Persistent depressive disorder (PDD) is a mental health condition that causes symptoms of low-level depression for 2 years or longer. It may also be called long-term (chronic) depression or dysthymia. Persistent depressive disorder may include episodes of more severe depression that last for about 2 weeks (major depressive disorder or MDD). Persistent depressive disorder can affect the way you think, feel, and sleep. This condition may also affect your relationships. You may be more likely to get sick if you have persistent depressive disorder.

The exact cause of this condition is not known. Persistent depressive disorder is most likely caused by a combination of things, which may include:

  • Genetic factors. These are traits that are passed along from parent to child.
  • Individual factors. Your personality, your behaviour, and the way you handle your thoughts and feelings may contribute to persistent depressive disorder. This includes personality traits and behaviours learned from others.
  • Physical factors, such as:
    • Differences in the part of your brain that controls emotion. This part of your brain may be different than it is in people who do not have persistent depressive disorder.
    • Long-term (chronic) medical or psychiatric illnesses.
  • Social factors. Traumatic experiences or major life changes may play a role in the development of persistent depressive disorder.

This condition is more likely to develop in women. The following factors may make you more likely to develop persistent depressive disorder:

  • A family history of depression.
  • Abnormally low levels of certain brain chemicals.
  • Traumatic events in childhood, especially abuse or the loss of a parent.
  • Being under a lot of stress, or long-term stress, especially from upsetting life experiences or losses.
  • A history of:
    • Chronic physical illness.
    • Other mental health disorders.
    • Substance abuse.
  • Poor living conditions.
  • Experiencing social exclusion or discrimination on a regular basis.

Symptoms of this condition occur for most of the day, and may include:

  • Fatigue or low energy.
  • Eating too much or too little.
  • Sleeping too much or too little.
  • Restlessness or agitation.
  • Feelings of hopelessness.
  • Feeling worthless or guilty.
  • Anxiety.
  • Poor concentration or difficulty making decisions.
  • Low self-esteem.
  • Negative outlook.
  • Inability to have fun or experience pleasure.
  • Social withdrawal.
  • Unexplained physical complaints.
  • Irritability.
  • Aggressive behaviour or anger.

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history, including your mental health history. This may involve tests to evaluate your mental health. You may be asked questions about your lifestyle, including any drug and alcohol use, and how long you have had symptoms of persistent depressive disorder.
  • A physical exam.
  • Blood tests to rule out other conditions.

You may be diagnosed with persistent depressive disorder if you have had a depressed mood for 2 years or longer, as well as other symptoms of depression.

This condition is usually treated by mental health professionals, such as psychologists, psychiatrists, and clinical social workers. You may need more than one type of treatment. Treatment may include:

  • This is also called talk therapy or counselling. Types of psychotherapy include:
    • Cognitive behavioural therapy (CBT). This type of therapy teaches you to recognize unhealthy feelings, thoughts, and behaviours, and replace them with positive thoughts and actions.
    • Interpersonal therapy (IPT). This helps you to improve the way you relate to and communicate with others.
    • Family therapy. This treatment includes members of your family.
  • Medicine to treat anxiety and depression, or to help you control certain emotions and behaviours.
  • Lifestyle changes, such as:
    • Limiting alcohol and drug use.
    • Exercising regularly.
    • Getting plenty of sleep.
    • Making healthy eating choices.
    • Spending more time outdoors.


  • Return to your normal activities as told by your health care provider.
  • Exercise regularly and spend time outdoors as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drink alcohol. If you drink alcohol, limit your alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor. Alcohol can affect any antidepressant medicines you are taking. Talk to your health care provider about your alcohol use.
  • Eat a healthy diet and get plenty of sleep.
  • Find activities that you enjoy doing, and make time to do them.
  • Consider joining a support group. Your health care provider may be able to recommend a support group.
  • Keep all follow-up visits as told by your health care provider. This is important.
  • Your symptoms get worse.
  • You develop new symptoms.
  • You have trouble sleeping or doing your daily activities.
  • You self-harm.
  • You have serious thoughts about hurting yourself or others.
  • You see, hear, taste, smell, or feel things that are not present (hallucinate).

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