Treatment for Persistent Depressive Disorder

What is Persistent Depressive Disorder?

Persistent Depressive Disorder, formerly known as Dysthymic Disorder (also known as dysthymia), has been recently renamed in the updated DSM-5 (2013).

The essential feature of persistent depressive disorder (dysthymia) is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents). This disorder represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder. Major depression may precede persistent depressive disorder, and major depressive episodes may occur during persistent depressive disorder. Individuals whose symptoms meet major depressive disorder criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder.

The Difference Between Persistent Depressive Disorder and Depression

These two terms are often misunderstood because they can be confusing to differentiate. Although persistent depressive disorder is a ‘type’ of depression, the difference between the two lies solely in severity.

People who suffer with persistent depressive disorder find it difficult to function normally on a daily basis. They struggle with motivating themselves to get things done and experience a lack of interest in daily activities. This often triggers anxiety, frustration, and even suicidal thoughts.

Persistent Depressive Disorder Symptoms

Individuals with persistent depressive disorder describe their mood as sad or “down in the dumps.” During periods of depressed mood, at least two of the following six symptoms from are present.

• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

Because these symptoms have become a part of the individual’s day-to-day experience, particularly in the case of early onset (e.g., “I’ve always been this way”), they may not be reported unless the individual is directly prompted. During the 2-year period (1 year for children or adolescents), any symptom-free intervals last no longer than 2 months.

In children and adolescents, the mood can be irritable and it must have lasted at least one year.

Persistent Depressive Disorder Causes

In order to be diagnosed with Persistent Depressive Disorder, there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode in the first 2 years, and criteria have never been met for Cyclothymic Disorder.
In order to meet the diagnostic criteria for Dysthymic Disorder, the symptoms may not be due to the direct physiological effects of a the use or abuse of a substance (for instance, alcohol, drugs, or medications) or a general medical condition (e.g., cancer or a stroke). The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

Some external factors can include:
Environmental factors

• Social Involvement – a negative family situation, work situation, or support system.

• Physical Location – the current location and condition of the location play a role in influencing a person’s well being and can also influence outlook on life. People who live in poverty or poverty-stricken geographical areas are at a higher risk of developing persistent depressive disorder.

• Past Location – the environment in which a person grew up and their experiences with others during that time can also be attributed to increasing the risk for developing persistent depressive disorder, especially if they were subjected to violence, abuse, or neglect.

Biological and Biochemical Factors

• Physical shifts in brain chemistry; a chemical imbalance.
• Physiological impairment such as emotional or mental illness.

Genetic factors

People who have one or more family members who suffer from major depression, personality disorders, or persistent depressive disorder also have an increased risk.

When and Where to Get Help

There are several treatments available for persistent depressive disorder. If you think you might be suffering with this condition, you are not alone.

For treating persistent depressive disorder, I believe psychotherapy is the best place to start. If you are interested in medication management in addition, give me a call at (610) 645-6300 or come talk with me in my Ardmore, PA office and we will work out a solution to get you back on the path to happiness.

Sources: Psychcentral.com