Persistent Depressive Disorder: Symptoms and Causes

It is common to find, throughout life, that they tend to appear sad, negative or with a constant melancholic air.

However, when it lasts over the years and begins to interfere with different aspects of the person's life, we can talk about persistent depressive disorder.

What is persistent depressive disorder?

Previously tagged 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 mood. and melancholic 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, that is, hereditary which, together with elements psychosocial factors such as detachment or lack of stimulation and rewards during childhood, predisposes the person to suffer from this disorder persistent depressive.

Symptoms

Within the typical symptoms of persistent depressive disorder, the symptom that most characterizes it is the experimentation on the part of the patient of a persistent state of demoralization, unease or grief and inconsolation; which lasts for at least two years.

When this disorder appears in children or adolescents, the manifestations go from being a depressed mood to being irascible or angry; and must last at least one year.

In addition, the person must have two or more of these symptoms for most of the time:

• feeling hopeless
• Lack of sleep or excessive sleep
• Lack of energy or constant fatigue
• Low self-esteem
• Lack of appetite or excessive feeling of hunger
• little concentration

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

Causes

As mentioned above, the specific causes of this persistent depressive disorder or chronic depression are still unknown. However, it is known that this 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 mental conditions or disorders such as anxiety or substance use disorders such as alcoholism or drug addiction the drugs.

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

Diagnosis

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

In addition, a series of laboratory analyzes must be carried out to rule out any possible physical origin of the disease.

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

1. Chronically depressed mood

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

2. Presence of two or more of these symptoms

• Loss or increase in appetite
• Insomnia or hypersomnia
• Lack of energy or fatigue
• Low self-esteem
• Concentration deficits or difficulties making decisions
• Feelings of hopelessness

3. duration of 2 years

The symptoms of the previous two points must have remained in the person for at least two years, intermittently for a maximum of two months.

4. No major depressive episodes

The person has not had a major depressive episode in the first 2 years and the symptoms are not better explained by another type of depressive disorder.

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

The person has never experienced a Manic Episode, Mixed Episode, or 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 diseases

The symptoms cannot be explained by the physiological effects of substance use or by any general medical condition.

8. Significant discomfort

The symptomatology causes clinically significant discomfort in the person. This discomfort generates a deterioration in work, social or any other important areas of the patient.

Treatment and prognosis

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

Although antidepressant medication works better for major depression than for disorder persistent depressive disorder, there are a number of drugs that can improve symptoms in the patient. These are:

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

With regard to the psychotherapy used in these cases, the most important thing is that the person is able to express their feelings and thoughts, as well as 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 causes the person to suffer from it over the years and even a lifetime, with very few people recovering completely.

With the use of an adequate treatment, the person can achieve a very significant improvement, being able to continue their usual routine satisfactorily. However, in most cases, permanent psychological therapy is required.