Persistent Depressive Disorder (Dysthymia)

What is it?

A form of chronic depression, persistent depressive disorder, or dysthymia, is longer lasting than other forms of depression and has less severe symptoms. It was formerly known as two diagnoses: dysthymia and chronic major depressive episode. Persistent depressive disorder may be present if a child appears irritable or depressed most of the time for more than a year.

Like other forms of depression, dysthymia may cause young people to have chronic feelings of sadness or worthlessness, making them unable to enjoy or perform well in daily activities. With dysthymia, the depression symptoms may be unnoticeable for some time because they are less acute – but longer lasting – than other types of depression.

Signs and Symptoms

A child with dysthymia is irritable, moody, sad or pessimistic for a long period. Other symptoms include behavior problems, poor performance at school, low self-esteem, and difficulty interacting with others in social settings. The intensity of individual symptoms may ebb and flow over a period of years, but typically symptoms do not disappear for over two months at a time. Because the disorder often occurs in children at the same time as other psychological disorders with similar symptoms, it can be difficult to diagnose.

Diagnosis and Treatment

A child with persistent depressive disorder can be diagnosed if she is depressed or irritable most of the day for at least a year. She must also have at least two of these symptoms, which are severe enough to cause distress or interfere with her ability to function at home, school or in other areas of her life: poor appetite or overeating; sleep problems; lethargy; low self-esteem; hopelessness; trouble concentrating; and difficulty making decisions.

The severity of dysthymia can vary, with some episodes severe enough to be diagnosed as major depressive disorder. Professionals may identify it as persistent depressive disorder “with intermittent major depressive episodes.” If symptoms for more than a year continuously meet the criteria for major depressive disorder, it may be persistent depressive disorder “with persistent major depressive episodes.”

Treatment for persistent depressive disorder includes medications and psychotherapy, including cognitive behavioral therapy and interpersonal therapy. Medications are believed to be a more effective treatment than psychotherapy when used alone, but a combination of medication and psychotherapy is believed to be most effective. Medications include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants. Children and adolescents should be closely monitored by health-care providers and their families when taking antidepressants, especially when they have just begun taking them or when their dose has recently changed.

What are the risk factors for children?

Children are at higher risk of developing persistent depressive disorder if they have a first-degree relative with the disorder. Other risk factors are negative temperament and environmental changes, such as the loss of a parent or sibling. Persistent depressive disorder may occur alongside other disorders, including anxiety and substance abuse.