Dysthymia, also referred to as Persistent Depressive Disorder, is a type of Depressive Disorder that is characterized by depressed mood that occurs over a long period of time. Unlike Major Depressive Disorder (MDD), the symptoms of Dysthymia may be less severe, but its duration is far longer than an episode of MDD. The onset of Dysthymia is considered to be early if it develops before age 21 and late if it develops after the age of 21 years old. In order to be diagnosed with Dysthymia, a person must experience the following:
- Depressed mood for the majority of the day, for more days than not, for at least 2 years.
- The presence of two (or more) of the following,2 in addition to a depressed mood:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration
- Difficulty making decisions
- Feelings of hopelessness
- During the 2-year period, the individual has never been without the symptoms of Dysthymia for more than 2 months.2
- The individual may simultaneously meet the criteria for MDD continually for 2 years.2
- The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.2
- Women are two to three times more likely to experience Dysthymia than men.1
- In 2006, lifetime prevalence rates of Dysthymia were between 3% and 6%.1
- In 2013, men and women who were between the ages of 35-39 were most harmed by Dysthymia (harm is defined as years of healthy life lost).
- Three-million Canadians aged 12-19 years old are at risk for developing Depression.
- In 2016, 40% of survey respondents said that they had never sought medical help for their depressed feelings.
- Of those people hospitalized for Depression, 33% did not receive recommended outpatient care within 30 days of discharge.
Behaviours associated with Dysthymia:
- Turning down a promotion because you believe you will fail.
- Sleeping during the day because you feel too tired to get up.
- Repeatedly missing psychological appointments because you believe that you cannot be helped.
- Ignoring a significant other’s requests to have a serious conversation about your relationship.
- Refusing to RSVP to your best friend’s wedding because you feel uncertain about your ability to attend.
- Watching TV instead of grocery shopping because you hardly ever feel hungry.
Feelings associated with Dysthymia:
Thoughts associated with Dysthymia:
- “My girlfriend doesn’t care about me. I’m sick and could be dying for all she knows.”
- “I’ll go to my child’s next dance recital. I’m too tired right now.”
- “I really don’t know if I feel like seeing him today. I’ll just ignore his message.”
- “I would apply to this job but I know they won’t hire me anyways.”
Dysthymia and the Body:
Some of the physical symptoms of Dysthymia include:
- Chronic joint pain
- Gastrointestinal problems
- Back pain
- Limb pain
- Increase or decrease in appetite
Dysthymia and the Brain:
As a type of Depressive Disorder, the areas of the brain associated with Dysthymia are the same as other types of Depression. The three main parts of the brain involved in Depression are the Prefrontal Cortex, the Amygdala, and the Hippocampus. The Prefrontal Cortex contains structures that are responsible for generating social emotions, pain modulation, solving complex tasks, and it holds the working memory. One area of the prefrontal cortex, known as the Dorsolateral Prefrontal Cortex (DLPFC), appears to be less active in people with Depression. The DLPFC is responsible for cognitive control, which also influences sensory and motor information. A decrease in DLPFC activity is associated with several symptoms of Depression, such as slowed movement and speech and an inability to feel pleasure.8
The amygdala is associated with arousal and reactions to threatening stimuli, as well as emotional learning and memory.8 In people who are experiencing Depression, the amygdala tends to be abnormally activated, leading to rumination (obsessive thoughts).
The hippocampus is a well-studied part of the brain in relation to Depression. A smaller hippocampal size is often found in people with Depression.8 Research indicates that ongoing Depression can lead to changes in the size of the hippocampus, which can impair a person’s ability to recall memories.8
Does Psychology Work?
- Cognitive Behavioural Therapy (CBT): CBT is a type of interactive therapy that focuses on changing unhealthy thoughts and behaviours. During a course of CBT, the Psychologist helps the client recognize negative thoughts, and assists them in creating a more balanced way of thinking. Another component of CBT is identifying behaviours that worsen emotional and mental health functioning and replacing them with more helpful ones. A large body of research has shown that CBT is an effective treatment for Dysthymia. In comparison to psychodynamic therapy, CBT is a more effective long-term treatment for Dysthymia.10 Other research has shown that CBT can enhance the positive effects of certain medications for the treatment of Dysthymia.
- Somatic Therapy: Physical aches and pains are common features of Depressive Disorders, and preliminary research suggests that Somatic Therapy can help ease the symptoms of Dysthymia. Somatic Therapy uses body techniques to give the Psychologist more insight into the client’s problem.11 Additionally, Somatic Therapy uses body exploration as a way to help people become more connected to their internal experiences. Research showed that people who received Somatic Therapy treatments had more favourable changes in their Depression scores than those people who were not treated with Somatic Therapy.11 One theory as to why Somatic Therapy is effective for treating Dysthymia is that movement can help increase the physical drive and improve the slow movements associated with Depression.11
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a type of therapy that is most commonly used in the treatment of Post-Traumatic Stress Disorder (PTSD). In this type of treatment, Psychologists trained in EMDR help clients to resolve distressing symptoms and overwhelming sensations or emotions. Multiple studies of EMDR have revealed that it is an effective treatment for reducing the symptoms of Depression, especially if the person is suffering from PTSD. Rumination has also been reduced via EMDR treatment in people with PTSD.
