How Persistent Depressive Disorder (DSM-5) Can Affect Your Life

Updated January 6, 2023by BetterHelp Editorial Team

Perhaps one of the most prevalent and often misunderstood psychiatric disorders is depression. Depression runs on a spectrum and affects each person differently. People can be depressed due to external or internal factors. For example, you can feel depressed due to the situation you are in, because of a chemical imbalance in the brain, or due to a medical condition. Some types of depression don’t last long, while other kinds can continue to impact a person for the entirety of their life. Persistent depressive disorder, or PDD, is one such kind of depression that can last a while and even reappear. Finding treatment can be vital, as depression can affect your life in a multitude of ways.  

You Don’t Have To Manage Symptoms Of Depression On Your Own

What Is Persistent Depressive Disorder?

Persistent depressive disorder is a type of long-term depression that is often marked by melancholy, low self-esteem, and loss of interest in previously enjoyed activities. Depression is more than just feeling sad; it's a tenacious feeling of emptiness and apathy. 

Some types of depression, like the situational kind, only last as long as a stressor is present or as long as someone needs to move forward. Persistent depression, however, can be enduring even when your life is seemingly going well. While you may not feel down most of the day every day, you might struggle with a depressed mood on more days than not. 

To be diagnosed with persistent depressive disorder, these feelings must occur for at least two years in adults. For children and teenagers, it can be diagnosed in one year. Often, those with PDD won’t be symptom-free for longer than two months. 

How PDD Can Affect Your Life

The symptoms of PDD can cause many disruptions to your daily life, including at work, school, in your social life, and even at home. 

  • PDD can cause you to withdraw from your close friends and family. Since connection with other people can be important for positive mental health, this may cause your depression to worsen.

  • PDD can affect your work life. You might not be able to be as productive at your job because depression can make it difficult to concentrate throughout the day. 

  • PDD can lead to physical health problems such as insomnia, a weakened immune system, a lower libido, fatigue, and a higher risk of a heart attack.

  • PDD can make you excessively self-critical and damage your self-esteem.

  • PDD can contribute to lower grades in school due to decreased concentration and apathy. 

  • PDD can make it hard to complete daily tasks, like brushing your teeth, cooking yourself a meal, or taking a shower. You may lack the energy to do even the simplest of tasks and might not be able to get out of bed at all some days. 

Persistent Depressive Disorder Or Dysthymia?

Before 2013, when the DSM-5 was released, PDD was called dysthymia. Dysthymia comes from an Ancient Greek term that translates to "bad state of mind." The reason the term changed from dysthymia to PDD is that it was combined with chronic major depressive disorder. There didn't appear to be any big differences between the two conditions, so mental health professionals took on the new term for good.

Causes Of PDD

PDD can begin early on, from childhood to young adulthood. As is the case with many other mental health disorders, there may not be a singular cause of persistent depressive disorder. Instead, it can develop from a combination of factors, such as:

Biological differences: Your brain may have unique physical alterations that cause depression. The origin of these changes is unknown.

Brain chemistry: Depression can be contributed to a chemical imbalance in the brain, which may involve too little or too many neurotransmitters or hormones.

Genetics: It's unknown which genes, in particular, can cause depression. However, there does appear to be a hereditary link between those with depression and those without it. In fact, scientists estimate that around 50% of the cause is genetic, and the other 50% is connected to other causes.

Trauma: Traumatic events can cause PDD. Untreated trauma or PTSD may result in the development of depression. If you have gone through a difficult or traumatic life experience, there may be a link between this experience and PDD symptoms.

Symptoms Of Persistent Depressive Disorder

If you have PDD, you may have a variety of different signs and symptoms and experience at least two of those listed below:

  • Insomnia/Hypersomnia: Insomnia is a condition that prevents a person from falling asleep. Their body may feel tired, but their restless mind may keep them up. Insomnia can also equate to difficulty staying asleep or getting low-quality rest. Occasional insomnia can be common, but if you're experiencing it chronically, it may be a sign of a serious condition. Hypersomnia is when you have trouble staying awake during the day or sleep excessively. Even if you had a good night's sleep, you might feel so sleepy during the day that you can fall asleep in dangerous circumstances, like driving or while on the job.

  • Poor Appetite/Overeating: If you don't feel hungry, and you normally are a healthy eater, you may be experiencing a symptom of PDD. People with depression may overeat or undereat, depending on the person. Both of these appetite changes can lead to weight loss or gain.

