Persistent Depressive Disorder

Persistent depressive disorder is a long-lasting form of depression where feelings of sadness and emptiness persist for years rather than weeks or months, affecting daily life, relationships, and the ability to find joy even during happy moments.

Table of contents

• What is persistent depressive disorder?
• Other names for this condition
• Signs and symptoms
• Causes and risk factors
• How is it diagnosed?
• Treatment options
• Living with the condition

What is persistent depressive disorder?

Persistent depressive disorder is a continuous, long-term form of depression that affects how you feel, think, and function in daily life. Unlike episodes of major depression that may come and go, this type of depression persists for an extended period, creating a steady pattern of low mood that becomes part of everyday life.^[1]

The condition is defined by a depressed mood that occurs most of the day, for more days than not, lasting at least two years in adults or one year in children and adolescents.^[2] While persistent depressive disorder may not always be as severe as major depression, its long duration makes it particularly challenging to manage. Many people with this disorder describe feeling as though they have been depressed for as long as they can remember, or that depression has become part of their personality.^[5]

This disorder can begin early in life and often becomes chronic, meaning it lasts for a long time or keeps returning. Because the symptoms develop gradually and persist for years, people with persistent depressive disorder may not realize they have a medical condition that can be treated. They might simply believe that feeling down is just who they are.^[5]

Other names for this condition

Dysthymia, Dysthymic disorder, Chronic depression

Persistent depressive disorder was previously known as dysthymia or dysthymic disorder. The name was changed when the diagnostic manual was updated in 2013, combining what were previously called dysthymic disorder and chronic major depressive disorder into one diagnosis.^[8]

Signs and symptoms

The main symptom of persistent depressive disorder is a low, dark, or sad mood that lasts most days for an extended period. In children and adolescents, this mood may appear as irritability rather than sadness, meaning they may seem easily annoyed, impatient, or angry.^[4]

People with this condition typically experience several additional symptoms along with the persistent low mood. These include feelings of sadness, emptiness, or feeling down that seem to never fully lift. There is often a loss of interest in daily activities that once brought pleasure or satisfaction. Many people describe feeling tired and lacking energy most of the time, making even routine tasks feel exhausting.^[1]

Low self-esteem, which means having a poor opinion of yourself, is common. People with persistent depressive disorder often criticize themselves harshly or feel they are not capable of accomplishing things. They may have trouble focusing their thoughts clearly and struggle to make decisions, even about small matters. Problems with completing tasks well and on time are frequent, which can affect work or school performance.^[2]

Changes in eating and sleeping patterns are also typical symptoms. Some people lose their appetite, while others find themselves overeating. Similarly, some have trouble falling or staying asleep, while others sleep too much but still feel tired. Feelings of hopelessness about the future are common, as is a tendency to view oneself, other people, and life events in a negative or discouraging way. Problems often seem harder to solve than they actually are.^[4]

The symptoms of persistent depressive disorder usually come and go over a period of years, with the intensity changing over time. However, symptoms typically do not disappear completely for more than two months at a time. In some cases, episodes of major depression may occur on top of the persistent depressive disorder, a situation sometimes called “double depression.”^[1]

Because of the long-lasting nature of these symptoms, they can interfere significantly with relationships, school, work, and the ability to handle daily activities. People with this disorder may find it hard to feel upbeat even during happy occasions. Others might describe them as having a gloomy personality, constantly complaining, or being unable to have fun.^[1]

Causes and risk factors

The exact cause of persistent depressive disorder is not fully understood by scientists. Most likely, it results from a combination of biological, psychological, and social factors working together.^[2] Depression appears to be caused by abnormal connections between different parts of the brain, preventing brain cells from communicating with each other as they should.^[2]

Like other forms of depression, persistent depressive disorder tends to run in families. If you have a biological family member with persistent depressive disorder, you may be more likely to develop it yourself, suggesting that genetics play a role.^[2]

This condition affects women more often than men. However, in men it may be underdiagnosed because men are less likely to talk to their doctors about their mood or emotional struggles.^[5]

Various life experiences may increase the risk of developing persistent depressive disorder. Some people with the condition have experienced a major loss in childhood, such as the death of a parent. Others describe being under chronic stress for extended periods. Research has found that greater childhood adversity and maltreatment are factors associated with chronic depression.^[8] However, it is often difficult to determine whether people with the disorder are under more stress than others, or if the disorder causes them to perceive or respond to stress differently.^[5]

How is it diagnosed?

