Overview

Persistent depressive disorder is a continuous, long-term form of depression. You may feel sad and empty, lose interest in daily activities and have trouble getting things done. You may also have low self-esteem, feel like a failure and feel hopeless. These feelings last for years and may interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions. You may be described as having a gloomy personality, constantly complaining or not able to have fun. Persistent depressive disorder is not as severe as major depression, but your current depressed mood may be mild, moderate or severe.

Because persistent depressive disorder is long term, coping with depression symptoms can be challenging. A combination of talk therapy and medicine can be effective in treating this condition.

Symptoms

Persistent depressive disorder symptoms usually come and go over a period of years. The intensity of symptoms can change over time. But symptoms usually don't disappear for more than two months at a time. Also, major depression episodes may occur before or during persistent depressive disorder.

Symptoms of persistent depressive disorder can cause major problems in your life and may include:

  • Sadness, emptiness or feeling down.
  • Loss of interest in daily activities.
  • Tiredness and lack of energy.
  • Low self-esteem, self-criticism or feeling you're not capable.
  • Trouble focusing clearly and trouble making decisions.
  • Problems getting things done well and on time.
  • Quickly becoming annoyed, impatient or angry.
  • Avoidance of social activities.
  • Feelings of guilt and worries over the past.
  • Poor appetite or overeating.
  • Sleep problems.
  • Hopelessness.

In children, symptoms of persistent depressive disorder may include depressed mood and being irritable, which means easily becoming annoyed, impatient or angry.

When to see a doctor

If these feelings have been going on for a long time, you may think they'll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.

Talk to your health care provider about your symptoms or seek help from a mental health professional. Or you can reach out to someone else who may be able to help guide you to treatment. This could be a friend or loved one, a teacher, a faith leader, or another person you trust.

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 888-628-9454 (toll-free).

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Causes

The exact cause of persistent depressive disorder is not known. As with major depression, it may involve more than one cause, such as:

  • Biological differences. People with persistent depressive disorder may have physical changes in their brains. It's not clear how these changes affect the disorder, but they may eventually help determine the causes.
  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals. Research indicates that changes in neurotransmitters may play a large part in depression and its treatment.
  • Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
  • Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people.

Risk factors

Persistent depressive disorder often begins early — in childhood, the teen years or young adult life — and continues for a long time. Certain factors appear to increase the risk of developing persistent depressive disorder, including:

  • Having a first-degree blood relative, such as a parent or sibling, with major depressive disorder or other depressive disorders.
  • Traumatic or stressful life events, such as the loss of a loved one or major financial problems.
  • Personality traits that include negativity, such as low self-esteem, being too dependent or self-critical, or always thinking the worst will happen.
  • History of other mental health disorders, such as a personality disorder.

Complications

Conditions that may be linked with persistent depressive disorder include:

  • Lower quality of life.
  • Major depression, anxiety disorders and other mood disorders.
  • Substance misuse.
  • Relationship difficulties and family conflicts.
  • School or work problems and trouble getting things done.
  • Continuing pain and general medical illnesses.
  • Suicidal thoughts or behavior.
  • Personality disorders or other mental health disorders.

Prevention

There's no sure way to prevent persistent depressive disorder. Because it often starts in childhood or during the teenage years, identifying children at risk of the condition may help them get early treatment.

Strategies that may help reduce or prevent symptoms include the following:

  • Take steps to control stress, to increase your ability to recover from problems — which is called resilience — and to boost your self-esteem.
  • Reach out to family and friends, especially in times of crisis, to help you get through rough spells.
  • Get treatment at the earliest sign of a problem to help prevent symptoms from worsening.
  • Consider getting long-term treatment to help prevent a relapse of symptoms.

Dec. 02, 2022
  1. Persistent depressive disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed May 14, 2022.
  2. AskMayoExpert. Persistent depressive disorder. Mayo Clinic; 2021.
  3. Giovanni Carta M, et al. Current pharmacotherapeutic approaches for dysthymic disorder and persistent depressive disorder. Expert Opinion on Pharmacotherapy. 2019; doi:10.1080/14656566.2019.1637419.
  4. Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression. Accessed May 14, 2022.
  5. Haller H, et al. Complementary therapies for clinical depression: An overview of systematic reviews. BMJ Open. 2019; doi:10.1136/bmjopen-2018-028527.
  6. Schramm E, et al. Review of dysthymia and persistent depressive disorder: History, correlates, and clinical implications. The Lancet. Psychiatry. 2020; doi:10.1016/S2215-0366(20)30099-7.
  7. Depression and complementary health approaches: What the science says. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/depression-science. Accessed May 14, 2022.
  8. Ng JY, et al. Complementary and alternative medicine recommendations for depression: A systematic review and assessment of clinical practice guidelines. BMC Complementary Medicine and Therapies. 2020; doi:10.1186/s12906-020-03085-1.
  9. Rush AJ. Unipolar major depression in adults: Choosing initial treatment. https://www.uptodate.com/contents/search. Accessed May 14, 2022.
  10. Stewart D, et al. Antenatal use of antidepressants and risk of teratogenicity and adverse pregnancy outcomes: Selective serotonin reuptake inhibitors (SSRIs). https://www.uptodate.com/contents/search. Accessed May 14, 2022.
  11. Using dietary supplements wisely. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/using-dietary-supplements-wisely. Accessed May 14, 2022.
  12. The lifeline and 988. 988 Suicide & Crisis Lifeline. https://988lifeline.org. Accessed Oct. 14, 2022.
  13. Kimmel MC, et al. Safety of infant exposure to antidepressants and benzodiazepines through breastfeeding. https://www.uptodate.com/contents/search. Accessed May 16, 2022.
  14. What is depression? American Psychiatric Association. https://psychiatry.org/patients-families/depression/what-is-depression. Accessed May 16, 2022.
  15. Depression: Parents' medication guide. American Academy of Child & Adolescent Psychiatry and the American Psychiatric Association. https://www.aacap.org/AACAP/Families_and_Youth/Family_Resources/Parents_Medication_Guides.aspx. Accessed May 16, 2022.
  16. Complementary health approaches. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Complementary-Health-Approaches. Accessed May 16, 2021.
  17. Depression: Helping yourself. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Support. Accessed May 16, 2022.
  18. Hall-Flavin DK (expert opinion). Mayo Clinic. May 28, 2022.

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