Persistent Depressive Disorder

Persistent Depressive Disorder Diagnosis and Treatment

Persistent depressive disorder can affect multiple areas of an individual’s life. Read on to learn more about symptoms and treatment methods.

The information presented on this page is an overview of the average evaluation of persistent depressive disorder and is offered here as a resource. At J. Flowers Health Institute, our evaluations and treatment plans are customized and tailored to each individual’s needs. We specialize in providing a comprehensive team approach to your care. Our evaluations may include a psychiatric evaluation, psychosocial and trauma assessments, and brain mapping for help diagnosing your symptoms to provide the holistic care you deserve.
If you would like to learn more about J. Flowers Health Institute, please do not hesitate to reach out.
We welcome any questions you have: 713.715.1618.

What Is Persistent Depressive Disorder?

Everyone experiences periods of intense sadness at some point in their lives. For most, sadness and other effects on mood that result from a specific event or situation pass with time. For others, this is not the case, which may lead to a mental health condition called persistent depressive disorder.

Depression is a term often used to describe the emotions someone experiences when they are sad. When depressed, it is also common to experience changes in appetite, problems with sleep, and a general lack of desire to participate in activities or obligations one usually enjoys.

Understanding Persistent Depressive Disorder (PDD) Disorder

Common Types of Depression Disorder

There are several types of depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). These include:
  • Major depression (major depressive disorder)
  • Bipolar disorder
  • Seasonal affective disorder
  • Situational depression
  • Postpartum depression
  • Persistent depressive disorder
Although each type of depression features common symptoms, each is also a unique diagnosis with specific characteristics. To ensure you receive the most effective treatment for their symptoms, it helps to understand how persistent depressive disorder differs from other types of depression.

Persistent depressive disorder and major depressive disorder are similar in many ways, and it is not uncommon for misdiagnosis to occur.

A Closer Look at Major Depressive Disorder Disorder

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.

Symptoms of Dysthymia

This disorder often causes multiple symptoms, such as:
  • A loss of interest in daily activities
  • Decreased productivity
  • Low self-esteem
  • Feelings of hopelessness
These feelings tend to last for several years and interfere with relationships and work output.1 As a result, affected individuals often find it difficult to be upbeat, even during happy occasions or after a significant achievement.
Regardless of the individual’s age, someone with persistent depressive disorder will experience depressive symptoms most of the day, on most days, for an extended period of time.

Note About Persistent Depressive Disorder

Those with this disorder are usually described as constantly having a downbeat demeanor. Although persistent depressive disorder is not considered as severe as major depressive disorder, it still causes significant obstacles to appreciating and enjoying life.
If you or a loved one have dysthymia, it is important to be patient and understanding of any symptoms.

Types of Dysthymia

During an assessment, mental health providers will evaluate a person’s level of depression. Depending on the outcome of this evaluation, a person could have one of three types of persistent depressive disorder, including:2
  1. Pure Dysthymic Syndrome: Depression symptoms will be persistent and significant, but will not meet the diagnostic criteria for a major depressive episode.
  2. Persistent Major Depressive Episodes: The person reports experiencing several severe major depressive episodes over a period of two years. Unlike major depression, however, the symptoms do not worsen or improve with time. Instead, they remain consistent throughout.
  3. Intermittent Major Depressive Episodes: An individual will experience some episodes of major depression with chronic depressive symptoms. To be diagnosed with this type of dysthymia, one must experience eight or more weeks of major depression in the previous 24 months.

Is Persistent Depressive Disorder a Disability?

Depression is considered a disability under the Americans With Disabilities Act and the Blue Book. The Blue Book is 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:3
  • Depressed mood
  • Diminished interest in activities
  • Appetite disturbances
  • Sleep disturbances
  • Psychomotor agitation 
  • Decreased energy
  • Difficulty concentrating or thinking
  • Feelings of guilt
  • Suicidal thoughts
Those with dysthymia usually exhibit most of these symptoms, lasting for a considerable amount of time.

Prevalence of This Condition

Data from the National Institute of Mental Health indicates more than 21 million Americans experienced at least one episode of depression in 2020.4 Recent studies conducted during and post-COVID-19 suggest the prevalence rate of dysthymia has increased since the early 2000s. 
It is estimated that between 2.5% and 3% of the population will experience persistent depressive disorder at some point in their lives. Dysthymia is also more common in those with a first-degree relative who shares the same condition.5

Causes and Risk Factors

Like several similar mental health concerns, researchers do not fully understand the specific causes of dysthymia. Studies suggest several causes and risk factors contribute to the development of persistent depressive disorder. 

