Persistent Depressive Disorder Basics

Persistent depressive disorder (PDD), also called dysthymia, is a form of chronic depression, with symptoms that are less severe but longer lasting than other forms of depression. In this guide you'll learn about how to recognize PDD, how it's diagnosed in children and current treatment options.

PDD: What Is It?

Persistent depressive disorder, also called dysthymia, is a form of chronic depression, with symptoms less severe but longer lasting than other forms of depression. It is a new diagnosis that combines two earlier diagnoses: dysthymia and chronic major depressive episode. If a child appears to be irritable or in a depressed mood most of the time for over one year, persistent depressive disorder is a possible diagnosis. Like other forms of depression, dysthymia afflicts young people with chronic feelings of sadness or worthlessness, and an inability to take pleasure and perform well in the activities of daily life. With dysthymia in particular, the symptoms of depression may go unnoticed for some time, as they are less acute but longer lasting than in other forms of depression.

PDD: What to Look For

A child with persistent depressive disorder appears to be irritable, moody, sad or pessimistic over a long period of time. Other symptoms can include behavior problems, poor performance at school, low self-esteem, and difficulty interacting with other children in social situations. The intensity of individual symptoms may ebb and flow over a period of years, but typically symptoms do not disappear for over two months at a time. Because the disorder often occurs in children at the same time as other psychological disorders with similar symptoms, it can be particularly difficult to diagnose.

PDD: Risk Factors

Children are at higher risk of developing persistent depressive disorder if they have a first-degree relative with the disorder. Other risk factors are temperamental (negative affectivity) and environmental, such as the loss of a parent or sibling.

PDD: Diagnosis

For a child to be diagnosed with persistent depressive disorder, she must exhibit a depressed mood or irritability most of the day for at least one year. In addition, she must have at least two of the following symptoms, to the point where they cause her distress or interfere with her ability to function well at home, in school, or in other areas of daily life: poor appetite or overeating, trouble sleeping, persistent tiredness or lack of energy, low self-esteem, hopelessness, trouble concentrating, and difficulty making decisions.

When a child has persistent depressive disorder, the severity of her symptoms may vary, at times including episodes severe enough to meet the criteria for major depressive disorder. Rather than give these children two separate diagnoses, clinicians are instructed to identify it as persistent depressive disorder “with intermittent major depressive episodes.” If her symptoms over more than a year continuously meet the criteria for major depressive disorder, clinicians are instructed to call it persistent depressive disorder “with persistent major depressive episodes.”

PDD: Treatment

Treatments for persistent depressive disorder include medications and psychotherapy, including cognitive behavioral therapy and interpersonal therapy. Medications are believed to be a more effective treatment than psychotherapy when used alone, but a combination of medication and psychotherapy is believed to be the most effective treatment. Medications include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). Children and young adults should be closely monitored by their health-care providers and their families when taking antidepressants, especially when they have just begun taking them or when their dose has recently been changed.

PDD: Risk For Other Disorders

In children, persistent depressive disorder often occurs alongside other disorders, especially anxiety disorders and substance abuse disorders.