Persistent depressive disorder (dysthymia)
Depressed mood on more days than not for at least two years in adults, usually milder than a major episode but far more chronic. People often cannot remember feeling otherwise and treat it as their personality.
What drives it
It is a long, low-level shutdown that often begins early in life and becomes a settled stance: expect little, ask for little, so disappointment cannot land so hard.
How it shows
Work
Reliable, often conscientious, but joyless. They meet deadlines and rarely complain, yet never seem pleased by a win: 'It'll probably fall through anyway.' Low energy is constant rather than episodic. They are often underplaced relative to their ability because they do not push for anything.
Relationships
A steady pessimism that partners come to see as just who they are. Gloomy forecasts, low expectations of being looked after, difficulty receiving pleasure or praise. Friends describe them as 'a bit heavy' or 'serious'. Major depressive episodes can sit on top ('double depression') and then they drop much lower.
Self
You assume this is what life feels like for everyone. Good things register faintly and briefly. You think of yourself as a realist. You have no clear memory of a stretch longer than a couple of months when you felt well.
What tells it apart
Depressive character: Depressive character is described by its self-critical, guilt-prone relational style and can coexist with real enjoyment; dysthymia is defined by chronic low mood, low energy and sleep or appetite change, and it often responds to treatment in a way that surprises the person ('I didn't know I could feel like this').
Major depression: Major depression has a clearer onset and a more severe, impairing drop; dysthymia is milder and so long-standing that the person and those around them read it as temperament.
Anhedonia: Anhedonia is one symptom (loss of pleasure) that runs across many conditions; dysthymia is a chronic mood state in which low mood, pessimism and fatigue travel together.
A test
Ask when they last felt well for two months straight; if they cannot remember, or the answer is 'never really', suggest an assessment, because chronic depression is treatable and routinely mistaken for character.
Questions to carry
- When was the last stretch of two months that felt well, and how long ago was it?
- Which low, steady heaviness have I come to call my personality, and since when?
How strong the research is
moderate. Chronic low-grade depression is well documented and treatable, but DSM-5's merger of dysthymia with chronic major depression is debated and its boundary with depressive temperament is unclear.
Where it comes from
Dysthymic disorder in DSM-III, 1980, shaped by Hagop Akiskal's work on subaffective disorders; renamed persistent depressive disorder in DSM-5, 2013