Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- ICD-10 code
- F34.1
- Who leads care
- A psychiatrist and a psychotherapist working as a team
- Format
- Video consultations, psychotherapy sessions, online treatment monitoring
- Duration
- First appointment 50 minutes; a course of treatment lasts several months or more
- Confidentiality
- Medical confidentiality; you can book without naming your employer
- When it is urgent
- Thoughts of death or suicide — call 103, 112, or the 150 helpline
- Outcome
- Lasting improvement in mood and energy, renewed interest in life
What you should know
Dysthymia is often called “quiet” depression: a person goes to work and keeps up with their responsibilities, yet lives for years with a sense of dullness, fatigue, and harsh inner criticism. The clinical criteria are low mood on most days for at least two years in adults, plus several accompanying symptoms: disturbed sleep or appetite, low energy, low self-esteem, difficulty concentrating, and hopelessness. It is precisely this chronic course that makes the disorder invisible to others.
Why treat something that is “bearable anyway”? Because dysthymia increases the risk of major depression developing on top of it — an overlap known as double depression — and reduces quality of life just as much as more dramatic disorders. At Psychiatry Online, diagnosis and treatment take place over video: convenient for people who work in government agencies or offices on the left bank and cannot set aside half a day to travel to a clinic in the depths of winter.
Signs and Symptoms of Dysthymia
- low mood on most days that drags on for years
- a sense that “I’ve always been like this,” even though life once felt easier
- chronic tiredness and lack of energy, even after a weekend off
- low self-esteem, constant self-criticism, and a feeling of inadequacy
- difficulty concentrating and making even simple decisions
- disturbed sleep or appetite with no obvious physical cause
- pessimism and a feeling that nothing will ever change for the better
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
What Causes Dysthymia
Dysthymia develops through a combination of biological vulnerability and long-term stress. Research links it to disruptions in the stress-regulation systems and in the neurotransmitters responsible for motivation and pleasure. Early experiences also play a major role — an emotionally cold environment or chronic criticism in childhood — along with the beliefs about oneself formed on that basis. These beliefs sustain self-criticism and turn low mood into a constant background.
Maintaining factors include chronic overload, isolation, and a lack of daylight and exercise. A long winter, wind, and short days reduce time spent outdoors and physical activity, which makes fatigue worse. Working under constant deadlines in civil service or office jobs without time to recover reinforces the feeling that there is never enough energy. It is also important to rule out physical causes: thyroid problems and anemia can produce a similar picture.
How Online Treatment for Dysthymia Works
During the video appointment, the psychiatrist asks how long your low mood has lasted, whether there have been periods of improvement, and how your sleep, appetite, and ability to work have changed. Standardized questionnaires are used to assess the severity of symptoms and then track progress. Prepare a list of the medications you take and any recent test results. You will need a quiet place, headphones, and a stable connection — the appointment can even be held from your car in the office parking lot.
Lab tests cannot be done online: if the doctor suspects hormonal problems or anemia, these are checked in person at a laboratory. Whether medication can be prescribed and a prescription issued depends on Kazakhstan law and the requirements for an initial in-person examination. If your condition worsens sharply, or you have thoughts of death or suicide, you need urgent help: call 103, 112, or the 150 helpline.
How we help
Cognitive behavioral therapy
CBT works with automatic negative thoughts and deep-seated beliefs about one’s own inadequacy. Patients learn to notice distortions — discounting the positive, catastrophizing, “all-or-nothing” thinking — and to test them against the facts. A version called CBASP was developed specifically for chronic depression; it focuses on interpersonal patterns and has proven effective precisely in long-standing cases.
Medication
Clinical guidelines allow the use of antidepressants for dysthymia, especially in combination with psychotherapy: the combination works better than either method alone. The class of medication and the length of the course are decided by the psychiatrist. The effect is usually assessed after several weeks, and medication is tapered off gradually and only in agreement with the doctor.
Behavioral activation
This method is based on a simple mechanism: in depression, people cut back on activity, and that lowers their mood even further. The therapist helps you gradually return to activities that bring pleasure or a sense of achievement. In winter, these might be walks during daylight hours, workouts at the gym, or time with loved ones — small steps with a clear plan.
Support and relapse prevention
Dysthymia tends to come back, so a maintenance phase is important once you feel better. At follow-up appointments at Psychiatry Online, you discuss early warning signs, your sleep and workload, and a plan for difficult periods such as winter or year-end reporting. This helps you hold on to your progress instead of starting over each time.
Myths and facts
MythDysthymia is just a pessimistic personality
FactDysthymia is described in ICD-10 as a distinct disorder with clear criteria. Its chronic course creates the illusion that it is a personality trait, but after treatment many patients find that their “real” character is much calmer and more cheerful.
MythIf the symptoms are mild, there’s no need for treatment
FactMild does not mean harmless. A long course without treatment increases the risk of major depression and erodes quality of life, relationships, and the ability to work. Timely treatment helps prevent this.
MythAntidepressants change your personality
FactProperly chosen antidepressants do not change your personality or cause “artificial happiness.” They help restore the systems that regulate mood. You remain yourself, but with more energy for life and for psychotherapy.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Astana
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
You can book in Astana online or at one of two branches: 72 Bogenbay batyra St., Astana, 37 Petrova St., office 23, Astana. Our coordinator replies on WhatsApp within minutes at any time, and a doctor usually connects by video the same day; home visits are available too — all city districts and nearby settlements.
Confidential and private
An online appointment in Astana is first of all about privacy: no clinic visit, no waiting room. A private room and headphones are enough. Data is stored in a secure system with restricted access and does not enter any state registry without legal grounds.
Questions and answers
How can I tell dysthymia from ordinary tiredness?
Tiredness goes away after rest or a vacation, whereas dysthymia persists for months and years regardless of rest. The key signs are persistently low mood, self-criticism, and hopelessness. If you have recognized yourself in this description for more than two years, it is worth discussing with a psychiatrist.
How long does dysthymia treatment take?
The first changes usually appear within a few weeks, and lasting improvement within 2–3 months. In chronic cases, psychotherapy often lasts six months or longer. Once you improve, the doctor will recommend a maintenance phase to lower the risk of symptoms returning.
Do I have to take medication?
Not always. If symptoms are mild, you can start with psychotherapy. If they have lasted a long time or there are signs of major depression, clinical guidelines recommend a combined approach. The decision is made together with your doctor after diagnosis.
How often do I need to be in touch with my doctor?
While treatment is being adjusted, once every one to two weeks, then less often. Psychotherapy usually takes place weekly. The online format means you do not waste time traveling from Nura or Saryarka and do not have to cancel sessions because of the weather or traffic.
Can dysthymia turn into severe depression?
Yes, some patients with dysthymia develop an episode of major depression. If you notice a sharp decline, loss of interest in everything, disturbed sleep and appetite, or thoughts of death, see a doctor right away, and in an emergency call 103 or 112.
Is it anonymous?
Yes. You do not have to name your employer, and information about your consultation is protected by medical confidentiality under the Kazakhstan Code “On Public Health and the Healthcare System.” Information may be disclosed only in cases expressly provided for by law.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy