If you’ve been feeling “down” for so long that it almost feels like part of your personality, you’re not alone. Many people experience a quieter, ongoing form of depression that doesn’t always bring life to a halt, but instead makes everything feel heavier and harder to carry. This is called Dysthymia, or Persistent Depressive Disorder (PDD). If this resonates with you, please know: your experience is valid, your symptoms make sense, and support is available. With the right help, it is possible to feel lighter, more connected, and more hopeful again. 

What is Dysthymia? 

Dysthymia/Persistent Depressive Disorder is a chronic form of depression where a low mood is present most of the day, more days than not, for at least two years in adults (one year for children and adolescents). Alongside the low mood, people often experience some combination of low energy, poor sleep or sleeping too much, changes in appetite, low self-esteem, difficulty concentrating or making decisions, and a sense of hopelessness (American Psychiatric Association [APA], 2022). 

If you live with dysthymia, you might be able to get to work, take care of your family, and show up for commitments but you do it while feeling like you’re moving through molasses. It’s not laziness, and it’s not a character flaw. It’s depression. 

How Dysthymia Compares to Major Depressive Disorder

Major Depressive Disorder (MDD) tends to be more acute and intense, often showing up in episodes that last weeks to months. MDD can bring severe symptoms like markedly low mood, loss of interest, significant changes in sleep and appetite, and sometimes thoughts of death or suicide. 

Dysthymia/PDD, on the other hand, is typically less intense day-to-day but it’s more persistent. Think of MDD like a thunderstorm and dysthymia like a long, grey winter: different experiences, both real, both deserving of care. Some people experience “double depression”—a major depressive episode layered on top of persistent dysthymia. This can be especially tough and is a strong signal to seek support (Thase, 2014). 

Why Dysthymia Often Gets Overlooked 

Because dysthymia is chronic and often milder in presentation, it can be missed by others and by the person experiencing it. Maybe you’ve heard (or told yourself) things like, “I’m just not a happy person,” “I’m fine—just tired,” or “Everyone feels this way.” Over time, the low mood can start to feel normal. Friends, family, or even healthcare providers may not notice the gradual impact. You might keep functioning; showing up to work, parenting, paying bills, so it seems like you’re okay. But inside, it feels like joy is out of reach and life is in greyscale instead of colour. 

If this resonates, your experience is valid. The fact that you’ve been carrying this for so long says a lot about your strength. And you don’t have to keep carrying it alone. 

Common Symptoms of Dysthymia 

Everyone’s experience is unique, but common symptoms include (APA, 2022): 

• A persistent low or irritable mood most days for years 

• Low energy or fatigue; even small tasks feel like a lot of effort 

• Sleep challenges (trouble sleeping or sleeping too much) 

• Changes in appetite (eating more or less than usual) 

• Difficulty experiencing joy (anhedonia)  

• Difficulty concentrating or making decisions 

• Low self-esteem, self-criticism, or persistent guilt 

• A sense of hopelessness / feeling like things won’t get better 

These symptoms often wax and wane, but they don’t fully go away for long. People with dysthymia also have higher rates of co-occurring anxiety and physical health concerns, which can compound the burden (Thase, 2014; NIMH, 2024). 

How Therapy Can Help 

Therapy offers a consistent, compassionate space to understand what keeps the low mood going and how to loosen its grip. While there’s no single “right” path, many people find these things to be helpful: 

• Language for what’s happening. Naming dysthymia can be relieving. You’re not “lazy” or “too sensitive”, you’re living with a recognized condition that has evidence-based treatments. 

• New patterns, step by step. Therapy helps you identify the thoughts and behaviours that keep you stuck (like harsh self-talk or avoidance) and replace them with more helpful ones. 

• Reconnection with meaning and pleasure. Depression can narrow your world. Therapy focuses on gently expanding it. Reintroducing activities, relationships, and routines that bring vitality. 

• Skills for energy and motivation. Motivation often follows action (not the other way around). Therapists help you break tasks into doable steps and celebrate small wins that build momentum. 

• Attuned support. Dysthymia can feel lonely. Having a consistent, validating relationship with a therapist can itself be healing (Cuijpers et al., 2012). 

Medication is also helpful for many people with chronic forms of depression—sometimes in combination with therapy (Keller et al., 2000; NICE, 2022). If medication feels right for you, reach out to your physician or a psychiatrist. 

