Everyone may feel sad and low occasionally without any symptoms of depression. However, if these feelings are persistent and significantly affect daily functioning, it is advised to consult a mental health professional.
Persistent depressive disorder (PDD) and major depressive disorder (MDD) are the two main types of depression. Although most of their symptoms are similar, they differ in persistence and severity. PDD affects about 1.5% of U.S. adults, making it less common than MDD. Here are the causes, symptoms, and treatment options for persistent depressive disorder.
What is Persistent Depressive Disorder?
Persistent depressive disorder is a new term for a condition that used to be called chronic major depression or dysthymia. The term was changed in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) to properly reflect the severity and long-term nature of the condition. So what is persistent depressive disorder?
While both MDD and PDD are characterized by low mood or sadness, having symptoms for two weeks might be enough for making the MDD diagnosis, while for PDD the period of having light symptoms for most days is two years for adults.
What Causes Persistent Depressive Disorder
The exact causes of persistent depressive disorder are not fully understood. That said, researchers have identified multiple factors that may contribute to its development. These are explained below.
If one of the parents or siblings has PDD, a person has a high risk of getting it. Scientists believe PDD is connected to genes, but they’re yet to identify the specific genes that cause the problem. They believe environmental factors can trigger depression symptoms in people with these genes. But even though PDD can run in families, it doesn’t mean everyone in the family will get it. According to the American Journal of Psychiatry, the likelihood of inheriting depression is approximately 40%.
An imbalance of norepinephrine, serotonin, and dopamine in the brain can also cause PDD. That is because these neurotransmitters affect mood, motivation, and other cognitive processes. When they’re at low levels, one may experience depressive symptoms such as fatigue and loss of interest in many activities.
Certain medical conditions can lead to the development of the persistent depressive disorder. These include chronic fatigue syndrome, cancer, heart disease, chronic pain, diabetes, and neurological disorders. People with these conditions may experience consistent pain and worries that may contribute to the development of depression symptoms. Some illnesses can also alter the brain’s biological functioning, leading to PDD.
Research shows there’s a close link between personality and depression. People who are highly pessimistic, self-critical, or have low self-esteem have a higher risk of getting PDD. Also, people with high levels of neuroticism, a personality trait characterized by a tendency to experience negative emotions, may be more prone to developing PDD. Other personalities at increased risk include perfectionists and people who depend on others for emotional support and validation.
Environmental factors that may cause PDD include:
Early life stress. Adverse childhood experiences, such as abuse, trauma, or neglect, can increase the risk of getting PDD later in life.
Lack of social support. Social isolation, loneliness, or lack of supportive relationships can increase the risk of developing PDD.
Poor sleep. Sleep disturbances, including insomnia or sleep apnea, can increase the risk of PDD.
Chronic stress. Exposure to ongoing stressors, such as financial problems, relationship difficulties, or job stress, can lead to PDD.
Substance abuse. Substance abuse, including alcohol or drug use, can increase the risk of developing and worsening symptoms of PDD.
Symptoms of Persistent Depressive Disorder
Persistent depressive disorder symptoms are similar to those of major depressive disorder but less severe and more persistent over time. Occasionally, people with PDD may experience symptoms similar to MDD. Some common symptoms of PDD include:
Loss of appetite
Lack of energy
Diagnosis of Persistent Depressive Disorder
PDD diagnosis is just as complex as the condition itself. That’s because most causes remain unclear, and the disorder can easily co-occur with another condition. In case of co-occurrence, it may not be clear which disorder caused the other.
However, the guidelines set out by the DSM-5 can simplify the process. Mental health professionals use interviews and questionnaires to get information from the patient and check if their symptoms correspond with standard manifestations. So, apart from examining the depression signs, your doctor may ask:
How long have you had the symptoms?
How frequently do they occur?
How do they affect your daily activities?
It would be highly beneficial if you made some notes about your symptoms before visiting the doctor so as not to miss important details. Besides asking you questions, the doctor may also speak with those close to you since they may have observed your behavior over time.
Even if you have PDD symptoms, the doctor has to rule out other conditions before making a diagnosis because certain conditions can present similar symptoms. So the doctor may have to carry out additional tests to rule out disorders like bipolar, anxiety, substance abuse, thyroid dysfunction, and personality disorders.
A mental health professional might perform a thorough clinical assessment to evaluate the individual’s symptoms, medical history, family history, current medication, and other factors that could be causing depression. Additionally, they may use screening tools like patient health questionnaires to help diagnose PDD and exclude other mental health conditions.
According to DSM-5, a person fulfilling the following criteria is diagnosed with PDD:
Depressed mood most of the days, as observed by others for at least two years.
During the period of having a depressed mood, the person should present at least two of the following symptoms:
Fatigue or lack of energy
Overeating or loss of appetite
Difficulty sleeping or hypersomnia
Inability to concentrate and make decisions
During the two years, the person has never gone over two months without showing symptoms from the above A and B points.
The person may also present symptoms of major depressive disorder for two years continuously.
