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Mental Health Awareness: Persistent Depressive Disorder


Scientists have been studying the brain for generations, and yet understanding its complexities and intricacies remains elusive. Part of the problem with mental health awareness is that some people still believe that mental health is “all in your head”, or in other words, not real.

One particular mental health issue that is currently gaining recognition is persistent depressive disorder (PDD), also known as dysthymia or high functioning depression. It is a serious and disabling disorder that shares many symptoms with other forms of clinical depression, however it is experienced as a less severe but more chronic form of major depression.

PDD is characterized as a dominating depressed mood that is experienced for at least two years. In addition to this depressed mood, at least two of the following must also be present:

  • insomnia or excessive sleep
  • low energy or fatigue
  • low self-esteem
  • poor appetite or overeating
  • poor concentration or indecisiveness
  • feelings of hopelessness

The more severe symptoms that mark major depression, such as the inability to feel pleasure, lethargy and thoughts of death or suicide, are often absent in PDD. While PDD and Major Depressive Disorder are two different disorders, PDD can occur alone or in conjunction with other mood or psychiatric disorders. More than half of individuals who suffer from PDD will experience at least one episode of Major Depression. When PDD is accompanied by an episode of Major Depression, this is known as Double Depression. Those with PDD are also at a higher risk for anxiety and substance abuse disorders. Luckily, PDD is treated in a similar manner as other clinical depressions. Supportive therapy, psychotherapy and medication are all options for those struggling with PDD.

Persistent Depressive Disorder appears to have its roots in a combination of genetic, biochemical, environmental and psychological factors; chronic stress and trauma are common provocations as well. The ability to regulate one’s mood and prevent mild sadness from deepening and persisting is impaired by stress. Compounded by isolation and the unavailability of social support, chronic stress and social circumstances can contribute to the development of PDD. Trauma, such as loss of a loved one, a difficult relationship, or any other number of stressful situations may trigger a depressive episode. Once triggered, subsequent depressive episodes may occur with or without an obvious trigger. For the elderly, PDD is more likely the result of medical illness, cognitive decline, bereavement and physical disability. When looking at MRI scans of the brain, those with depression show that the parts responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally, and neurotransmitters appear to be out of balance when compared to the MRI image of a brain of a person without depression. While these images tell us much about what isn’t functioning properly in the brain, it still fails to tell us the what causes it.

The forbidding thing about PDD is how difficult it is to identify in someone, or even in yourself. People with PDD don’t always fit into the “mold” that we tend to put depressed individuals in. They aren’t necessarily gloomy all the time, isolating themselves or unable to function in school or work. Sometimes they are very active in their community, excelling at school or in work, and maintaining close and personal relationships with friends and family.

What’s so scary about a person who, according to all outward signs, is not being controlled by their depression? All of the news articles about suicide victims, where their friends and family are quoted as saying “they were such a happy person” or “I had no idea they were struggling.”

Many people with PDD do not get the treatment they need. Their struggle goes unnoticed by friends, family and even themselves, until it is too late. Awareness of PDD needs to be increased. PDD is real, and it is dangerous to ignore. There are too many people falling outside the radar of “classic” depression symptoms, and being left behind to fend for themselves.

If you think you might have PDD, see a therapist to see what treatment options will work for you.

Click here for suicide prevention resources.

If you need help now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to the Crisis Text Line at 741-741


(February 24, 2017). Persistent Depressive Disorder (Dysthymia). Psychology Today. Retrieved from https://www.psychologytoday.com/conditions/persistent-depressive-disorder-dysthymia

(June 13, 2017). COULD YOU HAVE HIGH-FUNCTIONING DEPRESSION? HERE IS HOW TO TELL. The South African College of Applied Psychology. Retrieved from http://www.sacap.edu.za/blog/counselling/dysthymia/

Leventhal, A. (May 2016). We Cannot Continue to Overlook ‘High-Functioning’ Depression. The Mighty. Retrieved from https://themighty.com/2016/05/high-functioning-depression-we-cant-overlook-the-overachievers/

Suicide Prevention Resources. The Mighty. Retrieved from https://themighty.com/suicide-prevention-resources/

Wright, A. (May 2017). What Are the Signs of ‘High-Functioning’ Depression and Could You Have It? The Mighty. Retrieved from https://themighty.com/2017/05/signs-of-high-functioning-depression-or-dysthymia/

Yu, C. (January 26, 2017). The secret battle of high-functioning depression. Headspace. Retrieved from https://www.headspace.com/blog/2017/01/26/high-functioning-depression/

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