Persistent Depressive Disorder: Symptoms and Treatment Options
Everyone gets the blues from time to time, but persistent depressive disorder (PDD) is more than hitting a rough patch in life. Depression isn’t something you can snap out of or wish away. It can affect every aspect of your life, including sleep, school, work and relationships.
Persistent depressive disorder affects many people at all ages and stages of life. Read on to learn more about PDD along with its symptoms, causes and treatments.
What Is Persistent Depressive Disorder?
Persistent depressive disorder tends to be a milder form of depression with bouts that linger and recur. You may know PDD by its former names, dysthymia or chronic major depression.
If you have PDD, you tend to have mild to moderate depression symptoms most days mixed in with brief periods when your mood is normal. Like other forms of depression, it can affect your:
- Behavior
- Mental and physical health
- Mood
- Thoughts
What Causes Persistent Depressive Disorder?
Mental health experts aren’t sure what causes persistent depressive order, although many believe it has to do with a chemical imbalance in the brain. For instance, the neurotransmitter serotonin is thought to affect your brain chemistry and influence mood.
PDD has been tied to lower levels of serotonin. An imbalance in other neurotransmitters might also be at play.
These include:
- Dopamine
- Epinephrine
- Gamma-aminobutyric acid (called GABA)
- Norepinephrine
Researchers have also found that key areas of the brain are smaller than normal in people with depression. These include moderate to large volume reductions in the frontal areas of your brain and hippocampus.
Who’s at Risk for Persistent Depressive Disorder?
Anyone at any point in their lives can have persistent depressive disorder. But emotional turmoil and physical trauma are thought to heighten your risk.
These include chronic or severe stress brought on by:
- Financial woes
- Losing your job
- Loved one’s passing
- Post-traumatic stress after you experience a traumatic event such as an assault or other crime perpetrated against you
- Relationship stressors, such as a divorce or breakup
- Serious illness
- Trauma to the brain, such as a concussion
Females are about twice as likely to have PDD than males. Unlike normal sadness, PDD symptoms linger long past the trauma that incited them.
What Are Common Persistent Depressive Disorder Symptoms?
The intensity of persistent depressive disorder symptoms can fluctuate, coming and going but never gone for more than 2 months. Adults battle with bouts of PDD for 2 years or longer.
For kids and teens, bouts of PDD come and go for at least a year. And instead of seeming depressed, they may seem irritable or moody. Some teens with depression may also be prone to eating disorders such as anorexia.
Along with feeling depressed or irritable, you must have at least 2 of these symptoms to be diagnosed with PDD:
- Decreased appetite or you overeat
- Fatigue or little energy
- Hopelessness
- Insomnia or sleeping too much
- Low self-esteem
- Trouble concentrating or making decisions
Persistent depressive disorder can impair your ability to stay employed or form and maintain close social bonds and intimate relationships. Others may see you as too negative or all doom and gloom to the point that you also feel this way about yourself most of the time.
Major Depressive Disorder vs. Persistent Depressive Disorder
Bouts of PDD often occur alongside major depressive disorder (MDD) — also called major or clinical depression. Countrywide, around 17% of people have MDD while roughly 3% have PDD.
The big difference between major depressive disorder vs. persistent depressive disorder is that MDD causes more severe and prolonged symptoms. To be diagnosed with MDD, you must have at least 5 depression symptoms from a lengthier list of criteria.
These include profound symptoms such as anhedonia. The term describes a loss of interest in most or all usual activities such as sex or other pleasurable hobbies.
Your MDD symptoms may feel relentless to the extent that you think of death or suicide as a release and may act on these thoughts.
How Is Persistent Depressive Disorder Diagnosed?
Along with performing a physical exam, your doctor talks with you about your:
- Symptoms
- Personal and family medical history
- Prescription and over-the-counter medicines, including the list of supplements, herbs and essential oils you currently take
They may use a depression questionnaire or screening tool to help guide your discussion and to better understand the type and severity of your depression. And, they may order lab tests to rule out other causes for persistent depressive disorder symptoms such as fatigue.
These include:
- Complete blood count (CBC)
- Chemistry panels such as a comprehensive metabolic panel (CMP)
- Urine pregnancy (for females at birth)
- Urine toxicology
- Thyroid-stimulating hormone (TSH) to test for thyroid issues such as hyperthyroidism
Which Persistent Depressive Disorder Treatments Help?
Treatment for persistent depressive disorder usually involves talk therapy alone or combined with medicines such as antidepressants. A care plan that includes both tends to be more effective than either treatment alone.
In general, the treatment approach that’s best for you often depends on your:
- Ability to tolerate various medicines used to treat PDD
- Other emotional or mental health issues you have
- Preferred and previous treatment methods
- Symptom severity and which ones you have
- Willingness and readiness to talk about the issues affecting your life and contributing to your symptoms
If your doctor determines that an antidepressant is warranted, a selective serotonin reuptake inhibitor (SSRI) may be tried first. Many people tolerate SSRIs well and find them effective. If these don’t help, a serotonin and norepinephrine reuptake inhibitor (SNRI) or tricyclic antidepressant (TCA) may be options.
Therapy for depression often involves talk therapy — also called psychotherapy or mental health counseling. But many types of mental health therapies can help with persistent depressive disorder.
These include:
- Cognitive behavioral therapy
- Canine- or equine-assisted therapy
- Interpersonal therapy
- Music or art therapy
You can try 1 or a mix of these therapies. The most important thing is finding a therapist that you can build trust and therapeutic rapport with.
Each session gives you an outlet for talking about your fears and what and why certain aspects of your life make you depressed, upset or anxious. A licensed therapist can help you:
- Boost your self-esteem
- Clear up distorted views you have of yourself or people and the world around you
- Cope with life stressors in healthy and effective ways
- Improve your social skills
Can Persistent Depressive Disorder Be Prevented?
Although you may not be able to prevent persistent depressive disorder, you can practice healthy lifestyle habits that support your mental and physical well-being. Aim to:
- Follow a nourishing eating plan such as the Mayo Clinic diet.
- Get routine physical activity and restful sleep.
- Limit drinking alcohol and stay away from illicit drugs.
- Practice stress-management techniques such as mindfulness meditation.
- Take your medicines as prescribed or recommended by your doctor, and report any undesired side effects or if doses no longer work well for you.
When Should I See My Doctor?
Talk with your doctor right away if you suspect you have persistent depressive disorder or notice your symptoms changing or getting worse.
And if you’re in urgent need of mental health support or are thinking about hurting yourself, call 988 to reach the nationwide Suicide & Crisis Lifeline.
You can also chat with a 988 counselor online. The lifeline is free to use and open 24 hours a day, 7 days a week.
Resource Links:
- “Depression (Major Depressive Disorder)” via Mayo Clinic
- “Depression Types, Causes, and Risk Factors” via HelpGuide
- “Dysthymia” via Johns Hopkins Medicine
- “Major Depression” via National Institute of Mental Health (NIMH)
- “Major Depressive Disorder” via StatPearls [Internet]
- “Persistent Depressive Disorder” via BMJ Best Practice
- “Persistent Depressive Disorder” via StatPearls [Internet]
- “Persistent Depressive Disorder (Dysthymia)” via Mayo Clinic
- “Persistent Depressive Disorder (Dysthymic Disorder)” via NIMH
- “Serotonin” via Cleveland Clinic
