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Persistent Depressive Disorder

dr. martin at his desk with a patientAndrew L. Martin, PsyD

Persistent Depressive Disorder (once called Dysthymia), or PDD, is a relatively long-lasting, milder form of depression, compared to Major Depressive Disorder.1 Because PDD begins gradually and lasts so long, many sufferers may not be aware of their symptoms until asked directly about them.

A medical or mental health provider must make the diagnosis of PDD. Some of the criteria providers use to make a PDD diagnosis include2:

  1. Depressed mood (“sad,” or “down in the dumps”), for at least two years
  2. The presence, when depressed, of two or more of:
  3. Poor appetite or overeating
  4. Sleeping too little or too much
  5. Low energy level or tiring out easily
  6. Feeling bad about oneself
  7. Difficulty concentrating or making decisions
  8. Feeling hopeless

Starting the diagnosis process with your primary care provider can be helpful, because they can rule out other problems that cause depressive symptoms (e.g., medication reaction, thyroid condition, etc.).

PDD is common. About 2% of the population meet criteria for PDD in any given year. PDD typically begins in childhood, adolescence, or early adulthood. The earlier the onset, the greater is the risk of also having substance use problems. Children who experience parental loss or separation are at greater risk, as are children with conduct disorder.

Treatment for Persistent Depressive Disorder can involve psychotherapy, medication, or both3.

  1. Treatment recommendations for treating depression in children include both cognitive-behavioral therapy and medication, with no clear evidence that one is better than the other. If considering medication, research suggests beginning with a trial of fluoxetine.
  2. Many types of therapy are effective in treating adults with depression, including cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), mindfulness-based cognitive therapy, psychodynamic therapy, and supportive therapy. If considering medication, second-generation antidepressants have been found most helpful. If considering combined treatment, CBT or IPT plus a second-generation antidepressant have been found most effective.
  3. For older adults, two types of psychotherapy have been found most effective – cognitive-behavioral therapy, and group life-review/reminiscence therapy. Interpersonal psychotherapy has been found effective as well, when combined with a second-generation antidepressant medication.

1 National Institutes for Mental Health. Persistent Depressive Disorder (Dysthymic Disorder). https://www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder.

2American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

3 American Psychological Association. Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts. https://www.apa.org/depression-guideline.

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