Overview

Persistent depressive disorder, also called dysthymia (dis-THIE-me-uh), is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly 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 incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.

Because of the chronic nature of persistent depressive disorder, coping with depression symptoms can be challenging, but a combination of talk therapy (psychotherapy) and medication can be effective in treating this condition.

Source: http://www.mayoclinic.com

Symptoms

Persistent depressive disorder symptoms usually come and go over a period of years, and their intensity can change over time. But typically symptoms don't disappear for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression.

Symptoms of persistent depressive disorder can cause significant impairment and may include:

• Loss of interest in daily activities
• Sadness, emptiness or feeling down
• Hopelessness
• Tiredness and lack of energy
• Low self-esteem, self-criticism or feeling incapable
• Trouble concentrating and trouble making decisions
• Irritability or excessive anger
• Decreased activity, effectiveness and productivity
• Avoidance of social activities
• Feelings of guilt and worries over the past
• Poor appetite or overeating
• Sleep problems

In children, symptoms of persistent depressive disorder may include depressed mood and irritability.

When to see a doctor

Because these feelings have gone on for such 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 primary care doctor about your symptoms. Or seek help directly from a mental health provider. If you're reluctant to see a mental health professional, 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, a faith leader, or someone else you trust.

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Source: http://www.mayoclinic.com

Causes

The exact cause of persistent depressive disorder isn't 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

Source: http://www.mayoclinic.com

Diagnosis

If your doctor suspects you have persistent depressive disorder, exams and tests may include

• Physical exam. The doctor may do a physical exam and ask in-depth questions about your health to determine what may be causing your depression. In some cases, it may be linked to an underlying physical health problem.
• Lab tests. Your doctor may order lab tests to rule out other medical conditions that may cause depressive symptoms. For example, your doctor may order a blood test to find out if your thyroid is underactive (hypothyroidism).
• Psychological evaluation. This includes discussing your thoughts, feelings and behavior and it may include a questionnaire to help pinpoint a diagnosis. This evaluation can help determine if you have persistent depressive disorder or another condition that can affect mood, such as major depression, bipolar disorder or seasonal affective disorder.

DSM-5

To diagnose persistent depressive disorder, many doctors use the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.

For a diagnosis of persistent depressive disorder, the main indication for an adult differs somewhat from that of a child:

• For an adult, depressed mood occurs most of the day for two or more years
• For a child, depressed mood or irritability occurs most of the day for at least one year

Symptoms caused by persistent depressive disorder can vary from person to person. When persistent depressive disorder starts before age 21, it's called early onset; if it starts at age 21 or older, it's called late onset.

Source: http://www.mayoclinic.com

Complications

Conditions that may be linked with persistent depressive disorder include:

• 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
• Personality disorders or other mental health disorders

Source: http://www.mayoclinic.com

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 ward off symptoms include the following:

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

Alternative medicine

Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for medical care.

For example, the herbal supplement called St. John's wort is not approved by the Food and Drug Administration (FDA) to treat depression in the U.S., though it's a popular depression treatment in Europe. It may help improve mild or moderate depression, but the overall evidence is not conclusive.

St. John's wort can interfere with a number of medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John's wort while taking antidepressants because the combination can cause serious side effects.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Persistent depressive disorder generally isn't a condition that you can treat on your own. But, in addition to professional treatment, these self-care steps can help:

• Stick to your treatment plan. Don't skip psychotherapy sessions or appointments, and even if you're feeling well, don't skip your medications. Give yourself time to improve gradually.
• Learn about persistent depressive disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about the disorder to help them understand and support you.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms get worse or return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
• Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you're having trouble sleeping, talk to your doctor about what you can do.
• Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression-related symptoms, but in the long run they generally worsen depression and make it harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug abuse.

Source: http://www.mayoclinic.com

Coping and support

Persistent depressive disorder makes it hard to engage in behavior and activities that can help you feel better. In addition to the treatments recommended by your doctor or therapist, consider these tips:

• Focus on your goals. Dealing with persistent depressive disorder is an ongoing process. Set reasonable goals for yourself. Stay motivated by keeping your goals in mind. But give yourself permission to do less when you feel down.
• Simplify your life. Cut back on obligations when possible. Structure your time by planning your day. You may find it helps to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
• Write in a journal. Journaling as part of your treatment may improve mood by allowing you to express pain, anger, fear or other emotions.
• Read reputable self-help books and websites. Ask your doctor or therapist to recommend books or websites to read.
• Stay connected. Don't become isolated. Try to participate in social activities, and get together with family or friends regularly. Support groups for people with depression can help you connect with others facing similar challenges and share experiences.
• Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, yoga and tai chi.
• Don't make important decisions when you're down. Avoid decision-making when you're feeling depressed, since you may not be thinking clearly.

Source: http://www.mayoclinic.com

Risk factors

Persistent depressive disorder often begins early — in childhood, the teen years or young adult life — and is chronic. Certain factors appear to increase the risk of developing or triggering persistent depressive disorder, 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

Source: http://www.mayoclinic.com