Persistent depressive disorder

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Permanent depressive disorder (PDD) is a chronic (ongoing) type of depression in which a person's mood is regularly reduced.

Persistent depressive disorder used to be called dysthymia.

What is persistent depressive disorder?

Previously referred to as dysthymia or dysthymic disorder, in the most recent volume "Diagnostic and Statistical Manual of Mental Disorders" (DSM-V) renamed persistent depressive disorder.

Persistent depressive disorder is considered a chronic affective condition that is characterized by the fact that a person experiences a constant depressed and melancholic mood and very low self-esteem.

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

Although its origin is not precisely established, it is believed that there is a genetic, i.e., hereditary component that, together with psychosocial elements such as withdrawal or lack of stimulation and encouragement in childhood, predisposes a person to suffer from this persistent depressive disorder.

Causes

The exact cause of PDD is unknown. Prone to familial diseases. More common in women.

Many people with PDD will also have an episode of major depression at some point in their lives.

Elderly people with PDD may have difficulty caring for themselves without help, struggle with isolation, or suffer from illness.

As mentioned above, the specific causes of this persistent depressive disorder or chronic depression are still unknown. However, it is known to be generally hereditary, affects more men than women, and affects about 5% of the population.

In addition, the occurrence of persistent depressive disorder has been found to be associated with other mental conditions or disorders, such as anxiety or substance abuse disorders, such as alcohol or drug abuse.

Another common characteristic of patients with chronic depression is that at least 50% of them will have a major depressive episode during their lifetime.

Symptoms

The main symptom of PDD is a state of despondency, gloominess, or sadness almost every day for at least 2 years.

In addition, two or more of the following symptoms will be present most of the time:

  • Feeling of hopelessness
  • Lack or excess of sleep
  • Lack of energy or constant fatigue
  • Low self-esteem
  • Lack of appetite or excessive hunger
  • Poor concentration

People with PDD often have a negative or discouraging view of themselves, their future, other people, and life events. Problems often seem intractable.

Within the symptomatology of major depressive disorder, the most characteristic symptom is an experience of a persistent state of demoralization, anxiety or sadness that lasts for at least two years.

When this disorder appears in children or adolescents, the manifestations change from depressed moods to irritable or angry moods; and this must last for at least one year. In children and adolescents, moods can be irritable rather than depressed and last for at least 1 year.

In addition, a person must have two or more of these symptoms for most of the time:

People with persistent depressive disorder are characterized by a negative view of themselves, a pessimistic view of their future, other people and almost everything around them; they have difficulty resolving any problem or conflict.

Tests

Your health care provider will collect a medical history of your mood and other mental health symptoms. Your doctor may also do blood and urine tests to rule out medical causes of depression.

Diagnosis

To make an effective diagnosis of persistent depressive disorder, the appropriate professional should take a medical history that assesses both mood and other symptoms associated with the condition.

In addition, a number of laboratory tests must be performed to rule out a possible physical origin of the disease.

A proper diagnosis of this disorder must consider the following DSM-V classification conditions:

1. Chronically depressed mood

The person must experience depressed mood most of the day and on most days for at least 2 years. This may be reported directly by the patient or observed by others.

2. Presence of two or more of the above symptoms

  • Loss or increase in appetite
  • Insomnia or hypersomnia
  • Lack of energy or fatigue
  • Low self-esteem
  • Concentration deficits or difficulty making decisions
  • Sense of hopelessness

3. Duration of 2 years

Symptoms of the two items listed above must have been present for at least two years, with intervals of no more than two months.

4. Absence of 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 having another type of depressive disorder.

5. Absence of manic or hypomanic episodes, etc.д.

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

6. Not present during psychotic disorder

These symptoms are not unique to a chronic psychotic disorder such as schizophrenia or delusional disorder.

7. Symptoms not caused by drugs or other illness

Symptoms cannot be attributed to physiological effects of substance use or medical illness.

8. Significant distress

Symptomatology causes clinically significant distress in the individual. This distress results in disruption at work, socially, or in any other important area of the patient's life.

Treatment

There are many steps you can take to improve PDD:

  • Sleep is sufficient.
  • Eat healthy, nutritious foods.
  • Take your medicines right. Discuss the side effects with your doctor.
  • Learn to recognize the first signs that your PDD is getting worse. Have a plan for how to react if this happens.
  • Try to exercise regularly.
  • Find activities that make you feel good.
  • Talk about your feelings with someone you trust.
  • Surround yourself with loving, positive people.
  • Avoid alcohol and illegal drugs. They can worsen your mood over time and affect your judgment.

Medications are often effective for PDD, although sometimes they don't work as well as for major depression and may take longer.

Don't stop taking medication on your own, even if you feel better or have side effects. Always call your provider first.

When it's time to stop taking the medication, your doctor will instruct you on how to slowly reduce the dose, rather than stopping the medication suddenly.

Persistent depressive disorder is a chronic illness. However, a person may benefit from treatment consisting of pharmacological therapy with antidepressants and psychotherapy.

Although antidepressant medications work better for major depression than for persistent depressive disorder, there are a number of medications that can lead to improvement in a patient's symptoms. These include:

  • 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)

As for psychotherapy used in such cases, the most important thing is for the person to be able to bring their feelings and thoughts out into the open and learn to manage them.

There are a number of very effective treatments for this:

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

People with PDD may also benefit from some forms of psychotherapy. Psychotherapy is a good way to talk about feelings and thoughts and learn how to manage them. It can also help you understand how the disorder has affected your life and help you cope more effectively. Types of psychotherapy include:

  • Cognitive Behavioral Therapy (CBT) to help you learn to be more aware of your symptoms and what's aggravating them. You will be taught problem-solving skills.
  • Psychotherapy or insight-based therapy, which can help people with PDD understand the factors that may be behind their depressive thoughts and feelings.

It can also help to participate in a support group for people who are experiencing problems similar to yours. Ask your therapist or health care provider to recommend a group.

Prognosis

PDD is a chronic illness that lasts for many years. While some people make a full recovery, others continue to experience some symptoms even with treatment.

Finally, the prognosis or course of PDD differs greatly from person to person. The chronic nature of the illness means that a person suffers from it for years or even a lifetime, and few people recover completely.

With appropriate treatment, the person may improve significantly and be able to continue his or her normal life in a satisfactory manner. However, most cases require ongoing psychological therapy.

PDD also increases the risk of suicide.

When to see a medical professional

Make an appointment with your doctor if:

  • You regularly experience depression or discouragement
  • Your symptoms are getting worse

Seek help immediately if you or someone you know shows signs of suicide risk:

  • Handing out things or talking about leaving and needing to bring "getting things in order"
  • Self-destructive behavior, such as self-harm
  • Sudden changes in behavior, especially calmness after a period of anxiety
  • Talking about death or suicide
  • Alienation from friends or unwillingness to go out

Alternate names

PDD; Depression – chronic; Depression – chronic; Dysthymia.