While it’s normal and healthy to feel sadness sometimes, struggling with negative emotions and motivation on a regular basis may be clinical depression, a disorder that can significantly interfere with daily life and satisfaction. There are many different types of depression and mental disorders involving depressive symptoms; Dysthymia and major depression are two common and similar diagnoses for depression, and are often confused with each other. It’s important to note the differences between these disorders, especially if you think you may be experiencing depression. Getting an accurate diagnosis is critical to deciding the best treatment option.
What is Major Depression?
Major depressive disorder (MDD) is the basic definition for a depressive episode that is clinically different from healthy levels of sadness. This disorder is often also referred to as major depression, severe depression, unipolar depression, and classic depression.
With major depression, individuals typically experience symptoms almost every day for much of the day, and depressive episodes can last multiple weeks to months. Some people may only experience one depressive episode, sometimes in response to challenges or events in life, while others experience recurring depression throughout their life. To be diagnosed, five or more symptoms must be present on most days for at least 2 weeks. Symptoms of major depression include:
- Intense sadness or grief
- Lack of energy or fatigue
- Insomnia or hypersomnia
- Lack of motivation or disinterest in usual activities
- Feelings of guilt, shame, or worthlessness
- Difficulty eating or overeating
- Inability to concentrate or make decisions
- Thoughts of self harm, death, or suicide
Symptoms of MDD often have a significant impact on daily life, responsibilities, and relationships.
What is Dysthymia?
In the DSM-V, dysthymia is now referred to as persistent depressive disorder (PDD), also referred to as chronic depression. Persistent depression is typically described as less severe depression symptoms that are longer lasting. To be diagnosed with PDD, an individual must have a depressive episode that lasts for 2 years or longer. While it may not be as intense as major depression, PDD still has a significant strain on daily life. Symptoms of PDD include:
- Intense sadness or hopelessness
- Feelings of inadequacy or low self-esteem
- Lack of interest in usual activities
- Lack of energy, changes in sleeping patterns
- Changes in appetite
- Difficulty functioning at work or school
- Difficulty concentrating or memory problems
- Withdrawal from friends and family
This longer-term form of depression is often less severe than MDD; for example, people with dysthymia may experience changes in appetite, but with major depression these appetite changes may cause you to gain or lose weight. Additionally, symptoms can become more or less intense for weeks or months at a time. In fact, about 75% of people with dysthymia also experience episodes of major depression. This is known as “double depression”.
Causes and Risk Factors
Both major depression and persistent depressive disorder can be a caused by a combination of biological and environmental factors. Females are more likely to be diagnosed with either type of depression. Diagnoses can occur at any age, but PDD is often diagnosed earlier in life.
Biological contributors: Having a hereditary predisposition, or a family history of depression, can make you more at risk to develop major depression or PDD. Additionally, experiencing excessive stress can lead to changes in your brain chemistry that can influence your mood.
Environmental contributors: Experiencing a traumatic event or dealing with challenges in life, such as financial issues or the death of a loved one, can lead to a clinical depressive disorder.
Treatment Options
The treatment options available for major depression and dysthymia largely overlap, but the most effective treatment varies depending on the individual and the type of depression. Common treatment options include:
- Psychotherapy: Talking to a therapist is always the first recommended treatment for depression. Therapy helps individuals discover underlying reasons for their depression and learn ways to cope with depression symptoms. There are many different types of therapy that can help people with depression, including cognitive behavioral therapy and group therapy. Psychotherapy is typically more effective for major depression; many individuals with PDD require supplemental treatment in addition to seeing a therapist.
- Antidepressant medication: Antidepressants are often prescribed for either type of depression, and should be used as a supplement to therapy that can help alleviate daily symptoms. Common antidepressants include SSRIs, SNRIs, and TCAs.
TMS & Brain Health offers transcranial magnetic stimulation and ketamine therapy as alternative treatment options for both persistent depressive disorder and major depression. Both TMS and Spravato (the esketamine nasal spray) are FDA-approved for treatment-resistant depression, or cases of depression that haven’t responded to other treatment methods. These options are clinically more effective than traditional antidepressant medications, have fewer side effects, and can offer lasting symptom relief.
Persistent depressive disorder (PDD) is a mild to moderate chronic depression. It involves a sad or dark mood most of the day, on most days, for two years or more. PDD is common and can happen to anyone at any age. The most effective treatment combines medication, counseling and healthy lifestyle choices.
