Dysthymia

Dysthymia

Persistent depressive disorder (PDD), formerly known as dysthymia, is defined as a low mood lasting for over two years. This newer diagnosis combines the two earlier diagnoses dysthymia and chronic major depressive disorder. It’s thought to be a milder but longer lasting form of depression. 

The symptoms of this disorder interfere with school, relationships, work, and daily activities. PDD tends to be more common in people with a family history of the condition. People with PDD often times display these symptoms: 

✅ having trouble feeling happy                 ✅ low self-esteem 
✅ described as “a gloomy personality”   ✅ poor concentration 
✅ changes in eating habits                         ✅ feelings of hopelessness 
✅ low energy or fatigue                                ✅ self harm 
✅ suicidal thoughts

✅ having trouble feeling happy
✅ low self-esteem 
✅ described as “a gloomy personality”
✅ poor concentration 
✅ changes in eating habits
✅ feelings of hopelessness 
✅ low energy or fatigue
✅ self harm 
✅ suicidal thoughts

Causes of Persistent Depressive Disorder

Similarly with major depressive disorder, traumatic events, the loss of a loved one, financial problems or high level of stress are thought to trigger PDD. However there is no specifically known cause of PDD. Researchers suspect the following may influence the onset of PDD:

💡  biological diagnoses or conditions
💡  chemical imbalance in the brain
💡  inherited traits from family members
💡  trauma

Misconceptions About Persistent Depressive Disorder

PDD is often described as chronic, though less severe than major depression. Depression and PDD are oftentimes mistakenly considered similar though follow different diagnosing criteria. 

The major difference between the two disorders is time: 

⏰ depression diagnosis: symptoms have been present for over 2 weeks 
⏰ PDD diagnosis: symptoms have been present for over 2 years

Also there are differences in the daily moods experienced: 

😶 major depressive diagnoses have a “normal” mood baseline (not feelings of overall sadness) when symptoms are managed
😶 PDD diagnosis experience an overall feeling of sadness all the time and cannot recall feeling different.

Signs and Symptoms of Persistent Depressive Disorder

Symptoms of PDD may come and go over a duration of time. Feelings of sadness may be alleviated for two months though resurface shortly after. It is also not uncommon to have a comorbidity between major depressive disorder and PDD called double depression. Some of the most common symptoms include: 

🚩  loss of interest in daily activities               🚩  avoidance of social activities
🚩  sadness, emptiness or feeling down.      🚩  poor appetite or overeating
🚩  hopelessness                                                🚩  sleep problems
🚩  tiredness and lack of energy                     🚩  suicidal thoughts 
🚩  irritability or excessive anger                     🚩  self harm
🚩  low self-esteem                                            🚩  feelings of guilt 
🚩  trouble concentrating                                 🚩  decreased activity
🚩  trouble making decisions                           🚩  decreased productivity

🚩  loss of interest in daily activities
🚩  avoidance of social activities
🚩  sadness, emptiness or feeling down
🚩  poor appetite or overeating
🚩  hopelessness
🚩  sleep problems
🚩  tiredness and lack of energy
🚩  suicidal thoughts 
🚩  irritability or excessive anger
🚩  self harm
🚩  low self-esteem
🚩  feelings of guilt 
🚩  trouble concentrating
🚩  decreased activity
🚩  trouble making decisions
🚩  decreased productivity

Diagnosing Persistent Depressive Disorder

In order for a professional to properly diagnose PDD, there is a symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. As defined in the DSM, you must experience a persistent depressive mood all day, everyday for the past two years to be diagnosed with PDD. Children or adolescents may be diagnosed with PDD after symptoms are present for one year. The diagnosable symptoms listed in the DSM-5 include: 

⚠️  depressed mood almost every day, all day 
⚠️  poor appetite or overeating 
⚠️  change in sleeping pattern
⚠️  low energy or fatigue 
⚠️  low self esteem 
⚠️  poor concentration 
⚠️  difficulty making decisions 
⚠️  feelings of hopelessness

Conditions Commonly Mistaken for Persistent Depressive Disorder

As previously addressed, the similarities between PDD and major depressive disorder are cause for common misdiagnosis. Otherwise identifying misdiagnoses related to PDD becomes challenging due to individual responses to life events. There are many factors that can alter a mood state and can occur sporadically throughout life. It is important to understand how, individually, we manage stress and what is helpful when coping with life demands. The following are other diagnoses often mistaken for PDD:

✳️ major depressive disorder       ✳️ anhedonia
✳️ bipolar disorder                          ✳️ ADHD
✳️ cyclothymia                                 ✳️ anxiety
✳️ dysphoria                                     ✳️ borderline personality disorder

✳️ major depressive disorder
✳️ anhedonia
✳️ bipolar disorder
✳️ ADHD
✳️ cyclothymia
✳️ anxiety
✳️ dysphoria
✳️ borderline personality disorder

Treating Persistent Depressive Disorder

Medication and talk therapy are the most common treatments for dysthymia. 

🧬 psychotherapy                     🧬 family therapy 
🧬 support groups                     🧬 crisis services 
🧬 cannabis / CBD                     🧬 medication management

🧬 psychotherapy
🧬 family therapy 
🧬 support groups
🧬 crisis services 
🧬 cannabis / CBD
🧬 medication management

Healthcare Professionals Who Treat Persistent Depressive Disorder

For the best results in a successful treatment of dysthymia, seek providers that have specialities in the assessment, treatment, diagnosis, and continuing support of patients diagnosed with dysthymia. 

Many medical and mental health providers are familiar with the diagnosis of dysthymia.  However if your chosen provider is not, they should always provide a knowledgeable referral source. Specialized providers will have the capabilities to diagnose using various testing methods to decrease the likelihood of misdiagnoses and unnecessary treatments. 

If you choose to utilize medication, psychotherapy should always be incorporated in treatment planning. 

The following are professionals involved in the treatment of dysthymia:

🧠 psychologists                      🧠 psychotherapist 
🧠 psychiatrists                        🧠 nurse practitioners
🧠 social worker 

🧠 psychologists
🧠 psychotherapist 
🧠 psychiatrists
🧠 nurse practitioners
🧠 social worker 

Recognizing Immediate Need for Persistent Depressive Disorder Treatment

PDD is a common but serious disease that ranges widely in severity. For those who experience severe depression- suicide is a real threat. The following warning signs should alert you to the immediate need for treatment:

🚨 talking about wanting to die
🚨 searching for way to kill yourself
🚨 buying a gun or other weapon
🚨 expressing hopelessness or having no reason to live
🚨 talking about feeling stuck, trapped, or being in unbearable pain
🚨 stating feeling like being a burden to others
🚨 increased use of drugs and/or alcohol
🚨 reckless behavior
🚨 increased anxiousness
🚨 change in sleeping pattern
🚨 withdrawn or isolated
🚨 displaying rage 
🚨 talking about revenge
🚨 extreme mood swings

Persistent Depressive Disorder Professional Organizations

Provided are some resources to help the start of seeking support for depression. Though these are national links, consider narrowing options down by searching in your current location. 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929
https://www.hopkinsmedicine.org/health/conditions-and-diseases/dysthymia