There are no blood tests or imaging scans that can diagnose persistent depressive disorder. Instead, the diagnosis comes from discussions with a healthcare provider about your symptoms, thoughts, feelings, and behaviors.^[2] Many primary care doctors can recognize when a patient may have some form of depression and may refer them to a mental health professional such as a psychologist or psychiatrist for a full evaluation.^[5]

When evaluating for persistent depressive disorder, your healthcare provider will conduct a physical exam, which is an examination of your body, and ask detailed questions about your health to determine what may be causing your symptoms. In some cases, depression may be linked to an underlying physical health problem.^[9]

Your provider may also recommend laboratory tests to rule out other medical conditions that can cause depressive symptoms. For example, a blood test might check whether your thyroid gland is not making enough thyroid hormone, a condition called hypothyroidism, which can cause symptoms similar to depression.^[9]

A psychological evaluation, which is an assessment of your mental and emotional state, is a key part of diagnosis. This includes talking about your thoughts, feelings, and behavior patterns. You may be asked to complete a questionnaire. This evaluation helps determine whether you have persistent depressive disorder or another condition that can affect mood, such as major depression, bipolar disorder, or seasonal affective disorder.^[9]

For a diagnosis of persistent depressive disorder in adults, the depressed mood must occur most of the day, for more days than not, for at least two years. In children and adolescents, the mood can be irritable instead of depressed, and the duration requirement is at least one year.^[9] Along with the persistent low mood, at least two additional symptoms must be present almost all the time, such as changes in appetite, sleep problems, low energy, low self-esteem, poor concentration, or feelings of hopelessness.^[4]

It is not necessary to wait for two years before seeking help. Anyone experiencing persistent or distressing symptoms should talk to a healthcare provider, as early treatment can prevent symptoms from worsening.^[5]

Treatment options

The most effective treatment for persistent depressive disorder typically combines medication and talk therapy, also called counseling. This combination approach has been shown to work better than either treatment alone.^[2] What your healthcare provider recommends will depend on factors such as how severe your symptoms are, your personal preferences, and any previous treatments you may have tried.^[9]

Antidepressants are prescription medications that can help relieve depression by affecting chemical messengers in the brain. There are many different types of antidepressant medications available for treating depression. You may need to take medication for a month or longer before you notice a significant difference in how you feel. It is important to continue taking the medication exactly as your healthcare provider prescribes, even if you start feeling better. If you experience side effects, let your provider know rather than stopping the medication on your own.^[2]

Sometimes medications for persistent depressive disorder do not work as well as they do for major depression and may take longer to show effects. When it is time to stop your medication, your provider will instruct you on how to slowly reduce the dose rather than stopping suddenly.^[4]

Several types of talk therapy have been shown to be effective for persistent depressive disorder. Cognitive behavioral therapy, often called CBT, is particularly helpful. In CBT, a therapist or psychologist helps you examine your thoughts and emotions and understand how they affect your actions. This therapy teaches you to recognize negative thinking patterns and develop more positive, realistic ways of thinking. You also learn problem-solving skills that can help manage symptoms.^[2]

Interpersonal therapy is another structured approach that focuses on current problems and the relationships in which they occur. Success in solving interpersonal conflicts through this therapy is associated with improved symptoms.^[11] Psychodynamic psychotherapy is a longer-term approach that helps people understand the factors behind their depressive thoughts and feelings, including how relationships and past experiences may influence current symptoms.^[11]

In addition to professional treatment, there are several self-care strategies that can help improve persistent depressive disorder. Getting enough sleep on a regular schedule is important. Following a healthy, nutritious diet supports both physical and mental health. Trying to exercise regularly, even if just light activity, has been shown to help with depressive symptoms. Looking for activities that bring happiness or satisfaction, even small ones, can make a difference. Talking to someone you trust about how you are feeling provides support. Surrounding yourself with people who are caring and positive is beneficial. It is important to avoid alcohol and illegal drugs, as these can make mood worse over time and impair judgment.^[4]

Joining a support group for people who are experiencing similar problems can also be helpful. Your therapist or provider can recommend appropriate groups in your area.^[4]

Living with the condition

Persistent depressive disorder is a chronic condition that can last for years. With appropriate treatment combining medication, talk therapy, and healthy lifestyle changes, many people can manage the disorder and feel significantly better.^[2] However, even with treatment, some people continue to have some symptoms. The chronic nature of this condition means that long-term treatment is often advisable.^[11]

Because of the high rate of symptoms returning, follow-up care is important. Patients who have improved with medication should be encouraged to continue treatment and follow-up visits for at least six months before considering any reduction in medication. Many people benefit from continuing treatment for longer periods.^[11]

It is important to learn to watch for early signs that symptoms may be getting worse and to have a plan for how to respond if this happens. If symptoms come back or do not improve with treatment, talking to your healthcare provider is essential.^[4]

Persistent depressive disorder increases the risk of suicidal thoughts and behaviors. If you regularly feel depressed or low, or if your symptoms are getting worse, contact your healthcare provider. Call for help right away if you or someone you know shows signs of suicide risk, such as talking about death or suicide, giving away belongings, performing self-destructive behaviors, suddenly changing behavior after a period of anxiety, or withdrawing from friends.^[4]

Researchers estimate that 1.5% of U.S. adults had persistent depressive disorder in the past year, and 2.5% of U.S. adults have experienced it at some time in their lives.^[2] This means that persistent depressive disorder is common, and effective help is available for those who seek it.