Dysthymia vs. Depression: What’s the Difference?

Dysthymia is an older term for chronic depression. It’s now called persistent depressive disorder (PDD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Unlike other types of depressive disorders that involve periods of typical, non-depressed moods, PDD is ongoing.

Dysthymia symptoms

Symptoms of PDD aren’t always as noticeable as symptoms of major depressive disorder. Instead, symptoms might resemble gloominess or pessimism.

Symptoms can change and evolve but are present most of the time. They include:

• lack of humor
• persistent gloom
• pessimism
• passivity
• lethargy
• introversion
• self-criticism
• judgment
• dissatisfaction

In the United States, PDD affects an estimated 1.5% of adults. It’s diagnosed more often in women than men.

When people say “depression,” what they usually mean is major depressive disorder (MDD), sometimes known as clinical depression. MDD is more severe than PDD, but episodes of major depression don’t typically last as long.

However, without treatment, MDD can return or become recurrent.

In a 2015 study of female twins, researchers noted several factors that could increase the chance of MDD becoming recurrent:

• psychiatric history
• family history
• adverse life events, both early and recent
• being unmarried
• financial difficulties
• problems with friends

Depression symptoms

If you have MDD, it can feel difficult to do typical activities because symptoms can interfere with your ability to function.

Symptoms may include:

• prolonged depressed mood
• fatigue
• feelings of worthlessness or guilt
• unintended weight fluctuations
• sleep changes
• restlessness
• psychomotor impairment
• loss of interest or enjoyment in most activities
• thoughts of death or dying

MDD is more common than dysthymia. It affects about 8.4% of U.S. adults. It’s also more commonly diagnosed in women than men.

MDD is more commonly diagnosed in people who are:

• lacking close, interpersonal relationships
• divorced
• separated
• widowed
• living with other mental health conditions

According to the National Institute of Mental Health, in 2020, major depressive episodes occurred the most in people ages 18–25 and those who reported belonging to two or more races.

Despite the shared symptoms between PDD and MDD, there are some crucial differences.

Diagnosis

Mental health professionals use several tools and information to diagnose depressive disorders.

They’ll ask you questions about your history and likely give you a mental health questionnaire. Then, they typically compare your answers to the criteria outlined in the DSM-5.

Dysthymia

To receive a PDD diagnosis, you must experience a depressed mood:

• for most of the day
• for more days than they feel well
• for 2 years or more

You also wouldn’t have a symptom-free period lasting longer than 2 months throughout the 2-year time frame.

You must also have at least two of the following:

• feelings of hopelessness
• low self-esteem
• sleep disruption (too much or too little sleep)
• appetite changes (over or under eating)
• fatigue or low energy
• difficulty making decisions or poor concentration

Depression

For a diagnosis of MDD, you must experience at least five of the following:

• depressed mood for most of the day
• loss of energy or fatigue
• noticeable loss of interest in or enjoyment of most activities
• increased or decreased physical movement
• too much or too little sleep
• difficulty thinking or concentrating
• appetite or weight changes
• feelings of guilt or worthlessness
• thoughts of suicide

These signs must last at least 2 weeks, and one of them must be a depressed mood or loss of pleasure or interest.

When diagnosing MDD, a doctor may ask questions to make sure you don’t have another condition. They’ll try to figure out if you’ve had episodes of mania or hypomania, or if your symptoms are the result of substance use or another medical condition.

Severity

Both dysthymia and major depression can interfere with work, school, and relationships. Symptoms can lead to physical illness because they may interfere with your ability to take care of yourself.

MDD has more severe effects, but they’re short-lived compared to the symptoms of PDD, which are long-lasting.

Treatment

The treatments for MDD and PDD are very similar.

Doctors suggest a treatment plan based on symptom severity.

For mild depression, psychotherapy is often the first-line treatment. For moderate depression, your doctor might recommend medication along with therapy.

Someone with severe symptoms, including suicidal thoughts, will likely need more intensive care to prevent a mental health crisis.

Research in 2019 suggests that therapy works for mild to moderate depression in about 48% of cases.

The types of therapy included in the study were:

• cognitive behavioral therapy (CBT)
• behavioral activation
• interpersonal psychotherapy

When treating depression, if no improvements happen after about 6 weeks, your doctor may suggest a different type of therapy or medication.

There are many types of antidepressants available. Common ones include:

• selective serotonin reuptake inhibitors (SSRIs), including citalopram (Celexa) and sertraline (Zoloft)
• serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor)
• bupropion (Wellbutrin)
• mirtazapine (Remeron)

Depending on the type of medication you’re prescribed, it can take up to several weeks for the medication to take effect. Most doctors will start you on a low dose and gradually increase as needed.

Other types of depression

The DSM-5 lists several other types of depressive disorders, including:

• depressive disorder due to another medical condition
• unspecified depressive disorder
• substance or medication-induced depressive disorder
• premenstrual dysphoric disorder
• disruptive mood dysregulation disorder

Dysthymia and major depression are two types of depressive disorders that can affect your ability to function in daily life. But they’re also both treatable.

Dysthymia — or persistent depressive disorder — is a long-lasting form of depression. Symptoms are less severe but they last for a long time. Major depressive disorder is often more severe than PDD.

No matter the type of depression, if you believe you’re having depression symptoms, you can reach out for support. A diagnosis can help you find the right treatment options for you. The first step is to visit a doctor or reach out for mental health support.