Counseling for Persistent Depressive Disorder

Counseling for Persistent Depressive Disorder

“Why is This Taking So Long?”

Almost everyone goes through periods of feeling down. There may have been something that caused sadness, or maybe it just happened for some reason that we can’t seem to pinpoint. However, if periods of extreme feelings of sadness and despair become disruptive to our ability to function as we normally do, there may be something more going on such as depression. If there is a diagnosis of depression that seems to last a very long time and does not appear to be improving despite treatment, such as counseling and/or medication, this could be what is called persistent depressive disorder.

What is Persistent Depressive Disorder?

Persistent depressive disorder (PDD), also called dysthymia, is a continuous long-term (chronic) form of depression. While there is no specific timeline that deciphers a determination of this, PDD symptoms usually come and go over a period of at least two years, and their intensity can change over time. Unlike other forms of depression, typically these symptoms don't disappear for more than two months at a time, rather they remain. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression. A determination can be a little tricky because PDD is a fairly new condition, only just appearing in the DSM-V, for which the diagnostic criteria are constantly evolving. PDD is an evolved version of what was called Dysthymia in the DSM IV.  If you have been experiencing long episodes of depression, or maybe you’ve been in the same “slump” for more than a few months at a time, you should talk to your doctor or counselor about the possibility of persistent depressive disorder. You know your body and your mind, so if something feels wrong for longer than you feel like you can or should be managing, you should seek out more treatment options.

Major Depression or Persistent Depressive Disorder?

PDD is usually less severe than major depressive disorder (MDD), but it’s ongoing. 

PDD and MDD have very similar symptoms (the main difference being their duration). Regardless, it is possible for a person to have symptoms of both disorders at the same time. The following are some symptoms for comparison.

Major Depressive Disorder (MDD) Symptoms

There are many symptoms of MDD, and not all of them have to be present at the same time for a professional to diagnose the issue. 

The symptoms of MDD are:

  • having a depressed mood that lasts for most of the day
  • having less interest or pleasure in most or all activities
  • experiencing fatigue
  • feeling worthless or guilty 
  • having difficulty concentrating and making decisions
  • unintentionally losing or gaining a significant amount of weight 
  • having trouble sleeping — insomnia — or sleeping too much 
  • experiencing a type of restlessness called psychomotor agitation or finding it difficult to think, speak, and do other everyday things, called psychomotor impairment
  • having frequent thoughts of death

Persistent Depressive Disorder (PDD) Symptoms

The symptoms of PDD can often overlap with those of MDD. 

As with MDD, not every PDD symptom needs to be present at the same time for a person to receive a diagnosis. 

PDD symptoms include:

  • feeling depressed or irritable
  • having a poor appetite or overeating
  • having insomnia or sleeping too much
  • experiencing fatigue or low energy 
  • having low self-esteem
  • having trouble concentrating or making decisions
  • having feelings of hopelessness

While it might seem as though the symptoms of MDD and PDD are quite similar, the difference between the two diagnoses might make all the difference in their alleviation, therefore making all the difference in your treatment. This is why it is important for you to discuss your symptoms with a professional. 


Causes of Persistent Depressive Disorder

The exact cause of PDD 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. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role 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 of Persistent Depressive Disorder (PDD)

Persistent depressive disorder often begins early — in childhood, the teen years or young adult life (although it can sometimes begin in adulthood as well)— and is chronic. Certain factors appear to increase the risk of developing or triggering PDD, including:

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

Complications of Persistent Depressive Disorder (PDD)

Symptoms and causes of PDD, if left untreated, can further lead to physical and/or mental conditions. Conditions that are commonly linked with persistent depressive disorder include:


  • A reduced quality of life
  • Major depression, anxiety disorders and other mood disorders
  • Substance abuse
  • Relationship difficulties and family conflicts
  • School and work problems and decreased productivity
  • Chronic pain and general medical illnesses
  • Suicidal thoughts or behavior
  • Additional mental health disorders

No one wants nor should they have to deal with such conditions due to PDD, which is why if you feel like this is what you are experiencing, you should reach out and discuss treatment options with a professional. 

Can I Prevent Persistent Depressive Disorder (PDD)?

Although you can’t necessarily prevent PDD or any other type of depression, you can do some things to make it less severe, such as:

  • 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.

These suggestions will often help make symptoms of PDD more manageable, but the best approach is to combine them with professional treatment, such as counseling.

How is Persistent Depressive Disorder (PDD) Treated?

While there is no one size fits all “cure,” the most effective treatments for PDD often combines medications and talk therapy, or counseling.

Antidepressants are prescription drugs that can relieve many types of 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. Talking to a therapist can 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 in order to make the symptoms of PDD subside.

When to Seek Out Help for Chronic Depression

Because you are experiencing these feelings that have gone on for such a long time, you may think they'll just always be part of your life; this is not something you should have to accept. If you have any symptoms of PDD, seek help because it can be treated. Talk to your primary care doctor about your symptoms and/or seek help directly from a mental health professional. If you're reluctant to see a mental health professional on your own at first, reach out to someone else who may be able to help guide you to treatment, whether it's a friend or loved one, a teacher, or someone else you trust. *If you feel like you may hurt yourself or attempt suicide, ALWAYS call 911 immediately. You can also contact the National Suicide Prevention Lifeline:

If you feel like you might have persistent depressive disorder, reaching out for help is the best next step. At Lansing Counseling, we do not want you to have to deal with such a chronic struggle. Here in our welcoming environment, we have licensed counselors who can work with you to find the right treatment for your PDD. To schedule an appointment, you can fill out our contact form below, email us: [email protected] or give us a call at: (517) 333-1499. 


Lansing Counseling

5030 Northwind Dr Suite 101
East Lansing, MI 48823

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