Persistent depressive disorder: symptoms, causes, and treatment.

A disorder formerly known as dysthymia. We explain its symptoms and diagnostic criteria.

It is common to find oneself, throughout life, having to seem sad, negative or with a constant melancholic air.

However, when this persists over the years and begins to interfere in the different aspects of the person's life we can speak of persistent depressive disorder.

What is persistent depressive disorder?

Previously labeled as dysthymia or dysthymic disorder, the latest volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) renames it persistent depressive disorder.

Persistent depressive disorder is considered a chronic affective condition that is distinguished by the fact that the person permanently experiences a depressed and melancholic mood and very little self-esteem. and melancholic mood and very low self-esteem.

Despite these indications, it does not correspond to major depression since it does not meet all the diagnostic requirements for it.

Although its origin is not clearly established, it is believed that there is a genetic component, i.e. hereditary, which, together with psychosocial elements such as detachment or lack of stimulation and rewards during childhood, predisposes the person to suffer from this persistent depressive disorder.

Symptoms

Within the symptomatology of persistent depressive disorder, the symptom that most characterizes it is the experience on the part of the patient of a persistent state of demoralization, dismay or grief and disconsolation; which lasts during at least one year.which lasts for at least two years.

When this disorder appears in children or adolescents, the manifestations change from a depressive mood to an irascible or choleric mood; and it must last at least one year.

The person must have two or more of these symptoms most of the time:

• Feeling of hopelessness
• Lack of sleep or excessive sleep
• Lack of energy or constant fatigue
• Low self-esteem
• Lack of appetite or excessive feeling of hunger
• Poor concentration

It is common for people with persistent depressive disorder to suffer from a negative self-concept, as well as a pessimistic view of their future, of others and of practically everything around them, making it difficult for them to solve any type of problem or conflict.

Causes

As mentioned above, the specific causes that provoke this persistent depressive disorder or chronic depression are still unknown. However, it is known that it is usually hereditary, that it affects more men than women and that it is suffered by approximately 5% of the population..

Similarly, it has also been established that the onset of persistent depressive disorder is related to other conditions or mental disorders such as anxiety or substance abuse disorders such as alcoholism or drug addiction.

Another common point that patients with chronic depression have in common is that at least 50% of them will suffer a major depressive episode in the course of their lives.

Diagnosis

To make an effective diagnosis of persistent depressive disorder, the relevant health professional should take a medical history in which both mood and other symptoms associated with this condition are evaluated.

In addition, a series of laboratory tests should be performed to rule out any possible physical origin of the illness.

A correct diagnosis of this disorder should take into account the following classificatory conditions established by the DSM-V:

1. Chronically depressed mood

The person must manifest a depressed mood during most of the day and on most days for at least 2 years. This can be referred directly by the patient or observed by people around him/her.

2. Presence of two or more of these symptoms

• Loss or increase of appetite
• Insomnia or hypersomnia
• Lack of energy or fatigue
• Low self-esteem
• Deficits in concentration or difficulty making decisions
• Feelings of hopelessness

3. Duration of 2 years

The symptoms of the two previous points must have remained in the person for at least two years, with intermittences of at most two months.

4. There are no major depressive episodes

The person has not suffered a major depressive episode during the first two years and the symptoms are not better explained by the presence of another type of depressive disorder.

5. There are no manic, hypomanic, etc. episodes.

The person has never experienced a manic episode, a mixed episode or a hypomanic episode. In addition, the criteria for cyclothymic disorder are also not met.

6. Does not appear during a psychotic disorder

The symptoms do not appear exclusively in a chronic psychotic disorder such as schizophrenia or delusional disorder.

7. Symptoms are not caused by drugs or other illnesses.

The symptoms cannot be explained by the physiological effects of substance use or medical illness.

8. Significant distress

The symptomatology causes clinically significant distress in the person. This discomfort generates an impairment at work, socially or in any other important area of the patient.

Treatment and prognosis

Persistent depressive disorder is a chronic condition. However, the person can benefit from a treatment that consists of pharmacological therapy with antidepressants and intervention with psychotherapy..

Although Antidepressant medication works better in major depression than in persistent depressive disorder, there are a number of drugs that can bring an improvement of symptoms in the patient. These are:

• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine or citalopram.
• Selective serotonin and norepinephrine reuptake inhibitors (SNRIs).
• Bupropion
• Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs)

Regarding the psychotherapy used in these cases, the most important thing is that the person is able to externalize their feelings and thoughts, and learn to manage them.

For this there are a number of very effective therapies:

• Cognitive behavioral therapy (CBT).
• Psychodynamic interventions
• Support groups

Finally, the prognosis or evolution of this disorder differs greatly from one person to another. Its chronic nature means that the person suffers from it over the years and even throughout life, with very few people recovering completely..

With the use of an adequate treatment the person can improve very significantly, being able to continue his usual routine in a satisfactory way. However, in most cases, permanent psychological therapy is required.