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Major Depression or Dysthymia?

Medically Reviewed by Jennifer Casarella, MD on July 26, 2020

Everyone struggles with down days. But you may often wrestle with hopelessness, lack of energy, and other feelings. Depending upon how long you’ve felt that way, you may have major depressive disorder (MDD) or another type of depression, called dysthymia.

Major Depression vs. Dysthymia

Major depressive disorder and dysthymia overlap in some ways. But there are key differences.

Dysthymia, now usually called persistent depressive disorder (PDD), involves fewer symptoms. But they last longer, at least 2 years. You can be diagnosed with MDD if you have symptoms for 2 weeks.

Both mood disorders are serious. Sometimes dysthymia can disrupt your life more, even with fewer symptoms.

What Are the Symptoms?

The two disorders share one symptom: a depressed mood on most days. To figure out if you have dysthymia, your doctor will ask about other possible signs:

  • Loss of appetite or overeating
  • Problems sleeping
  • Low energy or tiredness
  • Low self-esteem
  • Difficulty concentrating or making decisions
  • Feelings of hopelessness

If you have dysthymia, you’ll have at least two of these symptoms, along with a depressed mood. The symptoms will have hung on for at least 2 years without much relief.

If you have MDD, you’ll have more symptoms, at least five. They'll last at least 2 weeks. Some are like dysthymia symptoms. But they may be worse.

For example, someone with dysthymia may notice changes in eating habits. But if you have major depressive disorder, those changes may cause you to gain or lose a lot of weight.

The nine symptoms of major depressive disorder are:

  • Depressed mood
  • Loss of interest or pleasure in many or all activities
  • Sleep problems
  • Noticeable weight loss or gain
  • Faster or slower movements that others notice
  • Tiredness or low energy
  • Problems thinking or making decisions
  • Thoughts of guilt or worthlessness
  • Repeated thoughts of death or suicide, or a suicide attempt

What Are the Risk Factors?

You're more likely to get either type of depression if you’re female. Both types can start at any age. But PDD often shows up earlier in life.

Both PDD and MDD are probably caused by a mix of life events and physical problems. More than one of them could affect you, including:

Biology.Stress may cause changes to your brain. Plus, natural brain chemicals and how they function can influence your mood.

Heredity. Depression is more likely when you have close relatives with the condition.

Stress. Trauma in your life, such as money problems or the death of a loved one, can trigger depression.

How Are They Diagnosed?

No lab test can diagnose depression. But your doctor may order tests to make sure there isn’t another medical reason for your low mood, tiredness, and other symptoms. Your doctor also may refer you to a psychiatrist or psychologist.

Your doctor will ask a lot of questions about your symptoms. Whether you have depression, and which type, depends on how long the symptoms last and how much they affect your daily life.

Treatment

For both types of depression, your doctor can recommend several treatments. Sometimes they’re used together, including:

Medication. Your doctor can prescribe drugs called antidepressants to rebalance the natural chemicals in your brain. Which ones your doctor will prescribe depends on several things, including what other medications you take.

Some antidepressants take several weeks to work. Don’t stop taking one without talking to your doctor first. Sometimes, stopping or missing doses can cause a withdrawal reaction or make your depression worse.

Therapy. With therapy, you can learn ways to cope better. You might learn how to identify and prevent harmful thoughts. You could learn to manage stress or improve your social skills. Or you may work through longtime challenges, such as painful childhood memories.

Lifestyle. Don’t skimp on changes that can help your body as well as your mind, such as:

  • Keep up a healthy diet.
  • Get enough sleep.
  • Exercise regularly.
  • Avoid alcohol and illegal drugs, which can affect mood.
  • Spend time on hobbies and other things you enjoy.
  • Surround yourself with supportive friends and family.

Outlook

You may get both types of depression at some point in your life.

Three out of 4 people with PDD will have at least one period of MDD at the same time. Doctors call that double depression.

Neither type of depression is minor. It may take time and different treatments before you start to feel better. But once you and your doctor settle on the right medication and support, you'll likely feel your mood improve.

WebMD Medical Reference

Sources

SOURCES:

Cleveland Clinic: "Persistent Depressive Disorder."

Harvard Medical School: "Dysthymia," "Women and depression."

Mayo Clinic: "Persistent depressive disorder (dysthymia)."

Medscape: "Dysthymic Disorder."

UpToDate: "Unipolar depression in adults: Assessment and diagnosis."  

Medline Plus: "Antidepressants."

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