An Overview of Persistent Depressive Disorder (Dysthymia)

Table of ContentsView AllTable of ContentsSymptoms of Persistent Depressive DisorderTimeframe of Persistent Depressive DisorderAge of OnsetCauses of Persistent Depressive DisorderConfirming a Diagnosis of PDDTreatment for Persistent Depressive DisorderCoping With Persistent Depressive Disorder

Table of ContentsView All

View All

Table of Contents

Symptoms of Persistent Depressive Disorder

Timeframe of Persistent Depressive Disorder

Age of Onset

Causes of Persistent Depressive Disorder

Confirming a Diagnosis of PDD

Treatment for Persistent Depressive Disorder

Coping With Persistent Depressive Disorder

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This diagnosis reflects a spectrum of severity that can range from mild to severe; however, in its most severe form, it still does not meet the criteria for major depression. Essentially, it is a prolonged state of depression with fewer symptoms thanmajor depressive disorder(MDD).

Persistent Depressive Disorder Versus Dysthymia

In 2013, the 5th edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) consolidated dysthymia and chronic major depressive disorder into a new diagnosis known as “persistent depressive disorder(dysthymia),” with dysthymia in parentheses.These diagnostic changes were made to reflect the fact that there was no scientifically or clinically meaningful distinction between “chronic” major depressive disorder and what was previously known as dysthymic disorder.

The latest version of the DSM was published in 2022 and has some text revisions (DSM-5-TR), including the removal of “(dysthymia)” that once followed the PDD diagnosis. The American Psychiatric Association explained that there were enough changes made to the diagnostic criteria that keeping it may be “misleading and potentially confusing.”

The worddysthymiacomes from the Greek rootsdys, meaning “ill” or “bad,” andthymia, meaning “mind” or “emotions.” The termdysthymiarefers to a chronic state of depression.

The symptoms of persistent depressive disorder (PDD) are very similar tomajor depressive disorder. However, there is a wider range of symptoms available on the criteria list for major depression. You need to have three of the seven symptoms for PDD as opposed to five out of nine symptoms for MDD.

The main symptom of PDD is a sad or depressed mood nearly every day. In children, the mood may manifest asirritability.

In addition to depressed/irritable mood, at least two of the following symptoms are present:

Theadditional symptomsin the criteria list for MDD, (not included for PDD), are:

The symptoms of PDD are chronic, meaning that people experience a depressed mood for most days for a period ofat least two years.The timeframe has been reduced to one year for children and teens. In that two-year time frame for adults, they cannot be without symptoms for more than two months at a time.

While MDD includes more symptoms, the time frame is shorter. A diagnosis of major depression requires symptoms that last for a period ofat least two weeks; however, it often lasts several months. The majority (80%) of people have fully recovered within one year.

People with MDD may completely recover and never experience an episode of major depression again. However, one episode of MDD is a risk factor for developing PDD and/or recurrent major depression episodes down the road.

Double DepressionA person meeting the diagnostic criteria for persistent depressive disorder can also experience major depressive episodes. When the major depressive episode has ended, however, there is a return to the previous milder state of chronic depression rather than an absence of depressive symptoms. This co-occurrence of PDD and MDD is sometimes referred to asdouble depression.

Double Depression

A person meeting the diagnostic criteria for persistent depressive disorder can also experience major depressive episodes. When the major depressive episode has ended, however, there is a return to the previous milder state of chronic depression rather than an absence of depressive symptoms. This co-occurrence of PDD and MDD is sometimes referred to asdouble depression.

Can You Have ‘High-Functioning’ Depression?

Another distinction is that PDD may have anearlieronset than MDD, with symptoms first appearing during the childhood, teen, or young adult years. MDD is more likely to occur after puberty, peaking in early adulthood, but can occur at any time throughout adulthood.

Like other forms of depression, the exact cause of PDD is not known, but there are a number of factors that are believed to play a role, including:

In many cases, these factors interact to increase the risk of developing depression.

Factors That Increase the Risk of Depression

There is nolaboratory testfor diagnosing dysthymia or any other form of depression. If you are experiencing symptoms of depression, your doctor will evaluate your symptoms and medical history. You will be asked questions about the nature, severity, and duration of your symptoms.

In order to be diagnosed with persistent depressive disorder, your doctor will check to see if your symptoms meet the diagnostic criteria outlined in the DSM-5-TR, which includes duration requirements as mentioned previously.

Lastly, the symptoms must result in significant distress or impairment of normal functioning.

PDD is sometimes difficult to diagnose because symptoms are so long-lasting that many people begin to believe that their symptoms are simply a part of their personality or “who they are” rather than a result of a treatable condition. Or they may attribute these feelings to just being stuck in a rut rather than as symptoms of a mental health condition.

According to the American Psychiatric Association, between 0.5% and 1.5% of U.S. adults experience PDD each year. A 2017 study suggested that the lifetime prevalence of PDD with major depressive episodes was 15.2%.

