Persistent Depressive Disorder

Perhaps you have a longstanding tendency to feel flat and gloomy, and those close to you see you as a pessimistic kind of character. You can't recall the last time you slept well, you feel tired all the time, and your self-esteem could be better. Nothing excites you, even though plenty of things make you nervous. You are so used to feeling like this, perhaps ever since you can remember, that you have assumed your chronic sadness is part of your personality makeup, something you have to put up with. You are still able to lead a more or less normal life, and feel that pills and therapy are for those who can't cope (unlike yourself), so you haven't even considered seeking help. If you see yourself portrayed in this vignette, then you may have a persistent depressive disorder, which a recent article in the New York Times describes as "That Lingering ‘Meh’ Feeling."

Treatable Depression, Personality Trait, or Simply Unhappiness?

This condition has had a number of different names over the years: neurasthenia, neurotic depression, dysthymia, and chronic depression. It has also been conceptualized in different ways. For some, it is the expression of a certain type of personality, perhaps resembling the lovely Sadness character in the Pixar movie Inside Out. In the affective dimension, this personality represents one extreme, with the chronically bubbly and cheerful at the opposite end. Others have simply regarded it as a 'minor' depression that doesn't merit treatment.

Nowadays, however, persistent depression, or dysthymia, tends to be seen as a very significant and treatable type of depression, rather than a personality disorder or a minor ailment. This is because we have come to realize that a "sub-threshold" but persistent depression actually generates enormous amounts of suffering over the years. It is also strongly associated with other psychological morbidities, including an increased likelihood of developing a major depressive disorder.

Dysthymia is a difficult concept because it overlaps with so many other things. It overlaps with depression, with personality, and, of course, it also overlaps with unhappiness.

Treatment may help

Neither unhappiness nor temperament are readily amenable to treatment, but the good news is that dysthymia is, at least, potentially. A number of studies have shown that both psychotherapy and antidepressant medication can help in persistent depression, particularly in combination, proving that, at least in some cases, dysthymia is an abnormal state of mind that can be improved with therapeutic interventions.

Realizing and accepting that persistent depression is a treatable condition is particularly important because this type of depression is so very easy to miss, or perhaps dismiss, unlike other more acute and immediately obvious conditions. The chronic tends to be less glamorous than the acute, but just as deserving of treatment.

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