Chronic Depression: Symptoms And Treatment Of Persistent Depressive Disorder

Feeling sad, unhappy, or emotionally exhausted can be normal occasionally. However, if feelings intensify and do not subside over two weeks, you might be living with a mental health condition. For millions of people, depression is a daily challenge that affects their quality of life and overall perspective. 

When symptoms of depression do not subside independently, a treatment intervention may be recommended, including medications, therapy, or a combination approach. To understand depression, it can be helpful to understand different depressive disorder diagnoses and labels physicians and therapists use when treating clients.  

What is depression? 

The most recent version of this manual, the DSM-5TR, lists the following depressive disorders: 

• Disruptive mood dysregulation disorder
• Major depressive disorder (MDD)
• Persistent depressive disorder (dysthymia)
• Premenstrual dysphoric disorder
• Substance or medication-induced depressive disorder
• Depressive disorder due to another condition
• Other specified depressive disorder
• Unspecified depressive disorder
• Postpartum depression (PPD) 
• Seasonal affective disorder (SAD) 

Bipolar disorder can also have depressive symptoms, but it is listed under the “bipolar and related disorders” category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the fourth edition of the DSM, bipolar disorder was classified as a mood disorder, along with two of the above forms of depression—major depressive disorder and persistent depressive disorder (then called dysthymic disorder). 

What is chronic depression?

This long-lasting form of depression is known by several names, including clinical depression, dysthymic disorder, and persistent depressive disorder (PDD). Although these conditions were previously categorized as separate disorders, both are now referred to as persistent depressive disorder, the official term for chronic depression.  

Symptoms of chronic depression

Chronic depression involves persistent depressive symptoms for an extended period lasting over two years. If you are chronically depressed, you may experience the following symptoms: 

• Poor appetite or overeating
• Thoughts of hopelessness
• Oversleeping or insomnia
• Low energy or fatigue
• Low self-esteem 
• Poor concentration or decision-making
• Prolonged sadness, irritation, or apathy 
• A lack of motivation
• A loss of interest in previously enjoyed activities 

The confusion between chronic depression and major depressive disorder

Some people may confuse chronic depression with major depressive disorder, another condition. Both conditions have similar symptoms, and both are more common in women. Treatment methods for MDD and chronic depression are also similar. However, despite their similarities, MDD is different because it lasts over two weeks, whereas PDD lasts over two years. 

The symptoms of chronic depression can be mild, moderate, or severe. Traditionally, dysthymic disorder has been used to describe chronic mild to moderate symptoms. Dysthymic disorder is now a subcategory of persistent depressive disorder as categorized by the DSM-5TR, the most recent revision of the DSM-5. 

Dysthymia and major depression

Some people experience a type of depression known as double depression. This condition occurs when people experiencing dysthymia begin to have worsening symptoms, which can lead to an episode of major depression. This episode, in conjunction with their existing dysthymic disorder, results in double depression. 

Chronic depression vs. major depressive disorder

When people speak of depression, they are often referring to major depressive disorder. Depressive symptoms accompanying MDD can occur once or fluctuate for short or extended periods. These episodes may come and go, with the symptoms often being moderate to severe for over two weeks. 

Speak with a mental health professional for a proper diagnosis

To be diagnosed with chronic depression, the individual must experience continuous symptoms of depression for over two years. Although you may not meet the requirements to be officially diagnosed with chronic depression, it may not mean you aren’t depressed. The differences between the types of depression are not always clearly defined and can be confusing. As a result, speaking with a mental health professional can help you discover which diagnostic label (e.g., chronic depression, major depression, postpartum depression) may be most likely for your case. 

Getty/AnnaStills

Symptoms of chronic depression vs. major depressive disorder

Psychiatrists and therapists commonly use the DSM-5 as a reference to diagnose mental health disorders and provide care to individuals in need. The manual lists the definition and symptoms of persistent depressive disorder as follows: 

• A depressed mood occurring for most of the day, for more days than not, for at least two years (at least one year for children and adolescents)
• Symptom-free for no more than two months
• Poor appetite or overeating
• Insomnia (not sleeping) or hypersomnia (oversleeping)
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

The symptoms of chronic depression can be mild to moderate, and many may be shared with conditions like major depressive disorder (MDD). However, episodes that occur as part of MDD also include symptoms like thoughts of worthlessness, guilt, and thoughts of death. The DSM-5 does not include suicidal thoughts or actions as part of the symptoms of chronic depression because it is less common.

If you or someone you know is struggling or in crisis, help is available. Text or call 988 or chat 988lifeline.org. Support is available 24/7. If you are experiencing trauma, support is available.

Chronic depression in children and teens

Some children and teens experience prolonged depression, which may be diagnosed after a year of symptoms. Although teens and children experience similar symptoms to adults, there may be unique symptoms or presentations, depending on age. For example, children and teens may not have the words to describe symptoms of depression and may be more likely to isolate themselves from family instead of discussing their experiences. 

