Persistent Depressive Disorder

Overview

  • At least two years of depressive symptoms
    • Depressed mood most of the day on more than 50% of days
    • No more than 2 months symptom free
    • Symptoms can persist unchanged over long periods (≥ 20 years)
    • May include periods of more severe major depressive symptoms
    • Major depressive symptoms may be intermittent or last for the majority or entirety of the time period
  • Also known as dysthymia
  • Types of PDD
    • Mild depressive symptoms without any major depressive episodes (“with pure dysthymic syndrome”)
    • Mild depressive symptoms with additional major depressive episodes occurring intermittently (previously called “double depression”)
    • Major depressive episode lasting 2+ years (“with persistent major depressive episode”

DSM-5 Criteria

  • Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.

    • Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

  • Presence, while depressed, of two (or more) of the following:

    1. Poor appetite or overeating
    2. Insomnia or hypersomnia
    3. Low energy or fatigue
    4. Low self-esteem
    5. Poor concentration or difficulty making decisions
    6. Feelings of hopelessness

  • During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in aforementioned criteria for more than 2 months at a time.

  • Criteria for major depressive disorder may be continuously present for 2 years.

  • There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

  • The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

  • The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).

  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • Specify if:

    • Mild, moderate, severe
    • With anxious distress
    • With mixed features
    • With melancholic features
    • With atypical features
    • With mood-congruent psychotic features
    • With mood-incongruent psychotic features
    • With peripartum onset
    • Early onset: If onset is before age 21 years
    • Late onset: if onset is at age 21 years or older
    • With pure dysthymic syndrome: if full criteria for a major depressive episode have not been met in at least the preceding 2 years.
    • With persistent major depressive episode: if full criteria for a major depressive episode have been met throughout the preceding 2-year period.
    • With intermittent major depressive episodes, w/ current episode:
    • if the criteria for a major depressive episode are met, but there were periods of at least 8 weeks in at least the prior 2 yrs w/ symptoms below the threshold for a major depressive episode.
    • With intermittent major depressive episodes, without current episode:
    • if full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.
    • In full remission, in partial remission