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Dysthymia symptoms in adults include:

• Loss of interest in daily activities
• Feeling sad or down
• Hopelessness
• Lack of energy
• Fatigue
• Low self-esteem
• Trouble concentrating
• Trouble making decisions
• Self-criticism
• Excessive anger
• Decreased productivity
• Avoiding social activities
• Feelings of guilt
• Poor appetite
• Overeating
• Sleep problems

In children, dysthymia symptoms may include:

• Irritability
• Poor school performance
• A pessimistic attitude
• A lack of social skills

Dysthymia symptoms typically come and go over a period of years, and their intensity can change over time, too. But in general, you may find it hard to be upbeat even on happy occasions — you may be characterized as having a gloomy personality.

When dysthymia starts on or before age 21, it's called early-onset dysthymia. When it starts after that, it's called late-onset dysthymia.

When to see a doctor
It's perfectly normal to feel sad or upset sometimes or to be unhappy with stressful situations in your life. But with dysthymia, these feelings last for years and interfere with your relationships, work and daily activities.

If you have any symptoms of dysthymia, seek medical help. If not effectively treated, dysthymia commonly progresses into depression (major depression).

If you have a primary care doctor, talk to him or her about your symptoms. Or seek help directly from a mental health provider. If you're reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it's a friend or loved one, a teacher, a faith leader or someone else you trust.

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The exact cause of dysthymia isn't known. Dysthymia may have causes similar to depression, including:

• Biochemical. People with depression may have physical changes in their brains, and this may be true of dysthymia, too. The significance of these changes is still uncertain, but they may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in causing dysthymia.
• Genes. Depression appears to be common in people whose biological family members also have the condition, and this also appears to be the case with dysthymia.
• Environment. Again, as with depression, environment may contribute to dysthymia. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems and a high level stress.

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Although the precise cause of dysthymia isn't known, certain factors appear to increase the risk of developing or triggering dysthymia, including:

• Having biological relatives with depression
• Having biological relatives with dysthymia
• Stressful life events
• In adults only, being female

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Complications that dysthymia may cause or be associated with include:

• Reduced quality of life
• Major depression
• Suicidal behavior
• Substance abuse
• Relationship difficulties
• Family conflicts
• Social isolation
• School and work problems
• Decreased productivity

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Sometimes, a health care provider or other professional may ask you about your mood. Your doctor may bring it up during a routine medical appointment if you seem to be sad or down, for instance. Or you may decide to schedule an appointment with your family doctor or general practitioner to talk about your concerns. In either case, because dysthymia often requires specialized mental health care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment. Or, you may seek out a mental health provider on your own first.

What you can do
Being an active participant in your care can help your efforts to recover from dysthymia. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These may include:

• Why can't I get over dysthymia on my own?
• How do you treat dysthymia?
• Will psychotherapy help?
• Are there medications that might help?
• How long will I need to take medication?
• What are some of the side effects of the medication you're recommending?
• How often will we meet?
• How long will treatment take?
• What can I do to help myself?
• Are there any brochures or other printed material that I can take home with me?
• What websites do you recommend visiting?

In addition to the questions that you've prepared to ask, don't hesitate to ask questions that you think of during your appointment.

What to expect from your doctor
During your appointment, your doctor is likely to ask you a number of questions about your mood, thoughts and behavior. Your doctor may ask such questions as:

• When did you first notice symptoms?
• How is your daily life affected by your symptoms?
• What other treatment have you had?
• What have you tried on your own to feel better?
• What things make you feel worse?
• Have any relatives had dysthymia, depression or another mental illness?
• What do you hope to gain from treatment?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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When doctors suspect someone has dysthymia, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Physical exam. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
• Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
• Psychological evaluation. A doctor or mental health provider talks to you about your thoughts, feelings and behavior patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar issues in the past. You also discuss any thoughts you may have of suicide or self-harm. You may also be asked to fill out questionnaires about your mood and state of mind.

Checking for other conditions
Several other conditions have symptoms that may resemble the symptoms of dysthymia, including feeling sad or down, loss of interest in daily activities, and problems sleeping. Your doctor or mental health provider's evaluation will help determine if you have dysthymia or another condition that can affect your mood, such as:

• Depression
• Manic-depression (bipolar disorder)
• Personality disorders
• Seasonal affective disorder
• Substance abuse disorder

Diagnostic criteria for dysthymia
To be diagnosed with dysthymia, you must meet the symptom criteria spelled out in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

Main criterion
The main criterion to be diagnosed with dysthymia is:

• Having a depressed mood most of the time for two or more years (in children, the duration must be at least one year, and their mood can be irritable rather than depressed).

Additional criteria
In addition to that, you must have at least two of these symptoms, and they must cause you distress or interfere with your ability to function in your daily life:

• Poor appetite or overeating
• Sleep problems
• Fatigue or lack of energy
• Low self-esteem
• Hopelessness
• Poor concentration
• Trouble making decisions

Make sure you understand if you have been diagnosed with dysthymia or another condition so you can learn more about your specific situation and get appropriate treatment.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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The two main treatments for dysthymia are:

• Medications
• Psychotherapy

As stand-alone treatments, medications appear to be more effective at treating dysthymia than psychotherapy. But, using a combination of medications and psychotherapy may be slightly more effective in treating dysthymia than using only medications or only psychotherapy.

