If your doctor suspects you have persistent depressive disorder, exams and tests may include
- Physical exam. The doctor may do a physical exam and ask in-depth questions about your health to determine what may be causing your depression. In some cases, it may be linked to an underlying physical health problem.
- Lab tests. Your doctor may order lab tests to rule out other medical conditions that may cause depressive symptoms. For example, your doctor may order a blood test to find out if your thyroid is underactive (hypothyroidism).
- Psychological evaluation. This includes discussing your thoughts, feelings and behavior and it may include a questionnaire to help pinpoint a diagnosis. This evaluation can help determine if you have persistent depressive disorder or another condition that can affect mood, such as major depression, bipolar disorder or seasonal affective disorder.
To diagnose persistent depressive disorder, many doctors use the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.
For a diagnosis of persistent depressive disorder, the main indication for an adult differs somewhat from that of a child:
- For an adult, depressed mood occurs most of the day for two or more years
- For a child, depressed mood or irritability occurs most of the day for at least one year
Symptoms caused by persistent depressive disorder can vary from person to person. When persistent depressive disorder starts before age 21, it's called early onset; if it starts at age 21 or older, it's called late onset.
The two main treatments for persistent depressive disorder are medications and talk therapy (psychotherapy). The treatment approach your doctor recommends depends on factors such as:
- Severity of your symptoms
- Your desire to address emotional or situational issues affecting your life
- Your personal preferences
- Previous treatment methods
- Your ability to tolerate medications
- Other emotional problems you may have
Psychotherapy may be the first recommendation for children and adolescents with persistent depressive disorder, but that depends on the individual. Sometimes antidepressants are also needed.
The types of antidepressants most commonly used to treat persistent depressive disorder include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Talk with your doctor or pharmacist about possible side effects.
Finding the right medication
You may need to try several medications or a combination before you find one that works. This requires patience, as some medications take several weeks or longer for full effect and for side effects to ease as your body adjusts.
Don't stop taking an antidepressant without talking to your doctor — your doctor can help you gradually and safely decrease your dose. Stopping treatment abruptly or missing several doses may cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression.
When you have persistent depressive disorder, you may need to take antidepressants long term to keep symptoms under control
Antidepressants and pregnancy
If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.
FDA alert on antidepressants
Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the most serious warning for prescriptions.
In some cases, children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So watch them for possible worsening depression and contact the doctor right away if this occurs, or get emergency help if suicidal behaviors occur.
Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy or psychological counseling.
Different types of psychotherapy, such as cognitive behavioral therapy, can be effective for persistent depressive disorder. You and your therapist can discuss which type of therapy is right for you, your goals for therapy and other issues, such as the length of treatment.
Psychotherapy can help you:
- Adjust to a crisis or other current difficulty
- Identify issues that contribute to your depression and change behaviors that make it worse
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Find better ways to cope and solve problems
- Explore relationships and experiences, and develop positive interactions with others
- Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
- Learn to set realistic goals for your life
FDA doesn't monitor supplements
Dietary supplements aren't approved and monitored by the FDA the same way medications are. You can't always be certain of what you're getting and whether it's safe. Also, because some herbal and other dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider before taking any supplements.
Lifestyle and home remedies
Persistent depressive disorder generally isn't a condition that you can treat on your own. But, in addition to professional treatment, these self-care steps can help:
- Stick to your treatment plan. Don't skip psychotherapy sessions or appointments, and even if you're feeling well, don't skip your medications. Give yourself time to improve gradually.
- Learn about persistent depressive disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about the disorder to help them understand and support you.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms get worse or return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
- Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you're having trouble sleeping, talk to your doctor about what you can do.
- Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression-related symptoms, but in the long run they generally worsen depression and make it harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug abuse.
Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for medical care.
For example, the herbal supplement called St. John's wort is not approved by the Food and Drug Administration (FDA) to treat depression in the U.S., though it's a popular depression treatment in Europe. It may help improve mild or moderate depression, but the overall evidence is not conclusive.
St. John's wort can interfere with a number of medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John's wort while taking antidepressants because the combination can cause serious side effects.
Coping and support
Persistent depressive disorder makes it hard to engage in behavior and activities that can help you feel better. In addition to the treatments recommended by your doctor or therapist, consider these tips:
- Focus on your goals. Dealing with persistent depressive disorder is an ongoing process. Set reasonable goals for yourself. Stay motivated by keeping your goals in mind. But give yourself permission to do less when you feel down.
- Simplify your life. Cut back on obligations when possible. Structure your time by planning your day. You may find it helps to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
- Write in a journal. Journaling as part of your treatment may improve mood by allowing you to express pain, anger, fear or other emotions.
- Read reputable self-help books and websites. Ask your doctor or therapist to recommend books or websites to read.
- Stay connected. Don't become isolated. Try to participate in social activities, and get together with family or friends regularly. Support groups for people with depression can help you connect with others facing similar challenges and share experiences.
- Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, yoga and tai chi.
- Don't make important decisions when you're down. Avoid decision-making when you're feeling depressed, since you may not be thinking clearly.
Preparing for your appointment
You may decide to schedule an appointment with your primary care doctor to talk about your concerns or you may decide to see a mental health specialist, such as a psychiatrist or psychologist, for evaluation.
What you can do
Prepare for your appointment by making a list of:
- Any symptoms you've had, including any that may seem unrelated to the reason for which you scheduled the appointment
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins, supplements or herbal preparations that you're taking, and the doses
- Questions to ask your doctor
Taking a family member or friend along can help you remember something that you missed or forgot.
Basic questions to ask your doctor include:
- Why can't I get over this depression on my own?
- How do you treat this type of depression?
- Will talk therapy (psychotherapy) help?
- Are there medications that might help?
- How long will I need to take medication?
- What are some of the side effects of the medication you're recommending?
- How often will we meet?
- How long will treatment take?
- What can I do to help myself?
- Are there any brochures or other printed materials that I can have?
- What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor may ask you several questions, such as:
- When did you first notice symptoms?
- How is your daily life affected by your symptoms?
- What other treatment have you had?
- What have you tried on your own to feel better?
- What things make you feel worse?
- Have any relatives had any type of depression or another mental illness?
- What do you hope to gain from treatment?