Do You Have Mild, Low-Grade Depression?

How to Diagnose Persistent Depressive Disorder, or Dysthymia

Depressed man with drink
Getty Images/Chris Schmidt

Sometimes, when people experience mild, low-grade depression, they may not even realize they are depressed. In fact, their chronic feelings of sadness and low mood may have been around for so long that it simply feels normal to them.

However, it is not normal to go through life feeling unhappy all of the time. Everyone will experience periodic feelings of depression in response to sad or very stressful life events.

But constantly feeling bad does not have to be the story of your life.​​

Symptoms of Chronic Low-Grade Depression

Chronic low-grade depression is a symptom of a condition called dysthymic disorder, or dysthymia. Another name for this mood disorder is Persistent Depressive Disorder (PDD). While it was previously listed separately from chronic major depression, they are now combined as there is no scientifically meaningful difference between them.

The signs and symptoms of dysthymic disorder are very similar to major depressive disorder, except that they tend to be milder and they are chronic in nature. These may include:

  • Sadness or depression
  • No longer enjoying things that used to bring pleasure
  • Changes in weight or appetite
  • Sleep problems
  • Restlessness
  • Low energy
  • Fatigue
  • Feelings of hopelessness, worthlessness, or guilt
  • Problems with concentration or decision-making
  • Thoughts of death or suicide

Causes

As with major depressive disorder, dysthymic disorder is believed to be a multifactorial condition.

It appears to be caused by a combination of genetic susceptibility, biochemical imbalance, life stress, and environmental circumstances.

In about three-quarters of patients with dysthymia, it is difficult to tease out just what the primary cause of the disorder is, as these patients tend to have other complicating factors, such as chronic illness, another psychiatric disorder, or substance abuse.

In these cases, it becomes very difficult to say whether the depression would exist independently of the other condition. In addition, these comorbid conditions often create a vicious cycle wherein each illness makes the other more difficult to treat.

Diagnosis

Like other forms of depression, there isn't really a blood test or brain scan that can be used to make a diagnosis of dysthymic disorder. Instead, doctors must go by the signs that they can observe, as well as any symptoms patients report to them. They then seek to see if their patient's symptoms fit into a pattern laid out by the "Diagnostic and Statistical Manual of Mental Disorders (DSM)," which is a guidebook for diagnosing mental disorders such as depression.

In the case of dysthymic disorder, doctors check to see if the symptoms listed above have been present for an extended period of time. In addition, they consider whether the severity of the symptoms is less than what a patient might experience with a major depressive disorder.

Your doctor will also try to rule out any possible medical conditions, such as hypothyroidism, which might be causing your chronic mild depression. Blood and urine tests may be done to look for these conditions.

Other factors a doctor will consider when making a diagnosis include your medical history and whether or not there is any history of depression among your close relatives.

Treatment

Dysthymic disorder responds to the same treatments that are used to treat major depressive disorder.  Antidepressant medications are generally prescribed, with selective serotonin reuptake inhibitors (SSRIs) being a popular choice. In addition, talk therapy such as psychotherapy or cognitive behavioral therapy can often be quite helpful for those with dysthymic disorder. You'll have to work with your mental health care provider to develop a treatment plan that's most appropriate for you.

Self-care may help improve your symptoms:

  • Be sure to get enough sleep and ensure you have a sleeping environment that supports good rest.
  • Eat a healthy diet high in nutrition.
  • Avoid alcohol and illegal drugs.
  • Exercise regularly. Aim for 30 minutes of moderately-intense exercise most days of the week, and vigorous exercise if you are able to do so.
  • Find things to do that you enjoy.
  • Seek out people for friends who are positive and who show that they care about you.
  • Be sure that you are taking all of your medications correctly, and be sure to tell your doctor about any supplements or herbal medications you are taking.

If you note that your depression is getting worse, seek help. PDD increases the risk of suicide.

Sources:

American Psychiatric Association. Persistent depressive disorder (dysthymia). Diagnostic and Statistical Manual of Mental Disorders 5th ed. Arlington, VA: American Psychiatric Publishing, 2013;168-171.

Persistent Depressive Disorder. MedlinePlus. https://medlineplus.gov/ency/article/000918.htm.

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