An Overview of Persistent Depressive Disorder (Dysthymia)

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Persistent depressive disorder (PDD), formerly known as dysthymia, is a fairly new diagnosis that is characterized by chronic depression. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) consolidated dysthymia and chronic major depressive disorder under the umbrella of persistent depressive disorder, which includes any chronic depression running on a spectrum from mild to severe.

These diagnostic changes were made to reflect the fact that there is no scientifically meaningful distinction between chronic major depressive disorder and what was previously known in the DSM-IV as dysthymic disorder.

The word dysthymia comes from the Greek roots dys, meaning "ill" or "bad," and thymia, meaning "mind" or "emotions." The terms dysthymia and dysthymic disorder referred to a mild, chronic state of depression.

Symptoms

The symptoms of persistent depressive disorder are very similar to major depressive disorder. However, these symptoms are chronic, meaning that people have these depressive symptoms most days for a period of at least two years for adults and one year for children and teens. The symptoms include:

  • Decreased productivity
  • Feelings of guilt
  • Feelings of helplessness
  • Feelings of sadness
  • Hopelessness
  • Increases or decreases in appetite
  • Irritability
  • Lack of energy or fatigue
  • Loss of interest and pleasure in daily activities
  • Low mood
  • Poor self-esteem
  • Sleep difficulties
  • Social withdrawal
  • Trouble concentrating

While people with major depressive disorder may have days or periods where they feel better, those with dysthymia have depressive symptoms almost all the time for a long time.

PDD may have an early onset, with symptoms first appearing during the child, teen, or young adult years. In kids, the primary symptoms are depressed mood and irritability.

Double Depression

A person with mild depression meeting the diagnostic criteria for persistent depressive disorder can also experience major depressive episodes. When the major depressive episode has ended, however, there is a return to the previous state of chronic depression. This co-occurrence of PDD and major depressive disorder is sometimes referred to as double depression.

Causes

Like other forms of depression, the exact cause of PDD is not known, but there are a number of factors that are believed to play a role, including:

  • Brain chemistry: The balance of neurotransmitters in the brain can play a role in the onset of depression. Some environmental factors, such as prolonged stress, can actually alter these brain chemicals. Antidepressants work by altering these neurotransmitters in order to improve mood.
  • Environmental factors: Situational variables such as stress, loss, grief, major life changes, and trauma can also cause depression.
  • Genetics: Research suggests that having close family members with a history of depression doubles a person's risk of also developing depression.

In many cases, these factors interact to increase the risk of developing depression.

Diagnosis

There was and still is no laboratory test for diagnosing dysthymia or any other form of depression. If you are experiencing symptoms of depression, your doctor will evaluate your symptoms and medical history. You will be asked questions about the nature, severity, and duration of your symptoms.

Your doctor may conduct testing such as a physical and blood work to rule out any medical illnesses that might be causing your symptoms. To receive a diagnosis of PDD, your doctor must determine that your symptoms could not be better accounted for by drug or alcohol use, a medical condition, or another psychological disorder.

In order to be diagnosed with persistent depressive disorder, your doctor will check to see if your symptoms meet the diagnostic criteria outlined in the DSM-5, which includes duration requirements.

For adults, symptoms of depression must be experienced more often than not for at least two years prior. For children, the requirement was lowered to one year. Lastly, the symptoms must result in significant distress or impairment of normal functioning.

PDD is sometimes difficult to diagnose because symptoms are so long-lasting that many people begin to believe that their symptoms are simply a part of their personality or "who they are" rather than a result of a treatable condition.

According to the American Psychiatric Association, between 0.5% and 1.5% of U.S. adults experiencing persistent depressive disorder each year. A 2017 study suggested that the lifetime prevalence for PDD with major depressive episodes was 15.2%.

Treatment

The treatments for persistent depressive disorder are similar to other treatments of depression. Generally, a combination of psychotherapy and medications is the most effective.

Talk Therapy

Psychotherapy may involve a range of different techniques, but two that are often used are cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).

  • CBT: This type of therapy focuses on learning to identify and change the underlying negative thought patterns that often contribute to feelings of depression.
  • IPT: This therapy is similar to CBT but focuses on identifying problems in relationships and communication and then finding ways to make improvements in how you relate to and interact with others.

Medication

There are a number of different types of antidepressants that may be prescribed to treat PDD, including:

  • Selective serotonin reuptake inhibitors (SSRIs): These medications include sertraline Zoloft (sertraline) and Prozac (fluoxetine). SSRIs work by increasing serotonin levels in the brain, which can help improve and regulate mood.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): These medications include Cymbalta (duloxetine) and Pristiq (desvenlafaxine). SNRIs work by increasing the amount of serotonin and norepinephrine in the brain.

St. John's Wort, which has been reported to be helpful in cases of mild to moderate depression, is sometimes used as a self-help remedy. While St. John's Wort and other natural treatment options appear to work for some people with depression, it's important that you never take any supplement without first talking to your doctor. When combined with antidepressants, this herbal remedy may lead to a dangerous complication known as serotonin syndrome.

Coping

There are a number of different things that people can do to help cope with persistent depression. Because this type of depression is chronic, incorporating lifestyle changes and self-care with your medical treatments can be helpful. Some things that you can do that will complement therapy and medication:

It can be challenging to do many of these things when you are feeling depressed. While it may be a struggle, remember that you don't need to do it all perfectly. Even small changes can make a difference in your mood and mindset. For example, you might start out by making small goals and then gradually build on these over time.

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

Even very mild symptoms of depression can disrupt your ability to function and enjoy life, particularly when these symptoms are long-lasting. Fortunately, there are effective treatments available for persistent depressive disorder that can make a major difference in your health and well-being. Talk to your doctor about how you are feeling to explore the treatment options that are right for you.

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  2. Vandeleur CL, Fassassi S, Castelao E, et al. Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry Res. 2017;250:50-58. doi:10.1016/j.psychres.2017.01.060

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