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Persistent depressive disorder (PDD) is a type of chronic or long-term mild depression. Dysthymia and persistent major depressive disorder are two previously well-known diagnoses that are blended in this term.

Persons with PDD, like patients with other forms of depression, may feel very sad and despondent. While these symptoms appear in all types of depression, they can last for years in PDD.

Because these symptoms are persistent, they might cause problems at school, work, and in intimate relations. However, managing PDD with a mix of medication and treatment can be effective.

Persistent depressive disorder (PDD), also been known as dysthymia, is a relatively new diagnosis defined by chronic depression. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) merged chronic major depressive disorder and dysthymia under the framework of persistent depressive disorder, which encompasses any form of chronic depression ranging from mild to severe. In the United States, 3 to 6% of the population is affected by mental health conditions.

These diagnostic revisions account for the fact that there is no clinically substantial difference between dysthymic disorder and chronic major depressive disorder, as defined by the DSM-IV.

Dysthymia is derived from the Greek words dys, which means “sick” or “poor,” and thymia, which means “emotions” or “mind.” Dysthymic disorder or dysthymia were words used to describe a moderate, chronic form of depression.

This condition is characterized by sadness and a loss of interest or enjoyment in life. A person with dysthymia may also exhibit the following symptoms:

  • Anger
  • General dissatisfaction
  • Shame and Guilt
  • Feelings of helplessness
  • Uncontrollable hunger
  • Fatigue
  • Appetite suppression
  • Disordered Sleep
  • Concentration problems or delayed activity
  • Impulsiveness and indecisiveness
  • Irritability
  • Low self-confidence

Dysthymia Diagnostic Criteria

The symptoms listed above may occur as a result of dysthymia. However, in order to be identified with this mental health disorder, a person must meet specific criteria. As per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person must have been depressed for at least 2 years and for the majority of the day (or 1 year for teens and children). Furthermore, at least 2 of the following 6 symptoms must be present:

  • Overeating or a lack of appetite
  • Tiredness, general fatigue, or lack of energy
  • Sleep disturbances
  • Low self-confidence
  • Feelings of despondency
  • The capacity to think or focus has deteriorated.

Furthermore, throughout the first 2 years of this disturbance, no major depressive episode has occurred, and the current problem is not better characterized by major depressive disorder.

People can do a variety of things to assist themselves deal with persistent depression. Since this form of depression is chronic, it may be beneficial to combine lifestyle adjustments and self-care with your medication treatment. Some things you can do to supplement therapy and medicine include:

  • Alcohol and other drugs should be avoided.
  • Make daily rituals to help you organize your day.
  • Maintain a balanced diet.
  • Make good sleeping habits that you can stick to.
  • Get regular exercise at least three times per week.
  • Make plans to meet up with friends and get out of the house.
  • Use stress-relieving strategies like meditation and deep breathing.

When you’re depressed, it can be difficult to do many of these things. While it may be difficult, keep in mind that you don’t have to do everything precisely. Even minor adjustments can have a significant impact on your attitude and mindset. For instance, you could begin by setting minor goals and then progressively increase them over time.

Psychotherapy and medication are usually used to treat Persistent Depressive Disorder.


To manage PDD, health professionals may prescribe a variety of antidepressants, including:

  • Selective serotonin reuptake inhibitors (SSRIs) like sertraline and fluoxetine
  • Tricyclic antidepressants (TCAs) like amoxapine and amitriptyline
  • Duloxetine and Desvenlafaxine are examples of serotonin and norepinephrine reuptake inhibitors (SNRIs).

To find an effective remedy for your case individually, you may need to test a variety of drugs and doses. Patience is required because many drugs take a few weeks to be fully effective.

If you have any concerns regarding your medicine, speak with your doctor. Your doctor may advise you to adjust your medicine or dosage.

Never quit taking your prescription without first consulting with your doctor. Withdrawal-like symptoms and worsening depression symptoms can occur if medication is abruptly stopped or doses are missed.

Dysthymia Psychotherapy

The most successful treatment for PDD is a mix of psychotherapy and medication.

Cognitive-behavioral therapy or psychotherapy is frequently recommended by medical practitioners. Psychotherapy, often known as talk therapy, usually includes meetings with a mental health practitioner. These can take place in person or over the phone or via video calls. You can also join in on group sessions.

