Types of Depression

Major Depressive Disorder

People who have major depressive disorder have had at least one major depressive episode (five or more symptoms for at least a two-week period). For some people, this disorder is recurrent, which means they may experience episodes once a month, once a year or several times throughout their lives.

Dysthymia

Dysthymia is a low-level state of depressed mood that lasts a long time. The depressed state of dysthymia is not as severe as with major depression, but can be just as disabling.

Symptoms of dysthymia:

• Low self-esteem or self-confidence, or feelings of inadequacy
• Feelings of pessimism, despair or hopelessness
• Generalized loss of interest or pleasure
• Social withdrawal
• Chronic fatigue or tiredness
• Feelings of guilt or brooding about the past
• Subjective feelings of irritability or excessive anger
• Decreased activity, effectiveness or productivity
• Difficulty in thinking: poor memory, poor concentration or indecisiveness

Dysthymic disorder is diagnosed when these symptoms last for more than two years in adults (or one year in children) and a person has not been symptom-free for more than two months at a time.

People with dysthymia may be unaware that they have an illness. They might be able to go to work and manage their lives to some degree. However, they may be irritable, stressed, or sleepless much of the time. Many people with dysthymia believe their symptoms are just part of their personality. It may be more difficult for them to seek treatment.

About 3-6% of the population has dysthymic disorder. People with dysthymia often have their first symptoms earlier in life than those with major depressive disorder or bipolar disorder.

Some people have dysthymia along with periodic episodes of major depression. Martin B. Keller, M.D coined the term “double depression” to describe this.

How is dysthymia different from depression?

Two research studies suggest that the symptoms of depression and dysthymia do overlap but that symptoms such as weight change or sleep disturbance are less likely to be found in people with dysthymia. These symptoms are more prevalent in people with chronic major depression.  Other symptoms which are more psychological in nature such as feelings of hopelessness, helplessness and worthlessness are common to people with both dysthymia and chronic major depression. 

Looking at family history may help with diagnosis. Another recent report suggested that the family histories of people with dysthymia and chronic major depression were more similar to each other than to the family histories of people with an acute episode of major depression.

Treatments and therapies that are effective for treating depression, such as medication, psychotherapy and peer support can also work for people with dysthymic disorder.  As with depression, people with dysthymia may need to try more than one treatment or medication, and it may take several weeks for medication to work. During this time, it is important to seek support from friends, family, and a DBSA support group. People in DBSA support groups have “been there” and can offer support, understanding, inspiration and hope. 

Portions of this page were provided by David L. Dunner, M.D., Director of the Center for Anxiety and Depression and a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington in Seattle and a member of DBSA’s Scientific Advisory Board (SAB).

page created: May 3, 2006

page updated: March 12, 2007