Persistent Depressive Disorder
Persistent depressive disorder, which is also known as dysthymia, is a type of depression classified by chronic feelings of low mood that is long term, occurring most of the day or daily without lapses, and lasting at least two years or more in adults. In children and adolescents, this classification of low mood lasts for a year, and can include a more intense mood and increased irritability. PDD has sometimes been referred to as the precursor to major depression.
The exact cause of PDD is unknown, but some theories include:
- changes in neurotransmitters in the brain
- traumatic or stressful life events
- other mental health illnesses
- other chronic illnesses that cause biologic changes
People who suffer a traumatic life event, have personality traits such as low self-esteem or pessimism, or have a history of other mental health disorders are at risk for developing PDD.
People suffering from PDD may exhibit all or some of the following symptoms:
- inability to sleep or sleeping too much
- lack of energy
- low self-esteem
- loss of interest in daily activities
- poor appetite or overeating
- avoidance of social activities
- decreased productivity
They may tell you they feel sad or down all the time. They may have difficulty keeping a job, and other life responsibilities. Their appearance may be disheveled, or unkempt.
People with PDD will most certainly have a reduced quality of life and experience problems with relationships, school, and work activities. They may also show signs of suicidal thoughts and tendencies, which should be addressed.
If you or someone you know has these symptoms and/or has expressed suicidal thoughts, medical attention should be sought out immediately. There are therapies that can help patients with PDD relieve symptoms and live a productive, fulfilling life.
Some of the treatments for PDD will depend on the severity of symptoms and other underlying medical conditions.
Two of the mainstays of treatment are medications and psychotherapy.
Some of the medications used are Selective Serotonin Reuptake Inhibitors (SSRI) like Prozac, Paxil, and Zoloft. These medications take a few weeks to work effectively in the body, so it is imperative that the patient is seen by a health care provider for adjustments and discussion of symptoms and symptom relief. Once the patient begins taking these medications, they should never stop them abruptly, as this can cause severe physiologic side effects. If a patient starts to “feel better” and they have discussed a prior suicide thought or plan, they must be monitored closely, as they will now have the strength to carry it out. Some other drug classes that may be used to treat PDD are tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Both TCAs and SNRIs increase levels of serotonin and norepinephrine in the brain, which carry messages between brain cells and contribute to well-being, good mood, appetite, alertness, focus, and memory retrieval. Examples of TCAs include amitriptyline, doxepin, and imipramine. Common SNRIs include Effexor and Cymbalta.
Psychotherapy (talk therapy) is helpful for discussing feelings and thoughts and learning effective coping mechanisms. Cognitive-behavioral therapy (CBT) is a type of psychotherapy that helps change behaviors and moods by modifying thought patterns. CBT is a way of talking about how actions affect feelings and thoughts, and how the individual perceives themself, others, and the world.
The severity of symptoms will determine if these therapies should be administered in an outpatient setting or if a more therapeutically controlled environment would be helpful, such as an inpatient program.
Family support is an important component in treatment for PDD. Family members are often the ones seeing the signs of depression in an individual and can be instrumental in helping them seek treatment and follow through with treatment. It is important to remember that depression has an effect on the family as well. Seeking support for those family and friends affected by their loved one’s depression is also a factor to be considered. There are organizations and websites where family and friends can go for advice, referrals, and ways to cope with their loved one’s diagnosis.
Some other things patients can do in addition to seeking treatment include:
- getting enough sleep
- following a healthy diet
- taking medications as ordered
- trying to exercise regularly
- avoiding alcohol and illegal drugs
A patient might also be helped by moral support from family members, friends, or even therapists and nurses.
There is no sure way to prevent PDD. It often begins early – in children, teens, and young adults – so identifying children at risk of the condition may help get them early treatment.
Some preventative factors to consider include: taking steps to control stress; which helps build resilience and boost self-esteem; reaching out to family, friends, a coach, teacher, faith leader, or someone whom you trust, especially during times of crisis; and seeking treatment at the earliest signs of a problem.
I hope this video on persistent depressive disorder was helpful. Thanks for watching, and happy studying!