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:
- Loss of interest in daily activities
- Sadness, emptiness or feeling down
- Tiredness and lack of energy
- Low self-esteem, self-criticism or feeling incapable
- Trouble concentrating and trouble making decisions
- Irritability or excessive anger
- Decreased activity, effectiveness and productivity
- Avoidance of social activities
- Feelings of guilt and worries over the past
- Poor appetite or overeating
- Sleep problems
In children, symptoms of persistent depressive disorder may include depressed mood and irritability.
When to see a doctor
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 provider. 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:
- Biological differences. People with persistent depressive disorder may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
- Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
- Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
- Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people
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:
- Having a first-degree relative with major depressive disorder or other depressive disorders
- Traumatic or stressful life events, such as the loss of a loved one or financial problems
- Personality traits that include negativity, such as low self-esteem and being too dependent, self-critical or pessimistic
- History of other mental health disorders, such as a personality disorder
Conditions that may be linked with persistent depressive disorder include:
- Reduced quality of life
- Major depression, anxiety disorders and other mood disorders
- Substance abuse
- Relationship difficulties and family conflicts
- School and work problems and decreased productivity
- Chronic pain and general medical illnesses
- Suicidal thoughts or behavior
- Personality disorders or other mental health disorders
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:
- Take steps to control stress, to increase your resilience and to boost your self-esteem.
- Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
- Get treatment at the earliest sign of a problem to help prevent symptoms from worsening.
- Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.