Persistent depressive disorder (PDD) is mild or moderate depression that doesn’t go away. A person with PDD has a sad, dark, or low mood and two or more other symptoms of depression. The symptoms last most of the day, on most days, over a long period of time.
Healthcare providers used to call the condition dysthymia or dysthymic disorder.
What’s the difference between depression and persistent depressive disorder?
Persistent depressive disorder is a type of depression. It’s less severe than major depressive disorder — another type — but it’s ongoing. It’s defined as lasting at least two years in adults and at least one year in children and teens. During this time, symptoms can't be absent for more than two consecutive months to meet the criteria for PDD.
How common is chronic depression?
PDD can happen to anyone at any age. In fact, 3% or more of the U.S. population experiences it at some point in their lives.
PDD is more common in women and in people who have relatives with the same condition.
Scientists don’t fully understand what causes PDD. But it might be related to low levels of serotonin. Serotonin is a natural hormone that controls our emotions and feelings of well-being. It also influences other body functions.
PDD may get triggered by a traumatic event in life. Examples include losing a job, having a loved one die, experiencing a crime or going through a breakup.
What are the symptoms of PDD?
The main symptom of PDD is a sad, low or dark mood. Other signs may include:
- Fatigue.
- Feelings of hopelessness, worthlessness or isolation.
- Lack of appetite or overeating.
- Lack of concentration.
- Limited energy.
- Low self-esteem.
- Trouble at work or school.
- Trouble sleeping or sleeping too much.
Most people with PDD also have an episode of major depression at least once at some point, which is sometimes called “double depression.”
If you think you have PDD, talk to a healthcare provider. There are no tests for chronic depression, so the diagnosis comes from discussions with a provider. The provider might ask:
- Do you feel sad a lot?
- Are there particular reasons you feel down?
- Do you have trouble sleeping?
- Do you have trouble concentrating?
- Are you taking any medications?
- How long have you had these symptoms?
- Are the symptoms there all the time, or do they come and go?
Your healthcare provider may order blood or urine tests to rule out other causes. The healthcare provider also might refer you to a psychologist or psychiatrist to talk about your symptoms. These providers are specially trained to discuss mental health.
The most effective treatment for PDD combines medications and talk therapy, or counseling.
Antidepressants are prescription drugs that can relieve 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. A therapist or psychologist will 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.
Although you can’t prevent depression, you can do some things to make it less severe:
- 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.
With medication, talk therapy and lifestyle changes, you can manage PDD and feel better. But some people have depressive symptoms throughout their lives.
Most people with PDD will have one or more episodes of major depression. If depression gets worse, talk to your healthcare provider.
If you think about hurting yourself or someone else, tell somebody right away. You can tell a healthcare provider, a friend or a family member.
You can also contact the National Suicide Prevention Lifeline:
You’re not alone, and there’s always somebody who wants to help.
In addition to taking medication and going to therapy, consider doing things you enjoy, such as:
- Do something nice for someone else.
- Go to a movie, a show or a ballgame.
- Hang out with people who have positive attitudes.
- Paint, or try some arts and crafts.
- Spend time outside.
- Spend time with friends, in person or on the phone.
- Take a yoga class, learn to meditate, or walk with a friend.
A note from Cleveland Clinic
PDD can make you feel sad or down most of the day, most days, over a long period of time. Talk to your healthcare provider if you have depressive symptoms. Medication, counseling and healthy lifestyle choices can make you feel better. If you feel like you might hurt yourself or someone else, seek help immediately. You’re not alone.
Last reviewed by a Cleveland Clinic medical professional on 03/08/2021.
References
- American Academy of Family Physicians. Persistent Depressive Disorder (PDD). (//familydoctor.org/condition/persistent-depressive-disorder/) Accessed 3/6/2021.
- National Institute of Mental Health. Persistent Depressive Disorder (Dysthymic Disorder). (//www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder.shtml) Accessed 3/6/2021.
- Patel RK, Rose GM. [Updated 2020 Oct 7]. Persistent Depressive Disorder. (//www.ncbi.nlm.nih.gov/books/NBK541052/) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2020 Jan- Accessed 3/6/2021.
- Reynolds CR, Kamphaus RW. Persistent Depressive Disorder (Dysthymia). (//images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_PersistentDepressiveDisorder.pdf) Accessed 3/6/2021.
- Anxiety and Depression Association of America. Depression. (//www.adaa.org/understanding-anxiety/depression) Accessed 3/6/2021.
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