Persistent Depressive Disorder (PDD) is also known as Dysthymia or Dysthymic disorder. It is a mental disorder that primarily affects the mood of the sufferer. It is a chronic form of depression, where an individual suffers from a long-term depressed mood, which may even last for years.
In the case of affected children or adolescents, PDD can last for at least a year, while in adults, it is persistent for at least two years.
Studies show that PDD is more common and often more disabling than episodic major depression.
What is Persistent Depressive Disorder?
Let’s take a deeper look into what PDD, or dysthymia really is. Individuals suffering from Persistent Depressive Disorder may experience the symptoms way before they are diagnosed. This is due to the chronic nature of the disorder.
Often, such individuals may even feel that the depression is in their nature, which discourages them from reaching out for help or proper diagnosis.
Recognizing and diagnosing PDD is crucial for effective treatment and management. Psychotherapy, such as cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), along with antidepressant medications, are common approaches to managing PDD.
Early intervention and ongoing support from mental health professionals can help individuals with PDD regain a sense of control over their mood and improve their overall quality of life.
Symptoms of Persistent Depressive Disorder
Persistent Depressive Disorder (PDD), or dysthymia, can be characterized by a consistently low mood over a long period. The symptoms of PDD are generally less severe than those of major depressive disorder (MDD) but are more persistent and enduring.
Some of the key symptoms of PDD are listed below:
Depressed Mood
The main symptom of Persistent Depressive Disorder (PDD) is feeling down or sad almost all the time. This feeling is there most days, for a large part of the day, and it lasts for a long time. It’s like having a cloud over one’s head that never goes away.
People with PDD often feel a constant sense of sadness, as if they can’t find joy in things they used to enjoy. This sadness can also make them feel hopeless like things will never get better.
It’s not just a temporary feeling of being down, but a deep, ongoing sense of gloom that affects their daily life. They might struggle to see the positive side of things and feel weighed down by their emotions.
This persistent low mood is a key characteristic of PDD and is what sets it apart from other types of depression.
Poor Appetite or Overeating
People with PDD or Dysthymia might notice big changes in how they eat. Some may lose their appetite, meaning they don’t feel like eating much, which can lead to weight loss. On the other hand, some might find themselves eating more than they usually do, even when they’re not hungry, which can cause them to gain weight.
These shifts in eating habits are common in PDD and can be another sign that something is wrong. It’s not just about feeling sad; it also affects how they relate to food.
Insomnia or Hypersomnia
Sleep disturbances are common in PDD.
Like appetite, the sleep cycle of a PDD-affected individual also varies from person to person. Some might face difficulty falling and staying asleep (insomnia), while some might feel tired even after sleeping for more than 10 hours (hypersomnia).
Low Energy or Fatigue
Constant tiredness or low energy is a common symptom of Persistent Depressive Disorder. People suffering from PDD often feel exhausted, both physically and mentally, which makes it hard for them to get through their daily routines or enjoy activities they used to like.
This feeling of being drained all the time can affect everything they do, making even simple tasks feel overwhelming. The lack of energy can also make it difficult to stay motivated or focused, adding to the challenges they face every day.
Low Self-Esteem
People with Persistent Depressive Disorder often suffer from very low self-esteem. This means they don’t think highly of themselves and often feel worthless or not good enough. They might constantly believe they are failing or that they can’t do anything right.
These feelings of being inferior to others can make their mental health even worse. When someone feels this way all the time, it can be very hard for them to feel happy or confident. They might avoid trying new things because they already believe they will fail.
This negative self-view can affect their relationships, work, and overall quality of life. Feeling worthless and having low self-esteem can be one of the toughest parts of living with PDD.
Poor Concentration
Individuals often struggle with cognitive symptoms, which affect how they think. They might find it hard to concentrate on tasks, remember details, or make decisions. This can make it difficult for them to do well at work or school.
Everyday activities can become challenging because their mind feels foggy or slow. These cognitive problems can impact their ability to function normally and handle daily responsibilities, adding to the difficulties they face with PDD.
Feelings of Hopelessness
People with PDD often feel a deep sense of hopelessness about the future. They may believe things will never improve, which adds to their ongoing low mood. This constant feeling that nothing will improve makes it hard for them to feel optimistic about anything.
