Persistent Depressive Disorder: Symptoms, Causes, And Treatment

A disorder formerly known as dysthymia. We explain its symptoms and diagnostic criteria.

persistent depressive disorder

It is common to find, throughout life, that they tend to seem sad, negative or with a constant melancholic air.

However, when it persists over the years and begins to interfere with different aspects of a person’s life, we can speak of persistent depressive disorder.

What is persistent depressive disorder?

Formerly labeled dysthymia or dysthymic disorder, the latest volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) renames it Persistent Depressive Disorder.

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

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

Although its origin is not clearly established, it is believed that there is a genetic component, that is, hereditary, which, together with psychosocial elements such as detachment or the lack of stimulation and rewards during childhood, predisposes the person to suffer from this persistent depressive disorder.


Within the symptomatology of persistent depressive disorder, the symptom that most characterizes it is the experience by the patient of a persistent state of demoralization, unease or grief and grief ; which lasts for at least two years.

When this disorder appears in children or adolescents, the manifestations go from being a depressed mood to being irascible or angry; and it must last at least one year.

Also, the person must have two or more of these symptoms most of the time:

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

It is common for people with persistent depressive disorder to suffer from a negative self-concept, as well as a pessimistic view of their future, of others and of practically everything around them; so it is difficult for them to resolve any type of problem or conflict.


As mentioned above, the specific causes of this persistent depressive disorder or chronic depression are still unknown. However, it is known that this is usually hereditary, that it affects more men than women and that it is suffered by approximately 5% of the population.

Similarly, it has also been established that the appearance of persistent depressive disorder is related to other mental conditions or disorders such as anxiety or substance abuse disorders such as alcoholism or drug addiction.

Another point in common that patients with chronic depression have is that at least 50% of them will suffer an episode of major depression in their lives.


To make an effective diagnosis of persistent depressive disorder, the relevant health professional must take a medical history in which both the mood and the other symptoms associated with this condition are evaluated.

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

A correct diagnosis of this disorder must take into account the following classifying conditions established by the DSM-V:

1. Chronically depressed mood

The person must be in a depressed mood for most of the day and on most days for at least 2 years. This can be referred directly by the patient or observed by the people around him.

2. Presence of two or more of these symptoms

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

3. Duration of 2 years

The symptoms of the previous two points must have remained in the person for at least two years, with intermittences of at most two months.

4. There are no major depressive episodes

The person has not suffered a major depressive episode during the first two years and the symptoms are not better explained by the presence of another type of depressive disorder.

5. There are no manic, hypomanic, etc. episodes.

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

6. Does not appear during a psychotic disorder

Symptoms do not appear exclusively in a chronic psychotic disorder such as schizophrenia or delusional disorder.

7. The symptoms are not caused by drugs or other diseases.

The symptoms cannot be explained by the physiological effects of substance use or by a general medical condition.

8. Significant discomfort

The symptoms cause a clinically significant discomfort in the person. This discomfort generates a work, social deterioration or any other important areas of the patient.

Treatment and prognosis

Persistent depressive disorder is a chronic condition. However, the person can benefit from a treatment that consists of drug therapy with antidepressants and intervention with psychotherapy.

Although antidepressant medication works better in major depression than in persistent depressive disorder, there are a number of drugs that can improve symptoms in the patient. These are:

  • 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)

With regard to the psychotherapy used in these cases, the most important thing is that the person is able to express their feelings and thoughts, as well as learn to manage them.

For this there are a series of very effective therapies:

  • Cognitive behavioral therapy (CBT)
  • Psychodynamic interventions
  • Support groups

Finally, the prognosis or evolution of this disorder differs greatly from one person to another. Its chronic nature causes the person to suffer it over the years and even throughout life, with very few people who fully recover.

With the use of an adequate treatment, the person can improve significantly, being able to continue their usual routine in a satisfactory way. However, in most cases, permanent psychological therapy is required.

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