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Chronic Low-Grade Depression: What Is and How to Deal With It

Low-Grade Depression

Low-grade depression, also known as mild depression, encompasses symptoms that are less intense compared to severe depression. The common symptoms of severe depression, such as irritability, sadness, and lack of motivation, are still present, but they may not be as prominent.

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

Individuals with mild depression may not even be aware of their condition. Over a long period, persistent feelings of unhappiness and low mood may become the norm, and they may not recognize it as depression.

However, it is not healthy to continuously experience unhappiness in life. While it is common for everyone to have moments of low mood in response to challenging or sad life events, living with constant depression is not inevitable.

Low-Grade Depression Symptoms

Symptoms of low-grade depression or dysthymia (mild, chronic Depression) are significantly less intense than those of major depression. Dysthymia or chronic depression is therefore milder but usually lasts for a period of two years or more.

If you suffer from dysthymia or chronic depression you are likely to feel hopeless most of the time and have developed low self-esteem over years. The disorder dysthymia or chronic depression can interfere so heavily with daily activities that you can hardly enjoy any moment.

The symptoms of low-grade depression (dysthymia / mild, chronic depression) in adults are very similar to symptoms of major depression; they are however less intense and may include:

(These are possible symptoms)

Changes in feelings

You mostly feel constantly hopeless, helpless, and particularly worthless to the people around you and you develop a pessimistic attitude. You develop excessive feelings of guilt and are moreover convinced that your situation can only worsen and that nothing can be done to change that trend.

Concentration problems

You find it extremely difficult or almost impossible to concentrate now on tasks or projects you could handle easily previously. Remembering any kind of details and taking decisions to cause you huge problems.

Sleep problems

Your sleeping habits have changed: you suffer from insomnia, that is, you cannot fall asleep normally, you do not sleep enough or you sleep too long – practically the whole day – and have difficulties to awake.

Losing interest in anything

You do not show interest anymore in daily activities you used to enjoy, such as hobbies, sex, pastimes, meeting friends, etc.

Feeding negative thoughts

Most of the time – practically every day – you feel sad and down and constantly ‘generate’ negative thoughts and you are no longer in a position to control them – no matter how much time and effort you put into these actions.

Loss of energy

Most of the time you feel awfully tired and physically drained. Performing any little work or small tasks is now exhausting and a burden for you.

Changes in mood

Without any apparent reasons, you have changed significantly and you are now more irritable, extremely short-tempered, and even much more aggressive than previously.

Changes in eating habits

You have lost your appetite – apparently without any reason or you cannot stop eating although you know that it is unhealthy and that obesity may cause serious problems.

Increased alcohol consumption and reckless behavior

Your alcohol consumption has increased significantly and you are on the way to becoming addicted. Additionally, you behave increasingly recklessly.

Avoidance of social activities

You realize suddenly that you do not enjoy any more the company of the old good friends that you used to see regularly and that you consistently do your utmost not to accept invitations or participate in social activities.

Suicidal thoughts

Your main thoughts focus on the idea that your life is not worth living. If this is the way you feel when reading these lines, please stop reading and seek help at once.

The symptoms of low-grade depression (dysthymia / mild, chronic depression) in children are very similar to symptoms of major depression; they are however less intense. Dysthymia is sometimes accompanied by a lot of other disorders, and in children, may include:

(These are possible symptoms)

Changes in feelings

You mostly feel constantly hopeless, helpless, and particularly worthless to the people around you – your schoolmates and society in general – and you develop a pessimistic attitude. You develop excessive feelings of guilt and are also convinced that your situation at school and home can only worsen and that neither you nor anybody else can do anything to change that trend.

Changes in mood

Nothing has changed apparently around you: you have not moved to another town or another school and nothing has changed in the attitude of your parents and siblings, but you have changed significantly and are now more irritable, extremely short-tempered, and even much more aggressive than previously.

Concentration problems

You find it now extremely difficult or almost impossible to concentrate at school on tasks or subjects you could handle easily previously. Remembering already learned simple rules and doing your homework cause you huge problems.

Avoidance of social activities

You realize suddenly that you do not enjoy any more the company of your best friends whom you used to learn or play with regularly and that you consistently do your utmost not to accept their invitations or participate in social activities.

People who suffer from low-grade depression (dysthymia / mild, chronic depression) generally experience intermittent symptoms of depression over a period of several years. These depression symptoms may vary in intensity over time and the episode-free periods last rarely for more than two months.

