Persistent Depressive Disorder: Causes & Treatment

Depression is a common form of mental illness that can affect people of all ages. In fact, it’s one of the most common mental illnesses in the United States, with almost 20 million adults affected in the year leading up to 2019, respectively. 

Although many people think of all depressive illnesses as simply “depression,” the reality is that depression can come in many different forms.

Persistent depressive disorder, or dysthymia, is a long-lasting form of depression. It can cause similar symptoms to other types of depression, such as major depressive disorder, but may last for years at a time.

Like other forms of depression, persistent depressive disorder is treatable, typically with a mix of medication, therapy and lifestyle changes.

Below, we’ve explained what persistent depressive disorder is, the symptoms it usually involves and how it differs from major depressive disorder.

We’ve also discussed the options that are available to treat persistent depression and help you enjoy a higher quality of life. 

Persistent depressive disorder is a form of depression that lasts for an extended period of time, typically several years. It’s also referred to as dysthymic disorder or chronic major depression.

Like with clinical depression, if you have persistent depressive disorder, you may have a sad or empty-feeling mood, pessimistic feelings and other symptoms. These may last for several years at a time and have a significant impact on your thoughts, feelings and quality of life.

People with persistent depressive disorder often describe themselves as going “in and out” of a depressed state often, with recurrent depressive episodes that come and go.

Other people affected by this type of depression describe themselves as having depression for as long as they’re able to remember. 

Persistent depressive disorder is quite common. In the United States, an estimated 17 percent of all adults are affected by depression at some point in their lives, with three percent of adults affected by persistent depression. 

The symptoms of persistent depressive disorder are similar to those of other common types of depression. You may notice that your moods are affected, or that certain aspects of your life no longer feel exciting or interesting.

If you’re affected by persistent depressive disorder, you may have several or all of the following symptoms and signs of depression:

• Sad, empty or anxious moods that persist for long periods of time

• Recurring feelings that you’re guilty, worthless or of general low self-esteem

• Difficulty experiencing pleasure, including from your normal hobbies and interests

• Reduced levels of energy and persistent fatigue

• An irritable mood and shorter temper than normal

• Feelings of hopelessness and a pessimistic life outlook

• Physical aches, pains and digestive issues without a clear cause

• Difficulty staying still and a general feeling of restlessness

• Changes in your appetite, eating habits and/or weight

• Insomnia (difficulty falling asleep or staying asleep) or excessive sleepiness

• Difficulty focusing on specific tasks, making choices or remembering details

• Slower-than-normal speech and/or movement

• Suicidal thoughts and/or behavior

In order to be diagnosed with major depression, these symptoms normally need to persist for at least two weeks and occur on a daily or near-daily basis.

For a diagnosis of persistent depressive disorder, these symptoms need to occur over a period of at least two years, with breaks from symptoms of no longer than two months. 

Since major depressive disorder and persistent depressive disorder share the same symptoms, it’s possible to meet the diagnostic criteria for both illnesses at the same time. 

Because persistent depressive disorder can affect your feelings, thoughts and behavior, it often has a significant impact on your daily life. 

If you have persistent depressive disorder, you might find it harder to enjoy many aspects of life, to maintain relationships or to stay on top of your work or educational commitments. 

Experts aren’t yet completely aware of what causes depression, whether it’s clinical depression or persistent depressive disorder. However, research suggests that a range of biological, social and psychological factors all play a role in the development of depressive illnesses.

Certain factors may make you more at risk of developing persistent depressive disorder, as well as other forms of mental illness. These include:

• Genetic factors. If you have a family history of depression, you may have an elevated risk of developing depression yourself.

• Prior mental illness. If you’ve previously been affected by any mental illness, this may contribute to a higher risk of developing persistent depressive disorder.

• Stressful events. Depression can develop during periods of stress, or after a stressful life event that affects your physical or mental wellbeing.

• Social factors. Some social determinants of health, such as your living environment or economic stability, may play a role in the development of persistent depression. 

• Major life changes. Sudden, unexpected changes in life, particularly negative changes, may contribute to depression.

• Physical illnesses. Certain illnesses, including serious diseases such as heart disease, cancer, diabetes and Parkinson’s disease, are linked with a higher risk of depression.

• Medications. Some medications, including those used to treat the illnesses above, may increase your risk of developing depressive illness.

