Many people have an idea of what depression looks like: sadness, being more easily moved to tears, lack of motivation, not finding enjoyment in things, overeating, eating too little, sleeping too much, not being able to sleep, and generally feeling bad about yourself, others, and the future. The form of depression that we usually hear about is called “major depressive.” According to research, about one in five people will experience a major depressive episode at least once in their lives. This kind of depression lasts for at least two weeks, but often goes for several weeks or months, and sometimes longer. One-third of people will get over a major depressive episode within six months with no treatment at all, but another third will develop chronic symptoms without treatment. Major depressive episodes are responsive to both medication and talk therapy, with a combination of the two usually working more quickly than either alone to get people feeling better fastest. Dysthymia is not major depression, which may leave the impression that it is less impacting than major depression, but this is not necessarily so. Dysthymia can wreak havoc on a person’s life.

In contrast to a major depressive episode, dysthymia, or as it’s known by its newer name, “persistent depressive disorder,” is a lower-grade, typically more chronic and longer-lasting form of depression. Dysthymia is defined as a mild to moderate depression that lasts for at least two years without more than a two-month break. It’s slightly more common in women than men, and over a lifetime, 3 to 6% of people will have an episode of dysthymia. Many people who suffer from dysthymia have had the condition for years or even decades, and though it may sound surprising, many people do not know that they have a form of depression. They never thought of their experience this way. For people with dysthymia, there’s often a feeling that this is just how they are. They do not see themselves as having a condition which professionals classify as a form of depression. People with dysthymia have often felt bad for so long that it just seems normal.

Someone with dysthymia might describe themselves as a “pessimist.” They are often physically tired, irritable, don’t sleep well, and do not get much enjoyment from life. Eeyore in Winnie the Pooh is a classic dysthymic. People with dysthymia often say things like, “If I didn’t have bad luck, I’d have no luck at all”…..”I’ve had a black cloud hanging over me my whole life”…or “If something can go wrong, it will.” They often sigh a lot and have slumped down shoulders and posture. They tend to have a narrow range of emotions: sad, bitter, and grumpy. They don’t look happy even when things are going well. Their physical countenance may look drawn or haggard. People who love and care about them often feel worn out and discouraged in their attempts to help them feel better by pointing out the positive things in life. Loved ones may burn out in their attempts to help and emotionally connect. Suffering with dysthymia can feel exhausting, for both the person and those who care about them.

Effective treatment for dysthymia exists. The best outcomes occur when we combine the use of medication with specific models of psychotherapy that target the thinking styles that keep a person locked in chronic depression. Because dysthymia likely results from a mix of genetically based temperament and life experiences, good treatment promotes the expectation that the person may need “tuneups“ in the future because treatment is generally not a “one-and-done” experience. Dysthymia for many people is a remitting and relapsing condition, meaning that it can show back up over time depending on what’s going on in life and how much the person is using their coping and cognitive skills learned in treatment. Part of the goal of treatment is to make future depressive episodes shallower and shorter, and to get longer latencies between them— meaning more good times and less frequent, less intense bad times. If you think you may have dysthymia, remember that you do not have to accept this way of life as just who you are, or your “personality.” Effective treatment is available.