Persistent depressive disorder (PDD) is not ‘just who you are.’ Learn its symptoms so you can manage the condition and live well.

“… been this way, for as long as I can remember.”

If that’s a phrase that’s been echoed in your family while observing symptoms of seeming “down in the dumps” — with physical and mental malaise — these might be traits of persistent depressive disorder (PDD).

The condition is also known as dysthymia (dis-thigh-me-uh), or chronic depression. The primary feature is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years in adults, and at least 1 year for children and teens.

If you have PDD, you might describe your mood as sad or just not being able to “pick myself up.” During periods of depressed mood, symptoms can manifest in the mind and body, taking a toll on overall health.

Persistent depressive disorder can be more harmful to some people than major depression, which happens once in a while, because it lasts longer.

Chronic depression also causes physical signs and symptoms in some people with this disorder.

Poor appetite or overeating

In some people, a sign of PDD is weight loss due to poor appetite or a loss of interest in food. Other folks experience the opposite symptom and gain weight from overeating.

Insomnia or hypersomnia

Sleep changes like insomnia is another sign of persistent depressive disorder. While some people may have trouble sleeping, other people with chronic depression may sleep too much or feel excessively sleepy during the day.

Low energy or fatigue

Disrupted sleep may lead to low energy or chronic fatigue. Some people with PDD may sleep enough or oversleep but still feel tired and drained during the day.

The characteristic symptom of chronic depression is low mood or sadness that lasts for a serious period of time. Some people living with persistent depressive disorder might be more irritable or anxious. If you have this condition, you might also have mental and emotional effects such as:

  • slow response time
  • low self-esteem
  • problems focus or concentrating
  • loss of interest in activities and hobbies
  • feeling hopeless
  • feeling pessimistic


Everyone experiences chronic depression differently. Even though this mental condition is “persistent,” some people may have cycles where depression lets up, then begins again, mildly to moderately.

Co-occurring with other mental health conditions

In some people, chronic depression is the beginning of or leads to another mental health condition. These include:

Associated features

If you have PDD, you may have also been diagnosed with “associated features” before or while you have this condition. This means that you may have other symptoms or signs of a mental health disorder that are not symptoms of chronic depression but may be linked.

Associated features of PDD include:

  • With anxious distress
  • With mixed features
  • With attention deficit hyperactivity disorder (ADHD)
  • With seasonal affective disorder
  • With melancholic features
  • With atypical features
  • With mood congruent psychotic features
  • With mood incongruent psychotic features
  • With peripartum onset

Specifiers

Your doctor may also use specifiers when diagnosing chronic depression or other mental health conditions.

Specifiers add detail to symptoms to help accurately diagnose a disorder and rule out others. For example, for persistent depressive disorder, one specifier for depression is that it’s long-lasting.

Some specifiers of chronic depression might also be:

  • with pure dysthymic syndrome – full criteria for a major depressive episode has not been met in the past 2 years
  • with persistent major depressive episode – full criteria for a major depressive episode hasbeen met throughout the past 2 years
  • with intermittent major depressive episodes, withcurrent episode – periods of 8 weeks or more where you might not have met the full criteria for a major depressive episode in the past 2 years, but you do meet the criteria at the present time of reevaluation
  • with intermittent major depressive episodes, withoutcurrent episode – periods of 8 weeks or more where the person did not meet the full criteria for a major depressive episode in the last 2 years and does not meet the criteria at the present time of reevaluation

Persistent depressive disorder is fairly common and can begin at any age. It is more common in females than in males, but males may not be diagnosed as often.

When this mental health condition begins in childhood, it’s sometimes called pediatric dysthymic disorder.

About 3% of adults in the United States experience chronic depression every year. This number may be higher because many people may not know they have PDD or their condition has not been diagnosed.

A clinical study that looked at 3,720 people who lived in a city found that almost 15.2% may have had this chronic depression.

Persistent depressive disorder diagnostic criteria

To meet the diagnostic criteria for dysthymic disorder, the symptoms would have to be untethered to the use of a substance such as:

  • alcohol
  • drugs
  • medications

Your doctor might also consider other diagnostics, including a blood test, to rule out physical health conditions that may cause some similar symptoms like:

  • thyroid conditions
  • hormonal imbalances
  • stroke
  • head injury
  • cancer
  • tumors

To be diagnosed with persistent depressive disorder, symptoms must typically also cause significant distress or impairment in your family or social life, workplace, education, relationships, and other important areas.

In most cases, a mental health professional will look for at least two of the symptoms explored earlier.

At least two or three would have to be present during a mostly 2-year period:

  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness

There also can’t be a gap in symptoms for more than 2 months at a time during a 2-year period for adults or a 12-month period in younger folks.

Also, to be diagnosed with chronic depression, you must not have had a manic episode, a mixed episode, or a hypomanic episode in the first 2 years.

Persistent depressive disorder symptoms can be mild and long-lasting. For this reason, many people don’t tell their doctor. The chronic depression symptoms have become a part of their daily life.

Your doctor may recognize the signs and ask you clarifying questions about your symptoms before recommending treatment.

You will need to see a mental health professional to be diagnosed with and treated for chronic depression. Talk with your doctor or connect with a psychiatrist if you think you may have signs and symptoms of this mental health condition.

Psychotherapy

Therapy for persistent depressive disorder will frequently include educational, emotional, and social support. Cognitive-behavioral therapy (CBT) is commonly one-on-one therapy that helps you recognize and open up to change self-critical or harmful thought patterns.

Medication

Prescription medications can also help you manage chronic depression symptoms. Your doctor may recommend antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like:

These medications can be effective for many people, but they come with a risk of side effects.

Supplements

Some people with PDD may find that supplements also help reduce symptoms. This includes B vitamins to help you beat fatigue and feel more energized.

Note

It’s a good idea to check with your doctor before trying any supplement. Even natural supplements can interact with medications.

All kinds of depression have similar symptoms like feeling low, sleep problems, loss of interest, and feeling hopelessness. The main difference between a chronic depression like PDD and major depression is time.

Chronic depression consistently results in depression symptoms that last for at least 1–2 years, usually longer. Also, PDD typically carries mild to moderate symptoms, while major depression can result in severe symptoms.

In some people, PDD can turn into major depression if left untreated.

In many people, chronic depression is not diagnosed until symptoms become more noticeable, which coincides with the condition deepening to major depression.

Like other mental health conditions, chronic depression can get worse or cause disruption in your health and your overall quality of life. Talk with your doctor if you think you have persistent depressive disorder or any kind of depression. There are several treatments that can help.

Our all-inclusive guide to treating persistent depressive disorder offers information on medicine and self-help strategies.