This sense of hopelessness is a common and challenging symptom of PDD, making it difficult for them to see any light at the end of the tunnel.
These symptoms are present for a prolonged period and cause significant distress or impairment in social, occupational, or other important areas of functioning, which leads to disruption in such an individual’s daily functioning.
Causes of Persistent Depressive Disorder
Dysthymia or PDD is a complex mental disorder and it doesn’t arise due to a single cause. Instead, it results from a combination of genetic, biological, environmental, and psychological factors.
The primary factors that lead to the development of PDD in people are listed below:
- Genetic Factors- PDD tends to run in families, indicating a genetic influence. Individuals with a family history of depression or other mood disorders are at a higher risk of developing PDD.
- Biological Factors- Imbalances in neurotransmitter levels in the brain lead to depression. Neurotransmitters, such as serotonin, dopamine, etc., play critical roles in mood regulation, energy levels, and motivation.
- Hormonal Imbalances- Hormonal imbalances related to the hypothalamic-pituitary-adrenal (HPA) axis, can contribute to depression. The HPA axis is responsible for regulating the body’s response to stress, and dysregulation in this system can lead to chronic stress and depressive symptoms.
- Environmental Factors- Prolonged exposure to stressful life events, such as financial difficulties, work-related stress, and chronic illness, can trigger and maintain depressive symptoms. Childhood trauma, including abuse, neglect, and exposure to trauma, increases the risk of developing PDD later in life.
- Substance Abuse- Alcohol and drug use can alter brain chemistry and increase vulnerability to PDD.
- Social and Interpersonal Factors- Loneliness and isolation are significant risk factors for PDD. Positive social interactions and strong support networks are crucial for mental health. Relationship problems can even lead to the deterioration of mental health.
- Psychological Factors- Certain personality traits, such as high levels of neuroticism, low self-esteem, and a tendency toward excessive worry, are associated with an increased risk of developing PDD. Perfectionism and an excessive need for control can also contribute to chronic depressive symptoms.
Difference between Major Depressive Disorder and Persistent Depressive Disorder
Major Depressive Disorder
- MDD (Major Depressive Disorder) is characterized by severe depressive episodes that can last at least two weeks. These episodes are marked by intense symptoms that significantly interfere with daily functioning. MDD is episodic in nature, which means there can be periods of normal mood within the depressive episodes.
- Symptoms of MDD include a deep feeling of sadness, hopelessness, loss of interest in activities, significant weight change, sleep disturbances, fatigue, feelings of worthlessness, and suicidal thoughts. The intensity of symptoms is severe enough to disrupt an individual’s daily life.
- MDD can develop at any age, often triggered by significant life events, trauma, or major changes. The onset of MDD can be sudden.
- The prognosis of MDD varies from person to person, depending on the number and severity of episodes, response to treatment, and presence of co-occurring conditions. Recovery can be achieved fully, however, it has been noted to recur for some individuals.
Persistent Depressive Disorder
- PDD (Persistent Depressive Disorder) is a chronic form of depression where symptoms are less severe than MDD but usually last for a much longer duration. PDD is not episodic like MDD.
- Symptoms of PDD are similar but are usually less intense. They include a depressed mood most of the day, poor appetite or overeating, insomnia or hypersomnia, etc.
- PDD typically begins in childhood, adolescence, or early adulthood. The onset is usually more gradual when compared to MDD and usually goes unnoticed.
- In the case of PDD, the prognosis is more challenging to treat due to its chronic nature. Even with treatment, individuals often experience ongoing symptoms, but these can be managed to improve their quality of life.
Treatment for Persistent Depressive Disorder
Due to its chronic nature, PDD requires a comprehensive treatment approach. The primary goals of treatment are to reduce symptoms, improve quality of life, and enhance daily functioning.
The advances made in the 1980s and 1990s have yielded many advances in the diagnosis and treatment of depression and dysthymia.
Treatment typically involves a combination of psychotherapy, medication, and lifestyle changes.
Psychotherapy for PDD
The goal of psychotherapy is to help individuals understand and manage their depression by exploring the psychological and emotional factors that contribute to their condition. There are several types of psychotherapy that have been found to be effective in treating PDD.
Cognitive Behavioral Therapy (CBT)
CBT is designed to help individuals identify and change negative thought patterns and behaviors that contribute to their depression. This involves identifying and challenging distorted or irrational thoughts and replacing them with more realistic and positive thoughts which helps an individual to get rid of their depressed mood.
