An Overview of Persistent Depressive Disorder (Dysthymia)


An Overview of Persistent Depressive Disorder (Dysthymia)

Dysthymia is a milder, but long-lasting form of depression. It’s also called persistent depressive disorder. People with this condition may also have bouts of major depression at times.

Depression is a mood disorder that involves your body, mood, and thoughts. It affects the way you eat and sleep, think about things, and feel about yourself. It’s not the same as being unhappy or in a «blue» mood. It’s not a sign of weakness or something that can be willed or wished away. People with depression can’t «snap it» and get better. Treatment is key to recovery.

Dysthymia affects women twice as often as men. Some people may also have depression or bipolar disorder.

What causes dysthymia?

There is no clear cause for this type of depression. Mental health professionals think it’s a result of chemical imbalances in the brain. Many factors are thought to contribute to depression. These include environmental, psychological, biological, and genetic factors. Chronic stress and trauma have also been linked to this condition.

Dysthymia seems to run in families, but no genes have yet been linked to it.

What are the symptoms of dysthymia?

Dysthymia is  milder, yet more long lasting than major depression. Each person may experience symptoms differently. Symptoms may include:

  • Lasting sad, anxious, or “empty” mood
  • Less ability to concentrate, think, and/or make decisions
  • Less energy
  • Fatigue
  • Feeling hopeless
  • Weight and/or appetite changes due to over- or under-eating
  • Changes in sleep patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much
  • Low self-esteem

To diagnose this condition, an adult must have a depressed mood for at least 2 years (or one year in children and adolescents), along with at least 2 of the above symptoms. The symptoms of this illness may look other mental health conditions. Always talk with a healthcare provider for a diagnosis.

How is dysthymia diagnosed?

Depression often happens with other conditions, such as heart disease, or cancer. It may also happen with substance abuse or anxiety disorders. Often, people with dysthymia grow accustomed to the mild depressive symptoms and do not seek help. But, early diagnosis and treatment is key to recovery.

A diagnosis may be made after a careful psychiatric exam and medical history done by a mental health professional.

How is dysthymia treated?

Treatment may include one or a combination of the following:

  • Medicine. Many different medicines are available to treat depression. It often takes 4 to 6 weeks for anti-depressants to have a full effect. It’s important to keep taking the medicine, even if it doesn’t seem to be working at first. It’s also important to talk to your healthcare provider before stopping. Some people have to switch medicines or add medicines to get results.
  • Therapy. This is most often cognitive behavioral or interpersonal therapy. It focuses on changing distorted views of yourself and your environment. It also works to improve relationship skills, and identify and manage stressors.

Because this condition usually last for longer than 5 years, long-term treatment may be needed.

If you have depression, there are things you can do to help yourself. Depression can make you feel exhausted, worthless, helpless, and hopeless.

Such negative thoughts and feelings may make you feel giving up. It is important to realize that these negative views are part of the depression and may not reflect reality.

Negative thinking fades as treatment begins to take effect. Meanwhile, consider the following:

  • Get help. If you think you may be depressed, see a professional as soon as possible.
  • Set realistic goals and don’t take on too much.
  • Break large tasks into small ones. Set priorities, and do what you can as you can.
  • Try to be with other people and confide in someone. It’s usually better than being alone and secretive.
  • Do things that make you feel better. Going to a movie, gardening, or taking part in religious, social, or other activities may help. Doing something nice for someone else can also help you feel better.
  • Get regular exercise.
  • Expect your mood to get better slowly, not right away. Feeling better takes time.
  • Eat healthy, well-balanced meals.
  • Stay away from alcohol and drugs. These can make depression worse.
  • It is best to postpone big decisions until the depression has lifted. Before making a big change — change jobs, get married or divorced — discuss it with others who know you well and have a more objective view of your situation.
  • Remember: People rarely «snap » a depression. But they can feel a little better day-by-day.
  • Try to be patient and focus on the positives. This may help replace the negative thinking that is part of the depression, and the negative thoughts will disappear as your depression responds to treatment.
  • Let your family and friends help you.

Key points

  • Dysthymia is a milder, yet more chronic form of major depression. People with this illness may also have major depression at times.
  • There is no clear cause of this disorder, but mental health professionals think it’s a result of chemical imbalances in the brain. Some types of depression seem to run in families, but no genes have yet been linked to depression.
  • In general, nearly everyone with depression has ongoing feelings of sadness, and may feel helpless, hopeless, and irritable. Without treatment, symptoms can last for many years.
  • This condition is most often treated with medicine, therapy, or a combination of both.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


Persistent Depressive Disorder (PDD): Symptoms, Causes & Management

An Overview of Persistent Depressive Disorder (Dysthymia)

Persistent depressive disorder (PDD) is a mild to moderate chronic depression. It involves a sad or dark mood most of the day, on most days, for two years or more. PDD is common and can happen to anyone at any age.