The treatments for PDD are similar totreatmentsfor other forms of depression. Generally, a combination of psychotherapy and medications is the most effective.

Talk Therapy

Psychotherapymay involve a range of different techniques, but two that are often used arecognitive behavioral therapy(CBT) andinterpersonal therapy(IPT).

The Best Online Help Resources for Depression

Medication

There are a number of differenttypes of antidepressantsthat may be prescribed to treat PDD, including:

Herbal supplements such asSt. John’s Wort, have been reported to be helpful in cases ofmildtomoderate depression. While St. John’s Wort and othernatural treatment optionsappear to work for some people with depression, it’s important that you never take any supplement without first talking to your doctor.

When combined with antidepressants, this herbal remedy may lead to a dangerous complication known asserotonin syndrome.

Medications That Increase Serotonin

There are a number of different things that people can do to help cope with persistent depression. Because this type of depression is chronic, incorporating lifestyle changes and self-care with your medical treatments can be helpful. Some things that you can do that will complement therapy and medication:

If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

Even very mild symptoms of depression can disrupt your ability to function and enjoy life, particularly when these symptoms are long-lasting. Fortunately, there are effective treatments available for persistent depressive disorder that can make a major difference in your health and well-being. Talk to your doctor about how you are feeling to explore the treatment options that are right for you.

What Is Mild Depression?

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association. Depressive disorders. In:Diagnostic and Statistical Manual of Mental Disorders, 5thEd., Text Revision. Washington D.C.: 2022.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.American Psychiatric Association.Persistent depressive disorder.Monroe SM, Slavich GM, Gotlib IH.Life stress and family history for depression: The moderating role of past depressive episodes.J Psychiatr Res. 2014;49:90-95. doi:10.1016/j.jpsychires.2013.11.005Vandeleur CL, Fassassi S, Castelao E, et al.Prevalence and correlates of DSM-5 major depressive and related disorders in the community.Psychiatry Res. 2017;250:50-58. doi:10.1016/j.psychres.2017.01.060Xie Y, Wu Z, Sun L, et al.The effects and mechanisms of exercise on the treatment of depression.Front Psychiatry. 2021;12:705559. doi:10.3389/fpsyt.2021.705559

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association. Depressive disorders. In:Diagnostic and Statistical Manual of Mental Disorders, 5thEd., Text Revision. Washington D.C.: 2022.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.American Psychiatric Association.Persistent depressive disorder.Monroe SM, Slavich GM, Gotlib IH.Life stress and family history for depression: The moderating role of past depressive episodes.J Psychiatr Res. 2014;49:90-95. doi:10.1016/j.jpsychires.2013.11.005Vandeleur CL, Fassassi S, Castelao E, et al.Prevalence and correlates of DSM-5 major depressive and related disorders in the community.Psychiatry Res. 2017;250:50-58. doi:10.1016/j.psychres.2017.01.060Xie Y, Wu Z, Sun L, et al.The effects and mechanisms of exercise on the treatment of depression.Front Psychiatry. 2021;12:705559. doi:10.3389/fpsyt.2021.705559

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association. Depressive disorders. In:Diagnostic and Statistical Manual of Mental Disorders, 5thEd., Text Revision. Washington D.C.: 2022.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.American Psychiatric Association.Persistent depressive disorder.Monroe SM, Slavich GM, Gotlib IH.Life stress and family history for depression: The moderating role of past depressive episodes.J Psychiatr Res. 2014;49:90-95. doi:10.1016/j.jpsychires.2013.11.005Vandeleur CL, Fassassi S, Castelao E, et al.Prevalence and correlates of DSM-5 major depressive and related disorders in the community.Psychiatry Res. 2017;250:50-58. doi:10.1016/j.psychres.2017.01.060Xie Y, Wu Z, Sun L, et al.The effects and mechanisms of exercise on the treatment of depression.Front Psychiatry. 2021;12:705559. doi:10.3389/fpsyt.2021.705559

American Psychiatric Association. Depressive disorders. In:Diagnostic and Statistical Manual of Mental Disorders, 5thEd., Text Revision. Washington D.C.: 2022.

American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.

American Psychiatric Association.Persistent depressive disorder.

Monroe SM, Slavich GM, Gotlib IH.Life stress and family history for depression: The moderating role of past depressive episodes.J Psychiatr Res. 2014;49:90-95. doi:10.1016/j.jpsychires.2013.11.005

Vandeleur CL, Fassassi S, Castelao E, et al.Prevalence and correlates of DSM-5 major depressive and related disorders in the community.Psychiatry Res. 2017;250:50-58. doi:10.1016/j.psychres.2017.01.060

Xie Y, Wu Z, Sun L, et al.The effects and mechanisms of exercise on the treatment of depression.Front Psychiatry. 2021;12:705559. doi:10.3389/fpsyt.2021.705559

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