I said to my sister Mary “do you think it’s possible for someone to have been depressed for so long they don’t know the difference, they can’t recall ever having experienced anything else, if in fact they ever have?”  Mary has been depressed for so long as I can remember, and I’m older than she is.  She has a dysthymic disorder, with frequent drops into major depressive episodes.  She has basically been wandering around the country lost, for the past 30 years, and continues to wander.  I don’t think I’ve ever seen her happy, but that may reflect my filtering of experience.  Some families have the most likely to succeed person.  We have the most likely to commit suicide person.  I am surprised she is still with us.  She rejects all concrete offers of help. I feel pain in my heart when I think about her.

Dysthymic Disorder: eMedicine Psychiatry.

Major depressive disorder, dysthymia, double depression, and some apparently transient dysphorias may all be manifestations of the same disease process. These varieties of depressive mood states, while distinct diagnostic entities, share similar symptoms and respond to similar pharmacologic and psychotherapeutic approaches.^2,3

Although dysthymia was traditionally considered less severe than major depression, the consequences of dysthymia are increasingly recognized as grave and include severe functional impairment, increased morbidity from physical disease, and increased risk of suicide.

Of note, an estimated 75% of people with dysthymia meet criteria for at least 1 major depressive episode, referred to as double depression.⁴ Those with dysthymia who have depressive episodes tend to have longer periods of depression and spend less time fully recovered.⁵  In a 10-year follow-up study of people with dysthymia, 75% experienced some (at least 2 m) period of recovery from major depression; the mean time to recovery was 52 months from study entry. In this study, most (70%) of those who recovered experienced a relapse into another episode of depression, most commonly in the 3 years following recovery.⁶

Age

Most often, patients with dysthymia recall unexplained unhappiness in preadolescent childhood. Whether DSM-IV-TR adequately addresses dysthymia in children and adolescents is a matter of some controversy.¹⁰