The most effective treatment combines medication, counseling and healthy lifestyle choices. Persistent Depressive Disorder (PDD)

Persistent depressive disorder (PDD) is mild or moderate depression that doesn’t go away.

A person with PDD has a sad, dark, or low mood and two or more other symptoms of depression. The symptoms last most of the day, on most days, over a long period of time.

Healthcare providers used to call the condition dysthymia or dysthymic disorder.

What’s the difference between depression and persistent depressive disorder?

Persistent depressive disorder is a type of depression. It’s less severe than major depressive disorder — another type — but it’s ongoing. It’s defined as lasting at least two years in adults and at least one year in children and teens. During this time, symptoms can't be absent for more than two consecutive months to meet the criteria for PDD.

How common is chronic depression?

PDD can happen to anyone at any age. In fact, 3% or more of the U.S. population experiences it at some point in their lives.

PDD is more common in women and in people who have relatives with the same condition.

Scientists don’t fully understand what causes PDD. But it might be related to low levels of serotonin. Serotonin is a natural hormone that controls our emotions and feelings of well-being. It also influences other body functions.

PDD may get triggered by a traumatic event in life. Examples include losing a job, having a loved one die, experiencing a crime or going through a breakup.

What are the symptoms of PDD?

The main symptom of PDD is a sad, low or dark mood. Other signs may include:

  • Fatigue.
  • Feelings of hopelessness, worthlessness or isolation.
  • Lack of appetite or overeating.
  • Lack of concentration.
  • Limited energy.
  • Low self-esteem.
  • Trouble at work or school.
  • Trouble sleeping or sleeping too much.

Most people with PDD also have an episode of major depression at least once at some point, which is sometimes called “double depression.”

If you think you have PDD, talk to a healthcare provider. There are no tests for chronic depression, so the diagnosis comes from discussions with a provider. The provider might ask:

  • Do you feel sad a lot?
  • Are there particular reasons you feel down?
  • Do you have trouble sleeping?
  • Do you have trouble concentrating?
  • Are you taking any medications?
  • How long have you had these symptoms?
  • Are the symptoms there all the time, or do they come and go?

Your healthcare provider may order blood or urine tests to rule out other causes. The healthcare provider also might refer you to a psychologist or psychiatrist to talk about your symptoms. These providers are specially trained to discuss mental health.

The most effective treatment for PDD combines medications and talk therapy, or counseling.

Antidepressants are prescription drugs that can relieve depression. There are many different kinds of medications for the treatment of depression. The most commonly used fall into two broad categories:

  • Selective serotonin reuptake inhibitors (SSRIs).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs).

You may need to take medication for a month or longer before you feel a difference. Make sure to continue taking the medication exactly as your healthcare provider prescribed. Even if you have side effects or feel much better, don’t stop without talking to your healthcare provider first.

Counseling can also help manage PDD. One type of therapy, cognitive behavioral therapy (CBT), is often helpful for depression. A therapist or psychologist will help you examine your thoughts and emotions and how they affect your actions. CBT can help you unlearn negative thoughts and develop more positive thinking.

Although you can’t prevent depression, you can do some things to make it less severe:

  • Eat a well-balanced diet of nutritious foods.
  • Exercise several times a week.
  • Limit alcohol and avoid recreational drugs.
  • Taking prescribed medications correctly and discussing any potential side effects with your healthcare providers.
  • Watch for any changes in PDD and talk to your healthcare provider about them.

With medication, talk therapy and lifestyle changes, you can manage PDD and feel better. But some people have depressive symptoms throughout their lives.

Most people with PDD will have one or more episodes of major depression. If depression gets worse, talk to your healthcare provider.

If you think about hurting yourself or someone else, tell somebody right away. You can tell a healthcare provider, a friend or a family member.

You can also contact the National Suicide Prevention Lifeline:

You’re not alone, and there’s always somebody who wants to help.

In addition to taking medication and going to therapy, consider doing things you enjoy, such as:

  • Do something nice for someone else.
  • Go to a movie, a show or a ballgame.
  • Hang out with people who have positive attitudes.
  • Paint, or try some arts and crafts.
  • Spend time outside.
  • Spend time with friends, in person or on the phone.
  • Take a yoga class, learn to meditate, or walk with a friend.

A note from Cleveland Clinic

PDD can make you feel sad or down most of the day, most days, over a long period of time. Talk to your healthcare provider if you have depressive symptoms. Medication, counseling and healthy lifestyle choices can make you feel better. If you feel you might hurt yourself or someone else, seek help immediately. You’re not alone.

Last reviewed by a Cleveland Clinic medical professional on 03/08/2021.



