Persistent Depressive Disorder

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KEY POINTS

• Persistent depressive disorder (PDD) is when you have mild or moderate depression almost every day for 2 or more years. Depression is a condition in which you feel sad, hopeless, and uninterested in daily life.
• Treatment may include medicines, therapy, and learning ways to manage stress. In severe cases, you may need to be treated in the hospital.
• If you are depressed and feel that you could hurt yourself or someone else, call your healthcare provider or therapist right away.

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What is persistent depressive disorder?

Persistent depressive disorder (PDD) is when you have mild or moderate depression almost every day for 2 or more years. Depression is a condition in which you feel sad, hopeless, and uninterested in daily life. If you have PDD, at certain times in your life your depression may worsen and you may have what’s called major depression

What is the cause?

The exact cause of this disorder is not known. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Depression tends to run in families. It is not known if this is caused by genes passed from parent to child. It may also be that parents have a negative outlook, and children learn this behavior from the parents.
• It may be triggered by stressful events like problems at school, being bullied, loss of a friend, parents' divorce, or the death of a pet or family member. However, PDD can start with no specific cause.

PDD usually starts when you are a teen or young adult. It is more common in women than in men.

What are the symptoms?

Besides feeling very sad and uninterested in things you usually enjoy, symptoms may include:

• Being irritable
• Having trouble falling asleep, waking up very early, or sleeping more than usual
• Noticing changes in your appetite and weight, either up or down
• Feeling very tired or low energy
• Losing interest in sex
• Feeling worthless and guilty
• Not being able to concentrate or remember things
• Having physical symptoms, such as headaches and joint pain
• Worrying that you may never feel better

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

PDD can be successfully treated with therapy, medicines, or both.

Medicine

Several types of medicines can help. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine. Since PDD is often lifelong, you may need to take medicine for a long time.

Therapy

Seeing a mental health therapist is helpful. Cognitive behavioral therapy (CBT) is a form of therapy that helps you identify and change thought processes and learn ways to cope better with stress. Learning ways to replace negative thoughts with more positive ones can help your depression.

If medicine doesn’t work well enough, repetitive Transcranial Magnetic Stimulation (rTMS) may be another option. It uses magnetic pulses to stimulate nerve cells in the brain and relieve symptoms of depression.

Other treatments

Diets rich in fruits and vegetables are recommended. A multivitamin and mineral supplement may also be recommended. Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

Claims have been made that certain herbal and dietary products help control depression symptoms. Omega-3 fatty acids may help to reduce symptoms of depression. St. John's wort may help mild symptoms of depression. It will not help severe cases of depression. No herb or dietary supplement has been proven to consistently or completely relieve the symptoms of depression. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe. Talk with your healthcare provider before you use any of these products.

How can I take care of myself?

• Take your medicines every day, even if you are feeling well. PDD is a lifelong illness.
• Get support. Talk with family and friends. Consider joining a support group in your area.
• Be active. Do things you might enjoy, even if you don’t feel like doing it.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, try to quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise according to your healthcare provider's instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take. Certain medicines can add to the symptoms of depression.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one have serious thoughts of suicide or harming others.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  http://www.nimh.nih.gov/
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/