Persistent Depressive Disorder – Diagnosis and Treatment
Diagnosis
To find out if someone has persistent depressive disorder (PDD), the healthcare provider looks at several things.
They often start with a physical exam to check for medical issues that could explain the low mood, including conditions that are common in older adults. Sometimes, underlying health problems such as endocrine or thyroid issues can mimic symptoms of depression.
Laboratory staff usually conduct blood tests to check thyroid function. The goal is to make sure that other medical problems are not causing the depression symptoms, which might need a different treatment plan.
During a psychological evaluation, the provider talks to the person about their thoughts, feelings, and behavior.
The provider may ask the person to fill out a questionnaire that looks for mood disorders and also considers if other issues like anxiety disorders, personality disorder, or substance abuse disorder might be present.
Below is a summary table showing key aspects of the diagnostic process:
| Step | What It Checks For |
|---|---|
| Physical Exam | Underlying medical problems |
| Lab Tests | Problems like hypothyroidism |
| Psychological Evaluation | Mood disorders, anxiety, substance abuse, behavioral symptoms |
Diagnosis for PDD means:
- Adults: Depressed mood most of the day, more days than not, for at least 2 years.
- Children: Depressed or irritable mood most of the day, more days than not, for at least 1 year.
Doctors also assess family history of depression, as it can affect the person’s risk and prognosis.
They look at how symptoms of depression have lasted and identify if the depression pattern fits major depressive disorder, chronic depression, dysthymic disorder, or another type of mood disorder.
Early onset (before age 21) and late onset (after 21) are noted, as they can influence the outlook and possible treatment approaches.
Treatment
Medications Used for Persistent Depression
Doctors commonly use several types of medications to help manage ongoing depression.
Selective serotonin reuptake inhibitors (SSRIs) are often prescribed first. These medicines raise levels of serotonin in the brain, which can help improve mood.
Doctors may also prescribe serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). SNRIs target two chemicals—serotonin and norepinephrine—to help with mood and energy.
TCAs are older but still used when other types have not worked well.
Patients should talk with a healthcare provider or pharmacist about possible side effects. Headache, nausea, sleep changes, dizziness, or dry mouth can occur. Most side effects improve after the body adjusts, but each person responds differently.
| Type of Medication | Main Action |
|---|---|
| SSRI | Boost serotonin |
| SNRI | Boost serotonin and norepinephrine |
| TCA | Affect several brain chemicals |
Doctors may consider other treatment options, like brain stimulation therapies (for example, electroconvulsive therapy or repetitive transcranial magnetic stimulation) if medicines and talk therapy do not bring enough relief.
Choosing the Best Medication
Finding the right antidepressant or combination of medicines can take some time. Some people may need to try more than one medicine or a mix of medicines before finding what works best.
It can take several weeks for medication to start working and for side effects to lessen.
Stopping medication suddenly can cause symptoms to come back quickly or may lead to withdrawal-like reactions. Always work with a healthcare provider when stopping or changing a medicine.
Some people with persistent depression need to stay on their medicine for a long time to help manage symptoms.
Tips for Finding the Right Medicine:
- Be patient; it may take weeks to feel the full effect.
- Tell your provider if side effects are hard to handle.
- Never stop medication on your own.
- Keep in close contact with your healthcare provider during changes.
Antidepressants During Pregnancy and Breastfeeding
Pregnant or breastfeeding individuals need special care when taking antidepressants. Some medicines can pose risks to the unborn baby or to a nursing child.
Speak with a healthcare provider about the benefits and risks before starting or continuing any antidepressant during this time.
Decisions about medication use in pregnancy should be personalized. Sometimes, untreated depression also has risks to both mother and baby, so the provider will help weigh these choices.
Important Medication Safety Information
The U.S. Food and Drug Administration (FDA) warns about the possible risk of increased suicidal thoughts or actions in children, teens, and young adults under 25 who take antidepressants.
This risk may be highest in the first few weeks or when the dose is changed.
Family members and caregivers should closely monitor for mood changes, worsening depression, or signs of suicidal thoughts. If such symptoms appear, get help from a healthcare provider right away.
What to Watch For:
- Sudden mood shifts
- Unusual behavior
- Worsening symptoms
Psychotherapy
Talk therapy (psychotherapy) is a key part of treating persistent depressive disorder. A professional—such as a counselor, psychologist, or psychiatrist—helps the person understand and manage their thoughts, feelings, and actions.
There are several types of psychotherapy:
- Cognitive Behavioral Therapy (CBT): Focuses on finding and changing negative thoughts and behaviors.
- Interpersonal Therapy: Helps improve relationships and communication.
- Problem-Solving Therapy: Teaches new ways to cope with daily life stresses.
Talk therapy can support people to handle life changes, set realistic goals, manage symptoms, and develop healthy coping skills.
Ways Psychotherapy Can Help:
- Deal with stressful events
- Adjust negative thinking
- Build problem-solving skills
- Improve relationships
- Increase feelings of hope and self-control
Daily Habits and At-Home Strategies
Lifestyle changes can play a helpful role in managing persistent depressive disorder. Creating a steady routine and following the treatment plan as directed by a health professional is important.
Taking medications as prescribed and attending all therapy appointments can support recovery.
