Chronic Depression: Why You Have Felt Blue For So Long

Updated March 5, 2023by BetterHelp Editorial Team

Feeling sad, unhappy, or emotionally exhausted are things humans occasionally experience, but in some instances, these feelings intensify and do not subside which may lead to a diagnosis of a mood disorder. For many, depression is a daily challenge that affects their quality of life and overall perspective. In fact, millions of people worldwide experience depression. The World Health Organization estimates 300 million people (approximately 4% of the global population) are living with some type of depressive disorder as you read this. When symptoms of depression do not go away on their own, a treatment intervention can be incredibly helpful, including medications or mental health treatment. In this article, you will learn about a type of depression known as chronic depression, or persistent depressive disorder. Reading this material will help to increase your understanding of this chronic mood disorder and identify if you or a loved one may be experiencing symptoms and need to reach for mental health support. 

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This long-lasting form of depression is known by several names, including clinical depression, dysthymic disorder, and persistent depressive disorder (PDD). Although they were each previously categorized as separate disorders, clinical depression and dysthymic disorder have since been merged with PDD. In this article, we will refer to PDD as chronic depression since that is the term commonly used to describe long-lasting depression. We will also look at what chronic depression is, how it differs from major depressive disorder, and examine its symptoms, causes, and treatment options.

What Is Chronic Depression?

Chronic depression is the persistence of depressive symptoms for an extended period (usually years). If you are chronically depressed, you have likely lost interest in the things you used to love. In addition, you may experience the following:

  • Poor appetite or overeating

  • Hopelessness

  • Oversleeping or insomnia

  • Low energy or fatigue

  • Have low self-esteem

  • Poor concentration or decision-making

Sometimes chronic depression and major depressive disorder (MDD) are confused with one another since they show some similarities. For instance, in both cases, women are more likely to be affected by the disorder than men. The treatment methods for MDD and chronic depression are also very similar. Despite this misconception, MDD and chronic depression are not the same things, and each disorder is characterized by its own symptoms and considered to be a separate condition. The symptoms of chronic depression can be mild, moderate, or severe. Traditionally, the term, now called dysthymic disorder, has been used to describe chronic mild symptoms. Dysthymic disorder is now a subcategory of persistent depressive disorder as categorized by the DSM-V-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision). 

Some people experience a type of depression known as double depression. This 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 the 'double depression.' If you have experienced this and are seeking treatment, it is important to let your health care professional know about the episode in addition to the underlying chronic depression.

How Is Chronic Depression Different From Major Depressive Disorder?

Historically, many people did not distinguish between chronic depression and other types of episodic or shorter-term depression. However, today, when most people speak of depression, they are generally referring to major depressive disorder (MDD). Depressive symptoms that accompany MDD can occur once or fluctuate for short or long periods of time. These episodes come and go, with the symptoms themselves possibly being mild, moderate, or severe, and are thought to last more than two weeks, but less than two years.

To be diagnosed with chronic depression, the individual would have experienced nearly continuous symptoms of depression for over two years. Although you may not meet the requirements to be officially diagnosed with chronic depression (for example, having persistent depressive symptoms for a year and a half), this does not necessarily mean you are not chronically depressed. Unfortunately, the specific differences between the different types of depression are not always clearly defined and can be confusing. As a result, speaking with a mental health professional is the best way to find out exactly what diagnosis best matches your symptoms, as well as what the best treatment options are.

Chronic Depression Symptoms

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), is commonly used by psychiatrists and therapists as a reference to help diagnose mental health disorders and provide care to individuals in need. lists the definition and symptoms of chronic depression as follows:

A depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents). The individual is symptom-free for no more than 2 months.

During periods of depressive mood, at least two of the following six symptoms are present:

  • 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, moderate, or severe. Many of these symptoms are present in non-chronic depression, such as major depressive disorder (MDD). However, episodes that occur as part of MDD also include different symptoms such as feeling worthless or guilty, or having thoughts of death, suicidal ideation or attempting suicide. 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 are having suicidal thoughts, please speak with a health care professional, chat with someone who can help online, or call the suicide hotline right away: 1-800-273-TALK (8255).

Chronic Depression In Children And Teens

Unfortunately, some children and teens experience depression. As noted above, chronic depression may be present when depressive symptoms occur for a year or more. Although teens and children may experience similar symptoms compared with adults, the is often unique to members of this age group. Although depression is sometimes difficult to diagnose in teens, parents should be aware of their behavior, and note if depressive symptoms are present most of the time.

Causes Of Chronic Depression

The root cause of depression can vary depending on your genetic makeup, life experiences, and other factors. Episodes of major depression can be caused by the following factors:

  • Genes: 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 likely to occur in one twin if the other has depression. Genetically inherited depression is likely higher for women than men.

  • Situational: Certain life events like divorce, loss of a loved one, or losing a job can cause a depressive episode.

  • Social: Prolonged loneliness or lack of social support has been found to lead to depressive symptoms.

  • Physical Illness: Many types of physical illnesses can cause depression. For example, people who are heart disease or have had a previous heart attack are an increased risk for depression. John Hopkins Medicine reports that 1 in 5 people will have a depressive episode after a heart attack. 

