What Is Persistent Depressive Disorder?

Persistent depressive disorder is a mood disorder with chronic symptoms similar to depression. The symptoms of persistent depressive disorder are usually less severe than major depressive disorder (clinical depression) and are known to last longer.

The disorder used to be called “dysthymia” or “dysthymic disorder,” but the name was changed in the latest edition of the Diagnostic and Statistic Manual of Mental Disorders (the DSM-5). The DSM-5 reflects the updated name of this mood disorder, which is a consolidation of chronic major depressive disorder and dysthymia. Here we take a closer look at persistent depressive disorder, its symptoms, causes and treatment.

What Is Persistent Depressive Disorder?

The meaning of dysthymia in the Greek language is “bad state of mind.” Updated to the current name, persistent depressive disorder, in the 5^th Edition of the DSM, the condition is considered one of two primary forms of depression, with major depressive disorder being the other one.

Persistent depressive disorder usually has fewer serious symptoms than major depressive disorder, but is known to have a long duration. In fact, persistent depressive disorder often involves an ongoing depressed mood for at least two years, along with at least two qualifying symptoms.

Persistent depressive disorder is considered a mood disorder (along with conditions such as bipolar disorder and major depressive disorder). The condition is known to affect women at twice the rate of men.

Persistent depressive disorder affects the way a person feels about themselves, negatively impacts the mood, and also influences a person’s thoughts. Having a mood disorder—such as persistent depressive disorder—is different than simply experiencing sadness or having a low mood. It involves a specific course of disease that a person cannot simply snap out of or shake off as a bad day. Rather, people with a mood disorder must usually get treatment in order to feel better.

While persistent depressive disorder is considered a milder form of depression, people with this disorder can still experience periodic bouts of major depression.

Symptoms

When it comes to the symptoms of any mental disorder, including persistent depressive disorder, one must look at the DSM-5 criteria, which spells out what symptoms, traits, and characteristics must be present in order to be diagnosed with a mental illness.

The DSM-5 defines persistent depressive disorder as a long-term mood disorder with an insidious onset with at least two years of a depressed mood. The condition must also result in significant distress and impairment in functioning in important areas of your life.

The symptoms of persistent depressive disorder may include:

• A sad, anxious or empty mood that lasts
• Feelings of hopelessness
• Trouble with concentration
• Inability to easily make decisions
• Impairment of the normal thinking process
• Low energy level
• Fatigue
• An increase or a decrease in appetite that impacts a person’s body weight
• Insomnia (inability to sleep)
• Early morning waking
• Sleeping too much
• Low self esteem

Qualifying Symptoms

Although there are many different symptoms that a person with persistent depressive disorder may have, there are some specific qualifiers that must be present to be formally diagnosed with this type of depression. For example, an adult with persistent depressive disorder must have a depressed mood for at least two years to qualify for a diagnosis (for an adolescent or a child, the length of a depressed mood is just one year). In addition to having a depressed mood, a person must have at least two of the qualifying symptoms, including:

• Overeating
• Poor Appetite
• Insomnia
• Excessive sleep
• Low energy
• Fatigue
• Low self esteem
• Poor concentration
• Indecisiveness
• Hopelessness.

People with persistent depressive disorder become accustomed to their mild symptoms and often they do not seek help, therefore, it’s common that a person does not get diagnosed. If you have at least two of the above symptoms, along with a depressed mood for at least two years (if you are an adult) it’s important to seek a medical evaluation.

Diagnosis

Oftentimes, a diagnosis of persistent depressive disorder is made along with other medical or mental health conditions, such as substance abuse or an anxiety disorder.  The diagnosis process may include:

• A psychiatric evaluation: A medical history and psychiatric examination that involves in-depth questions about your symptoms (such as your thoughts, feelings, and behaviors). Sometimes questions are given in a written form.
• A family history: This is used to decipher whether there is any mental illness in your family (depression is often known to run in the family)
• A diagnostic evaluation: The information gathered during the psychiatric evaluation is compared with the DSM-5 criteria in established by the American Psychiatric Association.

Causes

Although there is no one cause of depressive disorders including persistent depressive disorder, experts feel that the condition may be linked to chemical imbalances in the brain. Several factors are linked with persistent depressive disorder, including:

• Environmental factors: Such as childhood parental loss or separation.
• Temperamental factors: Such as negative affective and thinking patterns.
• Biological factors: Such as a person’s brain chemistry
• Genetic factors: Depression runs in families, there may be a genetic link to the condition, but no specific genes have been linked with persistent depressive disorder yet.

Persistent depressive disorder is linked with long-term (chronic) stress as well as with trauma.

Treatment

Medication

There are many different types of antidepressants available today that are effective in treating depression. One drawback to medication is that it may take several weeks for these drugs to begin working, to lessen symptoms. Even if they don’t seem to work at first, it’s very important to continue taking antidepressants, as ordered by the prescribing healthcare provider.

These drugs can have unpleasant side effects (depending on which type of antidepressant you are taking). Be sure to report any side effects to your healthcare provider. Also, keep in mind that many side effects go away in time. If they do not subside, your healthcare provider may order a different type of antidepressant.

Psychotherapy

There are various types of therapy that are often employed when a person has persistent depressive disorder. Therapy focuses on helping a person with persistent depressive disorder change distorted self-concepts and one’s perception of the environment. Psychotherapy also aims to help a person with persistent depressive disorder to work on improving relationships and effectively managing stress. Common types of psychotherapy for persistent depressive disorder include:

• Cognitive behavioral therapy (CBT): A form of psychotherapy that has been found to be effective for a wide range of problems.
• Interpersonal therapy: This primarily focuses on the impact of your current relationships on your mood.
• Psychodynamic psychotherapy: This examines underlying conflicts and unconscious dynamics that may be contributing to your depression.

Because persistent depressive disorder is considered chronic, long-term therapy may be needed.

Coping

There are many things that you can do yourself that will help alleviate some of the symptoms of depression, this includes many lifestyle changes such as:

• Seeking professional help
• Eating a healthy diet
• Trying to get enough sleep
• Setting small attainable goals and continue setting small ones until bigger goals are met.
• Trying to connect with friends and family as much as possible
• Avoiding the use of alcohol (and drugs)
• Addressing negative thinking patterns
• Engaging in a regular exercise program (with the okay from your healthcare provider)

A Word from Verywell

Keep in mind that persistent depressive disorder is a serious illness and treatment is available. With an accurate diagnosis and proper treatment, most people can learn to live with persistent depressive disorder, and many get relief from their symptoms. If you have symptoms of persistent depressive disorder, be sure to talk to your primary doctor; don’t be afraid to ask for a referral to a mental health professional to get a thorough evaluation/diagnostic assessment. This is the first step to being proactive about your mental health.