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People who feel down for more than 2 years might have a mental health disorder called dysthymia.

Dysthymia is a chronic form of depression, with daily symptoms that are not as severe as those seen in a major depression. Although the daily symptoms are not as debilitating, the cumulative effects of years of depressed mood can be great. Many people live with undiagnosed and untreated dysthymia for decades and the disorder is actually associated with higher rates of suicide than major depression.

More women than men suffer from the disorder which affects nearly 11 million Americans over the age of 18. For most sufferers, first onset occurs in adolescence or young adulthood (although childhood dysthymia is possible) and people with dysthymia have a 50% likelihood of a major depressive episode at some point in life.

Symptoms of Dysthymia

The majority of dysthymic cases go undiagnosed. People commonly experience a young age of onset and such a long duration of symptoms that they don't even realize that the way they feel isn’t normal. Many people go undiagnosed until a bout of major depression prompts treatment and accurate diagnosis.


To meet the criteria for dysthymia, a person must have had a depressed mood for most of each day for 2 years or longer. For children and teens, a diagnosis is possible after 1 year of depressed mood.

A person must meet at least 2 additional criteria, also for at least 2 years:

  • Altered eating – either too much or too little
  • Sleeping problems, either insomnia or over sleeping
  • Fatigue
  • Low self esteem
  • Feelings of hopelessness or guilt
  • Concentration or decision making problems
  • Feelings of sadness
  • Aches and pains without obvious cause

The person may not have displayed manic behavior during the 2 year time period and no other medical condition or medication (or drugs or alcohol) can have caused the depressed mood.

To meet a dysthymic diagnosis, the symptoms must occur with enough severity to interfere with daily life in the home, at work or school or in other areas.

People with dysthymia may also have difficulty interacting socially, spend more time in isolation, perform poorly at work or at school, have trouble finishing assignments and get very easily discouraged.

What Causes Dysthymia?

Scientists do not yet understand what causes the disorder. Changes in serotonin levels in the brain may play a role. Other factors thought to influence the occurrence of the disorder include:

  • Difficulties at home or on the job
  • Major life stressors
  • Major illness
  • Medications
  • Social isolation

Most likely, dysthymia occurs after a negative interplay between biological and environmental factors

There is likely a hereditary/genetic component to the disorder. If a parent suffered from early onset dysthymia (onset before the age of 21) children have a strong likelihood of also succumbing.


The 2 primary treatments for dysthymia are:

  • Psychotherapy
  • Anti depressant medications

Most people respond to either psychotherapy or medication and so to increase the odds of success, the two therapies are commonly offered in conjunction.

The anti depressants most commonly prescribed for dysthymia are of the SSRI class, such as Prozac or Zoloft. Medications can take a while to start working, but people taking anti depressants should start seeing an improvement within a couple of months. If medication isn’t working, there is the possibility of a misdiagnosis.

Lifestyle changes such as increasing the amount of physical activity in a weekly routine or making better eating choices can also help to ease the severity of depressive symptoms. Alcohol, as a depressant, can worsen symptoms severity.

People suffering a co-occurring disorder (dysthymia and another disorder) may not respond as well to conventional treatments. For example, an alcoholic with dysthymia might not respond to anti depressants unless she first stopped her excessive drinking..

The Physical Effects of Dysthymia

Dysthymia is harmful to a person's physical health. Dysthymia increases the activity of the body's stress system, increasing the release of stress hormones such as cortisol chronically. This chronic over-activation can cause brain cell death and increase the risks of heart disease, diabetes and osteoporosis.

Getting Treatment

Only a minority of people suffering from dysthymia get the treatment they need; treatment that could transform lives for the better. Feeling "down" for more than 2 years is not normal, and there are medications and therapies that can restore the happiness and satisfaction to life.

No one should have to live a life of pessimism, sadness and hopelessness – and with treatment, no one does.

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Page last updated Aug 05, 2010

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