What Is Persistent Depressive Disorder?

It’s normal to go through tough times or feel sad sometimes. For instance, if you lost a loved one or your job, you might experience sadness or hopelessness for a time. But if your low mood worsens and takes over your life, you may have depression. 

It’s important to know that clinical depression comes in various forms — the most common being major depressive disorder (MDD). Another type of depression is persistent depressive disorder (PDD). It was previously referred to as dysthymia or chronic major depression.  

If you’ve had low-level feelings of depression for years, read on to learn more about PDD — including causes, symptoms, treatment options, and what to expect. 

What is persistent depressive disorder?

Persistent depressive disorder (PDD) is a type of depression that causes you to have a low mood. To be considered persistent, the depressed mood lasts throughout most of your days for at least 2 years. In children and teenagers, this mood will last at least 1 year.

In addition to a depressed mood, PDD can lead to additional depression symptoms like: 

• Lack of appetite or eating too much

• Trouble falling or staying asleep

• Low energy or feeling tired all the time

• Not feeling good about yourself (low self-esteem)

• Difficulty focusing or making decisions

• Feeling hopeless or like things will never get better

PDD and major depressive disorder have similar symptoms. It can be easy to confuse the two. But there are key differences between these mood disorders. Persistent depression symptoms are often milder, though they last much longer. And unlike major depressive disorder, you might not lose interest in activities you enjoy with PDD.  

Persistent depressive disorder affects an estimated 3% of people in the U.S. Many people with PDD will also have at least one major depressive episode, resulting in “double depression.” When the major depression ends, you may go back to experiencing your typical PDD symptoms. 

What causes persistent depressive disorder?

Researchers are not sure why people get PDD. This is an area of ongoing research. In fact, a 2021 analysis calls persistent depressive disorder “a poorly understood condition,” with changing diagnosis requirements. 

That said, experts believe that PDD is related in part to your brain chemistry. Neurotransmitters like serotonin, dopamine, epinephrine, and GABA all impact the brain chemistry of mood — and may play a role in persistent depressive disorder. 

Like other forms of depression, PDD may also be caused in part by other factors such as:

• Having a family history of depression

• Having a medical condition 

• Taking certain medications

• Having a history of trauma 

• Dealing with constant stress

How do you treat persistent depressive disorder?

The treatment options for persistent depressive disorder and MDD are similar. Like major depression, persistent depressive disorder is commonly treated with a combination of therapy and medications. 

Psychotherapy for persistent depressive disorder

Therapy can help you manage PDD by learning new ways to cope with your symptoms. There are several types of psychotherapy that can be effective for persistent depressive disorder:

• Cognitive behavioral therapy (CBT) helps you evaluate, challenge, and overcome negative thought patterns related to depression. It can also help you understand and change your behavior. 

• Interpersonal therapy (IPT) focuses on strengthening your personal relationships, which can help reduce your depression symptoms.

• Psychodynamic therapy helps individuals identify, understand, and resolve issues connected to past experiences that may contribute to depression.

Medications for persistent depressive disorder

Antidepressant medications are often used to treat persistent depressive disorder, just like for MDD. It can take 6 to 8 weeks until you notice a benefit from antidepressants. The most common ones are:

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram(Lexapro)

• ​Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta)

• Atypical antidepressants such as bupropion (Wellbutrin)

If antidepressants alone aren’t helping enough, your provider might recommend additional options. These medications may be added to your antidepressant or used as an alternative. They could include:

• Atypical antipsychotics like aripiprazole (Abilify) or quetiapine (Seroquel)

• Tricyclic antidepressants (TCAs) like amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), and imipramine (Tofranil)

• Monoamine oxidase inhibitors (MAOIs) like phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine sulfate (Parnate)

Individual treatment plans can vary depending on your persistent depression symptoms. Speak with your healthcare provider about the best options for you. 

Self-care practices to help manage depression

If you have PDD, you can try the following self-care techniques to help manage your depression symptoms: 

• Exercise regularly, such as walking, running, or biking. This may help relieve some symptoms of depression.

• Eat healthy food to support your mood and reduce your risk of chronic diseases.

• Get between 7 and 9 hours of sleep per day. You can also take a short nap of up to 30 minutes during the day to help you regain your energy and alertness. 

• Stay away from drugs and alcohol — they can make your depression worse.

• Practice relaxation techniques to lower stress, such as meditation and deep breathing.

• Confide in someone you trust instead of keeping your struggles to yourself.

• Gain strength and support from others. You can, for example, join a support group for people struggling with depression. 

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Written by:

Kara-Marie Hall, RN, BSN, CCRN

Kara-Marie Hall, RN, BSN, CCRN, is a registered nurse who specializes in writing health content that connects with everyone — no matter where they are in their health journey. She has over 10 years of clinical experience in a variety of specialties, including critical care, surgery, and hospice.

Edited by:

Renée Fabian, MA

Renée Fabian is the senior pet health editor at GoodRx. She’s worked for nearly 10 years as a journalist and editor across a wide range of health and well-being topics.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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