Evidence-Based Modalities We Use 

At Love This Therapy, our approach is warm, collaborative, and grounded in evidence. We tailor care to you, your history, values, culture, neurotype, and goals. Here are some modalities with strong support for persistent or chronic depression: 

Cognitive Behavioural Therapy (CBT) 

CBT helps you notice and shift unhelpful thought patterns (like “nothing ever works out” or “I’m a failure”) and behaviours (like withdrawing or procrastinating) that maintain low mood (Cuijpers et al., 2013; Cuijpers et al., 2016). We work on practical strategies, sleep routines, activity scheduling, and problem-solving so that life becomes more manageable and rewarding. 

Mindfulness-Based Cognitive Therapy (MBCT) 

MBCT teaches skills to notice rumination (the mind’s habit of looping on negative thoughts) and gently shift attention. Mindfulness practices can reduce relapse risk and soften self-criticism (Segal et al., 2018). 

Acceptance and Commitment Therapy (ACT) 

ACT helps you make room for difficult feelings while moving toward what matters to you. Instead of waiting to “feel motivated,” ACT builds values-driven action now, using skills like defusion, acceptance, and self-compassion (A-Tjak et al., 2015). 

Emotion-Focused Therapy (EFT) 

EFT helps you process underlying emotions like shame or sadness that may be stuck under the surface. By approaching feelings with compassion and curiosity, EFT can open space for relief and more authentic self-worth (Greenberg, 2017). 

Somatic Therapy 

Gentle body-based strategies (breathwork, grounding, movement) can help regulate your nervous system. Exercise, sleep hygiene, and nutrition support are meaningful adjuncts—exercise, for example, shows moderate antidepressant effects (Schuch et al., 2016). We’ll pace everything to your energy and needs. 

Eye Movement Desensitization and Reprocessing (EMDR) 

If trauma or chronic stress contributes to your depression, EMDR can be a powerful tool. EMDR helps your brain process difficult memories that may still feel “stuck” in the nervous system—memories that can quietly fuel feelings of hopelessness, worthlessness, or ongoing sadness. Through guided sets of eye movements or other forms of bilateral stimulation, EMDR allows the brain to reprocess these experiences in a safer, less overwhelming way. 

Signs You Might Be Ready to Reach Out 

• You’ve felt low or flat for a long time and worry this is “just who you are.” 

• Joy feels distant, and most days feel like “pushing through.” 

• You’re functioning, but it’s exhausting. 

• You want more. More energy, more meaning, more ease and you’re curious about what could change with support. 

If any of this feels familiar, counselling can help you gradually bring back a sense of lightness and ease. Healing isn’t usually dramatic, it often shows up in small, steady ways: sleeping more restfully, speaking to yourself with a bit more kindness, finding a walk genuinely enjoyable, or feeling more connected in a conversation. Over time, these small shifts build into meaningful change. 

Conclusion 

Dysthymia can make hope feel far away but hope can be practiced, like a muscle. With the right support, you can learn to meet hard days with compassion, make room for pleasure, and take steps that slowly change your inner world. 

If you’re feeling ready, or even just curious, reach out to Love This Therapy today. We’ll meet you where you are, move at your pace, and walk alongside you as you rediscover what makes life feel worth living. You can contact us at 604-229-4887 or info@lovethistherapy.com. We are here when you’re ready.  

References 

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing. 

A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764 

Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58(7), 376–385. https://doi.org/10.1177/070674371305800702 

Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A., & Theorell, T. (2016). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal of Affective Disorders, 202, 511–521. https://doi.org/10.1016/j.jad.2016.05.020 

Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLOS ONE, 9(6), e100100. https://doi.org/10.1371/journal.pone.0100100 

Greenberg, L. S. (2017). Emotion-focused therapy: Coaching clients to work through their feelings (2nd ed.). American Psychological Association. 

Keller, M. B., McCullough, J. P., Jr., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., … & Zajecka, J. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342(20), 1462–1470. https://doi.org/10.1056/NEJM200005183422001 

National Institute for Health and Care Excellence (NICE). (2022). Depression in adults: Treatment and management (NG222). https://www.nice.org.uk/guidance/ng222 

National Institute of Mental Health (NIMH). (2024). Depression. https://www.nimh.nih.gov/health/topics/depression 

Schuch, F. B., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P. B., Silva, E. S., … & Stubbs, B. (2016). Physical activity and incident depression: A meta-analysis of prospective cohort studies. American Journal of Psychiatry, 175(7), 631–648. https://doi.org/10.1176/appi.ajp.2018.17111194 

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2018). Mindfulness-based cognitive therapy for depression (2nd ed.). Guilford Press. 

Thase, M. E. (2014). Chronic depression: Diagnosis and classification. Current Opinion in Psychiatry, 27(1), 8–15. https://doi.org/10.1097/YCO.0000000000000033 

Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2017). Clinician’s quick guide to interpersonal psychotherapy. Oxford University Press.