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Persistent Depressive Disorder (PDD), formerly known as dysthymia.
It is is a mood disorder consisting of the same cognitive and physical problems as depression, with less severe but longer-lasting symptoms.
A serious state of chronic depression, which persists for at least two years in adults, and one year for children and adolescents.
It is less acute and severe than major depressive disorder.
A chronic disorder.
Globally dysthymia occurs in about 105 million people a year-1.5% of the population.
38% more common in women, occurring in 1.8% of women and 1.3% of men.
The lifetime prevalence rate in community settings appears to range from 3 to 6% in the United States.
In primary care settings the rate is higher ranging from 5 to 15 percent.
Prevalence rates tend to be somewhat higher in the US than rates in other countries.
Patients suffer may symptoms for many years before it is diagnosed, if diagnosis occurs at all.
Often accompanies with other mental disorders.
Dysthymia is characterized by an extended period of depressed mood combined with at least two other symptoms which may include insomnia or hypersomnia, fatigue or low energy, eating changes, low self-esteem, or feelings of hopelessness.
Other possible symptoms include poor concentration or difficulty making decisions.
Mild degrees may result in people withdrawing from stress and avoiding opportunities for failure.
Patients with severe dysthymia may even withdraw from daily activities.
Dysthymia often occurs at the same time as other psychological disorders, which adds a level of complexity in determining the presence of dysthymia, particularly because there is often an overlap in the symptoms of disorders.
There is a high incidence of comorbid illness and suicidal behavior.
At least three-quarters of patients also have a chronic physical illness or another psychiatric disorder, such as one of the anxiety disorders, cyclothymia, drug addiction, or alcoholism.
Common co-occurring conditions include major depression in up to 75%, anxiety disorders in up to 50%, personality disorders in up to 40%, and substance abuse in up to 50%.
Patients have a higher-than-average chance of developing major depression.
The rate of depression in the families of people with dysthymia is as high as fifty percent for the early-onset form of the disorder, suggesting a genetic predisposition.
It is linked to stress, social isolation, and lack of social support.
A hereditary predisposition is suggested by the fact there is a stronger likelihood of identical twins both having depression than fraternal twins.
People with dysthymia have a higher-than-average chance of developing major depression: over time 95% of dysthymia patients have an episode of major depression.
The term double depression refers when an intense episode of depression occurs on top of dysthymia.
Double depression is difficult to treat.
To prevent double depression dysthymia must be treated, with a combination of antidepressants and cognitive therapies, exercise and good sleeping habits.
Brain structures such as the corpus callosum and frontal lobe are different in women with dysthymia than in those without dysthymia.
The amygdala which is associated with processing negative emotions such as fear, is more activated in dysthymia patients.
There is increased activity in the insula and the cingulate gyrus.
There is a dulling of emotion that patients with dysthymia use to protect themselves from overly negative feelings, compared to healthy people.
The essential symptom involves the individual feeling depressed for the majority of days, and parts of the day, for at least two years, with low energy, sleep or appetite disturbances, and low self-esteem.
Symptoms are often experienced for many years before diagnosis.
Diagnostic criteria include:
During a majority of days for two years or more, the adult patient reports depressed mood, or appears depressed to others for most of the day.
When depressed, the patient has two or more of:
decreased or increased appetite
insomnia or hypersomnia
Fatigue or low energy
Reduced self-esteem
Decreased concentration or problems making decisions
Feelings of hopelessness or pessimism
During this two-year period, the above symptoms are never absent longer than two consecutive months.
During the duration of the two-year period, the patient may have had a perpetual major depressive episode.
The patient has not had any manic, hypomanic, or mixed episodes.
The patient has never fulfilled criteria for cyclothymic disorder.
The depression does not exist only as part of a chronic psychosis.
The symptoms are often not directly caused by a medical illness or by substances, including drug abuse or other medications.
The symptoms may cause significant problems in major areas of life functioning.
In children and adolescents, mood can be irritable, and duration must be at least one year, in contrast to two years needed for diagnosis in adults.
Dysthymia before age 21 is associated with more frequent relapses, psychiatric hospitalizations, and more co-occurring conditions.
For younger adults with dysthymia, there is a higher occurrence in personality abnormalities and the symptoms are likely chronic.
In adults suffering from dysthymia, the psychological symptoms are associated with medical conditions and/or stressful life events and losses.
Dysthymia is more chronic and long lasting) than major depressive disorder, in which symptoms may be present for as little as 2 weeks.
It often presents itself at an earlier age than Major Depressive Disorder.
It may be beneficial to work with children in helping to control their stress, increase resilience, boost self-esteem, and provide strong networks of social support. These tactics may be helpful in warding off or delaying dysthymic symptoms.
Psychotherapy is often effective in treating dysthymia.
Cognitive-behavioral therapy, can dissipate symptoms over time.
Initial drug therapy is usually SSRIs due to their more tolerable nature and reduced side effects compared to other antidepressants.
Most commonly prescribed antidepressants/SSRIs are escitalopram, citalopram, sertraline, fluoxetine, paroxetine, and fluvoxamine.
The mean response to antidepressant medications for people with dysthymia is 55%.
It may take an average of 6–8 weeks before the patient begins to feel these medications’ therapeutic effects.
Patients will generally need to try different brands of medication before finding one that works specifically for them: 1 in 4 of those who switch medications get better results regardless of whether the second medication is an SSRI or some other type of antidepressant.
SSRIs and TCAs are equally effective in treating dysthymia.
A combination of antidepressant medication and psychotherapy has consistently been shown to be the most effective line of treatment.
75% of people respond positively to a combination of cognitive behavioral therapy and pharmacotherapy, whereas only 48% of people responded positively to just CBT or medication alone.
Treatment resistance is somewhat common.