Persistent depressive disorder
PDD; Chronic depression; Depression - chronic; Dysthymia
Persistent depressive disorder (PDD) is a chronic (ongoing) type of depression in which a person's moods are regularly low.
Persistent depressive disorder used to be called dysthymia.
Causes
The exact cause of PDD is unknown. It can 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 may have difficulty caring for themselves, signs of cognitive limitations, struggle with isolation, or have medical illnesses.
If you often feel sad, blue, unhappy, miserable, or down in the dumps, you may have depression. Let's talk about depression, and what you can do to get out of your funk. Depression often runs in families. This may be due to your genes, passed down by your parents and grandparents, the behaviors you learn at home, or both. Even if your genetic makeup makes you more likely to develop depression, a stressful or unhappy life event may triggers the depression. Depression can have many causes, including internal factors like genetics, or negative personality. External factors, substance misuse, or trauma and loss. Common triggers include alcohol or drug use, and medical problems long-term pain, cancer or even sleeping problems. Stressful life events, like getting laid off, abuse at home or on the job, neglect, family problems, death of a loved one, or divorce, can send someone spiraling into depression. There are three main types of depression; major depression, atypical depression and dysthymia. To be diagnosed with major depression, you must demonstrate 5 or more of the primary symptoms for at least two weeks. Atypical depression occurs in about a third of patients with depression, with symptoms including overeating, oversleeping, and feeling like you are weighed down. Dysthymia is a milder form of depression that can last for years if not treated. Other forms include the depression that is part of bipolar disorder, postpartum depression, occurring after a woman gives birth, premenstrual dysphoric disorder, occurring 1 week before a woman's menstrual period and seasonal affective disorder, occurring in both males and females during the fall and winter seasons. No matter what type of depression you have and how severe it is, some self-care steps can help. Get enough sleep if you can, exercise regularly, and follow a healthy, nutritious diet. Avoid alcohol and recreational drugs. Get involved in activities that make you happy and spend time with family and friends. If you are religious, talk to a clergy member. Consider meditation, tai chi, or other relaxation methods. If you are depressed for 2 weeks or longer, contact your doctor or other health professional before your symptoms get worse. Treatment will depend on your symptoms. For mild depression, counseling and self-care may be enough. Either psychotherapy or antidepressant medicines may help, but they are often more effective when combined. Vigorous exercise and light therapy could offer significant benefit alone or in combination. Healthy lifestyle habits can help prevent and treat depression, and reduce the chances of it coming back. Talk therapy and antidepressant medication can also make you less likely to become depressed again. In fact, talk therapy may help you through times of grief, stress, or low mood. In general, staying active, making a difference in the life of others, getting outside and keeping in close contact with other people is important for preventing depression.
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. Your provider may also check your blood and urine to check for 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 provider.
- 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're 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 may take longer to work.
Do not stop taking your medicine on your own, even if you feel better or have side effects. Always contact your provider first.
When it's time to stop your medicine, your provider 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. It can also help to understand how your PDD has affected your life and to cope more effectively. 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, including dealing with negative thinking.
- Insight-oriented therapy 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 provider to recommend a group.
Outlook (Prognosis)
PDD is a chronic condition that can last for years. Many people recover fully while others continue to have some symptoms, even with treatment.
PDD also increases your risk of suicide.
When to Contact a Medical Professional
Contact your 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 "their 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
If you or someone you know is thinking about suicide, call or text 988 or chat
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
References
American Psychiatric Association. Persistent depressive disorder. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: American Psychiatric Association Publishing; 2022.
Fava M, Mischoulon D, Cassano P, Papakostas GI, Stem TA. Depressive disorders. In: Stern TA, Wilens TE, Fava M, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 28.
Schramm E, Klein DN, Elsaesser M, Furukawa TA, Domschke K. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry. 2020;7(9):801-812. PMID: 32828168
Version Info
Last reviewed on: 7/17/2024
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