An additional factor in depression is age. Although depression can develop at any age, it’s more common in older people, especially those aged 65 and above.

Like other forms of depression, persistent depressive disorder is treatable. If you think you may have persistent depressive disorder, it’s important to reach out to a mental health provider about your concerns. 

You can get professional help by asking your primary care provider for a mental health referral, by contacting a licensed psychiatrist in your city, or by consulting with a psychiatry provider via our online psychiatry service. 

In order to learn more about your needs, your healthcare provider may ask you some questions about your symptoms or request that you complete an assessment. 

Like other forms of depression, persistent depressive disorder is usually treated with medication and therapy. 

Antidepressants

If you have persistent depressive disorder, your mental health provider may give you medication to reduce the severity of your symptoms. 

A range of different antidepressant medications are used to treat persistent depressive disorder, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Antidepressants work by increasing the levels of certain chemicals, called neurotransmitters, in your brain and body. They can often improve depressed mood and other depressive symptoms, but may require several weeks to start working.

You may need to try several different antidepressants before finding a medication that works for you. 

If you’re prescribed an antidepressant, make sure to only use it as directed. Inform your mental health provider if you develop any side effects from your antidepressant. Do not stop taking any antidepressant medication without first talking to your healthcare provider. 

Psychotherapy

Persistent depressive disorder often improves with psychotherapy. In fact, research shows that a combination of therapy and medication is more effective than antidepressant medication on its own at treating depression and other mental health conditions.

Several types of therapy are used to treat depression. Your mental health provider may suggest cognitive-behavioral therapy (CBT), problem-solving therapy, interpersonal therapy or a different form of therapy to help you make progress.

As part of therapy for depression, you may learn new methods of thinking that help you to avoid inaccurate or harmful thoughts. 

Some forms of therapy may also involve relaxation techniques, methods of coping with stress or frustration, thinking techniques to identify certain emotions and behaviors, or other mental tools to help you deal with your symptoms and recover from depression.

Our guide to therapy for depression goes into more detail about the benefits of therapy, as well as the different methods used to treat depression. 

Habits and Lifestyle Changes

Although it’s difficult to treat depression with lifestyle changes alone, making small changes to your habits and daily routines may make your symptoms less severe and improve your results from medication and therapy. 

Try the following habits and techniques to better deal with your depression:

• Exercise regularly. Exercise releases endorphins — natural chemicals that enhance your mood. Try to get at least 150 minutes of cardiovascular exercise each week, as well as two strength training workouts.

• Spend time with friends and family. It’s easy to isolate yourself when you’re feeling depressed. Instead of spending time alone, try to spend time with your friends, family members and other loved ones.Not only can this improve your feelings and thoughts — it can also give you a valuable support network to help you make progress.

• Limit your alcohol consumption. Research suggests that depression and alcohol use disorders are closely linked. While you’re recovering from depression, it’s best to either avoid alcohol or limit your consumption to a small, responsible amount.

• Avoid illicit substances. Like alcohol consumption, illicit drug use is often associated with depression. Make sure to avoid illegal drugs or other substances that can affect your thoughts, moods or behavior. 

• Delay major life decisions. It’s important not to make any sudden, major decisions if you’re feeling depressed. Try to delay things like changing careers, getting married or moving to a new location until you’ve overcome your depression symptoms.

• Try mindfulness meditation. Some research suggests that mindfulness meditation can improve the symptoms of depression and anxiety. Try meditating at home or as part of a group to calm your mind and improve your recovery from depression.

• Be realistic about your progress. Depression isn’t something that improves overnight, but it is beatable. Set realistic goals and focus on making steady progress as you move towards recovery. 

Depression can take a serious toll on your mental wellbeing and quality of life, especially when your symptoms are severe or persistent. 

If you think you may have persistent depressive disorder, it’s important to talk to a mental health professional. You can do this by asking your primary care provider for a mental health referral or by reaching out to a psychiatrist or other mental health provider in your area. 

You can also connect with a licensed psychiatry provider from home using our online psychiatric evaluation service. 

Following your online evaluation, you’ll receive ongoing care and, if appropriate, science-based medication to help you control your depression symptoms and improve your wellbeing. 

Interested in learning more about dealing with depression? Our online mental health resources share effective strategies that you can use to deal with depression, anxiety and other common mental health disorders.