Dysthymia: symptoms and treatment

By Cristiano Antonino Last updated Feb 24, 2023

Dysthymia is one of the mood disorders, as it involves a mild but chronic form of depression

It implies an impairment of social relationships and often of work activity.

What is dysthymia

The term dysthymia, or dysthymic disorder, used to mean any form of altered mood, whether in the depressive or manic sense.

Nowadays, on the other hand, the definition of pure dysthymic syndrome applies to all those situations in which symptoms of depression occur continuously.

Even if in an attenuated manner and extent compared to those of major depression.

Development and course of dysthymic disorder

The onset of dysthymia is often early (before the age of 21) and has a chronic course.

Early onset is associated more with the presence of personality and substance use disorders.

It may happen that, even due to the milder severity of the symptoms, dysthymia is diagnosed late; that is, when its negative effects have been going on for one or two years.

It is possible, in fact, that the person suffering from this disorder is not fully aware of it.

He may consider the difficulties and discomforts as specific features of his character and way of being, at least until they are recognised and correctly diagnosed by a specialist.

Characteristics of dysthymia

The main characteristic of dysthymia is a mood that tends to be depressed most of the time (almost every day, according to what is reported by the person concerned and reported by others) for at least two years.

Dysthymic disorder sufferers often describe their mood as ‘sad’ or ‘down in the dumps’, as something that has always characterised them (e.g. ‘I have always been like this’).

The symptoms of dysthymia

The diagnosis can be made when at least two of the classic symptoms of depression are present:

Poor appetite or hyperphagia
Insomnia or hypersomnia
Low energy or asthenia
Low self-esteem
Difficulty making decisions or concentrating
Feelings and experiences of hopelessness

It is important, in order for dysthymia to be truly diagnosable, that during the two years concerned, the person has never been without the indicated symptoms for a period of two months (each time).

In the clinical history, there must also have been no major depressive episodes, cyclothymic disorder, manic or hypomanic episodes.

In pure dysthymic syndrome the criteria for a major depressive episode must not have been fully met in the previous 2 years.

Comorbidity

Dysthymia may be associated with other psychopathologies such as major depression, anxiety disorders, substance abuse and eating disorders.

Finally, dysthymia often coexists with the presence of a personality disorder, particularly of group B or C.

The mood instability typical of dysthymia may often be due to the latter.

Great care must therefore be taken in the differential diagnosis.

Treatment of dysthymia

In any case, dysthymia is a disorder that creates a lot of subjective discomfort, which is often underestimated, but can now be effectively treated.

It can be treated with low doses of the latest generation of antidepressant drugs, but above all with targeted cognitive-behavioural psychotherapy.

This can effectively intervene on the maintenance factors of the disorder and provide the patient with practical advice on how to react in order not to be overwhelmed by it.

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