Persistent Depressive Disorder (PDD)

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.


What is persistent depressive disorder?

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.


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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.


Symptoms and Causes

What causes persistent depressive disorder?

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.”


Diagnosis and Tests

How is persistent depressive disorder diagnosed?

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.

Management and Treatment

How is persistent depressive disorder treated?

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.


Can I prevent persistent depressive disorder?

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.

Outlook / Prognosis

What is the outlook for people with persistent depressive disorder?

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.

When should I seek immediate care?

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 Suicide and Crisis Lifeline at 988.

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

Living With

How can I cope with persistent depressive disorder?

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 like you might hurt yourself or someone else, seek help immediately. You’re not alone.

Medically Reviewed

Last reviewed on 03/08/2021.

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