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Persistent depressive disorder
Other Resources UpToDate PubMed

Persistent depressive disorder

Contributors: Scott Levy, Abhijeet Waghray MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

Persistent depressive disorder (PDD), also known as dysthymia, is a relatively new addition to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It contains aspects of 2 diseases from the fourth edition of the DSM: chronic major depressive disorder and dysthymic disorder. Evidence suggests the 2 conditions are different enough to warrant changes in treatment.

The hallmark symptoms of PDD are depressed mood occurring for at least 2 years along with 2 or more of the following symptoms: change in appetite, insomnia / hypersomnia, fatigue, low self-esteem, feelings of hopelessness, or impaired concentration. The length of time needed for diagnosis is different for children, only requiring at least a year of symptoms. Onset of symptoms often occurs in the teenage years.

Risk factors include parental loss or separation, family history of depression, and the presence of coexisting anxiety disorders or conduct disorders.

Proper screening in the primary care setting should be conducted.

Codes

ICD10CM:
F34.1 – Dysthymic disorder

SNOMEDCT:
78667006 – Dysthymia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Major depressive disorder – This is diagnosed when symptoms have lasted for 2 weeks or more. PDD symptoms require a longer time course.
  • Bipolar disorder type 2 (hypomania) – There is no aspect of hypomania included in the PDD diagnosis.
  • Cyclothymia – Mood swings are more common in cyclothymic disorder, including episodes of elevated mood and hypomania. In PDD, there is a more constant state of depressed mood without any evidence of hypomania.
  • Comorbid psychiatric illnesses should also be considered; PDD can be seen in other disease conditions.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 08/11/2020
Last Updated: 09/10/2020
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Persistent depressive disorder
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Persistent depressive disorder : Fatigue, Chronic duration lasting years, Depressed mood
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