In relation to your emotions and thoughts, CBT is based on your behavior and actions. You’ll use CBT to figure out what’s causing your depression and how to deal with it. This will entail speaking with mental health experts to help you understand your symptoms and develop effective PDD coping strategies.

This type of therapy can not only assist you in the near term, but it may also lower your chances of recurrence in the future.

Seeing a therapist can assist you in learning:

  • Healthy ways to express your feelings and thoughts
  • Deal with your feelings
  • Adapt to a personal crisis or hardship
  • Determine which ideas, actions, and emotions cause or worsen symptoms.
  • Negative beliefs should be replaced with good ones.
  • Reclaim a sense of fulfillment and authority over your life
  • Set attainable objectives for yourself
  • Changes in your way of life

Because PDD is a long-term condition, it’s critical that you take an active role in your therapy. Some lifestyle changes can assist to augment treatment methods and alleviate symptoms.

Along with your recommended treatment plan, you may want to make the following lifestyle changes:

  • At least 3 times every week, you should exercise
  • Consuming a diet consisting primarily of natural foods like vegetables and fruits
  • Abstaining from alcohol and drugs
  • Consultation with an acupuncturist
  • Yoga, meditation, or tai chi.
  • Writing and maintaining a journal

Dysthymia is a severe mental health problem that should not be addressed solely with complementary and alternative medicine. There are, nonetheless, numerous natural techniques to treat depression that can help you improve your mood, relieve stress, and manage your symptoms.

The following are some natural approaches to increase your attitude and control dysthymia symptoms:

1. Exercise

Exercising has been shown to boost mood in numerous studies. As per a review of a substantial corpus of literature on exercise and depression:

  • Clinical depression symptoms can be alleviated by structured exercise.
  • Exercise may make you feel better.
  • Benefits can persist three to twelve months after one training program is finished.
  • Aerobic activity (walking, running, swimming) and strength or resistance training may have similar benefits (stretching, weight lifting).
  • Talk therapy and exercise may be equally useful.

2. Manage your stress in a proactive manner.

Handling your stress in a proactive manner might help you avoid problems before they arise. You would have fewer problems disturbing yourself if you eliminate sources of stress. As per the Mayo Clinic, meditation or practicing relaxation exercises, tai chi, or yoga can help you relax and deal with stress.

You can focus on identifying your own stress and depressive symptoms triggers and avoiding them if at all possible. The following are examples of common triggers:

  • An unreasonable workload or a never-ending barrage of emails and deadlines
  • monetary constraints
  • Major life transitions, such as relocating
  • Fears, emotions, and ideas held within
  • Inability to control situations

3. Find an activity that you enjoy.

  • Say “no” to commitments you don’t want or need, such as extra job projects or other unimportant responsibilities.
  • Take a holiday to get away from your routine.
  • Meet up with friends and relatives who are supportive.
  • Participate in religious observances.
  • Slow your heart rate by using breathing exercises.
  • Avoid situations that cause you to feel stressed, depressed, or anxious.
  • Drinking and using recreational drugs should be avoided.

4. See a therapist.

Dysthymia can be treated with short-term therapy, according to research. There are a variety of methods of talk therapy or psychotherapy that can be beneficial, including:

  • Cognitive-behavioral therapy
  • Interpersonal psychotherapy 
  • Psychotherapy using the cognitive-behavioral analysis method
  • Counseling for problem-solving
  • Manualized group therapy
  • Couples, family, or group counseling
  • Therapies in combination

5. Maintain a social presence.

While it is beneficial to avoid stressful public or social situations, like over-commitment or public speaking to unproductive activities, it is also crucial to be involved in activities with friends, family, and the community. Interacting with others and remaining connected to others can help minimize depression symptoms.

You can get involved or stay active in a variety of ways:

  • Volunteer with a cause that is meaningful to you, such as a charity, religious organization, or neighborhood group.
  • Participate in social events with your friends and neighbors.
  • Concentrate on activities that you enjoy and that make you feel less lonely.
  • Spend time strengthening your most important relationships, such as those with your family, spouse, and closest friends.
  • Reduce the number of social media networks you utilize to put more emphasis on quality rather than quantity.
  • Consume foods that are good for your mental wellness.

