Persistent Depressive Disorder

What is persistent depressive disorder?

Persistent depressive disorder (PDD) is a mood disorder of continuous feelings of low-level sadness over a long period of time. (It has also been called “dysthymia,” or “chronic major depression”.)

Symptoms of PDD often develop slowly. It usually starts in adolescence or young adulthood.  Unlike major depressive disorder (which has repeated episodes of depression and recovery), PDD symptoms are constant and last for years. But these symptoms tend to be milder than in other major depressive episodes. Many people with PDD can recover with ongoing therapy and medications.

Most common symptoms

You might experience chronic feelings of sadness, irritability, and low mood. It feels like no matter what you do, you still feel low. These feelings get in the way of other areas of your life, such as work, family, and socializing. Like other forms of depression, PDD can cause cognitive symptoms (like trouble concentrating) and physical (like low energy, irregular sleep patterns).

You have PDD if you have symptoms of major depression that lasts for two continuous years without a break. Or if you have milder symptoms than major depression, but over a long period of time (sometimes decades).

Not all long-term depression is PDD. There are certain mental health conditions, like bipolar disorder, that can last for a long time or forever. There are also medical conditions (like hypothyroidism) or medications that can also cause low mood. It is important to consult a doctor and a mental health specialist to help understand your symptoms.

Main symptoms

• Depressed mood: feeling sad, empty, or having a low mood most of the time.
• Changes in sleep: including difficulty falling asleep, waking up in the early morning, or sleeping more than usual.
• Feeling low energy nearly every day.
• Low self-esteem.
• Decreased ability to concentrate and focus, such as while reading or multitasking.
• Difficulty remembering things.
• Changes in appetite, eating more or less.
• Difficulty making decisions.
• Feeling hopeless.

Other symptoms you may have

• Suicidal thoughts.
• Increased irritability (getting angry or annoyed easily).
• Body aches and pains.
• Excessive worry.
• Not participating in social activities.
• Decreased sexual desire.
• Ruminating (thinking about the same negative things over and over).

What triggers PDD?

Depression—including PDD—is complicated. There are biological, genetic, psychological, social, and environmental factors that contribute to it. Your risk is higher if other people in your family have depression. Or if you tend to have negative thought patterns. PDD is twice as common in women as in men.

Next steps

Some people feel most comfortable first talking with their doctor, but a mental health professional, like a therapist, specializes in this. You can check with your insurance company to find one in your plan, or find a local therapist on Psychology Today.

If you or someone you know is having thoughts about ending their life or is unable to take care of themselves due to depression, call 988 (the new Suicide and Crisis Lifeline) or 911, or go to the nearest ER right away.

Depression in children and adolescents

Children and adolescents may have slightly different symptoms, but most are similar to what adults experience. Children and teens are usually diagnosed with PDD if they have symptoms for one year. Also, young people tend to be more irritable as opposed to sad.

Treatment in children and teens is similar to those for adults. It includes talk therapy and other behavioral approaches like exercise, reduced screen time, and improving sleep hygiene. If those don’t work, antidepressant medications may be added.

Depression increases risk of suicide. The risks and benefits of medications should be discussed with your child’s doctor (some medications also increase risk of suicidal thoughts). But treatment is always needed. Tell your doctor about any changes in behavior or suicidal thoughts right away.

Causes of persistent depressive disorder

Like most mental health conditions, PDD is probably due to a complex mix of biological, psychological, and environmental factors.

• Brain chemistry: Abnormal levels of brain chemicals might affect mood. Or there could be a hormonal imbalance. For instance, stress, thyroid, or growth hormones may not be working correctly.
• Genetics: Depression runs in families.
• Psychosocial stressors: Severe negative life events—like separations and losses—and exposure to violence, neglect, emotional or physical abuse, or poverty can lead to depression.
• Depression is often a normal response to having a medical condition or other mental health issues, such as substance use or anxiety.

PDD treatment

Treatment varies from person to person. Your doctor may try a combination individual or group psychotherapy, lifestyle changes, and medication. It depends on your medical history, symptoms, personal preferences, and community resources.

Research shows that the combination of talk therapy and medications is often more effective than just one treatment. You may also need to try different medications and/or types of psychotherapy before noticing an improvement.

Psychotherapy

There are many different types of talk therapy that work. Cognitive behavioral therapy (CBT) is an effective one that focuses on recognizing and changing unhealthy patterns of thought. It also helps you make positive changes in behavior patterns, such as improving your sleep. But there are many other approaches that can help based on your preference and comfort level.

The most important thing is to feel that you trust and feel comfortable with your therapist. If you don’t, you need to find one you trust.

Medication

There are a variety of antidepressants used to treat PDD. Your doctor or a psychiatrist will recommend the best one for you. They will consider your symptoms, other health conditions, and concerns about side effects (every medication has different ones).

It might take 2 to 3 months to feel a change in your mood. Doctors are still figuring how long you should take medications for PDD.

Before stopping a medication, it’s important to weigh the risks (like possible worsening of symptoms) and benefits (not experiencing side effects) with your therapist.

Never stop any medication without checking with your doctor. They may need to wean yourself off of your dose to avoid serious side effects.

Neuromodulation treatments

Neuromodulation techniques are also effective.

• Electroconvulsive therapy (ECT) is also known as shock treatment. It is used when the depression is not responding to medications and other treatments. It causes a short seizure that changes the brain’s chemistry. It can, however, lead to mild memory loss.
• Transcranial magnetic stimulation (TMS) is a newer technique that uses magnetic fields to stimulate brain cells.

Prevention

These strategies can help strengthen your mental well-being.

• Avoid alcohol and other drugs. Alcohol, tobacco/nicotine, and other drugs may seem to help in the short term, but they can make symptoms worse overall.
• Get enough sleep. Sleep affects your mood. Try to go to sleep at the same time each day. Avoid caffeine and big meals before bed. Stop looking at bright screens at least two hours before bed. Keep your bedroom quiet and comfortable.
• Stay physically active. Regular exercise can help improve mood, even though it may be difficult to motivate if you’re feeling depressed. Try running, swimming, yoga, or other sports.