Persistent Depressive Disorder: Everything You Need To Know

Persistent Depressive Disorder: Everything You Need To Know

Everyone feels sad or gloomy every now and then, but for some people, feelings of hopelessness and melancholy can last for days, months, or years.

People with persistent depressive disorder (PDD) feel symptoms of depression most of the day, on most days, for at least two years. PDD can significantly interfere with day to day life, but with the right tools, it can be treated so it’s manageable.  

What is Persistent Depressive Disorder?

PDD, formerly known as dysthymia, is a continuous, long-term form of depression. Someone with PDD may lose interest in pleasurable activities, not be able to keep up with daily responsibilities like work or school, and/or may not be able to engage in social activities or carry on meaningful relationships. 

Over time, more than half of people with dysthymia experience worsening symptoms that lead to the onset of a full syndrome of major depression superimposed on their dysthymic disorder, resulting in what is known as double depression. 

Causes of Persistent Depressive Disorder?

It’s not fully understood what causes chronic depression, though it is likely a combination of  genetic, biological, and environmental factors.

Research has found that there are some differences in brain chemistry between individuals with and without depression. Namely, neurotransmitters such as serotonin, which affects mood and helps keep the body in balance, are markedly lower in individuals with depression — this is why antidepressants aim to help increase the amount of serotonin and other mood neurochemicals available for use by the brain. 

Symptoms of Persistent Depressive Disorder

Symptoms of persistent depressive disorder can look different in everyone, though it usually presents as:

  • Feelings of hopelessness or sadness
  • Lack of appetite, or overeating
  • Fatigue
  • Low self-esteem
  • Decreased productivity
  • Lack of interest in pleasurable activities
  • Avoidance of social activities
  • Irritability
  • Sleep problems, such as insomnia
  • Trouble concentrating

How is PDD Diagnosed?

PDD can only be diagnosed by a medical provider, licensed therapist, or psychiatric provider. 

An evaluation will likely be done to rule out other mood disorders, such as major depression or bipolar disorder. The main indication for PDD as opposed to major depression is the length of time it has persisted. For adults, depressive symptoms must be present for most of the day for two years or more. In children, it must be present for at least one year.

Can PDD Be Prevented?

Everyone’s risk for developing depression is different and there isn’t really much you can do to prevent PDD, but there are some things that can be done to make PDD symptoms more manageable. 

Engaging in healthy habits can be a successful means of managing depressive symptoms — at its base, this includes exercising regularly, eating a balanced diet and having regular meals, and frequently getting enough sleep each night. Beyond that, taking time to practice gratitude, pick up a hobby or two, and engage in meaningful relationships can help ground you. 

Alcohol and drug use are also major contributors to depression. Reducing your intake of these substances can help to lessen the severity of PDD symptoms. 

Treatment Options

If you struggle with PDD, or another type of depression, many people have found effective treatment with therapy, medication, or a combination of both. 

Through cognitive behavioral therapy, you can work with a licensed provider to identify negative thinking patterns that contribute to feelings of hopelessness, and work to find ways of restructuring how you perceive certain things. Your Brightside therapist is available to you everyday with unlimited messaging and video sessions to help you stay on track. 

Antidepressant medications are also highly effective methods for treating depression. Selective serotonin reuptake inhibitors (SSRIs), tricyclic medications, or serotonin and norepinephrine reuptake inhibitors (SNRIs) are all commonly used. Brighside’s psychiatric providers will look at hundreds of data points to match you to a medicine with a high chance of being effective for you specifically, and can work with you on making adjustments to your medication as needed.  

Other Coping Tips

Therapy and medication are highly effective at treating depression, but there are other techniques you can also implement to help you manage symptoms. 

  • One of the best things you can do is stay connected with family members and friends. Many people with depression feel isolated and outcast, so having frequent interaction with loved ones can help you gain a better outlook as well as enjoy fun group activities.
  • It’s also important to engage in healthy hobbies that make you feel good. Drawing, bike riding, writing, or reading are great ways to boost your happiness if you’re ever feeling down.
  • Meditation, yoga, and other mindfulness techniques are also helpful ways to cope with the feelings of stress and anxiety that often accompany PDD. You can take yoga classes or even use smartphone apps to guide you in lowering stress and teaching you proper breathing techniques.

Living With PDD

People with major depression will often experience depressive episodes, followed by periods where they are mostly symptom-free. However, PDD is often embedded into a person’s life since they’ve experienced symptoms for such a long period of time.

PDD usually has a subtle and early onset during childhood, but it can be difficult to detect because its symptoms present much less intensely compared to major depression. For that reason, some people with PDD may not even be aware that they have it.

Living with PDD generally revolves around feeling the weight of depression all the time, even if you’re able to still carry on with your daily tasks, have meaningful relationships, and participate in hobbies. An individual with PDD may seem tired or fatigued all the time, even if they’ve gotten enough sleep, or they may not eat regular meals (or may eat really often). 

With that said, it is important to remember that depression presents differently in everyone, which is why seeking professional help can be so beneficial to figuring out what you’re going through and what can help make you feel a little better. 


Persistent depressive disorder is a form of depression that is marked by more mild or moderate depressive symptoms over a long period of time. Rather than having singular major depressive episodes, those with PDD often feel melancholy during most days for at least two years.

Many people live with PDD for their whole lives because they don’t even recognize that they have it. Understanding the signs is essential for getting proper treatment to help regain one’s sense of self.

Brightside develops a personalized treatment plan that can get you back on track. Our psychiatric providers can ship medication to your door, and our licensed therapists can offer support whenever you need; all from the comfort of your own home.

85% of members feel better within just the first 12 weeks. Click here to join them.



Persistent Depressive Disorder (PDD): Symptoms, Causes & Management | Cleveland Clinic

Dysthymic Disorder and Double Depression: Prediction of 10-Year Course Trajectories and Outcomes | NCBI

What causes depression? | Harvard Health

Understanding Dysthymia | National Alliance on Mental Illness

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