​​What is Persistent Depressive Disorder? (Symptoms, Causes, and Treatment)

Have you ever been described as gloomy or incapable of having fun? Have those accusations hit a little too close to home because you truly do feel like it can be difficult for you to relax or have fun like other people in your life? If so, there’s a chance you could be struggling with a condition called persistent depressive disorder, or dysthymia. 

Persistent depressive disorder (PDD) is a chronic form of depression that frequently begins during childhood or adolescence and can continue for life. PDD has similar symptoms to major depressive disorder—irritability, fatigue, low self-esteem, hopelessness—but they tend to be milder and last for years instead of weeks. The biggest indicator that someone might be experiencing PDD is that they’ll experience symptoms for most of the day, on most days, over an extended period of time.

Below, we’ve broken down the research on symptoms, treatments, and best practices to empower you to better understand persistent depressive disorder for yourself or a loved one. 

Persistent depressive disorder signs and symptoms 

Moodiness, irritability, and fatigue are all potential signs of PDD in teenagers. Importantly, these symptoms will occur on most days for at least one year, and can’t be absent for more than two consecutive months to meet the criteria for PDD. In adults, symptoms should last for two years to qualify as PDD. 

Aside from feelings of depression, an official PDD diagnosis requires two or more of the following symptoms:

• Lack of appetite or overeating
• Sleeping too much or too little
• Excessive anger
• Low self-esteem
• Loss of interest in daily activities
• Hopelessness
• Trouble concentrating and making decisions
• Disinterest in social activities

How does persistent depressive disorder compare to major depressive disorder? 

A person with major depression will typically “cycle” through periods of depression and then be symptom-free for extended periods of time, while those living with PDD will experience persistent symptoms for years, according to the National Alliance on Mental Illness.

Major depression seems to be more prevalent than persistent depressive disorder in the United States. According to a 2020 report, seven percent of U.S. adults experienced a major depressive episode in the past year, while a 2003 report noted that approximately 1.5 percent of U.S. adults had persistent depressive disorder in the past year.

Persistent depressive disorder causes and risk factors

Similar to other forms of depression, the exact cause of persistent depressive disorder is unknown, but research suggests that it might stem from some of the following genetic and circumstantial factors:

• Family history of persistent depressive disorder or any other serious mental health condition
• Abuse, neglect, or other forms of physical or emotional trauma 
• Loss of a parent, friend, or loved one
• High amounts of stress
• Developmental or learning problems
• A history of smoking, alcohol use, high BMI, poor sleep, and/or sedentary behavior
• Chronic physical health conditions like diabetes or heart disease

Is PDD preventable?

While there’s no proven way to prevent persistent depressive disorder, early intervention can help to ease symptoms and improve overall quality of life. And if you do have PDD, there are steps you can take to hopefully make the condition more manageable. 

• Take medications as prescribed and monitor for potential side effects
• Eat a balanced diet rich in fruit, vegetables, fish, and lean meat
• Exercise regularly 
• Limit alcohol and avoid recreational drugs

Persistent depressive disorder diagnosis and treatment

If you’ve been living with PDD for awhile, you might have grown to associate some of the symptoms with your personality. However, we’re here to let you know that doesn’t have to be the case. With an official diagnosis—as well as a combination of medication and therapy—it’s possible to mitigate some of the symptoms and better manage the condition.

The process for diagnosing persistent depressive disorder is very similar to that of major depressive disorder. To start, your healthcare provider will conduct a physical exam and blood work in order to rule out any underlying health problems that could be responsible for the symptoms. You’ll also be asked to complete a self-reported psychiatric evaluation, such as a Patient Health Questionnaire-9 (PHQ-9), so that your provider can better understand your symptoms, thoughts, feelings and behaviors. This history is especially important for a PPD diagnosis since it requires at least one year of symptoms. 

Medication for PDD

Antidepressants are prescription medications that are frequently used to treat different types of depression, including persistent depressive disorder. The goal is to alleviate symptoms and prevent depression from returning. We’ve listed several categories of antidepressants below, but it’s best to speak with a healthcare provider to learn more.

• Serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)

Therapy for PDD

A study that followed 23 people with PDD for 9 years found that one of the most important components of treatment and recovery is having a team of healthcare providers that you can learn from and trust. For those individuals, this meant education to better understand their condition, tools to show themselves acceptance and compassion, and working with different therapists and psychiatrists until they found one that they connected with.

The team at Charlie Health operates with a similar philosophy. Our virtual intensive outpatient therapy program’s goal is to offer treatment plans based on specific needs and preferences. Those living with persistent depressive disorder can benefit from trying cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) skills, or mindfulness practices as they explore their own unique path toward recovery.

Below are some additional ways to help anyone who is struggling with depression to improve their quality of life.

Focus on what brings you joy

This can be easier said than done for individuals with PDD, but focusing on simple pleasures can be a helpful coping mechanism. Whether it’s spending time outdoors, seeing a movie, or nurturing hobbies like music or art—think about what makes you feel like you. 

Peer support groups

Support groups are an opportunity to connect with and learn from other people who are living with persistent depressive disorder. The National Alliance on Mental Illness (NAMI) offers various resources, including peer support groups and support groups for family members.

Helplines

The most important thing to remember is that you are never alone. If you or someone you know is experiencing a mental health crisis related to depression, the National Suicide Prevention Lifeline is always available. Call them at 988 or text the Crisis Text Line at HOME to 741741.

Find community and support with Charlie Health

Persistent depressive disorder can be a difficult condition to navigate on your own. Charlie Health’s intensive outpatient program (IOP) connects each client with a licensed therapist based on their individual needs, preferences, background, and experiences to promote healing in a safe, supportive space. Taking that initial step can feel daunting, but seeking support will make life so much brighter.

To learn more, read about major types of depression in teens and young adults on our blog.