Is Dysthymic Disorder a Second-Rate Depression?


Michael G. Rayel, MD

Dysthymic Disorder, used to be called Dysthymia, is a low-grade and yet chronic depression characterized by feelings of sadness or depression associated with lack of interest to do things and some physical symptoms such as lack of energy, sleep, and concentration.

Psychological symptoms such as feelings of hopelessness, helplessness, and worthlessness can also occur. In addition, some patients harbor thoughts of death and feelings of emptiness.

This is a type of clinical depression that is supposed to be "milder" than Major Depressive Disorder (MDD - used to be called Major Depression) because the symptoms don't necessarily happen everyday. Unlike patients who suffer from MDD, Dysthymic patients are not bed-bound, still able to work, and does not appear to be sick. But most of these individuals complain that they haven't felt "normal" or "happy" for a long time.

Moreover, Dysthymic Disorder is manifested by lack of drive and motivation. Hence, relatives and friends tend to misinterpret their mood and behavior. Some patients endure the stigma of being considered "lazy" or not "motivated enough" to do worthwhile goals.

As time passes by, patients with this disorder have difficulty functioning. But because they still appear normal, the illness is not recognized and patients don't get treated early. A lot of times, they are not referred to a psychiatrist.

So is Dysthymic Disorder a second-rate psychiatric disorder? Based on my experience, patients experience considerable emotional turmoil. In fact, some dysthymic patients eventually develop a more serious depression called Major Depressive Disorder. When "double depression" (dysthymic disorder and major depression occurring together) happens, patients are so depressed that they become a threat to themselves and become functionally impaired. At this time, psychiatric hospitalization becomes necessary.

So Dysthymic Disorder is a serious health problem that should be recognized and treated promptly. It is an illness that somehow hides its existence from everyone including clinicians and patients themselves.

What is the treatment? Dysthymic disorder can be treated by antidepressants and psychotherapy. Most patients respond to treatment although some still suffer despite adequate treatment. Also, there are some individuals who only respond minimally. As such, this illness can be more challenging to treat than others.

About the Author:

Copyright (c) 2004. Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader's Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: A Personal Development and Emotional Skills Game. For more information, please visit


Back to FAQS.ORG