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Persistent depressive disorder (Dysthymia)

Persistent depressive disorder (PDD) or dysthymia is a chronic type of depression that lasts for a long time. People suffering from this condition have continuous feelings of hopelessness and deep sadness that result in low moods. Besides, these feelings have a huge effect on sleep, appetite, and other physical functions.

So individuals with dysthymia end up losing interest in activities they used to enjoy and are even unable to complete certain daily tasks. Because of the long-term nature of PDD, these feelings impact negatively on a person’s education, employment, and relationships.

A person with dysthymia may be perceived as a complainer, pessimist, and gloomy. The National Institute of Mental Health statistics indicates that PDD affects about 1.5% of the US adult population. Although the severity of dysthymia doesn’t equal that of major depression, a victim’s depression mood varies from being mild to extremely bad.

Like other chronic disorders, it can be challenging to cope with the symptoms of this condition. But the effective treatment that includes medication and psychotherapy helps to deal with persistent depressive disorder.


While the symptoms of dysthymia may resemble those of depression, adults with PDD experience a depressed mood for most days over at least two years. For adolescents and children, the mood is constant for about one year.

While the intensity of PDD symptoms can change, the indications that are seen or experienced recurrently include:

  • Feeling down, sadness or emptiness
  • Lack of energy, tiredness or feeling incapable
  • Being uninterested in everyday activities
  • Self-criticism and low self-esteem
  • Excessive anger or irritation
  • Poor appetite or eating too much
  • Worrying of the past or feeling of guilt
  • Insomnia
  • Indecisiveness and difficulties in concentration
  • Decreased productivity and effectiveness
  • Social isolation

If these feelings are experienced over a long period, they might easily become a part of one’s life. so it’s very important to seek medical help when these symptoms are experienced for a longer time.


The exact thing that causes the persistent depressive disorder is still not known. But experts point out several factors that activate the development of dysthymia: Biological differences.

Brains of people with PDD are likely to adapt to physical changes. The implications of such changes are still unclear. However, they can aid in identifying the origins of depression.

Brain chemistry

Research shows that neurotransmitters contribute to depression. Depression occurs when there is a change in how neurotransmitters function and interact with neurocircuits. Neurocircuits maintain mood stability, and they play a major role in managing and treating depression.

  • Inherited traits
  • People with relatives who have suffered from the persistent depressive disorder have been found to suffer from the condition.
  • Life events
  • Traumatic events like financial problems, and losing a loved one can cause major depression. Great stress levels can also result in PDD.

Risk factors

Certain factors increase the risk of developing a persistent depressive disorder. These include:

  • Traumatic or stressful situations, such as financial problems and death.
  • Having a close relative with persistent depressive disorder.
  • Personality traits such as negativity, low self-esteem, self-critical, being too dependent or being pessimistic.
  • Other complications resulting from any past mental illness.

There are other conditions linked to dysthymia, including:

  • Substance abuse
  • General medical illnesses and chronic pain
  • Major depression and anxiety disorders
  • Reduced life quality
  • Family conflicts and relationship difficulties
  • Decreased productivity, work and school problems
  • Suicidal thoughts


Once the doctor detects that you may be suffering from a persistent depressive disorder, he or she is likely to request the following tests and exams.

  • Lab tests: The doctor may ask that you go for a lab test to rule out the possibilities of other illnesses that can contribute to depression. For instance, the doctor can order a blood test to see whether your thyroid is inactive or underactive.
  • Physical exam: During the physical examination, your doctor will ask in-depth questions to determine the causes of your depression.
  • Psychological evaluation: During this evaluation, you will discuss your feelings, behaviours, and thoughts with the doctor. The information you provide will be filled in a questionnaire that will help in pinpointing a problem. The results of the evaluation will show if you have any other condition that can alter your moods, including bipolar disorder, major depression or seasonal disorder.

Regarding the diagnosis of PDD, the key indications for adults are different from those of children. For instance, depressed mood in grownups can persist for two years or longer period. But youngsters are assessed if depression moods have continued for at least one year.


The core treatment for dysthymia includes talk therapy and the use of medications. However, a person’s treatment plan depends on several aspects, including:

  • Previous psychological health treatment
  • Level of medication tolerance
  • Severity of symptoms
  • Personal preferences
  • Related emotional problems
  • Willingness to address underlying situational or emotional issues

Psychotherapy is usually recommended as the first treatment option for adolescents and children. This also depends on the affected teenager or child and sometimes antidepressants may be administered.

Individuals with mild PDD who prefer treatment without using the medication can use natural remedies and implement several lifestyle changes to help cope with the condition.

The lifestyle changes that can help to alleviate dysthymia include:

  • Eating healthy diets
  • Having enough sleep
  • Exercising regularly
  • Setting small achievable goals
  • Avoiding excess alcohol
  • Abstaining from drug abuse

Some effective natural remedies to treat mild dysthymia are SAM-e (S-adenosylmethionine) and St. John’s wort. It is worth noting that these treatments may have side effects. Thus you need to cooperate with a physician when taking them.

Treatment that includes psychotherapy and medications is most effective in cases of moderate and severe PDD.


These are mainly antidepressants, and the common types for treating persistent depressive disorder are:

  • Tricyclic antidepressants (TCAs)
  • Norepinephrine and serotonin reuptake inhibitors (SNRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)

Your doctor should inform you about the side effects associated with these medications.


Psychotherapy, also known as psychological counselling or talk therapy, is a treatment method that involves a patient talking to a mental health expert about the condition and associated issues. There are different kinds of talk therapy, including the cognitive behavioural theory that are known to be effective in treating PDD. The factors that help to identify the right type of therapy include patient’s preferences, therapy goals, and length of treatment.

Psychotherapy helps you to:

  • Identify underlying issues that cause depression and behaviour changes that worsen it
  • Find better ways of solving and coping with problems
  • Adjust to current difficulties or crisis
  • Identify negative behaviours and beliefs and replace them with positive and healthy ones
  • Learn how to set smart goals in life
  • Regain control of your life and sense of satisfaction

If you are experiencing the above symptoms, reach out to your primary care doctor and share your feelings. You can also talk to a psychiatrist about your depressed mood and related symptoms. Alternatively, share your symptoms with a trustworthy person such as a loved one, friend, faith leader, or teacher who can help you to seek treatment.