Dysthymia Shouldn’t be a ‘Way of Life’: How the Low-Grade Depression is Diagnosed & Treated

People with dysthymia often feel (and sometimes their friends and loved ones do, too) that this is just the way they are. It’s not that they are depressed, negative, and think the glass is half empty, but that there is something wrong with the way they feel and that is how they have to live. Dysthymia, or dysthymic disorder, is a mild, ongoing depression that often goes unnoticed. But according to Beth Salcedo, MD, medical director of The Ross Center and former ADAA board chair, it doesn’t have to be a way of life. It’s diagnosable and treatable.

In the ADAA Patient Guide to Mood and Anxiety Disorders, a chapter on dysthymia recounts how people with this disorder, a persistent but less severe form of depression, are often late in seeking professional help. Although an estimated 1 to 6 percent of the world’s population has dysthymia, it remains an underdiagnosed disorder.

In a conversation with ADAA, Dr. Salcedo explained more about the disorder and her experiences with those who suffer from it.

Symptoms and impact: The cloud that rarely dissipates on its own

People don’t have devastating symptoms, Dr. Salcedo says, but rather, “they often glide through life with a sort of cloud hanging over their heads.” While it’s a well-known and sometimes overused analogy for depression, the cloud is apt, and the idea of ​​a “sort of” or “partial” shadow to describe dysthymia makes sense. In fact, it’s often more of a subtle cloud that follows the person everywhere and never seems to clear or disappear for only a brief period.

Typical symptoms of depression, such as changes in appetite, sleep, energy, self-esteem, and difficulty concentrating, occur with dysthymia, but may not affect the individual as severely as a condition such as major depressive disorder (MDD). Dr. Salcedo points out that many people with dysthymia can function to a degree that seems normal (to others in particular), but the problem affects them.

“They may think, well, I’m in pretty good shape, I’m getting by, I’m still working, I’m getting my kids to school, I’m sleeping well, etc.,” she told ADAA, “so they don’t seek treatment. But if you dig deeper, you realize it’s having an impact.”

Dr. Salcedo said an example of impact could be the person not getting the graduate degree they want because they don’t have the energy for it, or not getting involved in a relationship because they don’t have the stamina to handle everything they have on their plate plus this potential new friend or partner.

“The symptoms are milder but more persistent than those of major depression, which can last for several months and then remit. But dysthymia, while easy to rule out and harder to detect, can make it more difficult to manage and cope with over time,” said Dr. Salcedo.

When patients present for treatment

Dr. Salcedo says it’s usually during a time of crisis or when a person is facing a major event, whether negative or positive, that someone might come to her office. They’ve probably felt “weird” for a while, she adds, but they’re not comfortable or happy with that feeling. They know it’s not “just their personality” and can remember a time when they didn’t feel that way.

Stigma can be a factor in someone with dysthymia avoiding diagnosis and treatment, and people often think the illness will go away on its own. While that’s possible, Dr. Salcedo says, in her experience, dysthymia doesn’t usually resolve as quickly as major depression and probably won’t resolve without treatment.

“People with dysthymia have symptoms every day for at least two years,” Dr. Salcedo said, emphasizing that it’s not normal to feel this way for so long and that it’s important to seek treatment. “It’s not as well studied as MDD, but like MDD, many patients with dysthymia respond to therapy, medication and some lifestyle changes.”

Treatment results and options for living more fully

In addition to therapy, such as cognitive behavioral therapy (CBT) and medications like SSRIs or SNRIs, if needed, Dr. Salcedo says it’s good to look at one’s lifestyle and assess it. How will certain changes make you feel better? Cutting back on alcohol, eating healthier, exercising more frequently (perhaps in a group or with others), and optimizing the amount or quality of sleep are all good options.

“Some of these things can be done before or during treatment,” Dr. Salcedo said, “especially if one has the means to do so. If not, it will obviously be helpful to start medication and/or therapy as soon as possible, so that the person can work on these other adjustments.”

People will start to feel better on medication and should continue taking it for at least a year or more, she adds. She understands that many people start taking medication with the idea that they want to stop eventually, so she works with them from the beginning, discussing the possibility of reducing the dose, if that is their goal.

“But I encourage them to wait until they’ve spent a long time in remission and feel like they have the support systems they need to set themselves up for success,” Dr. Salcedo said. “There are options.” The choice to get treatment and enjoy life to the fullest should be a priority.