Imagine if every day felt like Blue Monday. It's not as far-fetched an idea as you may think. Persistent depressive disorder, also known as dysthymia or PDD, is thought to affect as many as 4.5% of the UK population, according to The Priory Group, with sufferers claiming to experience feelings of sadness and hopelessness on constant repeat.
So what exactly is persistent depressive disorder?
This condition is exactly as it sounds. “Persistent depressive disorder is a chronic form of depression lasting for at least two years in adults and one year in children," says Jason Ward, UKCP-accredited psychotherapist, and clinic director of DBT London. "Characterised by a persistent low mood and diminished interest or pleasure in daily activities, PDD often involves feelings of hopelessness, fatigue, and low self-esteem.” It is also thought to be more common in women than men.
According to the ICD-10 (International Classification of Diseases), dysthymia is chronic depression ‘which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder’.
What causes persistent depressive disorder?
As with other kinds of depression, there is no one direct cause of dysthymia. But sufferers often have an episode of major depression at some point in their lives.
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“Persistent depressive disorder is likely caused by a combination of genetic, biological, and environmental factors,” says counselling psychologist Dr Rina Bajaj. “Genetic predisposition and a family history of mood disorders increases the risk; brain chemistry imbalances and a history of early-life stress or trauma contribute. Chronic exposure to stressors and alterations in neurotransmitter function may also play a role. The exact interplay of these factors is complex, and research is ongoing to understand the multifaceted origins of PDD.”
If you are concerned that you are suffering from persistent depressive disorder, diagnosis involves a clinical assessment by a mental health professional. “Criteria include a minimum of two years of persistently depressed mood, along with additional symptoms such as changes in appetite, sleep, energy levels and low self-esteem,” Dr Bajaj adds. “The assessment considers the impact on daily functioning. The diagnosis rules out other medical or psychiatric conditions causing similar symptoms.”
Dysthymia vs depression - what is the difference?
- Dysthemia symptoms are less severe than major depressive episodes. "While not as intense as major depression, the prolonged nature of PDD can significantly impact one's overall quality of life,” says Jason. “Individuals with PDD may have difficulty functioning in social, work, or academic settings.”
- Dysthemia is a prolonged condition. To be diagnosed with depression, your symptoms need to have persisted for over two weeks, whereas to be diagnosed with dysthymia, your symptoms need to have been ongoing for at least two years. “Other types of depression may have more acute and severe episodes with distinct periods of remission,” Dr Bajaj notes. “PDD involves a prolonged and enduring course, impacting long-term mental wellbeing.”
What are the symptoms of persistent depressive disorder?
As well as a persistent low mood, symptoms of PDD typically also include:
- Poor appetite
- Disturbed sleep
- Low energy
- Poor concentration
- Feelings of hopelessness
- Low self-esteem
"A thorough evaluation considers the duration, intensity, and impact of symptoms, and rules out other medical and psychiatric conditions,” Dr Bajaj says. Also worth noting: while the intensity of symptoms can change over time, they don't tend to disappear for more than two months at a time.
Can someone with persistent depressive disorder still be happy?
Given that an ever-present low mood is a symptom of persistent depressive disorder, you may find it hard to feel jolly, even on happy occasions. To compound the problem, because the symptoms of PDD are less severe than a major depressive episode they are often played down or normalised – both by the sufferer and society. So someone's PDD is often written off as a miserable personality rather than a serious mental health condition and, in some cases, it means that PDD goes undiagnosed.
That said, “individuals with persistent depressive disorder can experience periods of happiness and improvement with appropriate treatment,” Jason notes.
Does PDD ever go away?
"While PDD is chronic, proactive management can lead to better overall mental wellbeing for those affected,” says Jason. This can take the form of psychotherapy, medication, or a combination of both, as well as cognitive-behavioural therapy (CBT) to manage symptoms and improve mood.
“Additionally, lifestyle changes, social support and coping strategies play crucial roles in recovery,” says Dr Bajaj. "Seeking professional help is essential for personalised guidance and treatment planning.”
If you're struggling with your mental health, please speak to your GP or call the Samaritans on 116 123. For information on finding a therapist, visit mind.org.uk.
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