Dear Patti,

As an only child, I had a difficult time growing up and often felt lonely. Although I knew my parents dearly loved me, my father had serious health problems, which often prevented my mother from being able to spend much time with me. We lost my dad seven years ago, which was unbelievably painful. I’m now 26, have a great boyfriend, wonderful friends and family and am at a time in my life when I should be happy, exploring life and having fun.

I know that’s what my father would want and yet, no matter how hard I try, I keep falling into a sad mood and becoming miserable and fatigued. My recent medical exam says I’m physically healthy, but I was diagnosed with depression; specifically, dysthymia. My doctor prescribed psychotherapy and an anti-depressant medication. So far I’ve had two counseling sessions, which have already helped a little.

What exactly is dysthymia? What causes it and how is it typically treated? I feel helpless when I feel like this and keep asking myself, “Why can’t I pull out of it?” I get so disgusted with myself for continually reacting this way.

  — Sophia

Dear Sophia,

The disorder you’re dealing with is a chronic form of depression and its main sign is a low, dark, or sad mood most days for at least two years. Dysthymia is less extreme and less intense than major depressive disorder; its symptoms, however, are similar. While major depression often occurs in episodes, dysthymia is less debilitating but — like major depression — can result in impaired functioning in work, social and personal areas, and interfere with the ability to enjoy life and find interest in things you used to find pleasurable. You may have difficulty concentrating, be indecisive, feel hopeless, negative and have low self-esteem, as well as overall feelings of inadequacy. Your appetite and weight may increase or decrease and there are often sleep disturbances. Although its exact cause is unknown, dysthymia appears to a combination of genetic, biochemical, environmental and psychological factors.

Since you’re suffering from depression, you may also have an inner voice that’s harsh and demands that you be perfect. If this is true, try to replace your punitive voice with a loving one by gently reminding yourself to be warm, kind and understanding concerning what you’re experiencing. To counteract these negative thoughts, you’ll need empathy, acceptance, respect and love from yourself, as well as loved ones.

Learn to be nonjudgmental about how you’re feeling. Take care of yourself just as you would a cherished loved one. Give full attention to the thoughts and feelings that keep coming up to consciousness. When in pain and despair, you don’t have to do anything special; just allow yourself to experience your feelings and avoid having a dismissive attitude toward yourself. Depression is just what it sounds like — feelings “depressed in.” Imagine you have a mountain of accumulated feelings on your shoulders; every time you face a feeling that has been weighing you down, the load lightens a little.

For many patients, a combination of medication and a solid relationship with a mental health professional is the most effective course of treatment. Psychodynamic, insight-oriented or interpersonal psychotherapy can help identify the feelings behind your symptoms. No matter how painful those feelings may be, exploring them will help resolve emotional conflicts, personal disputes, and issues of loss and separation, especially those derived from childhood experience. Supportive based therapy provides advice, reassurance, sympathy, and education about the disorder.

It’s important to communicate freely with your therapist. Try not to edit your thoughts and feelings in therapy, even if you express something that five seconds later you realize you don’t mean. Explore anything that naturally comes up even if released immediately or integrated later with more rational thoughts. Joining a support group may be beneficial, too, in learning stress reduction techniques.

This is clearly a difficult time for you but through the challenging experience of facing and experiencing your feelings, more depth, empathy and deeper love for yourself and others can develop. 

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, is a psychotherapist in private practice with offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her Web site,