Persistent Depressive Disorder: Symptoms, Causes, and Treatment

It is common to find them throughout life to appear sad, negative, or with a constant melancholy air.

However, when this lasts over the years and begins to interfere with different aspects of a person’s life, it can be referred to as persistent depressive disorder.

What is persistent depressive disorder?

Formerly called dysthymia or dysthymic disorder, the latest volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) renames it Persistent Depressive Disorder.

Persistent depressive disorder is considered a chronic affective disorder that stands out because the person is constantly in a depressed mood. and melancholy and very low self-esteem.

Despite these indications, it does not correspond to major depression because it does not meet all the diagnostic requirements for it.

Although its origin is not clearly established, it is believed that there is a genetic component, that is, hereditary, which, together with psychosocial elements such as disaffection or lack of stimulation and rewards during l childhood predisposes the person to suffer from this persistent depressive disorder.


In symptoms of persistent depressive disorder, the symptom that characterizes it the most is the patient’s experience of a persistent state of demoralization, anxiety or grief and desolation; which lasts at least two years.

When this disorder appears in children or adolescents, the manifestations range from depressed mood to irritability or anger; and must last at least one year.

In addition, the person should have at least two of these symptoms most of the time:

  • A feeling of hopelessness
  • No sound or excessive sound
  • Lack of energy or constant fatigue
  • low self-esteem
  • Lack of appetite or feelings of excessive hunger
  • low concentration

It is common for people with persistent depressive disorder to suffer from a negative self-concept, as well as a pessimistic outlook on their future, that of others, and virtually everything around them; It is therefore difficult for them to resolve any type of problem or conflict.

the causes

As mentioned above, the specific causes that cause this persistent depressive disorder or chronic depression are still unknown. However, it is known that this is usually inherited, affecting more men than women and is experienced by around 5% of the population..

Likewise, it has also been established that the onset of persistent depressive disorder is related to other mental conditions or disorders such as anxiety or substance abuse disorders such as alcoholism or drug addiction.

Another thing that patients with chronic depression have in common is that at least 50% of them will experience an episode of major depression throughout their lifetime.


To make an effective diagnosis of a persistent depressive disorder, the relevant health care practitioner should have a medical history in which the mood and other symptoms associated with the condition are assessed.

In addition, they will have to perform a series of laboratory tests to rule out any possible physical origin of the disease.

A correct diagnosis of this disorder should take into account the following classification conditions established by the DSM-V:

1. Chronically depressed mood

The person should be in a depressed mood for most of the day and most days for at least 2 years. This can be referred directly by the patient or observed by those around him.

2. Presence of at least two of these symptoms

  • Loss or increased appetite
  • Insomnia or hypersomnia
  • Lack of energy or fatigue
  • low self-esteem
  • Concentration deficits or difficulty making decisions
  • Feelings of hopelessness

3. Duration of 2 years

The symptoms of the previous two points must have been present in the person for at least two years, with intermissions of at most two months.

4. There are no major depressive episodes

The person has not had a major depressive episode in the first two years and the symptoms are not better explained by the presence of another type of depressive disorder.

5. There are no episodes of mania, hypomania, etc.

The person has never had a manic episode, a mixed episode or a hypomanic episode. In addition, the criteria for cyclothymic disorder are also not met.

6. Does not appear during a psychotic disorder

Symptoms do not appear exclusively in a chronic psychotic disorder such as schizophrenia or delusional disorder.

7. Symptoms are not caused by drugs or other illnesses

Symptoms cannot be explained by the physiological effects of substance use or by any disease.

8. Significant discomfort

The symptomatology causes clinically significant discomfort in the person. This discomfort causes a deterioration in the work, social or any other important area of ​​the patient.

Treatment and prognosis

Persistent depressive disorder is a chronic illness. however, the person may benefit from treatment which consists of pharmacological therapy with antidepressants and intervention with psychotherapy.

Although antidepressants work better in major depression than in persistent depressive disorder, there are a number of drugs that can improve symptoms in the patient. These are:

  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine or citalopram.
  • Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSRIs)
  • Bupropion
  • Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs)

Regarding the psychotherapy used in these cases, the most important thing is that the person is able to externalize their feelings and thoughts, as well as to learn to deal with them.

There are a number of very effective therapies for this:

  • Cognitive Behavioral Therapy (CBT)
  • psychodynamic interventions
  • Support groups

Finally, the prognosis or course of this disorder differs greatly from one person to another. Its chronic nature makes the person suffer over the years and even throughout their life, with very few people making a full recovery..

With the use of proper treatment, the person can achieve a very significant improvement and will be able to continue their usual routine satisfactorily. However, in most cases this requires ongoing psychological therapy.

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