What Is Chronic Depression?
Chronic depression is also known as a persistent depressive disorder (PDD) and was formerly known as dysthymia. This form of depression has less severe symptoms than major depressive disorder (MDD). Nevertheless, it has both cognitive and physical implications, and while the symptoms are less severe, they are longer lasting. Sometimes, people with persistent depressive disorder will also experience periods of major depressive disorder. When this occurs, it is called double depression.
What Causes Persistent Depressive Disorder?
Nobody is certain as to the exact causes of persistent depressive disorder or depression in general. There is some evidence that there is a genetic component, as people are more likely to have the disorder if someone else in their family also suffers from it. Other influences include stress, social isolation, and lack of a support system. Studies have also found that at least 75% have a chronic medical condition or psychiatric disorder. Up to 50% abuse substances like drugs and alcohol.
Neurological changes, such as changes in brain circuits and nerve cell pathways, have been noted in people with persistent depressive disorder. One study found that the corpus callosum and frontal lobe of the brain are different in people with persistent depressive disorder. The amygdala, which is a region of the brain associated with negative emotions, is more active in people with the condition. The same goes for the insula, which is associated with processing sadness.
Diagnostic Criteria for Persistent Depressive Disorder
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a publication of the American Psychiatric Association and provides diagnostic criteria for various psychological conditions. The criteria for persistent depressive disorder include:
- Feels depressed for most of the day for most days for two or more years
- He or she has two or more of the following symptoms when depressed:
- An increased or decreased appetite
- Insomnia or hypersomnia (decreased or increased sleep)
- Low energy or fatigue
- Low self-esteem
- A difficulty with making decisions and concentration
- A feeling of hopelessness and pessimism
- During the two year period of depression, the symptoms above are not absent for more than two consecutive months
- He or she may have had a major depressive episode during the two year period
- He or she has not had any episodes of mania or hypomania (which may otherwise indicate bipolar disorder)
- He or she has never fulfilled criteria for cyclothymic disorder
- The depression is not part of a chronic psychotic disorder, such as schizophrenia
- The symptoms are not part of another medical condition or substance use (such as drugs)
- The symptoms may negatively impact academic, professional, or social functioning
Treatment for Persistent Depressive Disorder
An estimated 1.5% of Americans suffer from persistent depressive disorder. There are various treatments that are available for persistent depressive disorder. It is important to know that if one treatment does not work, you may just need to try a different or additional treatment options.
One treatment options for persistent depressive disorder is psychotherapy. This is often a very effective treatment for the disorder. Sometimes, the person with persistent depressive disorder may seek therapy initially for another problem, such as stress or problems with academic or social functioning, at which point the persistent depressive disorder may be diagnosed. Therapy can help to challenge the person’s belief systems and learn healthy coping mechanisms.
Another treatment option is medication. Usually, the person with persistent depressive disorder will be prescribed an SSRI to start. It can take between six and eight weeks for these medications to become effective, so it’s important for the individual not to give up on them too soon. It also takes time to wean off of antidepressants, so make sure you consult with your doctor instead of quitting them cold turkey.
Finally, the person with persistent depressive disorder to make an effort to get on a regular sleep schedule. He or she should eat a healthy, balanced diet. Exercise has also been shown to offer positive effects for persistent depressive disorder. Finally, do not isolate yourself if you are depressed. Make sure you have a good support system and try to go out and engage in activities that you normally enjoy.