What to Know About Persistent Depressive Disorder (PDD)

Anna Giorgi
·9 min read

A Combination of Dysthymia and Chronic Major Depressive Disorder

Medically reviewed by Aleesha Grier, PsyD

Persistent depressive disorder (PDD) is a common type of chronic depression. Symptoms are often mild or moderate. This problem lasts for two years or longer.

"Persistent depressive disorder" is a somewhat new term. It is used to combine what was called dysthymia and chronic major depressive disorder in the past.

As with other types of chronic depression, people with this problem deal with feelings of deep sadness. They often live with a low, dark mood that may last for years. PDD is less severe but may last longer than major depressive disorder (MDD).

Most people with PDD can manage symptoms using prescribed drugs and talk therapy. Without treatment, people with PDD have a higher risk of major depression.

This article includes all you need to know about PDD. It describes PDD symptoms, risk factors, diagnosis, treatment, and outlook.

<p>fotostorm / Getty Images</p>

fotostorm / Getty Images

Depression Symptoms and PDD

Persistent depressive disorder causes a continuous feeling of low-level sadness or dark feelings over a long period. These symptoms typically develop slowly, beginning in childhood or young adulthood.

PDD tends to be milder than episodes that occur in major depressive disorder (also called clinical depression). In addition, PDD symptoms are constant and last for years, while major depressive disorder has repeated episodes of depression and recovery.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the standardized criteria for diagnosing persistent depressive disorder. A person with PDD has all the following characteristics:

  • Depressed mood for most of the day, for more days than not, lasts for at least two years in adults and at least one year in children.

  • While depressed, the individual has two or more of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, or feelings of hopelessness.

  • During the two-year period in which symptoms occur, the symptoms do not stop for longer than two months at a time.

  • Symptoms cause clinically significant distress or impairment in important areas of functioning.

  • Symptoms are not due to the effects of a medication or general medical condition.

  • Symptoms are not linked to a manic episode or a chronic psychotic disorder such as schizophrenia.

Learn More: An Overview of the DSM-5

What Causes PDD?

Scientists do not know the exact causes of PDD. Research indicates that it likely involves a combination of genetic, biological, environmental, and psychological factors.

Factors that can contribute to persistent depressive disorder include the following:

  • Biological factors: Having physical differences in your brain may affect the development of PDD.

  • Brain chemistry: Research indicates that changes or reductions in neurotransmitters including serotonin, norepinephrine, or dopamine, may lead to the development of depression. These neurotransmitters regulate how your brain changes and develops over time.

  • Genetic traits: Persistent depressive disorder is more common among people whose first-degree blood relatives, such as a parent or sibling, have this problem.

  • Life events: The loss of a loved one, financial problems, or other issues that trigger a high level of stress can enable PDD in some people.

Risk Factors for PDD

It is difficult to predict who will develop PDD. For many people, the problem begins early in life, often as early as childhood, adolescence, or young adulthood. Having the following risk factors seems to increase your chances of developing PDD:

  • Being female

  • Having a first-degree blood relative with major depressive disorder or another type of depressive disorder

  • Personality traits such as low self-esteem, negativity, extreme self-criticism, extreme dependence, and a predisposition to always think the worst will happen

  • A chemical imbalance in your brain

  • A traumatic or stressful life event

  • History of other mental health disorders such as a personality disorder or anxiety

Learn More: Is Depression Genetic?

Diagnosing PDD

If you have feelings of hopelessness, sadness, or emptiness for a long time, you may think that these feelings are simply part of your life. However, getting an accurate diagnosis can help you improve symptoms and live a better quality of life.

While there are no depression tests for identifying PDD, the following evaluations are used to reach a diagnosis:

  • Physical examination and comprehensive history

  • Laboratory tests to identify any underlying medical conditions that may be contributing to depressive symptoms such as complete blood count (CBC), differential blood count, basic metabolic studies, thyroid-function test, test for levels of B12 and folate, testosterone levels (men), Lyme titer, rapid plasma reagin test (syphilis test), human immunodeficiency virus (HIV) test, and urine and serum toxicological screenings (tests that screen for drugs that could be sources of overdose)

  • Medication history of prescribed and illegal substances that can cause depressive symptoms, such as beta-blockers, barbiturates, anabolic steroids and corticosteroids, statins, some antibiotics, marijuana, sedatives, opiates, and cocaine

  • Psychiatric evaluation: Questions about your symptoms, such as your thoughts, feelings, and behaviors, often using the Patient Health Questionnaire-9 (PHQ-9) and Ask Suicide-Screening questionnaire

  • Diagnostic evaluation: Questions concerning your symptoms compared to the criteria for persistent depressive disorder established in the DSM-5

Your healthcare provider will also consider a differential diagnosis to distinguish a persistent depressive disorder from other disorders with similar features. The differential diagnosis for PDD includes the following:

Learn More: How Persistent Depressive Disorder Is Diagnosed

How PDD Is Treated

PDD treatment involves an approach that uses a combination of medication and psychotherapy individualized to the type and severity of your symptoms.