It often involves encouraging individuals to engage in activities that they find pleasurable or rewarding, even when they don’t feel like it, to break the cycle of depression and inactivity.
Interpersonal Therapy (IPT)
IPT focuses on improving interpersonal relationships and social functioning, which can help reduce depressive symptoms. It is effective for individuals whose depression is closely linked to relationship issues. It helps them develop better communication skills and healthier relationships, which can alleviate depressive symptoms.
Psychodynamic Therapy
Psychodynamic therapy explores how past experiences, unconscious processes, and unresolved conflicts influence current behavior and feelings. It involves helping individuals become more aware of their unconscious thoughts and feelings.
Past experiences are often linked with shaping current behavior. Unresolved trauma may often lead to depression in many individuals. Psychodynamic therapy aims to identify such experiences and resolve them for the betterment of depressed individuals.
Dialectical Behavior Therapy (DBT)
It was originally developed for borderline personality disorder. DBT has been adapted for use in treating depression. It combines cognitive-behavioral techniques with mindfulness practices. Techniques include – mindfulness, distress tolerance, emotion regulation, and relationship improvement.
DBT is particularly useful for individuals who experience intense emotions and have difficulty managing them. It provides tools for coping with distress and improving emotional stability.
Mindfulness-Based Cognitive Therapy (MBCT)
MBCT combines cognitive therapy with mindfulness practices to help individuals become more aware of their thoughts and feelings in a non-judgmental way. MBCT includes techniques like Mindfulness Meditation, Decentering, and Body Scan. It helps individuals develop a healthier relationship with their thoughts and emotions.
Supportive Therapy
Supportive therapy provides a safe and supportive environment for individuals to express their feelings and receive empathy and encouragement. It includes the therapist listening attentively and providing validation and understanding. The aim is to be supportive towards the patient and make them feel heard and loved. It helps individuals develop practical solutions to their problems.
Medication for Persistent Depressive Disorder
Medication is a crucial component in the treatment of Persistent Depressive Disorder (PDD), especially for those who do not respond adequately to psychotherapy alone.
Antidepressant medications can help alleviate the chronic symptoms of PDD, such as persistent sadness, low energy, and poor concentration.
Some of the most common antidepressants are:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs work by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a key role in mood regulation.
SSRIs are generally considered the first line of treatment for PDD because of their efficacy and relatively mild side effects. They help improve mood, increase energy levels, and enhance overall well-being.
The mild side effects may include nausea, headache, sleep disturbances, sexual dysfunction, and increased anxiety initially. These side effects often diminish over time.
Some examples are Sertraline (Zoloft), Fluoxetine (Prozac), and Escitalopram (Lexapro).
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs increase the levels of both serotonin and norepinephrine in the brain. Norepinephrine is another neurotransmitter involved in mood and alertness.
SNRIs are prescribed for patients who may not respond fully to SSRIs. They can improve mood, energy levels, and concentration.
Some common side effects may include nausea, dry mouth, dizziness, insomnia, and sexual dysfunction.
Examples of SNRIs are Venlafaxine (Effexor) and Duloxetine (Cymbalta).
Tricyclic Antidepressants (TCAs)
TCAs work by increasing the levels of serotonin and norepinephrine in the brain. They are one of the older classes of antidepressants. TCAs can be very effective, especially in patients who do not respond to SSRIs or SNRIs. They are often used when other treatments have failed.
Common side effects include dry mouth, blurred vision, constipation, urinary retention, and dizziness. TCAs can also cause cardiac issues, so they require careful monitoring, especially in older adults.
Common MAOIs
MAOIs are usually reserved for patients who do not respond to other treatments due to their side effect profile and dietary restrictions.
Side effects include dizziness, insomnia, weight gain, and sexual dysfunction. Patients are advised to avoid foods containing tyramine (such as aged cheeses and cured meats) to prevent severe hypertensive reactions.
Examples of MAOIs are – Phenelzine (Nardil) and Tranylcypromine (Parnate).
Combination Therapy for PDD
This strategy refers to combining medication and psychotherapy to yield better and faster results in PDD patients. This approach can address both the psychological and biological aspects of the disorder, leading to more comprehensive and effective treatment.
Visit our website to know more.
