You’re intensely insecure and self-conscious, so much so it feels like one of your prime attributes. You’d describe yourself as a true-blue pessimist or cynic. You don’t really get excited about anything. You have a hard time connecting with others. And you find yourself constantly exhausted and drained.
Because it’s been this way for so long—decades maybe, you’ve lost count—you just assume it’s you. You assume this is who and how you are. This must be your personality. This is just your way of life.
However, these supposed traits and tendencies might actually be a diagnosable and treatable disorder. In other words, that pessimistic personality, that deep-seated self-doubt, or that sinking energy may be a symptom of an illness.
In her 2017 article in Open Journal of Depression, researcher Sherri Melrose, Ph.D, RN, noted that the above speaks to some of the ways health professionals have described individuals with a chronic form of depression called persistent depressive disorder (PDD). Before DSM 5 was published in 2013, PDD was known as dysthymia.
PDD is one of the most under-treated and under-diagnosed conditions.
“Some people may have been depressed from an early age and thus are unaware that there is any other way to feel,” said J. Kim Penberthy, Ph.D, ABPP, a board-certified clinical psychologist and professor of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine who specializes in chronic depression.
“Many have parents or caregivers who also suffer from PDD and thus, again, these symptoms may seem ‘normal,’” she said.
Signs and Symptoms
Signs of PDD include, according to Penberthy: “sadness, tearfulness, low self-esteem, low energy, poor concentration or attention, and feelings of helplessness or hopelessness.”
Individuals with PDD also often “withdraw socially,” and have physical symptoms, such as: “headaches or pain, poor sleep, fatigue, [and] appetite changes,” she said.
PDD has been referred to as a “smoldering mood disturbance.” Adults with PDD experience symptoms for at least 2 years (with no longer than 2 months without any symptoms). In kids and teens, PDD lasts at least 1 year.
“Trauma during childhood or later in life has been hypothesized to play a role in the development of PDD,” Penberthy writes in her new book Persistent Depressive Disorders. “Retrospective and prospective studies have found increased rates of traumatic events, especially childhood trauma, in patients with PDD,” she writes.
After experiencing a severely traumatic event in her teens, Maddie Baldassari, a writer, speaker, and mental health advocate, was diagnosed with chronic depression. Baldassari felt exhausted all the time and too tired to read or hang out with friends.
“Probably the most noticeable symptom for me is not showering. The thought of having to wash my hair and dry it and fix it was so overwhelming I wouldn’t even try,” she said. “And then I would be too embarrassed to leave the house and it just became a cycle.”
PDD also frequently co-occurs with other conditions such as major depression, anxiety disorders, and substance abuse.
PDD rarely gets better on its own, which is why Penberthy stressed the importance of getting help. She suggested seeking out a mental health professional who specializes in treating PDD (if possible), namely because the treatment may differ from treating acute depression.
“Treatments for PDD will typically need to be for a longer period of time and may require a combination of antidepressant medications or that the medications are given at higher doses for longer periods of time.”
Penberthy noted that research has found the following therapies to be effective: Cognitive behavioral analysis system of psychotherapy (CBASP), cognitive behavioral therapy (CBT) for chronic depression, and interpersonal psychotherapy (IPT). Penberthy is certified in CBASP. (You can learn more about these evidence-based interventions in this treatment article.)
Also, mindfulness based cognitive therapy has been shown to be helpful in preventing relapse in individuals who’ve improved, she said.
Today, Baldassari takes medication, sees a therapist twice a month, and volunteers at her local NAMI. She also relies on the skills she learned from dialectical behavior therapy (DBT). She regularly uses the skill of “opposite action.” For instance, any time she’s exhausted and overwhelmed and just wants to lay in bed, she does the opposite and gets up.
Sometimes, Baldassari feels hopeless, “like I am trapped on a merry go round of hopelessness and it won’t let me off.” This is when she uses the DBT skill of emotion regulation. Specifically, she asks herself this question: “Are these scenarios I am thinking true, or are they a fleeting feeling or emotion?”
“This oftentimes makes me more aware that it is a symptom of my illness and not my reality. I also use my husband as a sounding board as he has a good idea of when I am slipping into a state of depression.”
Baldassari stressed the importance of finding a good doctor—whether you do so on your first or fifth try—understanding that medications aren’t miracle workers, and being willing to try different medications (when appropriate).
“I still experience my depression but I found the right treatment for me, that allows me to live a successful life,” Baldassari said.
“I have been married for 16 years and [have] a job that I love. That is the important part to know: Your story is yours and you need to try and be your own advocate to live a life of wellness. Know that you aren’t alone and that many people have the same symptoms and you can get help with the proper treatment for you.”
And that starts with getting the right diagnosis, which starts with contacting a mental health professional. Which you can do today.
You can feel better. You can change your mood and your ways—no matter how deeply entrenched they might seem. And yes, you deserve that, even if it doesn’t feel like you do. After all, that’s the depression talking, and, thankfully, that depression is highly treatable.