplements aren't approved and monitored by the FDA the same way medications are. You can't always be certain of what you're getting and whether it's safe. Also, because some herbal and other dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your healthcare provider before taking any supplements.
Persistent depressive disorder makes it hard to engage in behavior and activities that can help you feel better. In addition to the treatments recommended by your doctor or therapist, consider these tips:
You may decide to schedule an appointment with your primary care doctor to talk about your concerns or you may decide to see a mental health specialist, such as a psychiatrist or psychologist, for evaluation.
Prepare for your appointment by making a list of:
Taking a family member or friend along can help you remember something that you missed or forgot.
Basic questions to ask your doctor may include:
Don't hesitate to ask other questions during your appointment.
Your doctor may ask you several questions, such as: