Feeling a little low mood could be a sign of dysthymia – 12/09/2023 – Balance

By the time Amanda Stern reached her mid-40s, she no longer suffered from clinical depression. And her panic attacks, which began in childhood, had largely disappeared. But instead of feeling happier, she said, “I felt enveloped by an infinite, flat sadness.”

Confused, she went to her therapist, who suggested she had dysthymia, a mild version of persistent depressive disorder, or PDD.

Stern, a New York City-based author, frequently writes about mental health but had never heard of the term. She soon realized that she had experienced dysthymia intermittently for decades. “I’m not suffering from it now,” she added, “but I imagine I’ll live with it again.”

She decided to write about it in her newsletter, How to Live, describing what it was like to exist in a “constant state of ’empty'” and sharing the tools that eventually helped her feel better.

It’s not clear why some cases of depression persist, but The New York Times asked experts to share what they know about PDD.

What is persistent depressive disorder?

Persistent depressive disorder is chronic depression that lasts at least two years in adults. As with many types of mental illnesses, there are different levels of severity.

The term “dysthymia,” a Greek word that can mean “low mood,” “mood change,” or “despondency,” is no longer included in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, but is still used by some mental health professionals to refer to the milder form of PDD.

Marnie Shanbhag, senior director of independent practice at the American Psychological Association, said less severe BPD is often diagnosed when people seek therapy for another problem, such as marital problems or work stress, and reveal that they feel constant sadness, lack of emotion or emotional apathy.

There may not seem to be a reason for this. “You’re just kind of ‘meh,'” Shanbhag said. “And you get used to it being like that.”

For Stern, clinical depression “brings me down. I can’t get out of bed, shower, eat or walk my dog.” With dysthymia, however, she can still function. She may not want to do the dishes, for example, but she won’t feel “overwhelmed” by the task.

Those who have the most severe form of PDD, referred to in the past as chronic major depressive disorder, may be unable to get out of bed after a sleepless night, lose their appetite, have such difficulty concentrating that they cannot do their work or feel too exhausted to clean the house or prepare dinner, said Dr. Paul Appelbaum, a professor of psychiatry at Columbia University and leader of the group responsible for revisions to the DSM.

It is estimated that about 2% of adults in the United States have had some form of PDD in the past year, and it is believed to be more common among women than men. However, it’s difficult to know its full extent because experts say the disorder tends to be underdiagnosed.

How is the diagnosis made?

PDD is diagnosed in adults who report feeling depressed “most of the day, most days” for at least two years, Appelbaum said. And if they find relief from their symptoms, he added, it doesn’t last more than two months.

Children and teenagers can also have PDD. (To make a diagnosis, Appelbaum said, symptoms will need to have lasted at least a year.)

“Like other forms of depression, it causes significant distress or impairment and is associated with an increased risk of suicide,” Appelbaum said.

Patients with the disorder will also experience at least two of the following symptoms:

• Poor appetite or overeating
• Insomnia or excessive sleepiness during the day
• Low energy or fatigue
• Low self-esteem
• Difficulty concentrating or making decisions
• Feelings of hopelessness

How is it treated?

PDD is usually treated with therapy and antidepressants.

There is no cure, but people can become “symptom-free, and the intensity of recurrences, if any, can be minimized,” Appelbaum said.

Because BPD can be long-lasting — and does not always interfere with the patient’s daily life — those who have the disorder may assume that their milder depressive symptoms are simply personality traits.

“It’s hard to convince people that they’re not just the negative person in their family or the person who always sees the bad side of things,” said Dr. Jessi Gold, a psychiatrist in St. Louis. But if someone is suffering or experiencing symptoms that interfere with daily life, it makes sense to seek treatment rather than simply saying, “This is how I am,” she added.

Stern can relate. When people close to her asked how she was, she said she was fine, but, according to her, “a deep sadness appeared, showing me that I was not well at all.”

She urged those who feel consistently unmotivated, apathetic or uninterested in the things they once enjoyed to seek help. “You may feel alone, but you’re not,” she said.

This article was originally published in The New York Times.