Amanda Stern, an author from New York City, found herself in her mid-40s no longer battling clinical depression or frequent panic attacks. Yet, instead of experiencing greater happiness, she described feeling trapped in an enduring, flat sadness. Perplexed by this emotional state, Stern turned to her therapist for guidance. Her therapist suggested she might be dealing with dysthymia, a milder form of Persistent Depressive Disorder (PDD).
Stern, who frequently writes about mental health, had never encountered this term before. However, upon reflection, she realized that she had faced bouts of dysthymia intermittently for many years. Although she wasn’t currently experiencing it, she understood that it might return in the future. Stern decided to share her experience in her newsletter, How to Live, describing the constant feeling of emptiness and the coping strategies that ultimately helped her overcome it.
To help shed light on PDD, this article seeks insights from experts.
Understanding Persistent Depressive Disorder (PDD)
Persistent depressive disorder, also known as PDD, is a type of chronic depression that endures for at least two years in adults. It encompasses varying degrees of severity, with the term “dysthymia” often used to describe the milder form of PDD, even though it is no longer included in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Marnie Shanbhag, Senior Director of Independent Practice at the American Psychological Association, explains that individuals with less severe PDD may often go undiagnosed. They might initially seek therapy for other issues such as marital problems or work-related stress but eventually reveal a persistent, low-level sadness, emotional flatness, or numbness that lacks an apparent cause. Over time, they may become accustomed to this emotional state, characterized by a constant feeling of indifference.
In contrast, clinical depression can incapacitate individuals, making it nearly impossible to complete even basic tasks. Those with PDD can still function to some extent, even if they lack motivation for certain activities.
Severe PDD, previously referred to as chronic major depressive disorder, can lead to more debilitating symptoms, such as the inability to get out of bed, loss of appetite, extreme difficulty concentrating, fatigue, and a lack of energy to perform daily chores or cook.
Approximately 2% of adults in the United States experience some form of PDD in a year, and it appears to be more prevalent among women. However, PDD is often underdiagnosed, making it challenging to gauge its full extent.
Diagnosis of PDD
PDD is diagnosed in adults who report feeling depressed “most of the day, for more days than not,” for a minimum of two years. Any relief from symptoms typically does not persist for more than two months. Children and adolescents can also experience PDD, with a diagnosis requiring symptoms to persist for at least one year.
PDD causes significant distress or impairment and is associated with an elevated risk of suicide. Patients must also experience at least two of the following symptoms:
- Poor appetite or overeating.
- Insomnia or excessive daytime sleepiness.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
Treatment for PDD
PDD is typically treated with a combination of therapy and antidepressant medication. While there is no cure, individuals can achieve symptom relief, and the frequency of recurrences can be minimized.
Because PDD can persist for an extended period and may not dramatically disrupt daily life, individuals with this disorder might mistake their milder depressive symptoms for their character traits. It’s essential to recognize that seeking treatment is crucial for those experiencing distress or symptoms that interfere with daily functioning. One should not simply accept these symptoms as an inherent part of their personality.
Dr. Jessi Gold, a psychiatrist in St. Louis, emphasizes that even though it may be difficult to convince oneself that they are not just “the negative person” in their family or social group, seeking help is crucial for those experiencing consistent unmotivation, apathy, or a loss of interest in activities they once enjoyed.
Amanda Stern echoes this sentiment, urging those who feel consistently lacking in motivation, apathetic, or disinterested in previously enjoyable activities to seek help. She reassures them that they are not alone in their struggle and that professional assistance can make a significant difference in their lives.
In conclusion, Persistent Depressive Disorder (PDD) is a chronic form of depression that persists for at least two years in adults. It encompasses various levels of severity and can often go undiagnosed. Seeking therapy and treatment is essential for individuals experiencing symptoms of PDD, as it can lead to significant distress and impairment.