Causes

The root cause of depression can vary depending on your genetic makeup, life experiences, and other factors. Below are a few potential causes. 

Genetics 

A family history of depression increases the chance that an individual will have depression. Studies that have observed depression in identical twins have noted that depression is more likely to occur in one twin if the other has depression. Major depressive disorder has an estimated heritability of 30-50%, which means there is a substantial genetic component to depression. Depression that is genetically inherited may be more prevalent in women than men.

Situational events 

Certain life events like divorce, losing a loved one, or losing a job can cause a depressive episode. However, this episode may not qualify as a chronic depressive diagnosis, as situational depression is often short-term. 

Social challenges 

Prolonged loneliness or lack of social support may lead to depressive symptoms. Studies show that humans need social interaction for well-being and physical health. Being lonely can be a significant cause of persistent depression, major depression, and other depressive disorders. 

Physical illness 

Many types of physical illnesses can cause depression. For example, people with heart disease or a previous heart attack are at an increased risk for depression. John Hopkins Medicine reports that one in five people will have a depressive episode after a heart attack. Other medical conditions that can play a role in depression include diabetes, bacterial infections, osteoporosis, and dementia.

Chronic depression is also more likely to occur in individuals with chronic physical illnesses. For example, chronic pain and depression have been found to co-occur in older individuals with pain. Although pain alleviation may help these individuals, some research shows that depression can cause worsened pain. For individuals with physical conditions that cause them to be confined to their residence, home health care that involves psychological treatment can help prevent symptoms of chronic depression from worsening. 

Treatment options

If you believe you may be living with chronic depression, talking to a doctor and getting professional help may be the first step. If you’re looking for immediate answers, you might also take an online screening and bring the results to your appointment with your provider. 

Although an online test result is not a medical diagnosis, it may offer insight into the symptoms you’re experiencing. Once you receive an accurate diagnosis from your doctor, they can discuss your treatment options with you, which may include antidepressants and psychotherapy. In cases of treatment-resistant depression, a provider may also suggest electroconvulsive therapy (ECT). Additionally, they can help you find a doctor or other professional who specializes in long-term forms of depression. 

Therapy can help people with depression identify the sources of their feelings, develop effective coping strategies, and address potential comorbid mental health conditions. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are commonly prescribed medications for depression. Always consult with a healthcare professional prior to starting or stopping any medication. 

When depression symptoms are treatment-resistant, electroconvulsive therapy (ECT) may be utilized. A form of brain stimulation therapy, electroconvulsive therapy works by activating certain brain regions through electrical currents. Research suggests that electroconvulsive therapy is an effective modality for treatment-resistant depression, leading to a high remission rate and producing limited side effects.  

Coping strategies in addition to treatment

While you wait for treatment, there are a few steps you can take at home to manage your symptoms and prevent depression from worsening. The following are coping strategies you can incorporate into your daily routine.

• Exercise and healthy eating: Exercise releases endorphins, and a healthy diet offers essential vitamins and nutrients to the body. 
• Sleep hygiene: Sleep hygiene can mean getting seven to nine hours of sleep each night, going to bed and waking up at the same time each day, cutting electronic use before bed, and not drinking caffeine after 2 pm. 
• Stress reduction: Stress reduction techniques can include deep breathing, meditation, progressive muscle relaxation, and guided imagery, among others. 
• Social activities: Social activities can include joining a support group, going to a club, or talking to someone new at work. 
• Coping techniques: Coping techniques can involve yoga, journaling, eating healthy foods, going for a walk, and other interactive and healthy self-care practices. 

Mental health therapy with a professional

When you are living with symptoms of a depressive disorder, you may believe you are isolated and alone, especially if you do not have a support system. However, you are not alone. Millions of people live with depressive disorders and find relief from symptoms with the help of a professional. With therapy, you can learn strategies to manage your symptoms and discover tools that may improve your quality of life.  

Online therapy as a treatment option for chronic and clinical depression

You can choose from several options when seeking therapy, including online therapy through platforms like BetterHelp. People with depression often struggle with finding the energy to attend in-person appointments regularly. With an online platform, you can connect with a provider from home. In addition, if you’re not motivated to attend therapy, you can choose between phone, video, or chat sessions. Chat sessions may be more available if you’re not up to talking with your therapist verbally. 

Effectiveness of ICBT for depression and other mental disorders

Research also supports the efficacy of online therapeutic interventions in treating depression. In a study published in JAMA Psychiatry, an extensive review revealed that people living with a depressive disorder who received internet-based cognitive behavioral therapy (ICBT) showed improved symptoms. Researchers also reported the treatment cost less while reaching a more diverse and significant number of people. Besides depression, online therapy is also effective for coping with life’s challenges and treating other mental health disorders.