Symptoms of Persistent Depressive Disorder (PDD)

Sometimes called “high-functioning depression,” PDD is a less intense but longer-lasting form of depression.

Because PDD causes symptoms that are less intense and longer lasting, it can look and feel very different than an episode of major depression.

Medically reviewed in May 2022

Depression is a mood disorder typically characterized by persistent feelings of sadness, worthlessness, guilt, and a loss of interest and enjoyment in things that were once enjoyable (as well as sleep disturbances, changes in appetite, lack of energy, and other symptoms).

It is also a disorder that affects people in different ways. The healthcare providers who diagnose, treat, and study depression recognize several different subtypes.

One of those subtypes is called persistent depressive disorder (PDD). It is formerly known as dysthymia or dysthymia disorder—terms that are sometimes still used.

PDD is described as mild or moderate, less intense, and less debilitating than major depression (also known as clinical depression and major depressive disorder).

PDD is also described as chronic—or lasting a long time. For a diagnosis of PDD, symptoms must be present for at least two years (one year for children and teens), with no gaps in symptoms longer than two months during that time.

Because PDD causes symptoms that are less intense and longer lasting, it can look and feel very different than an episode of major depression. Symptoms that are associated with persistent depressive disorder include:

  • General negative thinking and outlook
  • Feelings of low self-esteem, feeling like you have little-to-no value
  • Excessive self-criticism or guilt about the past
  • Lack of motivation, lack of productivity
  • Feeling tired or having very little energy day to day
  • Loss of interest in normal activities
  • Forgetfulness and short-term memory loss
  • Insomnia or oversleeping
  • Excessive or unexplained crying
  • Changes in appetite
  • Loss of interest in sex

This is not a comprehensive list of symptoms, and it is also worth repeating that depression is an experience that varies from one person to the next.

“High-functioning depression”
Persistent depressive disorder is also sometimes called “high-functioning depression.” This is because many people with PDD appear to be fine on the outside. Some may seem to excel in work, relationships, and interests despite the unwanted feelings, emotions, and thoughts that they are experiencing.

This can make it more difficult to recognize if you are experiencing symptoms of PDD, especially if you have been living with those symptoms for a long period of time. You may accept the feelings you are experiencing as normal.

This can also make it more difficult to recognize PDD in others. Many people, including close friends and loved ones, may only be able to see the ways that a person is doing well, and not the ways that a person is struggling.

Terms like “mild” and “high-functioning” should always be taken with caution. They can imply that PDD is a less serious diagnosis than other forms of depression—it is not.

PDD is a serious condition that requires treatment. It can significantly impair a person’s quality of life, including their relationships, career, and health.

Double depression
While symptoms never fully go away, PDD can get better at times and worse at other times. Many people with PDD also experience major depressive episodes. This is sometimes referred to as double depression.

During a major depressive episode, depression symptoms will be much more severe, more intense, and possibly debilitating. A major depressive episode lasts for at least two weeks. Once an episode ends, PDD symptoms return.

As with major depression, treatment for PDD often involves psychotherapy (such as cognitive behavioral therapy) or a combination of psychotherapy and antidepressant medications. As with any condition, treatment begins by working with a healthcare provider.

A healthcare provider will be your best source of information about your diagnosis and treatment options, and they can help you choose an appropriate approach to treatment based on your symptoms, your medical history, any coexisting health conditions, and your preferences.

If you have symptoms of PDD, talk to a healthcare provider about what you are experiencing. If you know someone who you believe may have PDD, encourage them to talk to a healthcare provider. Recognizing that something isn’t right and asking for help are often the biggest hurdles to getting treatment and getting better.

Article sources open article sources

MedlinePlus. Depression.
Beverly Merz. Six common depression types. Harvard Health Publishing. October 13, 2020.
Cleveland Clinic. Depression.
PsychDB (Psychiatry DataBase). Persistent Depressive Disorder (Dysthymia).
Luna Greenstein. Understanding Dysthymia. National Alliance on Mental Illness. January 17, 2018.
Cleveland Clinic. Persistent Depressive Disorder (PDD).
Mayo Clinic. Persistent Depressive Disorder (PDD).
Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. June 2016.
Johns Hopkins Health. Dysthymia.
American Academy of Family Physicians. Persistent Depressive Disorder (PDD).
Sean Grover. The Keys to Understanding High-Functioning Depression. Psychology Today. April 3, 2022.
Raj K. Patel and Gregory M. Rose. Persistent Depressive Disorder. StatPearls. July 1, 2021.
APA Dictionary of Psychology. "Double Depression."
UpToDate. Patient education: Depression treatment options for adults (Beyond the Basics).

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