Depression and dysthymia are two mood disorders, specifically two types of depressive disorders. Although they have certain similarities, they are independent psychological disorders

In this article we will know the main differences between major depression and dysthymia . In addition, we will see the changes that have occurred between DSM-IV-TR and DSM-5 in relation to these two disorders.

Differences between major depression and dysthymia

The most remarkable differences between these two depressive disorders are these.

1. Duration

According to the Diagnostic Manual of Mental Disorders (DSM-5), major depression, which is actually called Major Depressive Disorder, lasts at least 2 weeks (from which time the diagnosis can be made).

Dysthymia, on the other hand (called Dysthymic Disorder in DSM-IV-TR and Persistent Depressive Disorder in DSM-5), lasts much longer, namely at least 2 years in adults (1 year in the case of children and adolescents).

2. Existence of episodes

In addition, major depression is characterized by the concept of “episode”; specifically, in the DSM-IV-TR a major depressive episode could be diagnosed (single-episode major depressive disorder) or, in the case of 2 or more episodes, recurrent major depressive disorder.

However, in the DSM-5 this distinction disappears, and only major depressive disorder can be diagnosed (without the previous specification as to the number of episodes); for this, 1 major depressive episode is sufficient.

Episodes are periods of 2 weeks in which the diagnostic criteria for depression are met (the episode itself is a diagnosis), although it no longer makes sense to talk about them when they disappear in the latest version of the DSM (DSM-5), as we have seen.

In the case of dysthymia (persistent depressive disorder), however, there is no such concept of “episode” in either the DSM-IV-TR or the DSM-5; that is, dysthymia is always (directly) referred to as a disorder.

3. Intensity of symptoms

Following the differences between major depression and dysthymia, we also find a very remarkable difference: the intensity of the symptoms. Thus, while in major depression the symptoms are more intense, in dysthymia, although the duration is longer, the symptoms are of less intensity .

This makes dysthymia a less serious disorder than major depression, but that doesn’t mean it shouldn’t be treated properly and given the importance it deserves.

4. Major Depressive Episode

Among the DSM-IV-TR diagnostic criteria for dysthymia (dysthymic disorder), it was established that there had been no major depressive episode (major depression) during the first 2 years of the dysthymic disorder itself. In other words, if there had been, dysthymia could no longer be diagnosed.

In the DSM-5, however, this criterion disappears, since dysthymia is now called Persistent Depressive Disorder, and represents a consolidation of the dysthymic disorder and chronic depressive disorder defined in the DSM-IV-TR. That is, in DSM-5 it is possible that a major depressive episode has occurred during the first 2 years of dysthymia .

5. Interference level

Beyond the diagnostic criteria, differences between major depression and dysthymia are also observed in clinical practice. One of them is the degree of interference in daily life; while in major depression the interference is much more important , in dysthymia, although there may be some interference in the development of daily activities, it is always minor.

In other words, a person with major depression will have more difficulty leading a normal life; these difficulties can translate into such simple acts as getting out of bed, taking a shower, or getting dressed. In dysthymia, on the other hand, the degree to which the different spheres of life are affected is less, and therefore these actions can be carried out normally.

In summary, another of the differences between major depression and dysthymia is the person’s psychological discomfort , which is greater in depression than in dysthymia. We insist that this does not mean that dysthymia does not suffer.

6. Age of onset

The age of onset (mean age) is also one of the differences between major depression and dysthymia; thus, while major depression usually appears later (between 30 and 40 years old), dysthymia usually appears earlier (from 20 years old).

In fact, this specification exists in the diagnosis of dysthymia (DSM-IV-TR and DSM-5), and two conditions can occur: early onset, before age 21, and late onset, at age 21 or later.

7. Other differences

In summary, while major depression usually involves more intense and severe symptoms, dysthymia involves less severe symptoms; the symptoms may be the same (e.g. apathy, insomnia, low self-esteem, hopelessness,…), only they vary in intensity .

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In addition, dysthymia at a clinical level manifests itself as a general and lasting state of discontent, a certain sadness, pessimism, etc. This makes us see people with dysthymia as more negative, and think that it is their way of being in “general”, since it may have been years since such an alteration existed.

In contrast, in major depression the symptoms appear more intensely, and that makes it possible to detect many times the trigger (or triggers) that have led to the depression ; that is, it is not perceived so much as a “general state” of the person or “way of being”, “personality” (as in dysthymia), but rather it is focused as a time or period where the person is suffering significantly.

Bibliographic references:

  • American Psychiatric Association (APA) (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (revised 4th ed.). Washington, DC: Author.
  • Belloch, A.; Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.