Persistent depressive disorder: symptoms, causes, and treatment
It is common to find, throughout life, that they have to look sad, negative or with a constant melancholy.
However, when this lasts over the years and begins to interfere in different aspects of the person's life we can speak of persistent depressive disorder.
What is persistent depressive disorder?
Previously labeled as dysthymia or dysthymic disorder, the last volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) renames it as a persistent depressive disorder.
Persistent depressive disorder is considered a chronic affective condition that is distinguished because the person permanently experiences a depressed mood and melancholic and very low self-esteem.
Despite these indications, it does not correspond to a major depression since it does not meet all the diagnostic requirements for it.
Although its origin is not clearly established is believed that there is a genetic component, ie hereditary which, coupled with psychosocial elements such as detachment or lack of stimulation and rewards during childhood, predisposes the person to suffer this persistent depressive disorder.
symptom
Within the 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, distress or grief and despair ; 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 it must last at least one year.
Also, the person must have two or more of these symptoms for most of the time:
- Feeling of hopelessness
- 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 usual for people with persistent depressive disorder to suffer from a negative self-concept, as well as a pessimistic view of their future, of others and practically everything that surrounds them; so it is difficult for them to solve any type of problem or conflict.
Causes
As mentioned above, the specific causes that cause this persistent depressive disorder or chronic depression are still unknown. However, it is known that this is usually hereditary, affecting 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 disorders or disorders such as anxiety or substance abuse disorders such as alcoholism or drug addiction.
Another common point that patients with chronic depression have is that at least 50% of these will suffer an episode of major depression throughout their lives.
Diagnosis
To make an effective diagnosis of persistent depressive disorder, the pertinent health professional must make a clinical history in which both the mood and the other symptoms associated with this condition are evaluated.
In addition, a series of laboratory tests must be performed to rule out any possible physical origin of the disease.
A correct diagnosis of this disorder must take into account the following qualifying conditions established by the DSM-V:
1. Chronically depressed mood
The person must manifest a depressed mood for most of the day and most days for at least 2 years. This can be referred directly by the patient or observed by the people around him.
2. Presence of two or more of these symptoms
- Loss or increase of appetite
- Insomnia or hypersomnia
- Lack of energy or fatigue
- Low self-esteem
- Deficits of concentration or difficulties in making decisions
- Feelings of hopelessness
3. Duration of 2 years
The symptoms of the two previous points must have remained in the person for at least two years, with intermittencies of at most two months.
4. There are no major depressive episodes
The person has not suffered a major depressive episode during the first two years and the symptoms are not better explained by the presence of another type of depressive disorder.
5. There are no manic, hypomanic, etc. episodes.
The person has never experienced a manic episode, a mixed episode or a hypomanic episode. In addition, the criteria for cyclothymic disorder are not met.
6. Does not appear during a psychotic disorder
Symptoms do not appear exclusively in a chronic psychotic disorder such as schizophrenia or delusional disorder.
7The symptoms are not caused by drugs or other diseases
The symptoms can not be explained by the physiological effects of substance use or by any medical illness.
8. Significant discomfort
The symptomatology causes a clinically significant malaise 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. But nevertheless, the person can benefit from a treatment that is composed of pharmacological therapy with antidepressants and intervention with psychotherapy .
Although antidepressant medication works better in major depression than persistent depressive disorder, there are a number of drugs that can improve the patient's symptoms. These are:
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine or citalopram.
- Selective serotonin and noradrenaline reuptake inhibitors (SSRIs)
- Bupropion
- Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs)
Regarding the psychotherapy used in these cases, the most important thing is that the person is able to externalize 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 it over the years and even throughout life, with very few people recovering completely .
With the use of an adequate treatment the person can reach improvement very significantly and can continue his usual routine satisfactorily. However, in most cases a permanent psychological therapy is required.