Persistent Depressive Disorder (PDD)

An Overview of Persistent Depressive Disorder (Dysthymia)

Table of Contents

Persistent depressive disorder (PDD) is chronic depression that lasts a long time. A person’s moods are generally affected for at least 2 years (1 year for children and adolescents). Their depression is usually mild or moderate, rather than severe. Most people who have PDD can’t recall when they first became depressed.

PDD is a fairly common type of depression. It can begin in childhood or in adulthood. No one knows why. It appears to be more common in women. It used to be called dysthymic disorder or dysthymia.

The main symptom of PDD is a sad, low, or dark mood on most days. This lasts for at least 2 years. Children and teens with PDD can feel irritable instead of depressed. Their symptoms last for at least 1 year.

Other symptoms that happen much of the time include:

  • Poor appetite or overeating.
  • Difficulty sleeping or sleeping too much.
  • Low self-esteem.
  • Poor concentration.
  • Low energy.
  • Fatigue.
  • Feelings of hopelessness.
  • Most people who have PDD may have an episode of major depression at least once in their lives.
  • Older people who have PDD find it difficult to care for themselves. They feel isolated and have medical illnesses.

People who have PDD may have periods of normal mood that can last up to 2 months. Family members and friends may not even know that their loved one is depressed. This type of depression is mild. It may be difficult for a person to function at home, school, or work.

No one knows what causes PDD. It may be related to some changes in the brain that involve a chemical called serotonin. Serotonin helps your brain handle emotions and make judgments. Other medical problems and ongoing life stress may also play a role.

You may be at higher risk of developing PDD if you are a woman. It also tends to run in families. If a family member has it or another type of depression, you could be more ly to get it.

If you think you have PDD, discuss your concerns with your doctor. Your doctor will ask you questions to find out if you have depression and what type you have. Your doctor may ask you questions about your health and your symptoms.

This may include how well you’re sleeping, if you feel tired a lot, and if you have trouble concentrating. Your doctor will also consider medical reasons that may cause you to feel depressed. These could be problems with your thyroid or a certain medicine you may be taking.

He or she might order blood or urine tests to rule out these problems.

In general, PDD and other forms of depression are conditions that cannot be prevented. There are lifestyle changes you can make that can boost your mood and minimize symptoms, including:

  • Get enough sleep.
  • Follow a healthy diet.
  • Exercise.
  • Reduce or avoid your alcohol consumption.
  • Do not take illegal drugs.
  • Take medicines as prescribed by your doctor.
  • Watch for changes in your PDD. Talk to your doctor about changes.
  • Engage in activities that bring you enjoyment.
  • Talk to someone you trust about how you feel.
  • Be around people who are positive and uplifting.

PDD can be treated with an antidepressant medicine. This type of medicine helps relieve depression. Antidepressants don’t cause people to feel “high,” and they are not habit-forming.

It may take weeks or months before you and your doctor know whether an antidepressant is helping you. It is important for you to take the medicine exactly as your doctor tells you.

If the antidepressant helps you feel better, you may need to take this medicine for several years. You should continue to take the medicine, even if you begin to feel better.

If you stop taking the medicine, you may get depressed again.

Sometimes there are side effects from stopping antidepressant medicine suddenly. If you want to stop taking your medicine, talk to your doctor first. Your doctor can help you avoid side effects from stopping your medicine too quickly.

Should I see a counselor too?

Some patients find that counseling can help them deal with specific problems. It’s a safe place where you can talk about your thoughts and feelings. Many doctors believe that combining talk therapy with medicine is the most effective way to treat PDD and other types of depression.

PDD is a chronic condition. It can last for many years. If you have PDD, there are things you can do to help yourself feel better. Talk to your doctor about how you’re feeling. Get treatment for your PDD. It may help to find activities that make you feel good or help you feel a sense of accomplishment.

  • Go to a movie.
  • Take a drive on a pleasant day.
  • Go to a ball game.
  • Work in the garden.
  • Do something nice for someone else.


  • People with PDD sometimes experience episodes of major depression. This can make them think about suicide. If you have thoughts about hurting yourself or others, tell someone right away. You can tell your doctor, your family, or a friend.

    You can also call a suicide hotline. There may be a local number you can call. Or call the National Suicide Prevention Lifeline at 1-800-273-8255.

  • Get help right away. PDD and other forms of depression can be treated successfully.

There is always someone who can help you.

  • I’ve felt down for a long time. Could I have PDD?
  • Do I need treatment? What are my treatment options?
  • Should I see a counselor or someone else for talk therapy?
  • Will I need medicine to treat my symptoms? How long will I need to take it?
  • How is the treatment for PDD different than for major depression?
  • What should I do if I find myself in a very dark place or start having thoughts of suicide?

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.


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