What it is
Persistent Depressive Disorder (PDD), also called dysthymia, is a long-lasting low mood most days for two years or more in adults (one year in youth). Symptoms are typically milder than major depression but more persistent. Many people describe it as a “gray filter” on life. It’s treatable.
Common signs and symptoms
- Mood: chronic sadness, emptiness, or irritability
- Energy/sleep: low energy; insomnia or oversleeping
- Appetite: eating more or less than usual
- Thinking: low self-esteem, pessimism, trouble concentrating
- Motivation/interest: reduced enjoyment, social withdrawal
- Function: you may still “get things done,” but joy and motivation feel limited
People with PDD can also have episodes of major depression on top of the chronic low mood.
Why it happens
- Mix of biology (family history), long-term stress, early-life adversity, and habits that reduce rewarding experiences (withdrawal, low activity)
- Learned expectations: believing change isn’t possible can keep the cycle going
What helps right now
- Activity scheduling: plan one small, meaningful activity daily (walk with music, brief call, tidy one area)
- Mastery and pleasure: rate tasks for “pleasure” and “accomplishment” to rebalance your week
- Routine anchors: consistent wake time, mealtimes, and light exposure
- Social micro-connections: brief check-ins, shared hobbies, community groups
- Thought skills: gently challenge “nothing helps” by testing small changes
Evidence-based treatments
- Psychotherapies
- CBT and Behavioral Activation: core treatments for increasing rewarding activities and shifting thinking patterns
- CBASP (for chronic depression): focuses on interpersonal patterns and consequences
- Mindfulness-based approaches: reduce rumination and relapse
- Medications
- SSRIs/SNRIs; bupropion or others depending on symptoms
- Combined therapy + medication often outperforms either alone for chronic depression
- Lifestyle supports
- Steady sleep, regular movement, sunlight/daylight exposure, purposeful activities
When to seek help now
- Low mood most days for many months to years
- Functioning but joy is minimal; relationships or work are strained
- Episodes of deeper depression or thoughts of self-harm (seek urgent help)
How to talk to a clinician
- “I’ve had a low mood most days for over a year with low energy and pessimism. I’m functioning but not enjoying life. I’d like therapy—especially behavioral activation or CBT—and to discuss medication.”
Outlook
PDD can improve with consistent skills and support. Expect gradual gains: small sparks of interest, more social contact, improved energy. Chronic doesn’t mean permanent.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline (call/text 988); Crisis Text Line (text HOME to 741741); Veterans: 988 then 1; The Trevor Project: 1-866-488-7386 or text START to 678678
- Find care: FindTreatment.gov; Psychology Today directory; NAMI HelpLine (nami.org/help)
- Low-cost/community: Open Path Collective; Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Check in-network benefits, deductible, copay/coinsurance, telehealth coverage, prior authorization, out-of-network reimbursement, out-of-pocket max; keep call notes
- Work/school supports: FMLA, ADA accommodations, EAP; campus counseling
- Urgent options besides ER: Mobile Crisis via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.