Persistent depressive disorder known as dysthymia or low-grade depression, is less severe than major depression but more chronic. It occurs twice as often in women as in men.Persistent depressive disorder (PDD) is a serious and disabling disorder that shares many symptoms with other forms of clinical depression. It is generally experienced as a less severe but more chronic form of major depression. PDD was referred to as dysthymia in previous versions of the DSM.
Causes of Persistent Depressive Disorder
The exact cause of persistent depressive disorder isn’t known. As with major depression, it may involve more than one cause, such as:
- Biological differences – People with persistent depressive disorder may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
- Brain chemistry – Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
- Inherited traits – Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
- Life events – As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people.
- Genetics – having a first degree relative with a depressive disorder increases the risk
- Environmental/life events – loss of a parent during childhood, traumatic events such as loss, financial problems, and high levels of stress can trigger dysthymia
- Personality traits that include negativity – low self-esteem, pessimistic, self-critical, dependent upon others
- Brain chemistry—Exposure to severe or long-lasting stress can change the balance of chemicals in the brain that control mood.
- Heredity—Depressive disorders can be inherited from one or both parents.
- Environmental factors—Experiencing a trauma, loss, or hardship may trigger depressive symptoms in people who have an inherited susceptibility to developing the disorder.
Symptoms of Persistent Depressive Disorder
Symptoms of persistent depressive disorder can cause significant impairment and may include:
- Loss 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 trouble making decisions
- Irritability or excessive anger
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem, self-criticism, or feeling incapable
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
- Decreased activity and/or productivity
- Social isolation
- Sadness or feeling down
- In children, depressed mood and irritability are often primary symptoms.
- Decreased activity, effectiveness and productivity
- Avoidance of social activities
- Feelings of guilt and worries over the past
- Poor appetite or overeating
- Sleep problems
In children, symptoms of persistent depressive disorder may include depressed mood and irritability.
Diagnosis of Persistent Depressive Disorder
The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), published by the American Psychiatric Association, characterizes dysthymic disorder. The essential symptom involves the individual feeling depressed for the majority of days, and parts of the day, for at least two years. Low energy, disturbances in sleep or in appetite, and low self-esteem typically contribute to the clinical picture as well. Sufferers have often experienced dysthymia for many years before it is diagnosed. People around them often describe the sufferer in words similar to “just a moody person”. Note the following diagnostic criteria
- During a majority of days for two years or more, the adult patient reports depressed mood, or appears depressed to others for most of the day.
- When depressed, the patient has two or more of:
- During this two-year period, the above symptoms are never absent longer than two consecutive months.
- During the duration of the two-year period, the patient may have had a perpetual major depressive episode.
- The patient has not had any manic, hypomanic, or mixed episodes.
- The patient has never fulfilled criteria for cyclothymic disorder.
- The depression does not exist only as part of a chronic psychosis (such as schizophrenia or delusional disorder).
- The symptoms are often not directly caused by a medical illness or by substances, including drug abuse or other medications.
- The symptoms may cause significant problems or distress in social, work, academic, or other major areas of life functioning.
In children and adolescents, mood can be irritable, and duration must be at least one year, in contrast to two years needed for diagnosis in adults.
Early onset (diagnosis before age 21) is associated with more frequent relapses, psychiatric hospitalizations, and more co-occurring conditions. For younger adults with dysthymia, there is a higher co-occurrence in personality abnormalities and the symptoms are likely chronic. However, in older adults suffering from dysthymia, the psychological symptoms are associated with medical conditions and/or stressful life events and losses
Treatments of Persistent Depressive Disorder
The types of antidepressants most commonly used to treat dysthymia include the following:
- SSRIs (Selective serotonin reuptake inhibitors)
- TCAs (Tricyclic antidepressants)
- SNRIs (Serotonin and norepinephrine reuptake inhibitors)
It’s important to ask your doctor for detailed information about any potential side effects of medication and to discuss any history of suicidal thoughts or attempts. Though antidepressant medications can cause uncomfortable side effects for some, you should never abruptly stop taking these medications. Always consult your prescribing physician before making any changes to medication.
Talk therapy, or counseling, is a general form of treating dysthymia by discussing your symptoms and how they impact your life with a mental health provider. There are many benefits to psychotherapy, including:
- Crisis and symptom management
- Identifying triggers that contribute to your dysthymia and coping strategies to manage them
- Identifying negative beliefs and replacing them with positive ones
- Learning adaptive problem solving skills
- Exploring ways to build positive relationships with others
- Improving self-esteem
- Learning to set and attain personal goals
There are different kinds of psychotherapy available, and many people require a combination of treatments. Talk to your mental health provider about the following options:
- Cognitive Behavioral Therapy (CBT)
- Family therapy
- Group therapy
- Process oriented talk therapy
What can I do to help myself feel better?
Methods of improving symptoms of persistent depressive disorder include:
- Maintaining a healthy diet.
- Getting enough sleep.
- Exercising on a regular basis.
- Engaging in enjoyable/creative activities.
- Taking prescribed medications correctly and discussing any potential side effects with your healthcare providers.
- Watching for early signs that your symptoms may be worsening, and having a plan in place for how to respond if they do.
- Surrounding yourself with positive and supportive influences.
- Talking to trusted family members and friends about how you are feeling.
- Avoiding alcohol and illegal drugs which can negatively affect mood and impair judgment.
Lifestyle and Home Remedies of Persistent Depressive Disorder
Persistent depressive disorder generally isn’t a condition that you can treat on your own. But, in addition to professional treatment, these self-care steps can help:
- Stick to your treatment plan – Don’t skip psychotherapy sessions or appointments, and even if you’re feeling well, don’t skip your medications. Give yourself time to improve gradually.
- Learn about persistent depressive disorder – Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about the disorder to help them understand and support you.
- Pay attention to warning signs – Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms get worse or return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
- Take care of yourself – Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you’re having trouble sleeping, talk to your doctor about what you can do.
- Avoid alcohol and recreational drugs – It may seem like alcohol or drugs lessen depression-related symptoms, but in the long run they generally worsen depression and make it harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug abuse.