[9] As dysthymia is a chronic disorder, those with the condition may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all.
As a result, they may believe that depression is a part of their character, so they may not even discuss their symptoms with doctors, family members or friends.
[15] There are no known biological causes that apply consistently to all cases of dysthymia, which suggests diverse origin of the disorder.
[18] Patients with double depression tend to report significantly higher levels of hopelessness than is normal.
[16] Additionally, cognitive therapies can be effective for working with people with double depression in order to help change negative thinking patterns and give individuals a new way of seeing themselves and their environment.
A combination of antidepressants and cognitive therapies can be helpful in preventing major depressive symptoms from occurring.
[19] Another study, which used fMRI techniques to assess the differences between individuals with dysthymia and other people, found additional support for neurological indicators of the disorder.
Biologically these groups are also differentiated in that healthy individuals showed greater neurological anticipation for all types of events (positive, neutral, or negative) than those with dysthymia.
This provides neurological evidence of the dulling of emotion that individuals with dysthymia have learned to use to protect themselves from overly strong negative feelings, compared to healthy people.
surfaced in the literature regarding the HPA axis (structures in the brain that get activated in response to stress)[23] and its involvement with dysthymia (e.g. phenotypic variations of corticotropin releasing hormone (CRH) and arginine vasopressin (AVP), and down-regulation of adrenal functioning) as well as forebrain serotonergic mechanisms.
Early onset (diagnosis before age 21) is associated with more frequent relapses, psychiatric hospitalizations, and more co-occurring conditions.
[28][citation needed] However, in older adults with dysthymia, the psychological symptoms are associated with medical conditions and/or stressful life events and losses.
Dysthymia is far more chronic (long lasting) than major depressive disorder, in which symptoms may be present for as little as two weeks.
It may be beneficial to work with children in helping to control their stress, increase resilience, boost self-esteem, and provide strong social support networks.
The overall rate and degree of treatment success is somewhat lower than for non-chronic depression, and a combination of psychotherapy and pharmacotherapy shows best results.
In a 2010 meta-analysis, the benefit of pharmacotherapy was limited to selective serotonin reuptake inhibitors (SSRIs) rather than tricyclic antidepressants (TCA).
[32] The first line of pharmacotherapy is usually SSRIs due to their purported more tolerable nature and reduced side effects compared to the irreversible monoamine oxidase inhibitors or tricyclic antidepressants.
[citation needed] In a meta-analytic study from 2005, it was found that SSRIs and TCAs are equally effective in treating dysthymia.
[41] However, the author of this study cautions that MAOIs should not necessarily be the first line of defense in the treatment of dysthymia, as they are often less tolerable than their counterparts, such as SSRIs.
[33] Working with a psychotherapist to address the causes and effects of the disorder, in addition to taking antidepressants to help eliminate the symptoms, can be extremely beneficial.
The body of evidence was too small for any greater certainty although the study acknowledges that continued psychotherapy may be beneficial when compared to no treatment.
Additionally, if the person also has seasonal affective disorder, light therapy can be useful in helping augment therapeutic effects.