  • Low Self-Esteem: Depression may cause you to develop low self-esteem, or you might have struggled with it before. You may feel bad about your appearance, behavior, or just your life in general, even if the feeling is unwarranted.

  • Hopelessness: PDD can cause you to feel like there's no hope for yourself, your future, or anyone else around you. 

  • Low Energy/Fatigue: Your body may feel tired and not able to perform tasks as efficiently. While you might not fall asleep as you would with hypersomnia, you may still feel sluggish.    

  • Difficulty Deciding And Concentrating: PDD can lead to difficulties with concentration and decision-making. If you're a student, you may find it harder to listen to a lecture. If you're a team leader, you may not be as efficient in making decisions as you once were.

  • Irritability: PDD may cause you to feel easily irritated. Naturally, this can create poor relationships with your peers or family. 

You Don’t Have To Manage Symptoms Of Depression On Your Own


Many people who are living with a mental illness go undiagnosed; persistent depressive disorder is no exception. Since PDD symptoms can occur so frequently, the individual may believe that what they’re experiencing is typical. In some cases, people are prompted to seek help by concerned family or friends and then go on to receive a diagnosis. 

To be diagnosed, an individual must meet all the criteria above, and not have a manic, mixed, or hypomanic episode— as this could be a sign of another disorder, such as bipolar disorder. They must also not meet the criteria for cyclothymic disorder, which is marked by different emotional highs and lows.

Additionally, the depressive symptoms must not be caused by any other factors such as substance misuse or because of another condition like a stroke. The symptoms also must cause significant hindrances to the person's daily life, such as preventing them from functioning in work, school, at home, etc.


Like other forms of depression, PDD is treatable, and you can take different routes to manage its symptoms, including:


Psychotherapy can be a powerful resource for addressing PDD. Not only can traditional therapy work but self-help and support groups can be effective as well. One method that may be productive is cognitive behavioral therapy, where the person can develop strategies to cope with their depression. There are many different ways to go about receiving professional counseling, some of which may work more productively for certain people than for others. 


Depression can often be successfully treated with medications. Doctors may prescribe SSRIs when treating PDD, among other medicines. When being prescribed a new medication, you may find yourself in a trial-and-error situation. Different medications have different side effects, and various substances work more effectively for some people than for others. There are fewer side effects in SSRIs when compared to any medication, but if you're experiencing any ill side effects, always talk to your doctor.

It may take 6-8 weeks before you start to feel the effects of the medicine, so you might not have to change the medication if it's not working immediately. It can take a bit for it to get into your body. Always speak with a medical professional before deciding to start or stop a medication.


One of the most effective ways to treat PDD can be a combination of both medication and therapy. Antidepressants can help reduce or eliminate the symptoms of PDD, while psychotherapy can help you identify and heal from the root causes of the disorder. One study found that combined treatment with psychotherapy and medication was found to be notably superior to either treatment alone. Talking to your medical provider can help you decide which treatment plan might be most effective for you. 

Online Counseling With BetterHelp

Depression can be difficult to cope with on your own, even making it hard to get out of bed in the morning. Making it to therapy may be the last thing on your mind, even if you feel it could help. Online therapy with BetterHelp may provide you with a convenient, simpler way to still avail mental health care. Using a smart device and a reliable internet connection, you can connect with a therapist from the comfort of your home. 

The Efficacy Of Online Counseling

Online counseling can be a beneficial resource for those wanting to move past mental health conditions like persistent depressive disorder. One study found that an online-based therapy platform (BetterHelp) successfully helped adults experiencing depression overcome the severity of their symptoms. For those who had never participated in therapy before, these results were even more significant. 

The Takeaway

Persistent depressive disorder can cause a variety of symptoms depending on the person experiencing them. While everyone responds to different kinds of treatments in unique ways, there are several options available for managing your PDD. You can speak with a medical provider to find the treatment plan that might be most effective for you—which could include medication, therapy, or both. While PDD can make it difficult to get out of bed and leave the house, online therapy may allow you to still get the mental health care that you need. Working with a therapist, you can learn new tools for coping with your depression appropriately and move forward toward a healthier mindset.

You Don’t Have To Face Depression Alone. Our Experienced Counselors Can Help.

The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
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