Persistent depressive disorder (PDD), previously known as dysthymia, is a long-term form of depression that can quietly affect your daily life. Unlike major depression, which can come on suddenly and feel intense, PDD is often more subtle with symptoms that linger over time. When you have persistent depressive disorder, you can feel fatigued or low energy, have a dark outlook on life, and feel like everyday tasks are a burden.
Living with PDD can be a challenge, but it’s important to know that you don’t have to go through it alone. In this article, we’ll explore what persistent depressive disorder is, symptoms to watch out for, potential causes and risk factors, how PDD is diagnosed, and various treatment options that are available. Understanding persistent depressive disorder is the first step towards managing it, and with the right support, brighter days are possible.
What is persistent depressive disorder?
Persistent depressive disorder is a chronic form of depression that affects a person’s mood and overall function for an extended period of time, usually two years or more. Unlike major depressive disorder, which can occur in intense episodes, PDD is characterized by a continuous, mild to moderate feeling of sadness or hopelessness that persists for most of the day, on most days.
When you have PDD, you may feel like you’re ‘just getting by’ instead of thriving. You may feel sad, hopeless, or empty, lose interest in activities, and struggle to get even basic things done throughout the day. These feelings can last for years and impact your daily life, relationships, work or school, and overall sense of wellbeing.
PDD is common and will affect around 5-6% of the population at some point in their lives. It can be experienced by anyone at any age. While its symptoms are less severe than major depression, it can be just as debilitating due to its chronic nature. Persistent depressive disorder was originally referred to in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as dysthymia or chronic major depression.
See Similar: What is Low-Grade Depression? Symptoms, Diagnosis & Treatment
Links between PDD and other conditions
Persistent depressive disorder can be linked with other conditions, including:
- Major depression, anxiety disorders, and other mental disorders
- Lower quality of life
- Substance abuse
- Relationship difficulties
- Problems at school or work
- Chronic pain or other health issues
- Suicidal thoughts or behavior
- Personality disorders or other mental health issues.
What’s the difference between persistent depressive disorder and major depression?
Persistent depressive disorder and major depression are both types of depression. PDD is a chronic form of depression that lasts at least two years in adults (one year in children and adolescents) with symptoms that are less severe but longer lasting. Major depression, on the other hand, involves more severe symptoms that tend to occur in episodes that last at least two weeks.
Symptoms of persistent depressive disorder
Persistent depressive disorder symptoms are more subtle than major depression, which can make them easy to overlook or dismiss as just part of life.
Common symptoms of persistent depressive disorder include:
- Persistent sadness or low mood
- Fatigue or low energy
- Low self-esteem or self-criticism
- Difficulty concentrating or making decisions
- Lack of appetite or overeating
- Difficulty sleeping or sleeping too much
- Feelings of hopelessness, guilt, and emptiness
- Lack of interest in daily activities
- Impatience or irritability
- Social withdrawal
- Difficulty at work or school.
The intensity of PDD symptoms can change over time and most people with the disorder will also experience major depressive episodes at some point, called ‘double depression’.
Symptoms of PDD will usually last at least two years, and for many people, the disorder will go unrecognized as they accept these feelings as their ‘normal’ state. With proper diagnosis and treatment, however, people living with persistent depressive disorder can find relief and improve their quality of life.
See More: Seasonal Affective Disorder (SAD) – Symptoms & Causes
Causes of persistent depressive disorder
The causes of persistent depressive disorder are complex and not fully understood. As with major depression, PDD can involve more than one cause and be due to a combination of genetic, biological, and environmental factors.
- Genetic factors: Some evidence suggests that genetics play a role in the development of depression. If a close family member, such as a parent or sibling, has been diagnosed with depression or another mood disorder, it may increase your chances of developing persistent depressive disorder. However, genetics aren’t usually the sole cause of depression.
- Biological factors: Certain biological factors, like brain chemistry or hormonal imbalances, may contribute to persistent depressive disorder. For example, research demonstrates that abnormalities in mood-regulating neurotransmitters – such as serotonin – can play a role in the development of depressive disorders. Hormonal changes, like in postpartum or menopause, can also trigger or worsen PDD symptoms.
- Environmental factors: Like with major depression, certain environmental factors can lead to the development of persistent depressive disorder. This includes traumatic life events like the loss of a loved one, financial difficulties, chronic stress, or an unstable home environment.
- Chronic illness: Living with a chronic illness or enduring long-term physical pain can also be a contributing factor for depressive disorders. The constant strain of managing a health condition can lead to feelings of helplessness and despair, which can eventually develop into persistent depressive symptoms.
Keep Reading: The Link Between Depression and Chronic Pain
While all of these factors can play a role in PDD, it’s important to know that the disorder can sometimes develop without any obvious cause. Usually, a combination of factors contribute to the onset of PDD, and understanding these can help with finding effective treatment and support.
Risk factors for persistent depressive disorder
Certain risk factors can increase the likelihood of developing persistent depressive disorder. These include:
- Personal or family history of depression or other mood disorders
- Chronic stress
- Traumatic or stressful life events
- Early childhood adversity, such as experiencing abuse or violence
- Certain personality traits, such as negativity, low self-esteem, or self-criticism
- Living with chronic illness or pain
- Substance use
- Lack of social support.