Research indicates that medication and psychotherapy together are more effective than using either treatment alone. This combination has been linked with significantly higher rates of improvement, especially in more chronic, severe, and complex cases of depression versus using one form of treatment alone.

Medication

Medication for PDD involves the use of an antidepressant. These drugs work by impacting your brain's neurotransmitter system, which involves the chemicals and circuits that pass signals along nerve routes to your brain.

Several types of antidepressants treat PDD. Factors such as your personal and family histories of medication response, your preference, drug cost, and drug accessibility under insurance coverage are also considered.

It may take some time for you to find the drug that improves your symptoms with the least side effects. You may notice improvement as early as within two weeks, though full relief of symptoms may not occur until at least eight to 12 weeks.

The following medications include those most often used to treat persistent depressive disorder:

Selective serotonin reuptake inhibitors (SSRIs), including the following, which are typically used as a first-line treatment, may be prescribed:

Serotonin-norepinephrine reuptake inhibitors (SNRIs), including the following, may be prescribed:

  • Effexor (venlafaxine)

  • Cymbalta (duloxetine)

  • Pristiq (desvenlafaxine)

Atypical antidepressants, such as the following, may be prescribed:

Therapy

Psychotherapy, or talk therapy, is regarded as the first-line therapy treatment for mild to moderate depression like PDD. The type of psychotherapy you receive depends on your situation, including your symptoms and preference as well as a counselor's background and availability.

Research indicates no significant differences among the various types of psychotherapy in treating depression. The various types of psychotherapy used include, but are not limited to, the following:

  • Cognitive behavioral therapy (CBT): Therapy in which you work to identify and address thought patterns and beliefs that affect your life negatively

  • Interpersonal psychotherapy (IPT): Therapy that focuses on relieving symptoms by improving your present social relationships and interactions

  • Psychodynamic therapy: Therapy that uncovers unconscious thoughts, often based on the impact of childhood development that may be affecting your current behaviors, emotions, and perceptions

Lifestyle Changes

Medication and psychotherapy can help relieve symptoms, but making certain lifestyle changes can support your improvement, improve your quality of life, and help prevent your symptoms from progressing. These lifestyle changes include the following:

  • Engage in regular physical activity if cleared to do so by your healthcare provider.

  • Take steps to control stress to increase your resilience, which is your ability to recover from problems.

  • Prioritize sleep by maintaining a regular bedtime and waking pattern.

  • Eat regular meals that include a healthy diet.

  • Set small realistic goals and avoid taking on too much at one time.

  • Make an effort to connect with friends and family as often as possible.

  • Avoid making major life decisions until your symptoms improve.

  • Engage in activities that bring you enjoyment.

  • Talk to people you trust about how you feel.

  • Avoid using alcohol, nicotine, or other drugs.

Learn More: 10 Natural Remedies for Depression

Does PDD Ever Go Away?

PDD is a chronic condition that can last for many years. It's difficult to predict how long your symptoms will last. Many people continue to have symptoms despite continuous treatment. Others recover fully.

You can improve your prognosis by getting a diagnosis and following through on your individualized treatment plan. PDD is more likely to last longer without treatment and affect your quality of life. Living with untreated PDD also increases your risk of developing a more intense form of depression.

When to See a Healthcare Provider

Ignoring symptoms of PDD increases the chances of your problem worsening. Contact a healthcare provider if you have the following issues:

  • Ongoing feelings of depression, hopelessness, or negativity

  • Worsening symptoms related to persistent depressive disorder

Get immediate help for signs of suicide risk, which include the following:

  • Giving away belongings

  • Talking about going away and the need to get "affairs in order"

  • Performing self-injury or other types of self-destructive behavior

  • Suddenly changing behavior, especially calmness after anxiety

  • Withdrawing from friends or being unwilling to go out anywhere

  • Talking about death or suicide



Getting Emergency Care

If you or someone you know is thinking about suicide, call 911 immediately or go to a hospital emergency room. You can also get free and confidential support 24/7 at the 988 Suicide and Crisis Lifeline:



Summary

Persistent depressive disorder is a type of chronic depression. Symptoms can involve feelings of deep sadness. These dark feelings can begin in childhood or early adulthood. They may last for years due to the chronic nature of this problem.

With a proper diagnosis and treatment, people with PDD can often improve their quality of life. Treatment involves using a combined approach of prescribed drugs and talk therapy. Making certain lifestyle changes can also help you improve. Do not ignore PDD symptoms. If left untreated, PDD symptoms can get worse.

Read the original article on Verywell Health.