Persistent depressive disorder (previously known as dysthymia) is a long-lasting depression. It can feel as if it’s just part of who you are — but it doesn’t have to be.
Though not as common as depression, persistent depressive disorder (PDD) affects many people worldwide. Estimates suggest that 1.3% of adults in the United States experience this condition at some point in their lives.
PDD was previously known by two other names: dysthymia and chronic depression.
This condition often goes untreated. People may think that because they’ve lived with the symptoms for so long, it’s just part of who they are, or there’s no fixing whatever is “wrong” with them.
As the name suggests, persistent depressive disorder is persistent, so treatment won’t happen overnight — but there are many types of support and options on your side.
Treating persistent depressive disorder (PDD) is a lot like treating other types of depression. The best treatment is typically a combination of therapy, medication, and self-help strategies. You can learn more about these treatments below.
Psychotherapy — aka talk therapy — aims to help you manage your symptoms, constructively deal with problems in your life, and support you in your treatment.
There are several types of therapy for PDD.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is well-known for treating depression, among other mental health conditions.
One goal of CBT is to help you “rewire” your thoughts. Many people with depression experience distorted ways of thinking, which may be even more ingrained if you have persistent depression.
Your thoughts may automatically go to places like “I will never get better” or “I’m a failure,” which can make you feel worse. A therapist can help you learn to recognize these distortions and change your outlook.
CBT can also help you:
- explore how your emotions, thoughts, and behaviors affect your life and actions
- problem solve
- learn coping skills and relaxation techniques
Cognitive behavioral analysis system of psychotherapy (CBASP) is a newer therapy specifically developed for managing chronic depression.
CBASP combines elements of other therapies, like CBT, with psychodynamic and interpersonal strategies.
The goal of this therapy is to:
- learn to recognize the consequences of your behaviors
- develop social problem-solving skills
- grow interpersonal skills and empathy
- improve functioning and decrease isolation
Research is ongoing for this therapy, and it may not work well for everyone. It’s not as well known as therapies like CBT, so it may be more difficult to find a mental health professional who offers this treatment.
Interpersonal therapy (IPT) is a form of talking therapy that focuses on social and relationship problems that may contribute to the persistence of depression symptoms.
The goals of IPT are to help you communicate better, address relationship issues, and deal with difficult emotions in more positive ways.
Radically open dialectical behavior therapy
Radically open dialectical behavior therapy (RO-DBT) is a newer type of therapy that’s
Dialectical behavior therapy (DBT) is at the base of RO-DBT. This is a type of psychosocial therapy that helps you cope with difficult emotions.
RO-DBT is considered for people who “overcontrol” or attempt to cope by self-controlling. Overcontrol has been linked with social isolation and other relationship problems, perfectionist tendencies, and suppressed emotions.
Though this therapy may help some people with PDD, it is new and may have limited accessibility.
First-line treatments for PDD usually combine medication and therapy.
The medications for PDD are the same as those that treat other forms of depression. These include:
- selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft)
- serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) or duloxetine (Cymbalta)
- atypical antidepressants, like bupropion (Wellbutrin)
- tricyclic antidepressants (TCAs), including amitriptyline
Most doctors will likely start by prescribing an SSRI since most people tolerate them well, but it’s not uncommon for people to try several medications before finding one that works for them.
It’s not always easy to find the right med that relieves symptoms without causing too many side effects. Treating chronic depression may also involve some maintenance, which means tweaking the treatment over time.
While it can be a frustrating back and forth of trial and error, there are treatments out there that will help you.
There are a lot of things you can try to relieve some of your depression symptoms — from support groups to supplements, stress relief, and sleeping habits.
Since PDD is so long-lasting, making habit changes may help you learn how to cope and live better in the long term.
You don’t need to do this alone. Support can come in so many forms.
It often helps to reach out to loved ones, medical professionals, and support groups. These people can offer different types of support. Mental health professionals can help keep you on track with your treatment plan, while loved ones can learn how to support you in a crisis or join you on a weekly walk.
Need help finding a therapist? Psych Central’s search tool can help.
To find a support group:
- Visit Mental Health America’s support group database.
- Join an online support group through the Depression and Bipolar Support Alliance.
- Find a support group or family support group through the National Alliance on Mental Illness.
Exercise and eating
With PDD, making the decision to slowly add healthier foods or movement into your day may help you feel better in a lot of ways.
When it comes to exercise, the feel-good hormones that are released can boost your mood.
You don’t have to start with a gym membership or daily weight lifting. Any movement is beneficial, so consider a short walk or 10 minutes of morning stretching.
As for food choices, it’s best to avoid strict diets that can be hard to follow. Instead, consider adding healthier foods slowly, finding what you like best and what’s accessible to you. Your choices could include:
- more fruits
- whole grains
- fatty fish
While you’ll want to speak with a healthcare professional if you’re really struggling, you can also follow some tips for good sleep hygiene:
- Consistent sleep schedule. Going to sleep and waking at the same times, even on weekends, can be helpful. This may help you achieve a goal of 7 to 9 hours of sleep.