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 40%.6

Brain Chemistry

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

Life Events

An accumulation of stressors over a considerable period may also contribute to dysthymia. This can include stressors such as financial problems, traumatic events, the loss of a loved one, and 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:
  • Child abuse
  • Family history of depression
  • Character traits such as negativity and low self-esteem
  • Brain injury
  • Long-term illness

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. This can cause symptoms of increased sensitivity to rejection or failure, low self-esteem, headaches, and tiredness.
Environmental and genetic factors also can predispose a child to dysthymia. Therefore, mental health experts usually carry out dysthymia diagnoses with extensive interviews with the affected child and caregivers and close family members.

Youth with dysthymia often experience symptoms of other mental health concerns, such as anxiety and substance use disorders.

Important Note About Persistent Depressive Disorder in Children

In addition to genetics and environment, other risk factors for persistent depressive disorder in children are similar to those in adults.
Examples may include:7
  • Excessive stress
  • Family history
  • Trauma, such as abuse, neglect, or loss of a parent or loved one
  • Long-term health challenges
  • Developmental or learning delays
  • Co-occurring mental health diagnoses
  • Experimentation with drugs or alcohol

Diagnosis of Persistent Depressive Disorder

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

Physical Exam

A physical exam is usually conducted first. 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.

A medical evaluation is crucial to rule out or diagnose any underlying medical conditions that may contribute to depressive symptoms.

Lab Tests

Lab tests help to rule out the presence of other medical conditions that could cause depressive symptoms. For example, hyperthyroidism, a condition whose symptoms can 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 assessment determines if patients have persistent depressive disorder or other closely related conditions, such as major depressive disorder, bipolar disorder, or seasonal affective disorder.

Research indicates dysthymia often co-occurs with other mental health conditions. For example:
  • 70% of those with borderline personality disorder also have persistent depressive disorder.8
  • Dysthymia co-occurs with substance use disorders between 30% and 40% of the time.9
  • Up to 75% of those with dysthymia develop major depressive disorder. This is sometimes called “double depression.”10

Diagnostic Criteria

The criteria for diagnosing dysthymia include the presence of two or more of the following symptoms:11
  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness
  • Frequent complaints of physical ailments such as headache, stomach ache, or fatigue
  • Loss of enjoyment in usual activities and hobbies
  • Thoughts of or attempts at self-harm

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, co-occurring medical or mental health concerns, and previous treatments.
The following treatment options are all accredited and available to those with depression:


Antidepressants are the most common class of medication prescribed for patients with depressive disorders. Examples include:
  • Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Lexapro, Paxil, and Zoloft.
  • Tricyclic antidepressants, including Elavil, Tofranil, and Vivactil.
  • Serotonin and norepinephrine reuptake inhibitors, such as Effexor and Cymbalta.
  • Other medications may also be used, such as Remeron and Wellbutrin.
Studies suggest medications are highly effective for reducing the intensity and frequency of depression symptoms.
One study from 2015 found that approximately 55% of individuals with dysthymia who used antidepressants as part of their treatment plan experienced symptom reduction. This is compared to 31% who took a placebo.12
While all the above-listed types of antidepressants are effective, SSRIs are the most commonly prescribed due to fewer significant side effects.

Talk Therapy

Talk therapy involves psychological counseling. A mental health professional will discuss the depressive condition with the patient and help 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). In addition to CBT, other talk therapy models include dialectical behavior therapy (DBT) and contingency management.
For children and teens with dysthymia, talk therapy is often the first treatment option. Unfortunately, some antidepressant medications, while highly effective, are not recommended for use in children and teens.

What to Expect During Therapy

Other Approaches to Healing

In addition to psychotherapy and medication, several alternative or complementary treatment options can further alleviate depression symptoms.

An article posted by the Cleveland Clinic suggests incorporating the following into your routine:13
  • Regular exercise
  • Eating a healthy and balanced diet
  • Avoiding alcohol and substance use
  • Engaging in hobbies or other activities
  • Connecting with a strong support network of family and friends
  • Remaining engaged with your treatment provider and therapy team
Anyone struggling with persistent depressive disorder should seek support immediately from a qualified and experienced mental health professional.
Persistent Depressive Disorder

Persistent Depressive Disorder Treatment Options at J. Flowers Health Institute

J. Flowers Health Institute provides many programs that help address, evaluate, and treat mental health disorders, such as persistent depressive disorder.

Our highly-qualified staff prioritizes the health and well-being of each patient. Our team of caring and compassionate care providers will work with you or your loved one to develop a plan of care that aligns with your unique treatment needs and goals.

How Can We Help?

If you or a loved one are struggling with persistent depressive disorder or other symptoms related to mental health struggles, reach out to us today. Our Living MRI tool can help take a comprehensive look at your symptoms in order to ensure that you’re getting the best treatment for your needs.

We can also provide holistic treatments and a Bespoke Stabilization Program uniquely tailored to your individual needs, circumstances, and experiences.

Let us help you take the first steps toward healing and recovery. Begin the path to a better quality of life by calling J. Flowers Health Institute today. We will be with you every step of the way.

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