The 7 differences between major depression and dysthymia

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

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.

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Differences between major depression and dysthymia

The most remarkable differences that exist 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 for a minimum of 2 weeks (from which the diagnosis can already be made).

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

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2. Existence of episodes

Furthermore, major depression is characterized by the concept of "episode"; Specifically, the DSM-IV-TR could diagnose a major depressive episode (major depressive disorder of single episode) or, in the case of 2 or more episodes, major depressive disorder recurrent.

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

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

In the case of dysthymia (persistent depressive disorder), however, this concept of “episode” does not exist, neither in the DSM-IV-TR nor in the DSM-5; that is, dysthymia is always referred to (directly) as a disorder.

3. Intensity of symptoms

Continuing with 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 less intense.

This makes dysthymia a less serious disorder than major depression, which does not mean that it should not be treated properly and that it should not be given the importance it deserves.

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4. Major depressive episode

Among the DSM-IV-TR diagnostic criteria for dysthymia (dysthymic disorder), it was established that there were no there have been no major depressive episodes (major depression) during the first 2 years of the alteration of the dysthymia. That is, if it had existed, dysthymia could no longer be diagnosed.

In DSM-5, however, this criterion disappears, since dysthymia is renamed Depressive Disorder Persistent, 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 there was a major depressive episode 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 everyday life; while interference is much more important in major depressionIn dysthymia, although there may be some interference in the development of daily activities, it is always less.

In other words, a person with a major depression will have more difficulties in leading a normal life; These difficulties can be translated into simple acts such as getting out of bed, showering, or dressing. On the other hand, in dysthymia, the degree of affectation of the different spheres of life is less, and therefore these actions can be carried out normally.

In summary, another of the differences between major depression and dysthymia is the psychological discomfort of the person, which is greater in depression than in dysthymia. We insist that this does not imply 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 the ages of 30 and 40), dysthymia usually appears earlier (from the age of 20).

In fact, in the diagnosis of dysthymia (DSM-IV-TR and DSM-5) there is this specification, being able to give two conditions: early onset, before age 21, and late onset, at age 21 or with posteriority.

7. Other differences

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

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

In contrast, in major depression the symptoms appear more intense, and This means that the trigger (or triggers) that have led to the depression can often be detected; that is, it is not perceived as much as a "general state" of the person or "way of being", "personality" (as in dysthymia), but rather is approached as a time or period where the person is suffering from important.

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.