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Persistent depressive disorder

Persistent depressive disorder is a chronic (ongoing) type of depression in which a person's moods are regularly low. But, symptoms are not as severe as with major depression.

Persistent depressive disorder used to be called dysthymia.

Alternative Names

PDD; Chronic depression; Depression - chronic

Causes

The exact cause of persistent depressive disorder (PDD) is unknown. It tends to run in families. PDD occurs more often in women.

Most people with PDD will also have an episode of major depression at some point in their lives.

Older people with PDD often have difficulty caring for themselves, isolation, or medical illness. 

Symptoms

The main symptom of PDD is a low, dark, or sad mood on most days for at least 2 years. In children and teens, the mood can be irritable instead of depressed and lasts for at least 1 year.

In addition, two or more of the following symptoms are present almost all of the time:

  • Feelings of hopelessness
  • Too little or too much sleep
  • Low energy or fatigue
  • Low self-esteem
  • Poor appetite or overeating
  • Poor concentration

People with PDD will often take a negative or discouraging view of themselves, their future, other people, and life events. Problems often seem hard to solve.

Exams and Tests

Your health care provider will take a history of your mood and other mental health symptoms. The health care provider may also check your blood and urine to rule out medical causes of depression.

Treatment

There are a number of things you can try to improve PDD:

  • Get enough sleep.
  • Follow a healthy, nutritious diet.
  • Take medicines correctly. Discuss any side effects with your doctor.
  • Learn to watch for early signs that your PDD is getting worse. Have a plan for how to respond if it does.
  • Try to exercise regularly.
  • Look for activities that make you happy.
  • Talk to someone you trust about how you are feeling.
  • Surround yourself with people who are caring and positive.
  • Avoid alcohol and illegal drugs. These can make your mood worse over time and impair your judgment.

Medicines are often effective for PDD, though they sometimes do not work as well as they do for major depression and they may take longer to work.

Do not stop taking your medicine on your own, even if you feel better or have side effects. Always call your doctor first.

When it is time to stop your medicine, your doctor will instruct you on how to slowly reduce the dose instead of stopping suddenly.

People with PDD may also be helped by some type of talk therapy. Talk therapy is a good place to talk about feelings and thoughts, and to learn ways to deal with them. Types of talk therapy include:

  • Cognitive behavioral therapy (CBT), which helps you learn to be more aware of your symptoms and what makes them worse. You will be taught problem-solving skills.
  • Insight-oriented or psychotherapy, which can help people with PDD understand factors that may be behind their depressive thoughts and feelings.

Joining a support group for people who are having problems like yours can also help. Ask your therapist or health care provider to recommend a group.

Outlook (Prognosis)

PDD is a chronic condition that can last for years. Though many people completely recover, others continue to have some symptoms, even with treatment.

PDD also increases the risk of suicide.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

  • You regularly feel depressed or low
  • Your symptoms are getting worse

Call for help right away if you or someone you know develops signs of suicide risk:

  • Giving away belongings, or talking about going away and the need to get "affairs in order"
  • Performing self-destructive behaviors, such as injuring themselves
  • Suddenly changing behaviors, especially being calm after a period of anxiety
  • Talking about death or suicide
  • Withdrawing from friends or being unwilling to go out anywhere

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013. 

Fava M, Cassano P. Mood disorders: major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008:chap 29.

Updated: 9/2/2014

Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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