Persistent depressive disorder (PDD) is a form of chronic depression. The term combines two earlier diagnoses — dysthymia and chronic major depressive disorder.

Like other types of depression, people with PDD may experience feelings of deep sadness and hopelessness. While these symptoms are present in all forms of depression, in PDD they may persist for many years.

The constant nature of these symptoms means that the condition may interfere with school, work, and personal relationships. However, a combination of medication and therapy can be effective in treating PDD.

The symptoms of PDD are similar to those of depression. However, the key difference is that PDD is chronic, with symptoms occurring on most days for at least 2 years.

Many doctors use the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose PDD. This manual is published by the American Psychiatric Association. The PDD symptoms listed in the DSM-5 include:

  • depression almost every day for most of the day
  • having a poor appetite or overeating
  • difficulty falling asleep or staying asleep
  • low energy or fatigue
  • low self-esteem
  • poor concentration or difficulty making decisions
  • feelings of hopelessness

Finding help

If you or someone you know is considering suicide or self-harm, please seek help. The following services can provide confidential assistance, information, and support:

If you or someone you know is facing mental or substance use disorders, call SAMHSA’s National Helpline at 800-662-4357.

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Depression is common — anyone can experience it at any time.

The National Institute of Mental Health estimates that 19.4 million Americans experienced at least one major depressive episode in 2019 alone. This represents close to 7.9 percent of all American adults.

In addition, around 2.5 percent of Americans will experience PDD at least once in their lifetime.

The cause of PDD isn’t known. Certain factors may contribute to the development of the condition. These include:

  • imbalances in brain circuitry
  • stressful or traumatic life events, such as the loss of a loved one or financial problems
  • physical brain trauma, such as a concussion

PDD is a complex mood disorder. While researchers do not fully understand the exact causes of PDD, some biological and circumstantial factors can increase your risk of developing the disorder.

These can include but are not limited to:

  • a family history of the condition
  • a history of other mental health conditions, such as anxiety or bipolar disorder
  • chronic physical illness, such as heart disease or diabetes
  • drug use

Around 21 percent of people who have a substance abuse disorder also have depression. This may eventually lead to a person developing PDD.

To make an accurate diagnosis, your doctor will first perform a physical examination. They will also order blood tests or other laboratory tests to rule out possible medical conditions that may be causing your symptoms.

If your doctor believes you have PDD, they’ll likely refer you to a mental health professional for further evaluation and treatment.

For a diagnosis, adults must have symptoms of PDD nearly every day for 2 or more years. For children or teens, they must experience a depressed mood or irritability most of the day, nearly every day, for at least 1 year.

Your doctor will ask you certain questions to assess your current mental and emotional state. It’s important to be honest with your doctor about your symptoms. Your responses will help them determine whether you have PDD or another type of mental health condition.

Treatment for PDD typically consists of medication and psychotherapy.


Medical professionals may recommend various types of antidepressants to treat PDD, including:

You may need to try different medications and dosages to find an effective solution for your specific situation. This requires patience, as many medications take several weeks to take full effect.

Talk with your doctor if you continue to have concerns about your medication. Your doctor may suggest changing dosage or medication.

Never stop taking your medication as directed without speaking with your doctor first. Stopping treatment suddenly or missing several doses may cause withdrawal-like symptoms and make depressive symptoms worse.


A combination of medication and psychotherapy is the most effective method for treating PDD.

Medical professionals will commonly suggest taking part in psychotherapy or cognitive-behavioral therapy (CBT).

Psychotherapy, which may be referred to as talk therapy, typically involves sessions with a mental health professional. These can happen either in person or remotely via phone or video calls. You may also participate in group sessions.

CBT focuses on your actions and behaviors in addition to your thoughts and emotions. In CBT, you will work to identify and deal with what is causing your depression. This will include talking with mental health professionals to help you accept your symptoms and establish safe coping habits for PDD.

This form of therapy can not only help you in the short term but may also reduce your risk of future relapses.

Working with a therapist can help you learn how to:

  • express your thoughts and feelings in a healthy way
  • cope with your emotions
  • adjust to a life challenge or crisis
  • identify thoughts, behaviors, and emotions that trigger or aggravate symptoms
  • replace negative beliefs with positive ones
  • regain a sense of satisfaction and control in your life
  • set realistic goals for yourself

Lifestyle changes

PDD is a long-lasting condition, so it’s important to participate actively in your treatment plan. Making certain lifestyle adjustments can complement medical treatments and help ease symptoms.

Lifestyle changes that may help alongside your prescribed treatment plan include:

Since PDD is a chronic condition, some people may experience symptoms for many years.

However, identifying symptoms and seeking help is a crucial first step to improving the long-term outlook for people with PDD.

Research shows that a combination of psychotherapy and medication programs can be effective in treating PDD symptoms and preventing future relapses.

Alongside these treatments, lifestyle changes, such as eating a healthful diet and exercising regularly, may also help you manage PDD and improve your long-term outlook.