Persistent Depressive Disorder

Persistent Depressive Disorder Diagnosis and Treatment

Learn about the causes, symptoms, and treatment methods for persistent depressive disorder.

Table of Contents

Understanding Persistent Depressive Disorder

Persistent depressive disorder, also known as dysthymia, is characterized by a long-term form of depression. In other words, it is a mild or moderate kind of depression that doesn’t go away. One of the distinct characteristics of dysthymia is that it lasts for at least two years in adults and over a year in children and teens. Symptoms can be absent for as long as two consecutive months in adults.


This disorder causes loss of interest in daily activities, decreased productivity, low self-esteem, and feelings of hopelessness. These feelings tend to last for several years and interfere with relationships and work output. As a result, affected individuals often find it difficult to be upbeat, even during happy occasions or after a significant achievement.


Those with this disorder are usually described as possessing a gloomy personality, constantly having a downbeat demeanor, and incapable of having fun. Although persistent depressive disorder is not considered as severe as major depressive disorder, it still causes significant obstacles against appreciating and enjoying life.

Is Persistent Depressive Disorder a Disability?

Depression is considered a disability under the Americans With Disabilities Act and the Blue Book—the Social Security Administration’s (SSA) comprehensive list that outlines medical conditions that make an affected individual qualify for disability benefits.

In the Blue Book, depressive disorders are recognized as a disability if it is characterized by at least five of the following features:

  • Depressed mood
  • Diminished interest in activities
  • Appetite disturbances
  • Sleep disturbances
  • Psychomotor agitation and retardation
  • Decreased energy
  • Difficulty concentrating or thinking
  • Feelings of guilt
  • Suicidal thoughts

Those with dysthymia usually exhibit most of these symptoms, and they last for a considerable amount of time, thereby qualifying the individual as a disabled person.

Prevalence of Persistent Depressive Disorder

From 2001 to 2003, the National Comorbidity Survey Replication (NCS-R) found that the prevalence rate for dysthymia was about 1.5% of the population in the United States, with 49.7% experiencing severe impairment. It is estimated that around 2.5% of the population will experience persistent depressive disorder at some point in their lives. Additionally, data showed the disorder appeared more common in women than men.3

Persistent Depressive Disorder Causes and Risk Factors

Several causes and risk factors contribute to the development of persistent depressive disorder. They are examined below:

Persistent Depressive Disorder Causes

Causes for this disorder include genetic, biological, and environmental factors.


Like major depressive disorder, persistent depressive disorder is linked to genetic susceptibility. In families with a history of dysthymia, the rate of people suffering from dysthymia can be as high as 50%.4

Brain Chemistry

Medical and health professionals have linked persistent depressive disorder to a chemical imbalance in the brain. Neurotransmitters, such as dopamine, norepinephrine, and serotonin, play a role in an individual’s overall mood. As such, if the brain is not releasing enough neurotransmitters, feelings of well-being and happiness decrease.

Life Events

An aggregation of stressors and increased hassles over a considerable period has been linked to dysthymia, such as financial problems, traumatic events, the loss of a loved one, mental or physical abuse.

Risk Factors

Several risk factors have been found to increase the development of persistent depressive disorder. The various risk factors associated with dysthymia include:

  • Stress and traumatic life events
  • Child abuse
  • Family history of depression
  • Character traits, such as negativity and low self-esteem
  • Brain injury
  • Long-term illness

Signs and Symptoms of Persistent Depressive Disorder

Persistent depressive disorder is marked by signs or symptoms in an affected individual. Dysthymia symptoms are generally the same in most adults, but persistent depressive disorder can also be detected in children.

Common Symptoms of Persistent Depressive Disorder

Some common symptoms of dysthymia include: 5

  • Loss of interest in daily activities
  • Sadness and emptiness
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness

Persistent Depressive Disorder in Children

In children, persistent depressive disorder is diagnosed if they exhibit a consistent low, sad, or irritable mood for one year. It usually disturbs children’s sleep, eating, and thinking patterns and causes symptoms, such as increased sensitivity to rejection/failure, low self-esteem, headaches, and tiredness.


Environmental and genetic factors often predispose a child to dysthymia. Therefore, mental health experts often carry out dysthymia diagnoses with extensive interviews with the affected child and caregivers/close family members.

Diagnosis of Persistent Depressive Disorder

Diagnosis of Persistent Depressive Disorder

Mental health experts diagnose dysthymia through exams and tests. Three evaluations are involved in the process:

Physical Exam

A physical exam is usually conducted. At the same time, in-depth questions are asked to determine the patient’s mental state and identify the root causes of the depressive disorder.

Lab Tests

Lab tests are usually conducted to rule out the chance of other medical conditions that could cause depressive symptoms. For example, hyperthyroidism, a condition whose symptoms closely mirror depression, is usually tested for and ruled out.

Psychological Evaluation

An evaluation to pinpoint a specific diagnosis is usually conducted using a questionnaire to understand the patient’s thoughts and feelings. A psychological evaluation determines if patients have persistent depressive disorder or other closely related conditions, such as major depressive disorder, bipolar disorder, or seasonal affective disorder.

Diagnostic Criteria

The criteria for diagnosing dysthymia include the presence of two or more of the following symptoms:6

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

Treatment for Persistent Depressive Disorder

The treatment process for dysthymia involves a combination of medications and talk therapy. Persistent depressive disorder treatment depends on personal preference, the severity of symptoms, tolerance for medications, and previous treatments. The following treatment options are all accredited and available to those with depression:7


Antidepressants are the most common class of medication prescribed for patients with depressive disorders. Examples are selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and serotonin and norepinephrine reuptake inhibitors.

Talk Therapy

Talk therapy involves psychological counseling. A mental health professional discusses the depressive condition with the patient and helps them formulate new coping strategies, identify behaviors that led to dysthymia, and regain a sense of control over their actions and lives. Usually, the preferred form of talk therapy is cognitive behavioral therapy (CBT).

Finding Help

Anyone struggling with persistent depressive disorder should seek support immediately with a qualified and experienced mental health professional.

Dysthymia Treatment Options at J. Flowers Health Institute

J. Flowers Health Institute provides programs that help address, evaluate, and treat mental health disorders, such as persistent depressive disorder. Our highly qualified staff prioritize the health and well-being of each patient. Begin the path to a better quality of life by calling J. Flowers Health Institute today.