Persistent depressive disorder

• Overview:

  • Presence of chronic depressive symptoms for more than 2 years
  • Less severe than chronic depression but more chronic
  • Low spontaneous remission rate
• Clinical features:

  • Depression mood >2 years
  • Reduced/increased appetite
  • Insomnia or hypersomnia
  • Low energy/fatigue
  • Poor concentration
  • Feelings of hopelessness
  • Symptoms do not remit for more than 2 months at a time
• Subtypes:

  • Pure dysthymia without full criteria for major depression during the last 2 years
  • Persistent major depressive episode - full criteria for major depressive episode have been met during the preceding 2 years
  • Intermittent major depressive episodes with current episode - criteria for major depressive episode are currently met, but there have been periods of at least 8 weeks in the last 2 years that are below the threshold
  • Intermittent major depressive episodes without current episode - one or more major depressive episodes in the last 2 years
• Management:

  • SSRIs are first line - best evidence for citalopram and fluoxetine
  • Psychological therapy - CBT, psychodynamic or interpersonal therapy
  • Due to chronic course, patients will need longer course of treatment
• Persistent depressive disorder is also known as dysthymia