Dysthymia (Persistent Depressive Disorder)

Persistent depressive disorder (PDD), also known as dysthymia, is a form of chronic depression. Dysthymia impacts every life aspect and can lead to feelings of hopelessness and inadequacy, decreased productivity, and low self-esteem. The chronic nature of the disorder may significantly impact one’s relationships, school/work, and/or daily activities. However, it is considered a less severe form of major depressive disorder. A combination of medications and psychotherapy can help alleviate the symptoms of persistent depressive disorder.

Symptoms

Symptoms of persistent depressive disorder tend to come and go over time, and their intensity can also fluctuate. These symptoms, however, rarely go away for more than two months at a time. There are some instances where an episode of major depressive disorder can occur before or during a PDD episode, which is known as double depression.  

Symptoms of persistent depressive disorder include:  

  • losing interest in daily activities  
  • feelings of sadness or emptiness  
  • feelings of hopelessness  
  • decreased energy  
  • low self-esteem and feelings of inadequacy  
  • loss of focus, concentration, and the ability to make decisions  
  • irritability or increased anger  
  • avoiding social activities  
  • reduced activity, effectiveness, and/or productivity  
  • overthinking about the past, feeling guilty and worried about past events  
  • decrease in appetite or overeating  
  • sleep disturbances or sleeping too much  

Prevalence

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the global yearly prevalence of persistent depressive disorder is around 0.5%.

Prognosis

Persistent depressive disorder is a chronic condition; hence it is expected to have long-lasting effects on clients. Studies have found that around 46-71% of people diagnosed with dysthymia have been in remission for periods ranging from 1 to 6 years. Therefore, with proper treatments and prolonged interventions, clients can expect to see significant improvements.

When to seek help

Since symptoms of persistent depressive disorder last for an extended period of time, it is easy to believe that they will never go away. If you or someone you know is experiencing any of the symptoms of dysthymia, seek help from a mental health professional as soon as possible.

Treatment

There are two main methods to treat persistent depressive disorder: psychotherapy and/or medications. The treatment methods differ depending on the severity of symptoms experienced and the client’s personal preference and history of treatment methods.  

  • Psychotherapy

Psychotherapy involves talking to a mental health professional using “talk therapy” to help clients learn how to better cope with their symptoms. The most commonly used therapy modality for treating dysthymia is Cognitive Behavioural Therapy (CBT); however, other modalities may also be used depending on how the clients respond to the treatment method and the goals they want to get out of therapy. Psychotherapy is used to raise clients’ awareness of and help them identify their symptoms and how they affect them, as well as to learn healthy coping strategies to manage their symptoms.  

Psychotherapy is usually the first recommendation for treating persistent depressive disorder; however, in some cases, medications may also be used.  

  • Medications

The medications that are most commonly used to treat persistent depressive disorder include:  

  • Selective serotonin reuptake inhibitors (SSRIs)  
  • Tricyclic antidepressants (TCAs)  
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)  

Clients may react differently to different medications, which is why it is essential to work alongside a doctor to determine the right type and dose of the medication that will be used. Some medications may take some time (up to several weeks) to show any effect or side effects as the body begins to respond to them. Clients should not stop taking these medications without the supervision of their doctors, as this may cause withdrawal-like symptoms or worsen the symptoms of depression. Clients may need to take these antidepressants for a long-term period in order to manage the symptoms of persistent depressive disorder.