The term “early-onset dysthymia” is used to qualify as a chronic depression disorder experienced by people under age 21. The term “late-onset dysthymia” is used to qualify as a chronic depression disorder experienced by people above age 21.

Prevalence of dysthymia

According to the National Institute of Mental Health, dysthymia (called chronic depression), is responsible for causing disability among U.S. citizens of all ages. More precisely, an estimated 2.5% of U.S. adults experience persistent depressive disorder at some time in their lives. [ Ref. NIMH ]

This type of depression can affect everybody: men and women, children, teenagers, adults but is rarely diagnosed and professionally treated.

How is dysthymia diagnosed?

There are no dedicated blood, X-ray or other laboratory tests yet capable of diagnosing dysthymia. The diagnosis is therefore performed based on the signs and symptoms experienced by the patient and on the doctor’s observation of the person's attitude and behavior in general.

At the time of the visit, the chronic depression symptoms are less intense than in people with major depression, which will have been experienced already for a longer time. However, mental health care professionals, psychologists, or psychiatrists specialized in evaluating symptoms of depression are best qualified to determine chronic depression.

The doctor will start performing a complete medical history and a full physical examination, then check if other mental health problems can be responsible for the reported dysthymia. He or she will most probably inquire about your mood and thoughts during the visit and may also let you fill in a questionnaire to help identify possible depression symptoms.

Some blood tests and other laboratory work may be performed additionally to exclude any other medical problem that is the cause of the chronic depression. An underactive thyroid – as well as alcohol and drug – can generate symptoms that are very similar to those of major depression.

Should you feel depressed and have experienced ‘severe’ symptoms of depression for at least a fortnight, do not hesitate, and see your mental health care professionals, psychologists or psychiatrists as soon as possible.

How is dysthymia treated?

Your doctor has several treatment options he can choose from to treat your symptoms of low-grade depression, i.e., dysthymia (mild, chronic depression): medications and psychotherapy (also called ‘talk therapy’). Both treatments can be used separately and medication seems to be the more effective one to treat dysthymia. However, professionals do believe that a judicious combination of medication and appropriate psychotherapy may enhance effectiveness significantly.

To decide about the type or treatment to be used to fight your chronic depression, your doctor may take into consideration several factors, such as the severity level of your dysthymia symptoms, the kind of treatments you have possibly already received to treat your depression symptoms, your preferences and/or capability of toleration certain medications, your other personal emotional problems.

Medications for dysthymia

Dysthymia / chronic depression – or more precisely their symptoms – is most commonly treated effectively with antidepressants, such as Selective serotonin reuptake inhibitors (SSRIs) Serotonin and norepinephrine reuptake inhibitors (SNRIs), and Tricyclic antidepressants (TCAs).

Antidepressants generally require a certain time – sometimes several weeks or longer – before they start to work optimally and make your life easier. When you experience an episode of dysthymia, you are expected to continue taking your prescribed antidepressant for at least half a year – without any interruption.  Should you decide to stop taking your antidepressants for a while, this may cause a sudden worsening of your dysthymia,  and you should consult your doctor beforehand to arrange a working decreasing plan for the next few weeks. 

How to find the right medication for your dysthymia?

Selective serotonin reuptake inhibitors (SSRIs) are mostly chosen to treat dysthymia for two reasons: they work effectively and the side effects that they generate are generally more tolerable for the patients.

Taking your situation and type of depression into consideration, your doctor will choose a specific antidepressant or a combination of medications. Should you experience disturbing side effects, do not panic, continue to take the prescribed antidepressants, and inform your doctor correspondingly and with full details.

You should be aware that certain depressants may even worsen your depression when the therapy is stopped suddenly. In other words, you cannot stop abruptly taking the chosen antidepressant, and create so-called withdrawal symptoms until a more suitable and appropriate medication – with more tolerable side effects – is found to combat your dysthymia.

It is always a good idea to discuss thoroughly the pros and cons of possible side effects with a professional and to make up your own decision. People suffering from dysthymia may have to continue taking antidepressants for a long time to be able to keep their depression symptoms under control.

Psychotherapy for dysthymia

Psychotherapy – also called talk therapy – is increasingly used in dysthymia to teach and so help people learn about their mood and condition, thoughts, feelings, etc., and develop genuine coping skills and “stress management” to deal with the odds of everyday life.

Psychotherapy can also help both the patient and his or her family better understand the specifics of dysthymia. Your doctor has several treatment options he can choose from to treat your symptoms of dysthymia: medications and psychotherapy – also called ‘talk therapy’. Take the necessary time to discuss – together with your therapist – what you believe will best suit your requirements.

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