[neutrino]

For a while now (probably a couple of years) I've been wondering if maybe I have Dysthymia (I just got some sort of Deja vú. Perhaps I've written about this before.). I've been depressed since I was 14 years old or so (I turn 24 this month) and I don't remember what happiness or peace feel like. I know I've written this before but it's like my "standard mood" is depressed and then I have episodes of extremely low mood as well that last for between one week and several months. Episodes where I completely lose the will to do things, think of suicide though I don't want to die etc etc. I read the diagnostic criteria for Dysthymia the other day and I could pretty much relate to all of it.

When it comes to depression I've only ever been diagnosed with "moderate depressive episode" (as far as I know) but seriously, how is a decade of depression an "episode"? I mean, that's almost half my life.

Don't professionals (psychologists, psychiatrists etc) know about Dysthymia? How do I know if my depression is major depression or Dysthymia? Also, why do people think of Dysthymia as "mild"? I don't know if I have that particular disorder but if I do, it's not "mild". At least not in my opinion. The level of severity varies for me. Some days I feel numb. I feel low pretty much every day. Some days I feel so extremely miserable that I "want" to die. Some days I just want to hide in my bed. Some days I can function pretty well but feel really depressed as soon as I don't manage to keep myself distracted from my thoughts. Some days I feel like hitting myself in the head. I'm never happy. Never peaceful. Always affected by it. Always more or less low. Always depressed. Always anxious.

Does anyone here have Dysthymia? Could you tell me what it's like for you?

Thanks.

[Rohag]

Years ago one professional speculated I suffer from both major depressive disorder and dysthymia. From my subjective perspective, whatever I have is both chronic and debilitating.

The 2013 publication of the DSM-5 brought a change. This is from Doc John's Psych Central Professional summation:

Dysthymia is gone, replaced with something called “persistent depressive disorder.” The new condition includes both chronic major depressive disorder and the previous dysthymic disorder. Why this change? “An inability to find scientifically meaningful differences between these two conditions led to their combination with specifiers included to identify different pathways to the diagnosis and to provide continuity with DSM-IV.”

[Agentfyre]

Dysthymia is supposed to be a less severe form of depression that occurs chronically for at least a couple years. Major depression is what encompasses those more debilitating features that you described. And you're right, an episode isn't a chronic thing. But Major Depression can have a "chronic" specifier. That's why it sounds like you experience something more like major depression: chronic than anything else. And it's entirely possible your therapist has that specifier somewhere in his/her diagnosis. Really, Dysthymia is supposed to be milder depression over a long period.

As for the DSM-5 change, this makes sense because often times it can be real hard to define the fine line between when someone is experiencing a particularly debilitating depression over time, or a somewhat debilitating depression over time. Where exactly is that line? And since that's so vague, do away with the line entirely and just call it all persistent depressive disorder. That's the mindset anyways.

So, neutrino, you're absolutely right. It's unfair to categorize what you experience as being merely an episode. But it's equally unfair to classify it as a mild depression in the case of dysthymia. It may be helpful instead to see it more as chronic major depressive disorder or as persistent depressive disorder as Rohag pointed out. I hope this helps some. Either way, we're here for you!

[Hellion]

I feel like Dysthymia(from what you describe) tends to be my 'normal' state...then of course sometimes either due to stress or even just sort of randomly the depression gets really severe, and have certainly been suicidal over it....I also have had anxiety issues as far as I can remember and PTSD from something more recent. But yeah I am not really ever feeling like I am totally without the depression its like its always there even if just more lingering in the back of my mind.

[neutrino]

Originally Posted by Agentfyre

Dysthymia is supposed to be a less severe form of depression that occurs chronically for at least a couple years. Major depression is what encompasses those more debilitating features that you described. And you're right, an episode isn't a chronic thing. But Major Depression can have a "chronic" specifier. That's why it sounds like you experience something more like major depression: chronic than anything else. And it's entirely possible your therapist has that specifier somewhere in his/her diagnosis. Really, Dysthymia is supposed to be milder depression over a long period.

As for the DSM-5 change, this makes sense because often times it can be real hard to define the fine line between when someone is experiencing a particularly debilitating depression over time, or a somewhat debilitating depression over time. Where exactly is that line? And since that's so vague, do away with the line entirely and just call it all persistent depressive disorder. That's the mindset anyways.

So, neutrino, you're absolutely right. It's unfair to categorize what you experience as being merely an episode. But it's equally unfair to classify it as a mild depression in the case of dysthymia. It may be helpful instead to see it more as chronic major depressive disorder or as persistent depressive disorder as Rohag pointed out. I hope this helps some. Either way, we're here for you!

Thanks for the reply. Very helpful.

Should I bring this up when talking to my psychologist? Emphasizing that I've been depressed for years and years that is. They probably know that already but sometimes I feel like they really don't get it.

[Lemongrab]

I was diagnosed with dysthymia last year. In the past doctors always assumed I was going through a major depressive episode and would put me on some SSRI which would either have nasty side effects or just not work. I have always been a melancholic person; my first depression diagnosis was in my teens. I do have times when I drop into a full depressive episode, which gradually works its way back up to my "slightly-below-happy" usual mood.
When I was diagnosed with dysthymia and put on mood stabilisers instead of anti-depressants I experienced a marked improvement in my condition.
Not that I'm unhappy or miserable - I consider myself as happy as the next person - my personality type is just not that of the happy-go-lucky, the incessantly cheerful or the optimist. I feel emotions very deeply and small things can really get me down and affect me for a while. Some days I just feel like sleeping all day or crying for no reason. Other days I'll make it through without a hitch. So dysthymia is a tricky thing: not easy to identify, and even trickier to manage, because sometimes the line between dysthymia and a major depressive episode can become quite blurred.

[Agentfyre]

Neutrino - Yeah, I would definitely emphasize that to my psychiatrist if I were you. Let him/her know that your concerned that they may not be identifying the chronic nature of what you've been experiencing. And then, if they disagree at least you have the right to have them explain to you why they disagree. They may see something that we're not getting here online.

And sometimes diagnoses are changed for insurance purposes or some other factor like that. For example, If insurance won't pay for a certain diagnosis, or if the agency has a set way of dealing with a particular diagnosis that the psychiatrist disagrees with in your case, they may change your diagnosis so that they can give you what they feel is the appropriate treatment (even though you're now labeled with an incorrect diagnosis).

Just keep all of this in mind when you talk to your psychiatrist, and remember that you have the right to ask questions and understand why they do what they do. After all, it's YOUR treatment, not theirs!