Depression is a term used to describe a group of conditions characterized by mood or cognitive changes. Persistent depressive disorder (PDD), previously referred to as dysthymia, is a type of depression that is low-level and chronic. This form of depression can be associated with the capability to participate in daily functioning but with a consistently low mood.
Persistent depressive disorder is more common in women, and the onset frequently occurs in childhood or young adulthood. However, PDD can affect anyone regardless of gender or age. In the United States, it is estimated that at least 3% of the population are affected by the disorder at some point in their lives.
SoCal Mental Health is an Orange County mental health treatment center that provides services to treat persistent depressive disorder. We use individual therapy, group therapy, and medication as needed to help treat symptoms of PDD.
What is Persistent Depressive Disorder (PDD)?
PDD is a continuous, low-level form of depression. This disorder can affect anyone, manifesting as a ‘low’ or ‘dark’ mood on most days. Recognizing that PDD is present can be difficult and acceptance of low mood on a daily basis may occur.
Because this form of depression is often mild and the ability for daily functioning can occur, it can sometimes go unnoticed or be misdiagnosed. However, understanding more about the symptoms, risk factors, and treatment available for persistent depressive disorder can give greater insight into this condition, inform available resources, and lead to more positive outcomes.
Persistent depressive disorder is more than just having a bad day or feeling sad sometimes. Although PDD can have periods of normal mood that last up to two months, the main feature of PDD is a continual low mood. For adults, this low mood must be present for at least two years, and in children and adolescents, it must be present for at least one year.
In addition, someone with PDD must have at least two of the symptoms below:
- Lack of concentration
- Decreased energy
- Change in sleep habits: sleeping too much or too little
- Change in eating habits: eating too much or too little
- Low self-esteem
Causes & Risk Factors
The precise causes of persistent depressive disorder are not known. However, it is believed that a combination of biological, environmental, and genetic factors is involved. Some of these factors can also be potential risk factors for developing the condition.
Potential causes of PDD include:
- Biological – Chemical imbalances in the brain can affect how the brain functions and the brain’s role in mood stabilization. Serotonin imbalance may cause an inability to regulate emotions.
- Environmental – Life stress and trauma likely also contribute to the onset of persistent depressive disorder. For example, experiencing certain losses such as the death of a loved one or losing a job, or other circumstances like financial difficulties and traumatic events can be triggers that lead to PDD.
- Genetic – Although a conclusive link has not been established, there appears to be a genetic association as it is common for those with persistent depressive disorder to have a relative that shares the disease.
Although it is clear that PDD is a chronic condition likely involving multiple causative factors, more research is needed to determine the specific causes. There are, however, certain factors that seem to increase a person’s risk of developing PDD. Risk factors that can increase the likelihood of PDD include neuroticism, high states of anxiety, and trauma.
How is a Diagnosis of PDD Made?
In order to be diagnosed with persistent depressive disorder, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) has certain criteria that must be met. The DSM-V is a manual used to diagnose mental health disorders that are published by the American Psychiatric Association. According to the DSM-V, PDD can be diagnosed when depressive symptoms occur consistently for at least two years.
Health professionals may use the following assessments to make an accurate diagnosis:
- Physical examination – A doctor will conduct a physical exam to rule out a medical and biological basis for depression symptoms. This exam will involve questions about medical health history and current symptoms.
- Psychiatric evaluation – An in-depth discussion about current and past medical history, current medication, and depression screening tools such as the patient health questionnaire help assess persistent depressive disorder.
Treatment for PDD
Because PDD is a chronic disease, it can require multiple treatments. The treatment involves using medication, psychotherapy, or a combination of both. In addition, alternative methods of treatment can help with overall wellbeing.
This type of medicine is used to help alleviate depression by reducing the symptoms. Antidepressants can take between four and six weeks for the medication to be fully effective. It is best to keep the doctor informed of any side effects or ineffectiveness of the medicine as the dosage may need to be adjusted, or a different type of anti-depressant may be required.
Combining medication with psychotherapy can be a more effective treatment than simply taking antidepressants. Developing a therapeutic relationship with a counselor can provide the foundation for growth and safety that aids in improved health. Specifically, therapy can help with developing skills for changing negative thinking patterns and improving stress management.
Psychotherapy can be performed on a group, individual, or family level to best help improve mental health. This kind of therapy is often referred to as “talk therapy” and can be completed in as little as a few session for current issues or longer for life-long struggles.
Cognitive-Behavioral Therapy (CBT) is an evidence-based psychotherapy that is often considered the golden standard of treatment for mental health disorders, including PDD. CBT is based on the theory that thoughts, behaviors, and emotions are linked together and can impact each other. Changing thinking, behaviors, and feelings can positively impact overall wellbeing.
CBT primarily focuses on the present moment problems but can take into account past experiences. This psychotherapy teaches new life skills and coping mechanisms to change behaviors and thought patterns. Therapists and clients can take a collaborative approach to create goals and objectives to determine the best methods of treatment.
Holistic therapies can be used in conjunction with traditional therapeutic methods to enhance overall wellbeing. Mindfulness-based stress reduction (MBSR), yoga therapy, art therapy, meditation, and aromatherapy are holistic therapies that can be used to help symptoms of persistent depressive disorder.
Holistic methods can complement and enhance evidence-based treatments. A customized treatment plan can include these holistic modalities and be developed based on diagnosis, needs, and preferences.