Persistent Depressive Disorder in Adults

ICD-10 code: F34.1

Persistent depressive disorder (dysthymia) is part of a cluster of diagnoses called the depressive disorders.  Depressive disorders are a group of psychiatric conditions that include:

  • Major depressive disorder (including major depressive episode)
  • Persistent depressive disorder (dysthymia)
  • Premenstrual dysphoric disorder
  • Disruptive mood dysregulation disorder (children only)

The depressive disorders are characterized primarily by mood disturbance (sad, empty, or irritable mood).  Individuals with depressive disorders often experience significant somatic changes, such as disruptions in sleep (insomnia or hypersomnia), eating (overeating or loss of appetite), or energy level.  Changes in cognition, such as difficulty concentrating, indecisiveness, and morbid ideation (such as thoughts of death) are also common.  

Individuals with major depressive disorder experience pervasive sadness or anhedonia (loss of interest) along with significant changes in somatic and/or cognitive functioning.  To be diagnosed, these problems must be present nearly every day for at least two weeks.  Individuals with persistent depressive disorder (dysthymia) experience similar symptoms, including sad mood and problems with somatic and/or cognitive functioning that occur most days for at least two years. Individuals with premenstrual dysphoric disorder experience marked changes in mood and interpersonal functioning that begin sometime following ovulation and remit within a few days of the onset of menses. Disruptive mood dysregulation disorder is diagnosed in children under 12 years old who experience persistent irritability and extreme behavioral dyscontrol.

What is persistent depressive disorder (dysthymia)?

Persistent depressive disorder (PDD) is a new diagnosis in DSM-5.  It is a consolidation of DSM-IV chronic major depressive disorder and dysthymic disorder.  PDD affects approximately 0.5% of adults in a given year.  

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Understanding Persistent Depressive Disorder

PDD severity can range from mild to debilitating.  In severe cases, PDD can lead to significant role impairment, including an inability to fulfill responsibilities at work, school, home, or in interpersonal relationships.  Many people with PDD also have other psychiatric conditions, most commonly anxiety disorders, substance use disorders, and personality disorders.  Personality disorder comorbidity is particularly common in the case of early-onset (before age 21) PDD.

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How is persistent depressive disorder treated?

PDD is a newly recognized disorder in DSM-5.  Therefore, there are no published guidelines on its treatment.  However, the disorder can be conceptualized as a consolidation of chronic major depressive disorder and DSM-IV dysthymia.  Therefore, treatments that are known to be effective for chronic major depressive disorder and/orDSM-IV dysthymia may be efficacious for PDD.

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