Dysthymia (Persistent Depressive Disorder)

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What are persistent depressive disorder symptoms and signs?

In order to meet criteria for the diagnosis of persistent depressive disorder, a person must experience depression, which can look like (present as) a loss of interest or general discontent (may be irritability or excessive anger in children and adolescents) most of every day, more days than not for at least two years in a row in adults, and one year for children and teens. The persistent depressive disorder sufferer will not have more than a two-month symptom-free period during the course of the illness and must experience at least two of the following signs and symptoms of this type of depression:

  • Loss of appetite or excessive hunger
  • Insomnia or excess sleepiness
  • Fatigue or other physical symptoms; slowness in activity and thought
  • Low self-esteem/feelings of inadequacy
  • Lack of concentration or making decisions
  • Hopelessness

A person with persistent depressive disorder can also have major depression but does not suffer from cyclothymia, never has the mania or hypomania of bipolar disorder, and does not have symptoms that are better explained by another mental-health problem, the effects of a medication, drug of abuse, or medical condition.

How do health-care professionals diagnose persistent depressive disorder? What types of doctors treat persistent depressive disorder?

Many health-care providers may help make the diagnosis of persistent depressive disorder and treat the condition, including licensed mental-health therapists, pediatricians, or other primary-care providers, specialists whom one sees for a medical condition, emergency physicians, psychiatrists, clinical psychologists, psychiatric nurses, and social workers. One of these professionals will likely perform or refer for an extensive medical interview and physical examination as part of determining the diagnosis. Persistent depressive disorder may be associated with a number of other medical conditions, the result of exposure to alcohol or other drugs of abuse or as part of a general medical condition, so routine laboratory tests are often performed during the initial evaluation to rule out other medical causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed.

As part of the evaluation, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the presence of depression. Thorough exploration for any history or presence of mental-health symptoms will be conducted such that persistent depressive disorder can be distinguished from other types of depression like major depression, depressive symptoms in reaction to stress (adjustment disorder), or depression as part of the mood swings of bipolar disorder or cyclothymia. The mental-health practitioner will also explore whether or not other forms of mental illness are present.

Medically Reviewed by a Doctor on 4/8/2016

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