Education about this condition can make a big difference. When people understand their symptoms and the nature of their disorder, it is easier to stay motivated and informed.
Involving family or friends by sharing information can also help them offer helpful support.
Being alert to any changes in mood or behavior is important. Working with a healthcare provider to spot warning signs or symptom triggers lets people act quickly if problems begin to return.
Involving a friend or family member to help notice these changes can increase safety and support.
Self-care is key in daily life. This includes eating balanced meals, sleeping well, and staying physically active. Simple activities like walking, gardening, dancing, or swimming can be beneficial.
Good sleep habits, such as keeping a regular bedtime, can improve both mental and physical health.
Avoiding alcohol and recreational drugs is strongly advised. While these substances might seem to provide relief, they usually make symptoms worse over time and can cause setbacks.
If stopping use is difficult, it is wise to ask a healthcare provider for help.
List of Helpful Strategies:
- Stick to the prescribed treatment.
- Educate yourself and loved ones.
- Watch for mood changes.
- Eat a balanced diet.
- Stay active daily.
- Keep a regular sleep schedule.
- Avoid alcohol and recreational drugs.
| Strategy | Benefit |
|---|---|
| Regular activity | Boosts mood and energy. |
| Balanced diet | Supports body and mind. |
| Good sleep habits | Improves overall well-being. |
| Substance avoidance | Reduces relapse risk. |
Non-Traditional Approaches
Manufacturers can sell supplements, such as herbal products and vitamins, without FDA review or approval before they reach the market.
Because of this, no guarantee exists for their strength, safety, or even the ingredients listed on their packaging.
| Supplements | FDA Approval Needed | May Interact with Medicines |
|---|---|---|
| Herbal (e.g. St. John’s wort) | No | Yes |
| Vitamins | No | Yes (sometimes) |
These items may react with common prescription drugs or other treatments.
St. John’s wort, for example, can mix poorly with blood thinners, birth control, chemotherapy, HIV medicines, and other medicines meant to prevent organ rejection.
Some products, like St. John’s wort, have been tested in clinical trials but have not been approved for treating depression. When thinking about supplements, speak with a healthcare provider first.
They can help you avoid harmful side effects and make sure alternative treatments fit with your prescribed care plan.
Key Tips:
- Do not replace prescribed medications with supplements.
- Always check with your doctor before starting any new product.
Coping Strategies and Finding Support
Living with persistent depressive disorder can be challenging, but practical ways exist to manage symptoms and boost daily life. Creating a plan or routine helps provide structure and reduces feelings of being overwhelmed.
Using calendars, checklists, or sticky notes can make it easier to remember important tasks and keep organized.
Focusing on setting realistic goals makes progress feel possible. It is important not to expect too much from oneself during difficult times and to adjust goals as needed. Success with small goals can help build better self-esteem over time.
Low energy is a common part of persistent depressive disorder. Prioritize tasks, take regular breaks, and avoid overcommitting. When energy is low, allowing oneself to rest is as important as getting things done.
Keeping a journal can aid in understanding feelings and tracking mood changes. Writing about emotions such as anger, sadness, or fear can provide a safe outlet.
Staying connected with friends, family, or support groups can combat loneliness and isolation. Even simple activities like text messages or short phone calls have value.
Support from others, especially those who understand persistent depressive disorder, can help manage dark thoughts, including suicidal feelings.
Learning stress management skills—like meditation or deep breathing—can reduce tension. Books or websites, recommended by professionals, offer self-help suggestions.
Avoid making big decisions when feeling down. Mental clarity can be affected by depression, making decision-making harder during low points.
Getting Ready for Your Visit
How to Prepare Ahead of Time
Before meeting with a healthcare provider or mental health professional, get organized.
Making a simple list can make it easier to share information and have your questions answered.
Items to write down:
- A list of any symptoms, even if they do not seem related.
- Important personal events or stresses, such as major life changes.
- All current medicines, supplements, and vitamins, including doses.
- Questions or concerns to discuss during the appointment.
Example Questions for the Provider:
| Question | Purpose |
|---|---|
| Can you explain how this type of depression is treated? | To understand treatment options. |
| Would counseling or talk therapy help? | To learn about therapy choices. |
| Is there a medicine that could help me? | To find out about medicines. |
| Are there side effects I should know about? | To discuss safety and risks. |
| How long will treatment take? | To set expectations. |
| How often will we meet? | To plan for sessions. |
| Are there printed guides or resources? | To access helpful materials. |
Bringing a family member or friend can be useful, especially if you are worried about forgetting something. Their help can make it easier to remember advice and questions discussed.
This can be especially valuable for someone at risk for dementia or with memory problems.
Tip: Do not hesitate to ask all of your questions. Your provider is there to help.
What Questions the Provider Might Ask
During your appointment, your health care provider or mental health professional will ask you about your symptoms and how they affect your life. Questions may include:
- When did your symptoms start?
- How are your daily activities affected?
- What treatments or self-help steps have you tried?
- Are there triggers that make you feel worse?
- Does anyone in your family have depression or mental health issues?
- What are your goals for treatment?
Be honest and provide as much detail as possible. Your answers give the provider a full picture. More questions may come up based on what you share and your symptoms, so being prepared can help the visit go smoothly.