Which treatment approach you take depends on such factors as:

• The severity of your dysthymia symptoms
• Your desire to address emotional or situational issues affecting your life
• Your personal preferences
• Previous treatment methods
• Your ability to tolerate medications
• Whether you're pregnant or breast-feeding
• The availability of mental health services in your community
• Your health insurance coverage

Medications for dysthymia
The psychiatric medications most commonly used to treat dysthymia are the same kinds used to treat depression. They include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine and dopamine reuptake inhibitors (NDRIs)
• Combined reuptake inhibitors and receptor blockers
• Tetracyclic antidepressants
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)

SSRIs are often the antidepressant of choice because, in general, they work well and their side effects are more tolerable. MAOIs are usually last choices because they can have serious side effects and require strict dietary restrictions because of rare, but potentially fatal, interactions. Which one is best for you depends on your individual situation. When you have dysthymia, you may need to take antidepressants long term to keep symptoms under control.

All antidepressant medications have potential side effects, such as weight gain, sexual problems and diarrhea. Of particular concern is the worry that young people taking these medications might have a higher suicide risk. The Food and Drug Administration (FDA) requires that all antidepressant medications carry warnings about suicide risk in young people. The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants.

Psychotherapy for dysthymia
Psychotherapy can help you learn about your condition and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy coping skills and stress management. Psychotherapy can be especially helpful if:

• You need help learning to make decisions
• You have self-defeating behavior patterns

You and your therapist can talk about which type of therapy is right for you, your goals for therapy, and other issues, such as the number of sessions and length of treatment.

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Dysthymia generally isn't an illness that you can treat on your own. But you can do some things for yourself that build on your treatment plan. In addition to professional treatment, follow these lifestyle and self-care steps for dysthymia:

• Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going.
• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, depression symptoms may come back and you could also experience withdrawal-like symptoms.
• Learn about dysthymia. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your dysthymia symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends in watching for warning signs.
• Get active. Physical activity and exercise may reduce symptoms in depression-related conditions. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy.
• Avoid drugs and alcohol. Alcohol and illegal drugs may worsen depression-related symptoms.

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You may be interested in trying to relieve dysthymia symptoms with complementary or alternative medicine strategies, such as nutritional and dietary supplements and mind-body techniques.

Keep in mind that nutritional and dietary products aren't regulated. The FDA doesn't test them for safety, purity or effectiveness. You can't always be sure of what you're getting and if it's safe. Also, be aware that herbal and dietary supplements can interfere with the way certain prescription medications work or can cause dangerous interactions that can harm your health. Talk to your doctors and other health care providers before taking any herbal or dietary supplements.

Nutritional and dietary supplements
Here's a look at some nutritional supplements commonly used for dysthymia and major depression:

• St. John's wort. This herb has been used to treat a variety of ills, including depression-related disorders. It may be helpful if you have mild or moderate depression, such as dysthymia, but the overall evidence is inconclusive. In addition, St. John's wort has the potential to interact with many medications, such as antidepressants, allergy medicine and blood thinners.
• SAMe. Pronounced "sam-EE," this is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosylmethionine. This supplement appears to be effective and well tolerated, but it's quite expensive and because it's unregulated, the quality of the product isn't guaranteed. This supplement can also cause harmful reactions if taken with other antidepressants.
• Omega-3 fatty acids. These are polyunsaturated fats found mostly in seafood. Good sources of omega-3s include fatty, cold-water fish, such as salmon, mackerel and herring. Flaxseed, flax oil and walnuts also contain omega-3 fatty acids, and small amounts are found in soybean and canola oils. Omega-3 fatty acids may be most helpful when combined with antidepressants.

Mind-body connections
Mind-body techniques are thought to strengthen the communication between your mind and your body. Complementary and alternative medicine practitioners believe that these two systems must be in harmony for you to stay healthy or to heal.

As with dietary supplements, take care in using these techniques. Although they may pose less of a risk, relying solely on these to treat dysthymia may not be effective enough. If you try mind-body techniques first to treat your dysthymia but your symptoms worsen or don't improve, be sure to consult your health care providers.

Mind-body techniques that have been used on people with dysthymia symptoms include:

• Acupuncture
• Yoga
• Meditation
• Guided imagery
• Massage therapy

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Coping with dysthymia can be challenging since it can have such a strong hold on your life. Dysthymia makes it hard to engage in the behavior and activities that may help you feel better. Talk to your doctor or therapist about improving your coping skills, and consider these tips to cope with dysthymia:

• Simplify your life. Cut back on obligations when possible, and set reasonable schedules for goals.
• Write in a journal to express your pain, anger, fear or other emotions.
• Read reputable self-help books and consider talking about them to your doctor or therapist.
• Don't become isolated. Try to participate in normal activities and get together with family or friends regularly.
• Take care of yourself by eating a healthy diet and getting sufficient sleep.
• Join a support group for people with depression-related conditions so that you can connect to others facing similar challenges.
• Stay focused on your goals. Recovery from dysthymia is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals.
• Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
• Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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There's no sure way to prevent dysthymia. Because dysthymia often starts in childhood, identifying children at risk of the condition may be of some benefit, though, by encouraging early treatment. Also, taking steps to control stress, to increase your resilience and to boost low self-esteem may help ward off dysthymia symptoms. Friendship and social support, especially in times of crisis, can help you weather rough spells. Also, treatment at the earliest sign of a problem can help prevent dysthymia from worsening. Long-term maintenance treatment also may help prevent a relapse of dysthymia symptoms.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.