Depression comes in many flavors — none of them tasty. Persistent depressive disorder (PDD), formerly known as dysthymia, is depression that’s in it for the long haul.
PDD is commonly referred to as “high-functioning depression” since those who experience it are often high performers and overachievers who seem just fine.
While PDD may not be as severe as major depression, it is serious and can take a toll on your quality of life. From low self-esteem to losing interest in things that were once your jam, the symptoms are no walk in the park, and they tend to stick around for months at a time.
The persistent nature of PDD can make living with this kind of depression especially tough. But it is treatable, and some treatment options can be incredibly effective.
The defining characteristic of PDD is that symptoms typically don’t go away for more than 2 months at a time before creeping back up again.
Here are the symptoms you should look out for:
- trouble sleeping
- appetite changes (eating too much or not enough)
- feeling wiped out and low on energy
- a downturn in productivity
- feeling withdrawn and avoiding social situations
- losing interest in activities
- feeling irritable or more angry than usual
- difficulty making decisions or concentrating
- worrying about the past or feeling guilty
For a conclusive PDD diagnosis, these symptoms need to be present for 2 years or more in adults and 1 year in children and adolescents.
Again, PDD is not to be confused with major depressive disorder (MDD). When it comes to the difference between the two, timing is everything. While a PDD diagnosis requires symptoms to last 2 years or more, MDD can be diagnosed after just 2 weeks of symptoms.
PDD and MDD share certain symptoms, including lethargy, changes in appetite, trouble focusing, hopelessness, and sleep disturbances. The symptoms associated with PDD are less severe but must last longer than those associated with MDD for PDD to be diagnosed.
Another difference to keep in mind is that people with MDD have a “normal” baseline mood when they’re not having a depressive episode. If you have PDD, it may be hard to remember the last time your mood felt normal.
Major depressive episodes can happen in tandem with or before the onset of PDD. This is commonly referred to as double depression.
PDD can occur in super successful people with perfectionist tendencies, which makes it hard to detect.
Look out for behaviors like:
- constantly doubting oneself and one’s actions
- perceived criticism from parents as well as self-criticism
- worrying about mistakes
A 2011 study explains the link between depression and perfectionism as stemming from extreme self-criticism when goals or expectations aren’t met (basically, beating yourself up a lot).
Research published in 2008 found childhood perfectionism to be a strong indicator of future depressive disorders.
Compared with MDD, PDD may be more difficult to treat, especially when symptoms aren’t as severe and don’t affect someone’s ability to achieve.
Perfectionists with PDD may find it difficult to believe that they have a problem. Others may have dealt with the symptoms for so long that they just accept them as part of day-to-day life.
PDD can be treated using medication and psychotherapy, individually or in combination. When determining a treatment approach, your doctor will take into account a variety of factors, including:
- blood tests to rule out any potential physical causes of your symptoms
- your ability to comply with the treatment plan
- the duration and severity of your symptoms
- making sure your PDD isn’t misdiagnosed (hypomanic episodes associated with bipolar disorder can be mistaken for PDD)
Depending on your symptoms and medical history, your doctor may prescribe one of three types of antidepressants.
- SSRIs (selective serotonin reuptake inhibitors) like sertraline (Zoloft) or fluoxetine (Prozac).
- SNRIs (serotonin-norepinephrine reuptake inhibitors) like venlafaxine (Effexor)
- TCAs (tricyclic antidepressants) like imipramine (Tofranil)
Talking it out
On its own or combined with an antidepressant regimen, psychotherapy has proven effective at treating PDD. And just as with medication, there are different approaches, including interpersonal or insight-oriented psychotherapy, psychodynamic therapy, and cognitive behavioral therapy.
Both cognitive behavioral and interpersonal therapies work by adjusting the way you see yourself and your environment while teaching you how to cope with stressors and improve your relationships.
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has proven to be especially useful at treating PDD. It works by focusing on unfavorable interpersonal encounters and helping patients understand the consequences of their behavior. Patients are also taught to develop problem-solving techniques to use in these situations.
In addition to a formal treatment plan, lifestyle changes and alternative therapies like these can help you manage your PDD:
- Avoid alcohol. Chemical depressants like alcohol can make depression symptoms worse.
- Stay healthy. Research has found that exercise has comparable results to psychotherapy and medication.
- Stay informed. Learning more about your condition can help you feel more in control.
- Go alternative. Acupuncture and certain supplements, like St. John’s wort and fish oil, may help reduce your depression symptoms.
- Write it down. Journaling is another simple and cost-effective way to cope when you’re feeling down.
Still not sure if you’re just in a bad mood or if it’s something more serious like PDD? Talk to your doctor if you’re experiencing any of the following:
- depression that doesn’t stem from a traumatic event or change, or a depressed mood that takes longer than you expect to go away
- changes in sleep or appetite
- random bouts of sadness
- a depressed mood accompanied by chronic illness
- a loss of interest in relationships or activities
- physical pain with no apparent cause
- thoughts of suicide or death
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Seeking help may make you feel vulnerable, so it helps to be prepared. Your doctor may do a physical exam or blood work to rule out any physical causes of your symptoms.
Once that’s out of the way, it’s time to get honest. Your doctor will most likely ask you a variety of questions to get a clearer picture of your emotional and mental state. It’s best not to hold anything back.
Many doctors rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association, to determine whether a patient has PDD.
The symptoms outlined in the DSM-5 include:
- poor self-esteem
- fatigue or low energy
- difficulty making decisions or concentration
- overeating or poor appetite
- problems falling or staying asleep
Several factors contribute to the onset of PDD, including:
- inherited traits (your family history may play a role)
- major life events like money problems or the loss of a loved one
- brain chemistry and chemical imbalances
- biological differences and underlying physical conditions, like diabetes and heart disease
A family history of depression and certain underlying conditions may increase your chance of developing PDD. Women, people with low self-esteem, and people who lose a parent before the age of 15 appear to be more susceptible to the condition.
PDD comes with a host of potential complications, some more serious than others.
- problems at work or school
- other mental health or personality disorders
- substance misuse and addiction
- lower quality of life
- family conflicts and relationship problems
- other medical illnesses and chronic pain
- suicidal thoughts or actions
Unfortunately, there’s no way to prevent PDD. Since most cases develop in childhood and adolescence, the best thing you can do is get it diagnosed early and seek treatment as soon as possible.
You can also take steps to curb the symptoms, like managing stress and establishing a strong support system of family and friends to help you get through rough patches.
If you suspect that you or someone you know has PDD, getting treatment fast and setting up a long-term treatment plan can prevent the condition from worsening.
It may be easier said than done, but PDD is manageable. You are your best advocate when it comes to seeking treatment, so don’t let stubbornness, perfectionism, or fear stop you. It’s OK to ask for help, and you deserve the opportunity to live your best possible life.