What Is Persistent Depressive Disorder (PDD)?
Persistent depressive disorder (PDD) is a form of chronic depression.
It’s a relatively new diagnosis that combines the two earlier diagnoses dysthymia
and chronic major depressive disorder. Like other types of depression, PDD
causes continuous feelings of deep sadness and hopelessness. These feelings can
affect your mood and behavior as well as physical functions, including appetite
and sleep. As a result, people with the disorder often lose interest in doing
activities they once enjoyed and have difficulty finishing daily tasks.
These symptoms are seen in all forms of depression. In PDD,
however, the symptoms are less severe and longer lasting. They can persist for
years and may interfere with school, work, and personal relationships. The
chronic nature of PDD can also make it more challenging to cope with the
symptoms. However, a combination of medication and talk therapy can be
effective in treating PDD.
Symptoms of Persistent Depressive Disorder
The symptoms of PDD are similar to those of depression. However, the
key difference is that PDD is chronic, with symptoms occurring on most days for
at least two years. These symptoms include:
- persistent feelings of sadness and hopelessness
- sleep problems
- low energy
- a change in appetite
- difficulty concentrating
- a lack of interest in daily activities
- decreased productivity
- poor self-esteem
- a negative attitude
- avoidance of social activities
The symptoms of PDD often begin to appear during childhood or
adolescence. Children and teens with PDD may appear to be irritable, moody, or
pessimistic over an extended period. They may also display behavior problems,
poor performance at school, and difficulty interacting with other children in
social situations. Their symptoms may come and go over several years, and the severity
of them may vary over time.
of Persistent Depressive Disorder
The cause of PDD isn’t known. Certain factors may contribute to the
development of the condition. These include:
- a chemical imbalance in the brain
- a family history of the condition
- a history of other mental health conditions,
such as anxiety or bipolar disorder
- stressful or traumatic life events, such as the
loss of a loved one or financial problems
- chronic physical illness, such as heart disease
- physical brain trauma, such as a concussion
Persistent Depressive Disorder
To make an accurate diagnosis, your doctor will first perform a
physical examination. Your doctor will also perform blood tests or other
laboratory tests to rule out possible medical conditions that may be causing
your symptoms. If there’s no physical explanation for your symptoms, then your
doctor may begin to suspect that you have a mental health condition.
Your doctor will ask you certain questions to assess your current
mental and emotional state. It’s important to be honest with your doctor about
your symptoms. Your responses will help them determine whether you have PDD or
another type of mental illness.
Many doctors use the symptoms listed in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) to diagnose PDD. This manual is published by
the American Psychiatric Association. The PDD symptoms listed in the DSM-5
- a depressed mood almost every day for most of
- having a poor appetite or overeating
- difficulty falling asleep or staying asleep
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making
- feelings of hopelessness
For adults to be diagnosed with the disorder, they must
experience a depressed mood most of the day, nearly every day, for two or more
For children or teens to be diagnosed with the disorder, they
must experience a depressed mood or irritability most of the day, nearly every
day, for at least one year.
If your doctor believes you have PDD, they’ll likely refer you to a
mental health professional for further evaluation and treatment.
Persistent Depressive Disorder
Treatment for PDD consists of medication and talk therapy.
Medication is believed to be a more effective form of treatment than talk
therapy when used alone. However, a combination of medication and talk therapy
is often the best course of treatment.
PDD can be treated with various types of antidepressants, including:
- selective serotonin reuptake inhibitors (SSRIs),
such as fluoxetine
(Prozac) and sertraline (Zoloft)
- tricyclic antidepressants (TCAs), such as amitriptyline
(Elavil) and amoxapine
- serotonin and norepinephrine reuptake inhibitors
(SNRIs), such as desvenlafaxine (Pristiq) and duloxetine (Cymbalta)
You may need to try different medications and dosages to find an
effective solution for you. This requires patience, as many medications take
several weeks to take full effect.
Talk to your doctor if you continue to have concerns about
your medication. Your doctor may suggest making a change in dosage or
medication. Never stop taking your medication as directed without speaking to
your doctor first. Stopping treatment suddenly or missing several doses may
cause withdrawal-like symptoms and make depressive symptoms worse.
Talk therapy is a beneficial treatment option for many people with PDD.
Seeing a therapist can help you learn how to:
- express your thoughts and feelings in a healthy
- cope with your emotions
- adjust to a life challenge or crisis
- identify thoughts, behaviors, and emotions that
trigger or aggravate symptoms
- replace negative beliefs with positive ones
- regain a sense of satisfaction and control in
- set realistic goals for yourself
Talk therapy can be done individually or in a group. Support
groups are ideal for those who wish to share their feelings with others
who are experiencing similar problems.
PDD is a long-lasting condition, so it’s important to participate
actively in your treatment plan. Making certain lifestyle adjustments can
complement medical treatments and help ease symptoms. These remedies include:
- exercising at least three times per week
- eating a diet that largely consists of natural
foods, such as fruits and vegetables
- avoiding drugs and alcohol
- seeing an acupuncturist
- taking certain supplements, including St. John’s
wort and fish oil
- practicing yoga, tai chi, or meditation
- writing in a journal
Long-Term Outlook for People with Persistent
Since PDD is a chronic condition, some people never recover completely.
Treatment can help many people manage their symptoms, but it isn’t successful
for everyone. Some people may continue to experience severe symptoms that
interfere with their personal or professional lives.
Whenever you’re having a difficult time coping with your symptoms, call
the National Suicide Prevention Lifeline at 800-273-8255. There are people
available 24 hours per day, seven days a week to speak with you about any
problem you may be having. You can also visit their website for additional
help and resources.