Although nutrition alone cannot treat depression or dysthymia, it can help alleviate inflammation, improve mood, and maintain your body healthy so you can cope with stress better. A good diet might also increase your chances of remission from symptoms of depression. The SMILES trial in Australia discovered that a customized version of the Mediterranean diet plan greatly helped more patients achieve depression remission than support networks alone.

Additional research suggests that including omega-3 polyunsaturated fatty acids in a balanced diet can help to minimize depression symptoms.

6. Take aromatherapy into consideration.

Essential oils have a rich history of being used to treat depression. Even though several oils have been used to treat symptoms, scientific study on the therapy has been limited too far. Modern research suggests that aromatherapy and massage aromatherapy can help with depressive symptoms.

A review of aromatherapy-related depression studies indicated that aromatherapy massage or essential oil inhalation may be effective for certain persons with depression, despite the fact that some of the reviewed studies were of low quality. People who inhaled essential oils like lavender and rose otto reported reduced emotional stress and fewer depression symptoms in some circumstances. Similarly, massage combined with aromatherapy reduced depression symptoms – sometimes much more so than massage alone.

You can inhale the oil straight from the bottle, or put just a few drops on a cotton ball, add it to a diffuser, a few droplets in a bath, or mix it in a body lotion or massage oil and apply it to your skin. If you are generally sensitive to strong smells or have sensitivities to common carrier oils (like almond or coconut oil), proceed with caution or seek alternative treatment.

7. Inquire about herbal products and supplements.

Anyone seeking alternative or complementary therapy for depression, especially herbs and supplements, should speak with their doctor first, according to the Mayo Clinic. This is because supplements like St. John’s wort, which are often used to treat depression, can interfere with other prescriptions like birth control, blood thinners, cancer therapies, antidepressant meds, and more.

Consult a health care expert before starting or stopping any prescription, supplement, or herb to treat your dysthymia symptoms. There is some evidence to support the usage of:

St. John’s wort, omega-3 fatty acid, and SAMe supplements: According to a review of dozens of studies looking at herbs and supplements for depressive symptoms, St. John’s Wort, omega-3 fatty acids, and SAMe (S-adenosyl methionine) all have interesting results backing them up.

Passionflower, L-lysine, kava, magnesium, and L-arginine: According to another study, promising data supports kava, passionflower, magnesium, L-arginine, and L-lysine as potential herbal remedies and supplements for insomnia and anxiety relief.

Zinc: A randomized trial indicated that persons with serious depression who took a daily 25 mg zinc supplementation in conjunction with their antidepressant prescription had better symptoms than those who took a placebo.

Vitamin B12 and Folic acid: Low vitamin B12 and folate levels have been linked to depression in humans, based on one study. Early study suggests that these supplements may be effective in improving depression treatment outcomes, according to the researchers. They recommend testing dosages of 800 mcg of folic acid and 1 mg of vitamin B12 each day.

Traditional Chinese Medicine (TCM): Based on known research, the Xiao Yao San formula is the most effective therapy for the treatment of depression, according to a study of several studies on herbal plants used in China. Nevertheless, because this mixture was produced using varying herbal mixtures from trial to study, it may be hard to know exactly which element of the formula is effective for treating depressive symptoms.

Dysthymia is best treated with depression-focused CBT or Interpersonal Psychotherapy plus antidepressant medicines. This treatment focuses on depression symptoms as well as social functioning. CBT creates a therapeutic setting that is tailored to the patient’s demand for unequivocal acceptance and support. The patient should select the pace and length of therapy and degree of functioning. This enables clients to set measurable and attainable goals that will help them return to their previous functional ability. 

IPT is short psychotherapy focused on psychoeducation that integrates sentiments with experiences in the “here and now.” Antidepressant drugs, like serotonin reuptake inhibitors (SSRIs), are commonly provided to clients with dysthymia because they suffer from chronic depression (for instance, Paxil, Prozac, Zoloft). SSRIs function by increasing the amount of neurotransmitter serotonin, which influences mood, feelings, and impulses.

Antidepressants are helpful in treating dysthymia, as per one study; in a systematic review, the average response for any antidepressant was 55 percent among dysthymic people (compared with 31 percent response for placebo). The dosages were the same for serious depression. SSRIs, monoamine oxidase inhibitors, and tricyclic antidepressants are all similarly efficient in the treatment of dysthymia, according to a comprehensive review, however, SSRIs may be marginally better accepted.


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