What Is Persistent Depressive Disorder?

Everyone goes through tough times or feels sad sometimes. For instance, if you lost a loved one or your job, it’s normal to feel sad or depressed for a while. But if you’ve been feeling down for months — or even years — it’s possible that you could have a mood disorder known as persistent depressive disorder (PDD). 

PDD is a type of depression. It causes symptoms that go on for a long time — at least 2 years. In the past, PDD used to be called “dysthymia” or “chronic major depression.” And just like other types of depression, PDD can have a major impact on your personal life, your job, and even your health. 

Read on to learn more about PDD, as well as how treatment can help. 

What is persistent depressive disorder?

PDD is a type of depression that lasts a long time. When you have PDD, you feel sad or down on most days, most of the time, for at least 2 years (or 1 year if you’re a child or a teen). It’s typically less severe than major depression (MDD), but the symptoms last longer. PDD can begin at any age, even during childhood. 

PDD is different from MDD because your symptoms are there almost all the time. With MDD, your depression comes in episodes that start and stop. But in between the episodes, you might feel OK. People with PDD can have episodes of MDD, too, called “double depression.”

Symptoms of PDD

In addition to a depressed mood, PDD also causes other symptoms of depression: 

• Appetite changes

• Sleeping too much or too little

• Low energy or fatigue

• Low self-esteem

• Poor concentration

• Feelings of hopelessness

PDD diagnosis

To be diagnosed with PDD, you need to feel depressed plus have at least 2 of the symptoms listed above. 

For a diagnosis of PDD, your symptoms also have to cause problems in your daily life. This could mean:

• Having problems at work or school

• Having trouble in your personal relationships

• Struggling with self-care activities (like bathing, grooming, or eating) 

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And remember: With PDD, your symptoms must be present almost all of the time. If you do have symptom-free periods, they have to be shorter than 2 months to meet the criteria for diagnosis.

What causes persistent depressive disorder?

It’s not clear exactly what causes PDD. Just like many other mental health conditions, it may be connected to your brain chemistry and structure. This includes neurotransmitters like serotonin, dopamine, epinephrine, and more. 

Other factors seem to play a role too. These include your:

• Family history (genetics)

• Mental and physical health 

• Medications

• Living environment

• Life experiences

• History of trauma

• Chronic stress

Persistent depressive disorder treatment

The treatment options for PDD and MDD are similar. Like major depression, PDD is typically treated with medication and therapy. Let’s take a closer look. 

Therapy for persistent depressive disorder

Therapy is a common treatment for PDD. There’s some evidence that therapy may work best when combined with medication. 

Types of therapy that can help include: 

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

• Interpersonal therapy (IPT): IPT focuses on strengthening your personal relationships.

• Psychodynamic therapy: This type of therapy helps you identify, understand, and resolve issues connected to past life experiences.

Medications for persistent depressive disorder

Antidepressant medications are a good treatment for persistent depressive disorder. 

The most common types of antidepressants are listed below.

Selective serotonin reuptake inhibitors

Common selective serotonin reuptake inhibitors (SSRIs) include: 

• Fluoxetine (Prozac)

• Sertraline (Zoloft)

• Paroxetine (Paxil)

• Citalopram (Celexa)

• Escitalopram (Lexapro)

​Serotonin and norepinephrine reuptake inhibitors

Some common serotonin and norepinephrine reuptake inhibitors (SNRIs) include:

• Venlafaxine (Effexor)

• Desvenlafaxine (Pristiq)

• Duloxetine (Cymbalta)

Atypical antidepressants 

Common atypical antidepressants include:

• Bupropion (Wellbutrin) 

• Mirtazapine (Remeron)

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

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

• Tricyclic antidepressants (TCAs): amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), and nortriptyline (Pamelor)

• Monoamine oxidase inhibitors (MAOIs): phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), and selegiline patches (Emsam)

The right medication for you depends on your symptoms, your other mental and physical health conditions, and your personal preferences. And keep in mind: It can take a month or more before you notice a benefit from antidepressants. 

Self-care tips for persistent depressive disorder

If you have PDD, lifestyle changes and self-care techniques can help as well. Here are some ideas to consider:

• Get moving. Regular exercise can help with the symptoms of depression. This could include walking, running, or biking — anything, really, that helps to get your body moving. It’s OK to start small. 

• Focus on nutritious food. Eating nutritious food can help to support your mood, and it has other health benefits as well.

• Get enough sleep at night. Getting enough good-quality sleep can give your mental and physical health a boost. 

• Avoid drugs and alcohol. Consider cutting out drugs and alcohol, as they can make your depression worse.

• Reduce stress. Practice relaxation techniques to lower stress, such as meditation and breathing exercises. Just like many of the items on this list, this can help with mood and also have other health benefits. 

• Get support. Confide in someone you trust instead of keeping your struggles to yourself. For many people, joining a support group for people with depression can also go a long way. 

What happens if PDD goes untreated?

It’s hard to say what will happen if PDD goes untreated, especially since PDD symptoms can vary from person to person.

But we do know that having PDD can put you at risk for other problems. These include:

• Significant problems with work or school

• Significant problems in your personal relationships

• Treatment-resistant major depression

• Anxiety disorders

• Substance use disorders

• Poorer outcomes if you have coronary artery disease

• Pregnancy problems

• Suicidal thoughts

If you think you might have PDD, reach out to your primary care provider or a mental health professional. Getting treatment can not only help you feel better — it can potentially protect your long-term mental and physical health too. 

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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:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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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