Psychologists and psychiatrists at Shier Private Practice in Scottsdale, AZ specialize in the treatment of depression. Our private outpatient clinic offers a comprehensive psychiatric/medical assessment and treatment plan. Treatment may include medications, behavioral therapies or a combination of treatments.

Persistent depressive disorder (dysthymia) is characterized by a chronic, long-term form of depression during which an individual may feel hopeless, experience feelings of inadequacy or lack energy to engage in daily activities. The symptoms of persistent depressive disorder can significantly impact daily functioning and productivity. Symptoms of persistent depressive disorder may wax and wane over several years, however, they generally will not disappear for periods longer than 2 months. While persistent depressive disorder is less severe than major depressive disorder overall, symptoms may range in severity.

Persistent depressive disorder often has an early onset, first occurring in childhood, adolescence or early adulthood. It is approximated that persistent depressive disorder has a 12 month prevalence rate of .5%.

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
B. Presence, while depressed, of two or more of the following:

1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness

C. During the 2-year period of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

While the exact cause is unknown, persistent depressive disorder may be caused by biological differences, genetic factors, differences in brain chemistry and/or life events. Individuals with persistent depressive disorder may have differences in brain structure and chemistry than individuals without the disorder. Neurotransmitters likely play a role in the development of depression through their interactions with the neural circuits involved with mood stability. Dysthymia is more common in individuals whose blood relatives also have depressive disorders. Traumatic life events, such as significant losses, may increase one’s likelihood of developing persistent depressive disorder. Similarly, other mental health disorders or personality traits such as low self-esteem may increase risk.

Persistent depressive disorder can significantly impact one’s quality of life by limiting daily functioning. If left untreated, dysthymia may lead to interpersonal conflict, substance abuse, decreased productivity, suicidal thoughts or behavior and/or other mental health disorders such as major depression, anxiety disorders, mood disorders or personality disorders.

The diagnosis of persistent depressive disorder (dysthymia) requires a thorough biopsychosocial psychiatric and medical assessment to confirm the diagnosis and rule out other psychological or medical conditions. During this evaluation, the criteria defined by the DSM-5 will be utilized.

Psychotherapy (talk therapy) and medication are the two primary treatment methods for persistent depressive disorder; treatment may include a combination of both. The most commonly used medications in the treatment of persistent depressive disorder are selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin and norepinephrine reuptake inhibitors (SNRIs). Psychotherapies such as Cognitive Behavioral Therapy (CBT) have been proven to be effective.

1. Maintaining a balanced lifestyle can help an individual manage symptoms of dysthymia.
2. Relax – Engage in stress-reducing activities such as meditation, deep-breathing, or yoga when you are feeling depressed or anxious.
3. Diet and Exercise – Good diet and exercise provides significant psychological benefits and can help reduce feelings of depression and anxiety.
4. Avoid drugs and ETOH – Avoid self-medicating. Drugs and alcohol may worsen depressive symptoms as they wear off and increase your risk for physical health issues.
5. Support – Seek support from family, friends and/or support groups to avoid social isolation which may increase depressive symptoms.

Last update: February 25, 2019

The content on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.