FAQ: The Facts About Chronic Depression

Dr. Erin Olivo answers common questions about the symptoms and treatment of chronic depression.

Posted on | By Erin L. Olivo, PhD

What is chronic depression?

Chronic depression is a mental disorder sometimes referred to as dysthymia, or by its official psychiatric diagnostic label, persistent depressive disorder. This form of depression is characterized by a depressed mood that’s present most days for at least two years. Chronic depression is often described as a mild depression, but research evidence suggests this often isn’t the case. Chronic depression can be debilitating and severe and may coincide with episodes of major depression (a condition called double depression).

Though many people with chronic depression don’t seek treatment, it can be effectively treated with medication and psychotherapy.

Who is at risk?

The exact cause of chronic depression is not known but research suggests that it is probably caused by a combination of genetic, biological, environmental and psychological factors. Chronic depression is more common among women than among men. This may in part be explained by hormonal and biological differences as well as by psychosocial and life cycle stressors that more often affect women, such as caring for children or aging parents, abuse and relationship difficulties. Negative or stressful life events such as trauma or loss of a loved one can trigger a depressive episode, but often there is no obvious trigger. It is not known why some depression becomes chronic and others do not.

How can I recognize the symptoms?

The primary symptom of chronic depression is feeling sad, down or “empty” for an extended period of time. A person with this diagnosis might feel normal on some days, but their good mood usually doesn’t last for more than a couple of weeks at a time. Other symptoms include low self-esteem, low energy, lack of interest in pleasurable activities, irritability, poor concentration and memory, sleep difficulties and feelings of hopelessness. As with other depressive disorders, people with chronic depression often experience difficulties with relationships, work or school performances and are at an increased risk for substance abuse and suicidal behavior. Chronic depression often goes undiagnosed and untreated because many people mistake the symptoms as simply being part of their personality. A lot of people assume that they are pessimistic or moody and after years of feeling down they resign themselves to feeling generally miserable. In fact, people are often diagnosed inadvertently when seeking medical treatment for chronic aches and pains or digestive difficulties that are actually a symptom of their chronic depression.

What is the treatment for chronic depression?

The most effective treatment for chronic depression is a combination of medication and psychotherapy. The medications prescribed are typically the same as those used to treat major depression, but unfortunately these medications may not work as well or as quickly for chronic depression. Psychotherapy can help people to develop tools for coping with negative thoughts and emotions as well as develop new strategies for solving problems and achieving their goals. Research has shown that cognitive behavioral therapy and interpersonal therapy are two of the most effective treatment approaches for chronic depression.

What can I do if I notice the symptoms in myself, or someone I care about?

If you think that you or someone you care about has chronic depression, it is important to seek out medical advice to get properly diagnosed and treated. The longer you wait, the harder it can be to treat. If you don’t know where to go for help, ask your family doctor. If you are thinking of harming yourself or know someone who is, tell someone who can help immediately. Call 911 or go to your local hospital emergency room.

Article written by Erin L. Olivo, PhD
Erin L. Olivo, PhD is an Asst. Professor of Medical Psychology at Columbia University, College of Physicians and Surgeons