The factors that can lead to the development of major depression and chronic depression are very similar. However, some factors may be more or less likely to contribute to chronic depression. For instance, depression caused by situational factors like divorce is often short-lived, and in most cases, does not lead to chronic depression. Social factors, on the other hand, often lead to chronic depression if the individual's social situation does not change. Additionally, those who have depression often view their disorder as a burden, which can make them more reluctant to open up about their troubles or speak with others.

Chronic depression is also more likely to occur in individuals who have chronic physical illnesses. For example, chronic pain and depression have been found to co-occur in many individuals, particularly for older individuals. Although alleviation of pain may help these individuals, some research shows that depression can cause pain, particularly for those going through chronic depression.

Treatment Options

Are you wondering if you have chronic depression? Or are you thinking of what kind of treatment options may be available for you? In either situation, talking to a doctor and getting professional help is a must. However, taking an online chronic depression test can help to answer some questions you may have and give you a better idea of your symptoms before you speak with someone professionally.

We Understand That This Is A Difficult Time For You

Keep in mind that an online test result is not a medical diagnosis, and a proper diagnosis should only be rendered by a mental health professional. Once you receive an accurate diagnosis from your doctor, they will discuss your treatment options, which will include antidepressants (depending on your situation) as well as psychotherapy to get to the root of your depression and help you overcome it. While you wait to speak to a doctor or in addition to your treatment plan, there are a few things you can do on your own and at home to better manage or find relief from your symptoms.

  • Work towards a healthy lifestyle through changes such as improved eating habits and exercise.

    • Exercise can help produce feel-good hormones in your body.

    • A healthy diet lets the entire body function better, including your mood.

  • Get appropriate sleep and practice good sleep habits.

    • Get 7-9 hours of sleep each night.

    • Go to bed at the same time and wake up at the same time each day.

    • Remove television and screens from your bedroom.

    • Do not consume any caffeine after 2 pm.

  • Reduce stressors through relaxation techniques such as:

    • Deep breathing and meditation exercises

    • Progressive muscle relaxation

    • Guided imagery

  • Engage in social activities and/or support groups.

    • Join an in-person or online support group to connect with other people going through depression.

    • Join local groups to participate in activities you might enjoy and to make friends.

  • Learn coping and problem-solving skills.

    • You and your therapist can develop skills to meet your individual needs.

    • You can develop coping skills for when you feel your depression worsening.

    • You can learn problem-solving choices that are in the interest of reducing your depression.

Reaching For Help

When you are living with symptoms of a depressive disorder, you may begin to feel isolated, especially if you do not have support resources in place. It is very important that you remember you are not alone in feeling this way. Millions of people live with depressive order and find relief and recovery from depression by seeking the help of a mental health professional. With therapy, you can learn strategies to managing your symptoms and discover tools that can help you improve the quality of your life. 

There are several options for you to choose from when seeking therapy, including online therapy. People with depression often struggle with finding the energy to attend in-person appointments on a regular basis. Research also supports the efficacy of online therapeutic interventions in the treatment of depression. In a study published in JAMA Psychiatry, an extensive review revealed that people managing depressive disorder who received internet-based cognitive behavioral therapy (ICBT) showed an improvement in symptoms. Researchers also reported the treatment cost less while reaching a diverse and large number of people. 

If you are interested in therapy online, consider reaching out to one of our BetterHelp counselors who can give you more information and advice on what your next steps should be. If you or a loved one has been depressed for years (or even weeks or months), it is never too late to seek help from a professional. If searching for and speaking in person with a mental health professional is too intimidating or inconvenient, talking online with someone at BetterHelp might be a better option for you. Hundreds of people have spoken to the licensed and professional counselors at BetterHelp and have come away feeling more empowered, more positive, and in control of their life. Read below for some reviews of BetterHelp counselors, from people experiencing similar issues.

Counselor Reviews

"Colleen has been an intricate part of my healing, and I know that I would not be as successful as I am without her encouragement, support, and advice. She is always there when I need her without hesitation and fully understands the goals I have and the challenges I face. She has wonderful techniques in helping me release and cope with stress and anxiety, and it has greatly reduced my depression. Colleen is an absolutely fantastic therapist, and I can't recommend her highly enough!"

"I put off finding a therapist for a long time. I dreaded my first conversation with Neil and all the awkward, clunky explanations I'd have to give about my depression and anxiety. All of the things that felt like dirty little secrets that caused me so much pain. But I was so pleasantly surprised by the way Neil accurately picked up on what I was saying and gave me more insight into how my brain was working. It made my issue feel so much less of a personal problem and more of a universal problem we could examine together. He always gives me a thoughtful response within a day or two any time I send a message. I actually think we've made more progress in between sessions just by being able to communicate things that are coming up in real time. Neil is intelligent and kind. I really appreciate his communication style and highly recommend him."


If you are going through depression or think you might be experiencing the symptoms of it, simply reading this article is a great first step towards gaining a better understanding of the condition and getting on the path to recovery. In your most difficult moments, tell yourself that you are not alone, and you will get better. All you need are the right tools. Take the first step.

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