What is persistent depressive disorder?
Persistent depressive disorder (PDD) is a chronic (ongoing) type of depression in which a person’s moods are regularly low. But, symptoms are not as severe as with major depression. Persistent depressive disorder used to be called dysthymia.
How common is persistent depressive disorder?
Please discuss with your doctor for further information.
What are the symptoms of persistent depressive disorder?
The main symptom of PDD is a low, dark, or sad mood on most days for at least 2 years. In children and teens, the mood can be irritable instead of depressed and lasts for at least 1 year.
In addition, two or more of the following symptoms are present almost all of the time:
- Feelings of hopelessness
- Too little or too much sleep
- Low energy or fatigue
- Low self-esteem
- Poor appetite or overeating
- Poor concentration
People with PDD will often take a negative or discouraging view of themselves, their future, other people, and life events. Problems often seem hard to solve.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
Because these feelings have gone on for such a long time, you may think they’ll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.
Talk to your primary care doctor about your symptoms. Or seek help directly from a mental health provider. If you’re reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it’s a friend or loved one, a teacher, a faith leader, or someone else you trust.
If you think you may hurt yourself or attempt suicide, call your local emergency number immediately.
What causes persistent depressive disorder?
The exact cause of persistent depressive disorder isn’t known. As with major depression, it may involve more than one cause, such as:
- Biological differences. People with persistent depressive disorder may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
- Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
- Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
- Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people.
What increases my risk for persistent depressive disorder?
There are many risk factors for persistent depressive disorder, such as:
- Having a first-degree relative with major depressive disorder or other depressive disorders
- Traumatic or stressful life events, such as the loss of a loved one or financial problems
- Personality traits that include negativity, such as low self-esteem and being too dependent, self-critical or pessimistic
- History of other mental health disorders, such as a personality disorder
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is persistent depressive disorder diagnosed?
- Physical exam. The doctor may do a physical exam and ask in-depth questions about your health to determine what may be causing your depression. In some cases, it may be linked to an underlying physical health problem.
- Lab tests. Your doctor may order lab tests to rule out other medical conditions that may cause depressive symptoms. For example, your doctor may order a blood test to find out if your thyroid is underactive (hypothyroidism).
- Psychological evaluation. This includes discussing your thoughts, feelings and behavior and it may include a questionnaire to help pinpoint a diagnosis. This evaluation can help determine if you have persistent depressive disorder or another condition that can affect mood, such as major depression, bipolar disorder or seasonal affective disorder.
To diagnose persistent depressive disorder, many doctors use the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.
For a diagnosis of persistent depressive disorder, the main indication for an adult differs somewhat from that of a child:
- For an adult, depressed mood occurs most of the day for two or more years
- For a child, depressed mood or irritability occurs most of the day for at least one year
Symptoms caused by persistent depressive disorder can vary from person to person. When persistent depressive disorder starts before age 21, it’s called early onset; if it starts at age 21 or older, it’s called late onset.
How is persistent depressive disorder treated?
The two main treatments for persistent depressive disorder are medications and talk therapy (psychotherapy). The treatment approach your doctor recommends depends on factors such as:
- Severity of your symptoms
- Your desire to address emotional or situational issues affecting your life
- Your personal preferences
- Previous treatment methods
- Your ability to tolerate medications
- Other emotional problems you may have
Psychotherapy may be the first recommendation for children and adolescents with persistent depressive disorder, but that depends on the individual. Sometimes antidepressants are also needed.
The types of antidepressants most commonly used to treat persistent depressive disorder include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Talk with your doctor or pharmacist about possible side effects.
Finding the right medication
You may need to try several medications or a combination before you find one that works. This requires patience, as some medications take several weeks or longer for full effect and for side effects to ease as your body adjusts.
Don’t stop taking an antidepressant without talking to your doctor — your doctor can help you gradually and safely decrease your dose. Stopping treatment abruptly or missing several doses may cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression.
When you have persistent depressive disorder, you may need to take antidepressants long term to keep symptoms under control
Antidepressants and pregnancy
If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.
FDA alert on antidepressants
Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the most serious warning for prescriptions.
In some cases, children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So watch them for possible worsening depression and contact the doctor right away if this occurs, or get emergency help if suicidal behaviors occur.
Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy or psychological counseling.
Different types of psychotherapy, such as cognitive behavioral therapy, can be effective for persistent depressive disorder. You and your therapist can discuss which type of therapy is right for you, your goals for therapy and other issues, such as the length of treatment.
Psychotherapy can help you:
- Adjust to a crisis or other current difficulty
- Identify issues that contribute to your depression and change behaviors that make it worse
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Find better ways to cope and solve problems
- Explore relationships and experiences, and develop positive interactions with others
- Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
- Learn to set realistic goals for your life
FDA doesn’t monitor supplements
Dietary supplements aren’t approved and monitored by the FDA the same way medications are. You can’t always be certain of what you’re getting and whether it’s safe. Also, because some herbal and other dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider before taking any supplements.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage persistent depressive disorder?
The following lifestyles and home remedies might help you cope with persistent depressive disorder:
- Stick to your treatment plan. Don’t skip psychotherapy sessions or appointments, and even if you’re feeling well, don’t skip your medications. Give yourself time to improve gradually.
- Learn about persistent depressive disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about the disorder to help them understand and support you.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms get worse or return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
- Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you’re having trouble sleeping, talk to your doctor about what you can do.
- Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression-related symptoms, but in the long run they generally worsen depression and make it harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug abuse.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Persistent depressive disorder (dysthymia). https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929. Accessed November 28, 2017.
Persistent depressive disorder. https://medlineplus.gov/ency/article/000918.htm. Accessed November 28, 2017.
Review Date: November 28, 2017 | Last Modified: November 29, 2017