Forty-three-year-old Owen can’t really remember a time in his life when he ever felt good, at least for more than a few days at a time. He’s struggled with insomnia, low self-esteem and making friends and maintaining relationships ever since childhood. Imposter syndrome caused him to abandon a promising media career in his 20s and pursue IT work instead. More often than not, he’s had the vague sense that happiness just isn’t for him. “I was pretty ambitious, but that voice in my head always kept me down and prevented me from reaching my potential,” Owen tells me. “I didn’t know how much I was self-sabotaging at the time.”
When he finally received a mental-health diagnosis at the age of 30 after a breakdown at work, it wasn’t clinical depression or anxiety like he expected, but something he was far less familiar with: dysthymia, a type of low-grade depression that never lets up.
Though it has far less name recognition, dysthymia is about as common as major depressive disorder or clinical depression. Some experts argue that it may even be underdiagnosed, as most of us don’t know what the fuck it is. Like many medical terms, dysthymia is derived from Greek and roughly translates to a “poor state of mind,” but it’s never made it into the average person’s mental-health vocabulary in the same way depression and anxiety have.
Things are made more confusing by the less extreme symptoms like fatigue, bad eating habits, sleeping too much or too little, low self-esteem, poor concentration and a feeling of hopelessness. If that sounds like almost everyone in quarantine right now, the biggest difference is that a person has to experience these symptoms for a minimum of two years in order to meet the criteria for dysthymia, clinical psychologist Carla Manly explains. “Due to its protracted nature, dysthymia can be extremely debilitating,” she warns.
Simply put, people who have dysthymia reside in a type of mental-health purgatory where they’re not healthy enough to lead happy lives, but rarely see themselves as sick enough to get help.
Unfortunately, there’s nothing about persistent low-grade depression that protects us from developing major depression as well. When they do happen in tandem, people develop what’s known as double depression, or the combination of recurrent low-grade depression and acute severe depression that comes and goes. All the while, the symptoms of dysthymia become more intense, and new symptoms such as substance abuse, self-harm and suicidal ideation can occur.
If the average person knew more about dysthymia, Manly suspects they’d seek treatment sooner. But when a person doesn’t meet the exact criteria for clinical depression, it becomes easier for them to accept their low feelings as their fate. “Many people tend to lump all depressive disorders into one category,” Manly explains. “Unfortunately, this lack of differentiation increases common misconceptions and stigmatization of various mental-health disorders.”
Which is why psychotherapists like Nick Bognar try to limit discussions about specific depression diagnoses, unless they think it would help their clients. Instead, he tries to focus on symptoms or getting people to recognize how they’re suffering. “Depressive disorders don’t hide themselves very often, but when they do, it’s often behind things like irritability — often a sign of depression that people justify by saying, ‘If everyone weren’t such an asshole, I wouldn’t be this pissy,’” Bognar tells me.
In his work with men in particular, Bognar’s found that a lot of psychological pain comes from not learning how to care for themselves at a young age. “Once we’ve established that they’re not feeling okay, we have to emphasize self-care. That can be concrete things like seeing a psychiatrist, and it can be things like taking time off from work or not taking on additional responsibilities,” Bognar says. “It can include talking to one’s family so that they understand what one is going through. Basically, we need to figure out whatever we can do to make the person’s environment as comfortable as possible, and that their self-care is as active as possible.”
The good news is that according to a decade-long study on the disorder, dysthymia has roughly a 74 percent recovery rate. The bad news is the relapse rate is almost as high (71.4 percent), which is why dysthymia is regarded as a chronic condition. And for many people like Owen who have been unhappy since childhood, it’s possible that their dysthymia is also partially rooted in brain chemistry (as such, the most effective course of treatment might be some combination of therapy and medication).
Owen’s diagnosis was especially important because it got him to consider going on an SSRI. “I was hesitant to go on medication at first, but that was probably the thing that most helped me get better,” he says. It was only after he experienced some relief from the medication that he was willing to try therapy, which “eventually led to me coming to terms with my condition and my life in general.”
And that was a source of comfort in and of itself. “I wasn’t just a failure, loser or any number of negative things I had thought about myself for my whole life,” Owen says. “I finally knew that something was medically wrong with me.”