How is persistent depressive disorder diagnosed?
Diagnosing PDD is a multifaceted process that involves clinical evaluation, taking patient history, and ruling out other potential causes for your depressive symptoms. Since there aren’t any definitive laboratory tests for depressive disorders, diagnosis relies on discussions between you and your mental healthcare provider.
The first step to take if you think you have PDD is to book a consultation with a mental health professional. During the consultation, you’ll be asked various questions about your emotional state, daily functioning, and any ongoing symptoms. Questions might include:
- How often do you feel sad or down?
- Can you think of specific reasons why you might be feeling this way?
- Do you have trouble sleeping or concentrating?
- How long have you been experiencing these symptoms?
- Are your symptoms constant or do they fluctuate?
- Are you currently taking any medications?
- Do you have any health conditions?
You might also be asked about your thoughts, feelings, and behavior, or to complete a questionnaire. This can help your mental health care provider rule out other mood disorders, such as major depression, bipolar disorder, or seasonal affective disorder. Sometimes, you might be asked for blood or urine tests to rule out any other potential causes of your depressive symptoms.
To be diagnosed with persistent depressive disorder, you must meet specific criteria according to the DSM-5. For adults, this means experiencing a depressed mood for most of the day, on most days, for at least two years (one year for adolescents or children). This doesn’t mean that you have to wait two years before seeking help. Support and treatment is available for depressive symptoms no matter how long you’ve been experiencing them for.
We offer a depression self-assessment that can kick start the process of diagnosis. Simply fill out the questionnaire and one of our team members will review your responses and be in contact with further guidance.
How to treat persistent depressive disorder
The two main ways to treat persistent depressive disorder is with antidepressant medication and psychotherapy (talk therapy). Everyone’s experience of PDD is unique and treatments may depend on:
- The severity of your symptoms
- Treatment methods that have or haven’t worked for you in the past
- Your ability to tolerate medication
- Other symptoms you may have
- Your preferred treatment options.
Let’s look at each of these treatment options in more detail.
Antidepressant medication
Antidepressant medications are prescription drugs that help treat symptoms of depression. There are different types of antidepressants that work differently, and finding the right medication can take a bit of time and patience. The most commonly prescribed antidepressants for persistent depressive disorder are:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs).
When taking medication, it’s important to be patient and give the medicine enough time to take effect. You may need to take antidepressants for a month or more before you begin to notice a difference. Don’t give up too soon and continue taking your medication as directed.
If you have side effects or the medication doesn’t work, your medication management provider might adjust the dosage or change medication to find one that works best for you. When you want to stop taking medication, your mental health provider will help you slowly and safely decrease your dose.
Continue Reading: Do Antidepressants Work and How Effective Are They?
Psychotherapy
Psychotherapy, or talk therapy, can be helpful for some people with persistent depressive disorder. This involves safely talking about your feelings and thoughts and learning effective ways to manage them. It might also include learning how persistent depressive disorder affects your life and developing coping strategies.
Types of talk therapy for persistent depressive disorder include:
- Cognitive behavioral therapy (CBT): This helps you become aware of your symptoms and what factors make them worse. You might also learn how to identify negative thought patterns and learn how to replace them with more positive ways of thinking.
- Insight-oriented therapy: This can help you understand which factors might be contributing to your depressive thoughts and feelings.
- Support groups: This involves joining groups for other people with PDD or other depressive disorders. It can help you feel less alone in your experience while also providing a space to talk about your thoughts and feelings with people who understand the struggle.
Psychotherapy can be helpful for:
- Recognizing issues that contribute to your depressive symptoms and changing behaviors that make it worse
- Recognizing negative thoughts and behaviors and replacing them with positive ones
- Finding healthier ways to cope in everyday life
- Improving relationships by learning how to develop positive interactions with others
- Easing depressive symptoms such hopelessness and anger by regaining control over the disorder
- Learning how to set realistic goals for your life so you can move forward.
Similar Reading: How to Find & Choose a Good Psychiatrist for You
Other things you can do
As well as taking medication and going to therapy, there are many other things you can do to relieve symptoms of persistent depressive disorder and improve your mental wellbeing. These include:
- Eating a healthy and nutritious diet
- Exercising or moving your body
- Seeking support from friends or family members
- Participating in activities or hobbies you enjoy, like going to a movie or a ballgame
- Doing something nice for someone else
- Finding a creative outlet, such as painting or drawing
- Spending more time outdoors in nature
- Practicing meditation or mindfulness
- Avoiding alcohol and recreational drugs, which can actually worsen your symptoms.
See More: How Alcohol Makes Your Depression Symptoms Worse
When to get help for PDD
If you think you or someone you know might have persistent depressive disorder, it’s important to get help as soon as possible. While PDD is characterized by long-term, chronic depression, you don’t have to wait for symptoms to persist before reaching out for support. Early intervention can prevent persistent depressive disorder symptoms from worsening and make a difference in treatment.
The team at BestMind Behavioral Health are here to help you on your journey to mental wellbeing. Our licensed professionals specialize in effective depression treatment and can provide customized treatments that target your specific mental health symptoms and needs. From medication to telemedicine and Esketamine therapy, we are the go-to specialists for exceptional depression care. Get in touch with our team to reclaim your narrative and start your journey towards better mental health.
