The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines several outlined depressive disorders, including persistent depressive disorder (PDD). PDD is one type of depression that can last for extended periods and reappear throughout life. Treatment can be necessary for many with this condition, but PDD is considered treatable. Understanding how this condition can impact your life may be the first step in deciding whether to seek support.
What Is Persistent Depressive Disorder?
Persistent depressive disorder is a long-term form of depression often marked by melancholy, low self-esteem, and loss of interest in previously enjoyed activities. As with other types of depression, PDD comes with significant challenges in functioning that can impact various areas of life, including professional, social, emotional, and physical life.
Unlike situational types of depression like seasonal affective disorder, PDD is a long-term and recurrent form of depression that involves feeling down for most days for more than two years. In children, PDD can be diagnosed after one year of symptoms. For many with this condition, depression does not disappear for long, if at all. Although the symptoms may be less severe than major depressive disorder (MDD), they can overwhelmingly affect those experiencing them.
The Impacts Of PDD
The symptoms of PDD can cause many disruptions to daily life, including at work, school, social life, and home. Other impacts may include the following:
- PDD can cause you to withdraw from your close friends and family. Since connection with others benefits mental health, withdrawing from others may cause worsening symptoms.
- PDD can affect your work life. You might not be able to be as productive at your job because depression can make it challenging 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 challenging to complete daily tasks, like brushing your teeth, cooking a meal, or showering.
Persistent Depressive Disorder Vs. Dysthymia
Before 2013, when the DSM-5 was released, PDD was called dysthymia. Dysthymia comes from an Ancient Greek term that translates to "unwell state of mind." The term changed from dysthymia to persistent depressive disorder because dysthymia was considered a symptom of chronic major depression. PDD became its own condition with unique symptoms.
Causes Of PDD
Your brain may have unique physical alterations that cause depression. The origin of these changes may be unknown, but researchers have found that depression is around 40% to 50% hereditary. In addition, depression can be attributed to a chemical imbalance in the brain in some cases, which may involve too little or too many neurotransmitters or hormones.
Traumatic events can cause PDD as well as impacts from one's environment. Untreated trauma or post-traumatic stress disorder (PTSD) may result in the development of depressive symptoms. If you have gone through a difficult or traumatic life experience, consider speaking to a therapist for further guidance as you explore your symptoms.
Symptoms Of Persistent Depressive Disorder
If you have PDD, you may experience the following symptoms.
Insomnia Or Hypersomnia
Insomnia is a sleep disorder that can prevent a person from falling asleep. Although their body may feel tired, a restless mind or difficulty producing melatonin can contribute to insomnia. Insomnia can also involve difficulty staying asleep or consistently getting low-quality rest. Occasional insomnia can be common, but contact a medical professional if you're experiencing it chronically.
Hypersomnia involves difficulty staying awake during the day and sleeping excessively. Even if you slept enough during the night, you might feel so sleepy during the day that you can fall asleep in dangerous circumstances, like driving or on the job. If you're experiencing dangerous hypersomnia, contact a sleep specialist or doctor for guidance.
If you don't feel hungry and are typically a regular 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 changes or health concerns.
Depression may cause you to develop low self-esteem, or you might have struggled with it before. Regardless of whether the feeling fits your situation, you may feel distressed about your appearance, behavior, or life. If you haven't experienced this type of low self-esteem in the past, it could signify the development of a depressive disorder.
Hopelessness Or Low Mood
PDD can cause you to feel like there's no hope for yourself, your future, or anyone else around you. It is also associated with a persistently low mood for over two years, regardless of whether you have a "reason" to feel sad.
Low Energy Or Fatigue
When you're living with depression, you may notice your body feeling exhausted and struggling to perform tasks as efficiently. While you might not fall asleep as you would with hypersomnia, you may feel sluggish, fatigued, or unable to complete tasks.
PDD can lead to difficulties with concentration and decision-making. If you're a student, listening to a lecture may be more challenging. If you're a team leader, you may struggle to think of topics to discuss with your coworkers.
PDD may cause you to feel irritated. Irritability can cause challenges in interpersonal relationships or make you feel your emotions are out of your control. In some cases, irritability may lead to anger or aggressive behaviors.
How Is PDD Diagnosed?
Many people living with a mental illness go undiagnosed or receive a misdiagnosis. PDD symptoms often occur for long periods, so the individual living with this condition may believe that what they're experiencing is typical. In some cases, people are prompted to seek help by concerned family members or friends before receiving support.
To be diagnosed, an individual may be required to meet all the criteria above and not have a manic, mixed, or hypomanic episode— as these symptoms are connected to bipolar disorder, which is a different mood disorder. They must also not meet the criteria for cyclothymic disorder, which is marked by different emotional highs and lows.
Additionally, depressive symptoms must not be caused by other factors such as substance misuse or another condition like a stroke. The symptoms also must cause significant hindrances to the person's daily life, such as preventing them from functioning at work, school, or home.
Treatment For PDD
Like other forms of depression, PDD is treatable, and you can take different routes to manage its symptoms, including the following.
Psychotherapy is a practical resource for addressing PDD, and there are multiple forms one can try. One method that may be productive is cognitive-behavioral therapy, where clients can develop strategies to cope with their depression through cognitive and behavioral changes alongside a therapist. Therapy can also be attended in group, family, or couples formats, depending on an individual's needs.
Depression can often be successfully treated with medications. For many people, finding a medication that works may take a few tries. Different medications have different side effects, and various substances work more effectively for some people than others.
It may take six to eight weeks before you start to feel the effects of many medications, so talk to your doctor to track your symptoms as you go. In addition, consult a medical professional like a doctor or psychiatrist before starting, changing, or stopping any medication or medical depression treatment.
A Combination Of Treatments
One of the most effective ways to treat PDD is a combination of medication and therapy. One study found that combined psychotherapy and medication treatments were superior to either treatment on its own. Talking to your medical provider can help you decide which treatment plan might be most effective for you.
Treatment-Resistant Depression Options
For some people, average medical or psychotherapeutic treatments for depression don't work over an extended period. In these cases, their depression might be labeled "treatment-resistant." When one has treatment-resistant depression, they might be eligible for specific clinical trials or unique treatments like the following:
- Transcranial magnetic stimulation therapy (TMS)
- Electroconvulsive therapy
- Ketamine IV infusions
- Vagus nerve stimulation
- Biofeedback therapy
These treatments are often performed in a medical environment with psychiatrists and doctors, so discuss your options with a doctor before getting started.
Depression can be challenging to cope with independently, and persistent depression lasting for years can be stressful to cope with. If you struggle to make appointments, get out of bed, or find a therapist that fits your needs, you might appreciate the effectiveness of online therapy. Online therapy through a platform like BetterHelp can provide a convenient way to reach mental healthcare. Online therapy may also feel more manageable, as you can choose between phone, video, or chat sessions when you might not want to show your face during therapy.
In addition, studies back up the relevance of this type of therapy. One study found that an online-based therapy platform successfully helped adults experiencing depression manage the severity of their symptoms. These results were more significant for those who had never participated in therapy. If you're looking to start therapy and aren't sure where to look, an online therapy platform can be a valuable starting place.
For many people, a combination of therapy and other treatments is effective. Working with a therapist, you can learn new tools for coping with your depression alongside a compassionate professional. Consider reaching out online or in your area for further guidance and advice.
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