- Comfortable sleep environment. If possible, keep your bedroom dark and reserve it only for sleeping. If there’s outside noise or distractions, a sleep meditation podcast or white noise may help. In the morning, pulling back the curtains will allow some natural sunlight.
- Routine before bed. This can look like whatever you want it to. One idea could be brushing your teeth, setting out your clothes for the next day, and reading a chapter in a book. It can help to avoid screens at least an hour before bed.
While everyone gets stressed, if you’re living with chronic depression, stress can make it even harder than usual to cope.
Here are some stress-relieving activities:
- listening to music
- exercises, like yoga, walking or stretching
- drinking soothing tea
- writing it out
- crafting or creating, like drawing, painting, coloring, or crocheting
- spending time with pets, family, or friends
Evidence on the effectiveness of complementary medication for treating depression isn’t consistent. Nevertheless, you’ve likely heard of at least a few and wondered if they could help.
If you’re interested in supplements, your doctor may have suggestions. But know that some supplements can interact with your current medications or produce unwanted side effects.
St. John’s wort
This wild plant, hypericum perforatum, has often been touted for treating depression, although most evidence on St. John’s wort for depression is mixed.
St John’s wort can affect many medications, though, such as antidepressants and birth control pills. Consider talking with a healthcare professional before you try it. It’s also a stimulant and could intensify anxiety in some people.
This chemical is naturally made in the body and helps regulate cell functioning. Abnormal levels have been reported in some people with depression.
Small short-term trials have shown some benefit, but research is still inconclusive.
Though you can get vitamin D from sunshine (which comes with its own mood-boosting benefits), many doctors support supplementation as well.
Omega-3 fatty acids
These essential fatty acids are found in fatty fish, seeds, and nuts but can also be taken as a supplement.
Omega-3s have a lot of benefits, which
This is a type of amino acid. Some
Several other treatments may be recommended depending on the severity of your depression or if you haven’t responded well to first-line treatments.
Some of these include:
- Light therapy. If you have a hard time getting out of bed due to your depression, or your symptoms are affected by the seasons, you may find a light therapy box to be helpful. A light box can compensate for a lack of sunlight and
may helpwith sleep and serotonin levels.
- Repetitive transcranial magnetic stimulation (rTMS). rTMS is a type of brain stimulation therapy that’s less invasive than most others.
Researchis still ongoing, but the therapy has shown promise for its antidepressant qualities, at least for people with treatment-resistant depression.
- Electroconvulsive therapy (ECT). ECT is one of the most effective types of brain stimulation therapy. Doctors still don’t typically recommend it as a first-line therapy as it can cause memory loss and requires you to be under general anesthesia.
You may know persistent depressive disorder by a different name if you were diagnosed before the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) came out. PDD is a combination of two conditions: chronic major depressive disorder and dysthymic disorder.
According to the DSM-5 criteria, you might receive a PDD diagnosis if you’ve experienced depression most of the time for at least 2 years. In children and younger people, you need to have experienced symptoms for at least 1 year.
Along with depressed mood, at least 2 of the following symptoms must occur:
- appetite changes; either overeating or loss of appetite
- oversleeping (hypersomnia) or difficulty sleeping (insomnia)
- tiredness and low energy
- low self-esteem
- difficulty with decision-making and lack of concentration
- feeling hopeless
As with most mental health conditions, diagnosis occurs when symptoms interfere with your daily life and functioning.
Symptoms will also need to be present continuously, without more than 2 months of being symptom-free in the 2-year period.
Your doctor or a mental health professional will also eliminate other potential causes for your symptoms such as:
If you think you may have PDD — or any depression — you can reach out directly to a mental health professional or your primary doctor if that feels more comfortable.
The more information you have for your doctor, the easier it will be to eliminate other causes, diagnose a condition, and get you started on a treatment plan that will have some success.
You can better prepare for your appointment by making a note of your symptoms. For example, try to make a note of your symptoms, how long they have been present, and how they affect your life.
Information you can bring with you includes:
- A list of the main symptoms you’ve been experiencing.
- How long and how severe these symptoms are.
- Where the symptoms interfere with your functioning: Is it harder to work, focus, wake up or sleep? Are you overeating or never hungry? Do you also have anxiety or really “high” moods along with lows?
- A current list of medications or supplements you take.
- Your medical history, either conditions you have or anything that may run in your family.
Dealing with persistent depressive disorder can be challenging because of how long-lasting its symptoms are. You might feel as if it’s just how life is for you — but it doesn’t have to be.
Between first-line treatments like medication and therapy, along with so many coping tools — support groups, stress-relieving techniques, breathing exercises, and more — you can find a combination that will help manage your PDD.