The person hasn’t experienced manic, hypomanic, or mixed episodes and doesn’t meet the criteria for cyclothymic disorder.
There’s no possibility that the depression has resulted from delusional disorder, schizophrenia, or other psychotic disorder.
The symptoms don’t result from substance abuse, medical conditions, or medications.
The symptoms have clinical significance and affect the person’s social life, work, and other major life aspects.
The above criteria from the DSM-5 help differentiate PDD from MDD. The directives also help mental health specialists perform diagnoses.
If PDD goes without treatment, the symptoms can persist for many years, leading to significant impairment in a person’s daily functioning. Without intervention, PDD can also increase the risk of other mental health issues, such as substance abuse, anxiety disorders, and suicidal thoughts.
The longer a person stays with untreated PDD, the more likely they can experience social isolation, relationship difficulties, and work-related problems. PDD can also lead to physical health problems, such as chronic pain, poor appetite, and sleep disturbances, which can worsen the condition.
Therefore, it’s essential for those with PDD to seek professional help. Treatment can improve symptoms, reduce the risk of complications, and improve the overall quality of life. Below are the treatment options for PDD.
Treatment for Persistent Depressive Disorder
Persistent depressive disorder treatment involves a combination of medication and therapy. Similar techniques apply to PDD and MDD, although variations may be necessary depending on individual symptoms and needs.
The choice of persistent depressive disorder medication varies depending on the individual’s specific symptoms and medical history. However, certain antidepressants are the most effective in treating PDD. First-line choices for PDD are selective serotonin reuptake inhibitors (SSRIs), while serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered second-line agents.
SSRIs work by increasing serotonin levels in the brain. This neurotransmitter regulates mood, and its high levels can make one feel happy. Examples of SSRIs for PDD include sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro).
SNRIs work by increasing levels of both serotonin and norepinephrine in the brain. Norepinephrine helps to regulate attention, arousal, stress, and cognitive functions. Examples of SNRIs for PDD are duloxetine (Cymbalta) and venlafaxine (Effexor).
Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) are generally reserved for use when other medications for treating PDD aren’t effective, due to their side effects.
Antidepressant medications may take several weeks to start working, and it may take some trial and error to find the right medication and dosage for you. Therefore, work closely with your doctor to monitor any side effects and adjust the drugs accordingly.
Like medications, the most effective PDD therapy depends on the individual’s symptoms and needs. Some of the effective therapies for PDD include:
Cognitive behavioral therapy (CBT). It’s based on the principle that depression may come from unhealthy thinking and irrational behavior. Therefore, the treatment process focuses on helping the patient change the thinking patterns, which in turn helps to change the behavior patterns. It can help a person with PDD identify triggers of negative thoughts and learn how to counter them.
Interpersonal therapy (IPT). It’s a form of talk therapy that focuses on improving communication skills and relationships. IPT recognizes that relationship problems can trigger depression or worsen the symptoms of PDD. Therefore, it helps a person identify and address those relationship problems.
Mindfulness-based cognitive therapy (MBCT). This therapy combines the elements of mindfulness and meditation practices with CBT. It can help people with PDD learn to be more aware of their emotions and thoughts and develop coping skills for stressors and emotions.
Psychodynamic therapy. This talk therapy helps individuals with PDD identify how past events affect their current reactions to circumstances. The therapist works with the patient to identify thoughts, memories, and feelings from early life experiences, such as their relationship with their partners, parents, and others. The purpose is to uncover unresolved emotions, unconscious conflicts, and issues from the past that may contribute to current depression.
General Coping Strategies for PDD
Professional treatment for PDD is highly recommended. In addition to that, you can improve your condition by learning some general coping skills. Sometimes, you may not be able to prevent PDD because of the complexity of the causes, but the following strategies can help minimize the symptoms.
Practice self-care. Make time for self-care activities such as exercise, warm baths, and meditation. Eating a healthy diet and getting enough sleep can also help improve mood.
Engage in enjoyable activities. Find activities that make you feel better or had such effects in the past and spend time engaging in them regularly.
Avoid isolation. Although devoting some time to yourself is essential, avoid isolating yourself for long periods. Make an effort to connect with others regularly, such as your family, friends, support groups, or sports teams.
Manage stress. Sometimes, stress might be inevitable. So, learn healthy ways to manage it since it can worsen depression. You can try exercise, meditation, or practicing relaxation techniques.
Final Thoughts on Persistent Depressive Disorder
Thanks for reading this resource on persistent depressive disorder treatment options. Persistent depressive disorder is a type of depression that lasts for at least two years. It can result from unresolved stressful life events, but one’s personality and genetics can worsen the situation. There’s no single best treatment method for PDD. Your healthcare provider will determine the best medication and therapy based on your symptoms and needs.
If you have some of the symptoms of PDD, as described in DSM-5, it’s best to seek professional help. Note that PDD rarely disappears on its own. Instead, it can get worse when left untreated. Therefore, seek online help for depression today and live a quality life.
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