- Emotionally Focused Therapy (EFT): Researchers have shown that there is a relationship between relationship distress and Depression in one of the partners. Symptoms of Depression in one partner leads to greater relationship distress. Moreover, the greater the relationship distress, the more depressed the person became. Studies have also shown that relationship distress can lead to poorer treatment outcomes for people struggling with Depression.14 Multiple research studies have shown that EFT can significantly reduce relationship distress and can greatly improve Depression that co-occurs with relationship difficulties.14 Other research has demonstrated that EFT can work as effectively as pharmacology for the treatment of Depression in women.
Tips to Manage Dysthymia!
- Avoid Alcohol: Oftentimes, people with Dysthymia will try to cope with their negative moods and uncomfortable symptoms by drinking alcohol. Unfortunately, this can make Depressive symptoms worse because alcohol is a depressant for the brain and may reduce the effectiveness of psychological treatments.16 Although the symptoms of Dysthymia can feel unbearable, drinking alcohol will only make the symptoms worse in the long run. If quitting alcohol seems too difficult, it may be wise to “cut back” and to seek the advice of a Psychologist who specializes in addiction issues.
- Seek Social Support: People who experience Dysthymia often experience isolation. A lack of social support has been linked to negative treatment responses for people with Dysthymia, and it may also contribute to a return of depressive symptoms. Seeking the support of family, support groups, and friends can help lessen the negative impact of this condition.
- Exercise: Studies have shown that exercise can help release endorphins, which are the brain’s neurotransmitters that promote a sense of well-being. Researchers have found links between physical activity and depression and have concluded that exercise and/or physical activity can help reduce depressive symptoms.19 People with Dysthymia often experience a lack of energy and difficulty motivating themselves to exercise. To make the goal of exercising more achievable, physical activity can take on the form on walking, going for a bike ride, or stretching.
Deciding to seek help for Dysthymia is a commendable first step towards improving your well-being. At Hopewell Psychological, we understand that everyone’s experience of Dysthymia is unique and recognize that you may have different combination of symptoms from those listed above. Even if you are struggling with multiple conditions at the same time, such as Dysthymia and Anxiety, we are prepared to create a treatment plan specifically for you. We offer individual treatment options that are scientifically researched and we have extensive experience in treating a variety of mental health conditions. Improving interpersonal relationships can greatly improve your mental health and we also offer therapy for couples and families in addition to individual therapy. If you are struggling with Dysthymia, know that you are not alone. There is hope for recovery and we at Hopewell Psychological want to help you achieve a greater sense of well-being.
*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.
 “Section A-Affective Disorders.” Statistics Canada. Statistics Canada, 27 Nov. 2015. Web. 3 May 2017.
 Reynolds, C.R., and Kamphaus, R.W. “Persistent Depressive Disorder (Dysthymia).” Pearson Clinical. Pearson, 2013. Web. 2 May 2017.
 “Dysthymia in Canada.” HealthGrove. Graphiq Inc., 2017. Web. 3 May 2017.
 American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.” Washington: American Psychiatric Publishing. (2013). Print.
 “Mental Illness and Addictions: Facts and Statistics.” Centre for Addiction and Mental Health. CAMH. Web. 3 May 2017.
 Lin, E., et al. “Post-charge care for Depression in Ontario.” Canadian Journal of Psychiatry, 56.8 (2011): 481–489.
 Trivdei, M.H. “The link between depression and physical symptoms.” Primary Care Companion to the Journal of Clinical Psychiatry 6.1 (2004): 12-16.
 Palazidou, Eleni. “The Neurobiology of Depression.” British Medical Bulletin 101.1 (2012): 127-145.
 “Dorsolateral Prefrontal Cortex.” Science Direct. Elsevier B.V., 2005. Web. 8 May 2017.
 Hofmann, S. G., et al. “The efficacy of cognitive behavioral therapy: A review of meta-analyses.” Cognitive Therapy and Research 36.5 (2012): 427-440.
 Cuijpers, Pim, et al. “Psychotherapy for chronic major depression and Dysthymia: A meta-analysis.” Clinical Psychology Review 30 (2010): 51-62.
 Röhricht, Frank, et al. “An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression.” Journal of Affective Disorders 151 (2013): 85-91.
 Chen, Ying-Ren, et al. “Efficacy of Eye-Movement Desensitization and Reprocessing for patients with PTSD: A meta-analysis of randomized controlled trials.” Plos One 9.8 (2014): e103676.
 Wood, Emily, and Ricketts, Thomas. “Is EMDR an evidence-based treatment for Depression: A review of the literature.” Journal of EMDR Practice and Research 7.4 (2013): 225-235.
 Lebrow, J. L., and Chambers, Anthony L. “Research on the treatment of couple distress.” Journal of Marriage and Family Therapy 38.1 (2012): 145-168.
 Johnson, S. M, and Wittenborn, A.K. “New Research findings on Emotionally Focused Therapy: Introduction to special section.” Journal of Marital and Family Therapy 38.1 (2012): 18-22.
 “Dysthymia.” Behavioral Health Evolution. Hazelden Foundation, 2008. Web. 4 May 2017.
 Sansone, R. A., and Sansone, L.A. “Dysthymic Disorder. Forlorn and Overlooked?” Psychiatry (Edgmont) 6.5 (2009): 46-50.
 Ozbay, Faith, et al. “Social Support and Resilience to Stress.” Psychiatry (Edgmont) 4.5 (2007): 35-40.
 Dinas, P. C., et al. “Effects of exercise and physical activity on depression.” Irish Journal of Medical Science 180.2 (2011): 319-325.