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) consolidates 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:

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

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 ended, however, there is a return to the previous state of chronic depression. This co-occurrence of PDD and major depressive disorder is something referred to as double depression.

Causes

Like other forms of depression, the exact cause of persistent depressive disorder is not known. There are a number of factors that are believed to play a role.

  • Genetics: Research suggests that having close family members with a history of depression doubles a person's risk of also developing depression.
  • 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.

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

Diagnosis

There was and still is no laboratory test available 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.

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.

Also, the individual's symptoms could not be better accounted for by drug or alcohol abuse, a medical condition, or another psychological disorder. In addition, It was required that the patient had felt symptoms of depression more often than not for at least two years prior. For children, the requirement was lowered to one year.

Diagnosis requires two or more symptoms that are experienced most days for at least two years that are not better explained by another psychiatric or medical condition. The symptoms must not be attributable to substance use and must result in significant distress or impairment of normal functioning.

PDD is sometimes difficult to diagnose because symptoms are so long-lasting that people believe that it is simply a part of their personality or "who they are."

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: usually psychotherapy and medications. Generally, a combination of these two is the most effective.

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

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

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

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

  • Get regular exercise several times each week
  • Establish a consistent sleep schedule
  • Avoid alcohol and other substances
  • Eat a healthy diet 
  • Create daily routines that help structure your day
  • Practice stress management techniques such as deep breathing and meditation
  • Get out of the house and make plans with friends

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 all of this 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. 

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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