What Dysthymia Looks Like, According to Therapists

Learn about dysthymia, a chronic depressive disorder characterized by persistent low mood and symptoms that can last for years.

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Most people experience periods of sadness, depressive symptoms, or poor mental health at some point in their lives. But, the way depression symptoms manifest can help clarify what kind of condition a person might be facing. Some people may experience occasional bouts of sadness, while others live with persistent depressive symptoms, low energy, and even suicidal thoughts—typically signs of a depressive disorder.

One lesser-discussed depressive disorder is persistent depressive disorder (PDD), also known as dysthymia. This condition can cause a depressed mood and other depression symptoms but doesn’t cause a major depressive episode. “Dysthymia is a long-lasting, low-level form of depression,” says Charlie Health Group Facilitator Clary Figueroa, MSW. “It can feel like a dull sadness or emotional heaviness that doesn’t go away.” 

Read on to learn more about how this chronic form of clinical depression differs from other depressive disorders, the risks of ignoring its severe symptoms, and why this often-overlooked mental health condition deserves serious attention.

Common dysthymia symptoms 

Dysthymia can have some similar symptoms to other depression disorders. But, its distinct signs and lengthy presence help medical professionals make an accurate diagnosis. “It’s like carrying a weight you’ve gotten used to,” explains Charlie Health Group Facilitator Bree Williams, LPCA.

Here are common dysthymia symptoms:

• Persistent low mood or sadness
• Low energy
• Fatigue
• Low self-esteem
• Trouble concentrating
• Feelings of hopelessness
• Sleep changes 
• Changes in appetite
• Having a hard time feeling happiness or pleasure

What can cause dysthymia?

There’s no singular cause of dysthymia, as it varies from person to person. “Like other forms of depression, dysthymia is multifaceted — often a combination of biological, psychological, and environmental factors,” says Williams.

According to Williams, here are some of the factors that can cause dysthymia:

• Genetics: A family history of depression or mood disorders increases the risk
• Brain chemistry: Imbalances in neurotransmitters like serotonin or dopamine can contribute
• Chronic stress or trauma: Long-term exposure to emotional neglect, instability, or childhood adversity can lead to persistent depressive patterns
• Negative thinking patterns: Constant self-criticism or pessimism can reinforce your low mood
• Medical conditions: Chronic illness, thyroid issues, or hormonal imbalances can affect your mood over time

Understanding how dysthymia is different from other depressive disorders

Depression can present in a range of mental health disorders or come in tandem with conditions like anxiety disorders or bipolar disorder. Among depressive disorders are major depressive disorder (MDD), seasonal affective disorder (SAD), and PDD.

While dysthymia involves ongoing, milder symptoms, major depressive disorder tends to present as more intense episodes lasting a shorter time. This chronic low mood often begins in adolescence or young adulthood and can last for years. “Dysthymia is less severe but more constant,” says Figueroa. “It’s the difference between a storm and a long stretch of cloudy skies; both affect your life, just in different ways.” People with dysthymia might still function day to day but often feel persistently low energy, disconnected, or unmotivated.

Diagnosing persistent depressive disorder 

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person living with PDD will experience a “depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others.” 

Diagnosis requires symptoms to persist for at least two years in adults (one year in children and adolescents) and involves identifying a chronic depressed mood, even if it is less severe than in major depression, explains Charlie Health Licensed Creative Arts Therapist Courtney Way, MA, LCAT.

The condition’s name and classification changed between the DSM’s fourth and fifth editions. In the DSM-4, it was known as dysthymic disorder and filed under mood disorders. The condition’s characteristics remained almost identical in the DSM-5, but its name changed to persistent depressive disorder, and it is now classified as a depressive disorder. 

Treatment options for dysthymia

Effective treatment can include medication, lifestyle changes, and support from others,” says Figueroa. “Even if the symptoms have been around for a long time, people can feel better with the right care.” 

1. Therapy 

Therapy can be a critical tool in treating dysthymia. There are a range of different techniques that can be beneficial depending on a person’s symptoms and potential causes. Williams outlines some of the best therapy options for dysthymia:

• Cognitive behavioral therapy (CBT): Helps challenge negative thinking and develop healthier beliefs about self and life
• Psychodynamic therapy: Explores underlying emotional wounds or patterns from the past that keep you stuck
• Interpersonal therapy (IPT): Focuses on improving relationships and addressing unresolved grief or conflict
• Culturally sensitive therapy: Especially important for Black clients or clients of color to address generational trauma, racial stress, and identity-related factors that often go unspoken in traditional therapy settings

2. Medication 

You might also consider taking medication to manage PDD symptoms. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) are often taken in conjunction with attending therapy sessions, the experts say. Antidepressants can provide an extra boost or support on top of other treatment options when properly monitored by a certified medical professional. 

3. Lifestyle changes

Introducing new habits into your life can also go a long way toward improving dysthymia’s symptoms. Way recommends trying things such as exercising, focusing on your social connections and supports, practicing mindfulness and meditation, and taking measures to sleep well. 

“Because the symptoms are milder but persistent, people often assume this is just their personality or their ‘normal,” says Williams. “But living in a fog of emotional heaviness for years is not something you just have to accept — it’s something you can heal from.” 

How Charlie Health can help 

If you or a loved one are struggling with persistent depressive disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides behavioral health treatment for people dealing with serious conditions, including dysthymia, anxiety disorders, substance use disorder, and more. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With support, managing your mental health is possible. Fill out the form below or give us a call to start healing today.