Do You Have Mild, Low-Grade Depression?

Depressed young man

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People with mild, low-grade depression may not even realize they are depressed. In fact, the chronic feelings of sadness and low mood they experience may have been around for so long that they feel normal.

However, it is not normal to go through life feeling unhappy all of the time. Everyone experiences occasional bouts of low mood in response to sad or stressful life events, but constantly feeling depressed does not have to be the story of your life.

Symptoms

Chronic low-grade depression is a symptom of persistent depressive disorder (PDD), formerly known as dysthymia or dysthymic disorder.

Dysthymia was previously listed separately from chronic major depression in the Diagnostic and Statistical Manual of Mental Disorders, but the disorders have since been combined as of the fifth edition, as no scientifically meaningful difference was found between them.

The signs and symptoms of PDD are very similar to major depressive disorder, except that they tend to be milder and are chronic in nature.

Symptoms of PDD include:

  • Appetite or weight changes
  • Fatigue
  • Feelings of hopelessness, worthlessness, or guilt
  • Lack of enjoyment or pleasure in things
  • Low energy and reduced motivation
  • Restlessness
  • Sadness, tearfulness, frequent crying
  • Sleep problems
  • Thoughts of death or suicide
  • Trouble concentrating, focusing, and making decisions

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Causes

As with major depressive disorder, persistent depressive disorder is also believed to be a multifactorial condition—meaning they are likely caused by a combination of genetic susceptibility, biochemical imbalance, life stress, and environmental circumstances.

In about three-quarters of patients with dysthymia, the primary cause of the disorder is not clear. But people with PDD tend to have other complicating factors, such as chronic illness, another psychiatric disorder, or substance use issues.

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.

Doctors and mental health professionals can check to see if a patient's symptoms fit into a pattern laid out by the DSM-5, a guidebook for diagnosing mental disorders such as depression.

With dysthymic disorder, doctors will need to determine if the patient's symptoms have been present for an extended period of time (a minimum of two years for adults and one year for children). In addition, they will consider whether the severity of the symptoms is less than what a patient might experience with a major depressive disorder.

Doctors will also use blood and urine tests to try to rule out possible medical conditions, such as hypothyroidism, that could cause symptoms like chronic mild depression.

Other factors a doctor will consider when making a diagnosis include a patient's medical history, as well as whether there is a history of depression in their family.

Treatment

Persistent depressive disorder responds to many of the same treatments that are used to treat major depression. Antidepressant medications are generally prescribed, with selective serotonin reuptake inhibitors (SSRIs) being a popular choice.

In addition, psychotherapy, also known as talk therapy, can often be quite helpful for people with chronic low-grade depression. You'll have to work with your mental health care provider to develop a treatment plan that's most appropriate for you.

Depression Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Mind Doc Guide

Coping

There are also several self-care treatments that can help treat chronic mild depression. Here are a few suggestions to keep in mind:

  • Aim for 30 minutes of moderately-intense exercise most days of the week, and add vigorous exercise if you are able to do so.
  • Avoid alcohol and illegal drugs.
  • Be sure that you are taking your medications correctly. Tell your doctor about any supplements or herbal remedies you take.
  • Eat a varied and nutritious diet.
  • Find things to do that you enjoy.
  • Get enough sleep and ensure you have a restful sleeping environment.
  • Seek out people for friends who are positive, supportive, and show that they care about you.

If you have been diagnosed with dysthymia, but your depression symptoms are getting worse, make sure you talk to your doctor. They will reevaluate your symptoms and adjust your treatment if necessary.

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Article Sources
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  1. Persistent Depressive Disorder. U.S. National Library of Medicine. Reviewed July 8, 2018.

  2. Depression. National Institute of Mental Health. Revised February 2018.

  3. Melrose S. Persistent depressive disorder or dysthymia: An overview of assessment and treatment approachesOpen Journal of Depression. 2017;06(01):1-13. doi:10.4236/ojd.2017.61001

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