Persistent depressive disorder, or dysthymic disorder, is a type of chronic depression that impacts an estimated 1.5 percent of U.S. adults. It is considered a relatively new diagnosis and essentially combines two earlier diagnoses, dysthymia and chronic major depression, to describe a continuous, long-term type of depression that can last years, negatively impacting your relationships, school, work, and daily activities. Coping with persistent depressive disorder can be difficult because it is chronic in nature, however, some combination of talk therapy (psychotherapy) and medication are proven to help with treatment and managing symptoms.
Signs and Symptoms of Dysthymic Disorder
Although it is a less severe form of depression, the impact of persistent depressive disorder can still be great. An individual with persistent depressive disorder can experience a range of symptoms that are seen in all forms of depression. What sets this diagnosis apart is that the symptoms are less severe and longer lasting, making it hard for a person to cope with the long-term impact. The signs of persistent depressive disorder usually come and go over multiple years and the intensity can change, with major depression episodes occurring intermittently.
Some common symptoms of dysthymic disorder in adults include:
- Sleep problems
- Avoiding social activities
- Lack of interest in daily activities
- Sadness, emptiness, or feeling down
- Tiredness and lack of energy
- Low self-esteem, self-criticism or feeling incapable
- Trouble concentrating and difficulty making decisions
- Irritability, excessive anger, or having a negative attitude
- Decreased activity, effectiveness, and productivity
- Feelings of guilt and worries over what has happened in the past
- Poor appetite or overeating
A person with persistent depressive disorder can expect their symptoms to appear during childhood or adolescence, often manifesting as irritability, moodiness, or pessimism for long spans of time. These individuals may seem easily agitated and have performance and behavior issues in a school environment that vary over time. It is also important to note the main indication for an adult with this disorder differs somewhat from that of a child. For an adult, depressed mood occurs most of the day for two or more years and for a child, depressed mood or irritability occurs most of the day for at least one year.
What Causes Persistent Depressive Disorder?
Individuals who have dysthymic disorder may wonder why and how they have come to experience the illness. While the cause is not widely known or fully understood, there are a variety of factors that can contribute to the development of mental health disorders. Each of these factors work together to reinforce common symptoms of depression and can even heighten a person’s feelings of stress. These include:
- Genetics or family history of persistent depressive disorder
- Traumatic life experiences and feelings of isolation
- Chronic stress or a medical illness
- A chemical imbalance in the brain
- Poor coping strategies and problems managing stress
- Physical brain trauma
If left untreated, there are complications linked with persistent depressive disorder that can negatively impact a person’s quality of life. These include substance abuse, family conflicts and relationship issues, thoughts of self-harm and suicide, chronic pain and illness, as well as decreased productivity in a school or work environment. To help limit further complications related to the disorder, consider seeking treatment and prevention options.
How to Prevent Persistent Depressive Disorder
There is no magic, silver bullet when it comes to preventing dysthymic disorder, but there are a few strategies that can help with preventing certain symptoms from developing further. A person can take steps to help control their stress and increase resilience to help get through particularly challenging situations as they undoubtedly arise. Reaching out to family and friends during particularly difficult times can also help a person weather the hard moments.
Most importantly, a person can seek treatment at the earliest sign of persistent depressive disorder to help with managing and preventing further symptoms. This may entail a long-term maintenance treatment to help prevent the possibility of symptoms coming back. The best way to start treatment is by seeking a diagnosis from a doctor or psychiatrist.
Diagnosing Persistent Depressive Disorder
Once a person makes the decision to get help for their chronic depression, the process of diagnosing persistent depressive disorder includes a few steps. A doctor may administer a few different types of exams and self-evaluations, including:
- Physical examination. The doctor may complete a physical exam and ask in-depth questions about a person’s health to determine what may be causing the depression. In some cases, it may be linked to an underlying physical health problem.
- Lab tests. A doctor may order lab tests to rule out other medical conditions that may cause depressive symptoms. For example, they may order a blood test to find out if an individual’s thyroid is underactive (hypothyroidism).
- Psychological evaluation. This includes discussing your thoughts, feelings, and behaviors, including a possible questionnaire to help pinpoint a diagnosis. This evaluation can help determine if a person has persistent depressive disorder or another condition that can negatively affect mood, such as major depression, bipolar disorder, or seasonal affective disorder.
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 years. A person can also expect their doctor to reference the Diagnostic and Statistical Manual of Mental Disorders when diagnosing persistent depressive disorder, a manual published by the American Psychiatric Association. If a doctor believes a person has dysthymic disorder, they will likely refer them to a mental health professional for further evaluation and treatment.
Treating Persistent Depressive Disorder
After diagnosis, a combination of medication and talk therapy is generally used to treat chronic depression. A doctor will work with each individual to determine the best mix of treatment for the severity of a person’s symptoms, personal preferences, how the diagnosis is impacting quality of life, previous treatment methods, and the ability to take medications without major side effects.
While medication is believed to be a more effective form of treatment, the combination of both therapy and medication tend to be the best form of treatment. When medications are prescribed, the following types of antidepressants are most commonly used to treat persistent depressive disorder:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft)
- Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil) and amoxapine (Asendin)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine (Pristiq) and duloxetine (Cymbalta)
Before starting medication, it is important to talk with a doctor or pharmacist about any possibly disruptive side effects. Sometimes a person will need to try a few different medications and dosages to find the best solution, and this process may take several weeks and months for its complete effect. One important note is to not stop taking the medication as directed without speaking with a doctor first, as this may exacerbate any depressive symptoms.
Known as talk therapy or psychological counseling, psychotherapy in this case entails the individual with persistent depressive disorder speaking with a mental health professional about their condition. There are different types of therapy that can be used to treat chronic depression, including cognitive behavioral therapy, and a therapist will work with each individual to determine the right type of therapy for his or her situation, including the likely duration of therapy.
CBT can be done individually or in a group setting. Support groups can be a beneficial way to share feelings with others who are experiencing similar symptoms and issues. There are many benefits of seeking talk therapy for persistent depressive disorder, as it can help individuals develop the following skills:
- Adjust to a crisis or other current difficulty
- Identify issues that contribute to depression and change behaviors that make it worse
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Find better ways to cope and solve problems
- Explore relationships and experiences, and develop positive interactions with others
- Regain a sense of satisfaction and help ease depression symptoms, such as anger
- Learn to set realistic and achievable goals
Managing Persistent Depressive Disorder Symptoms Long-term
Persistent depressive disorder, or dysthymic disorder, is a chronic and long-term mental health issue, and some individuals may never fully recover from it. Treating persistent depressive disorder can be difficult because of its long-term nature, however, some combination of talk therapy (psychotherapy) and medication is proven to help with managing symptoms. Getting help is an important step toward improving a person’s relationships, school, work, and daily activities — all of which can be negatively impacted by persistent depressive disorder. Seeking a diagnosis is the first step to acknowledging the illness and properly treating it.