Persistent Depressive Disorder – PDD (F34.1)

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What is Persistent Depressive Disorder?
Photo courtesy of pixabay.

What if you don’t ever remember being happy?

Persistent Depressive Disorder – PDD (F34.1) is new to the DSM-5. The DSM is the book professionals use to identify mental illnesses. This diagnosis is the result of merging Dysthymia and another group of symptoms which was being researched as Chronic Major Depression. Some other variations on the depressive theme were being called Minor Depressive Disorder, which did not get recognized as such but kind of fits here.

While we may label these conditions as chronic or minor, there is nothing minor about them if you are someone who has this condition?

The defining characteristic of Persistent Depressive Disorder – PDD, is a pervasive sadness that just won’t go away. People who have this condition are always sad or unhappy. They may describe themselves as “always down” or having the blues. While this can cause a lot of impairment, people who have PDD come to think of their chronic sadness as “Just the way I am.”

It is estimated that about two percent of the U. S. population has PDD. Many people with PDD also experience a substance use disorder. There is also an overlap between PDD and Cluster B and Cluster C personality disorders, both of which, to my way of thinking, may have their roots in negative childhood experiences.

Persistent Depressive Disorder (PDD) is more disabling than Major Depressive Disorder.

PDD has been identified on brain scans and seems to affect at least four separate brain regions. PDD is long-lasting, at least two years, often more. During this time someone with PDD may also experience an episode of Major Depressive Disorder. While the major depressive episode may come and go the PDD often remains relatively constant. Because of this constant feature, people with PDD may not be able to ever feel really happy and their functioning, day-to-day, is more impacted than those with Major Depressive Disorder only.

Persistent Depressive Disorder (PDD) is chameleon-like.

Chronic unending depression has a lot of variations. This disorder can exhibit itself a great many ways. As a result, there are eighteen separate specifiers that can and should be added after the F43.1 These specifiers are not exclusive, so one person may also get several specifiers added to the Persistent Depressive Disorder (PDD) diagnosis.

Specifiers include with:

Anxious distress – anxiety commonly co-occurs with depression.

Mixed features

Melancholy features

Atypical features

Mood-congruent psychotic features

Mood-incongruent psychotic features

Peripartum features

In partial remission

In full remission

Early onset – before 21

Late onset – at or after age 21

Pure dysthymia syndrome

Persistent major depressive episode

Intermittent major depressive episode, currently with MDD

Intermittent major depressive episode, currently without MDD

Mild

Moderate

Severe

The symptoms of Persistent Depressive Disorder.

To qualify for PDD a person should have the following symptoms:

  1. Felt depressed or down, or had others see them this way, most of the day, most days, over a two-year period.
  2. Had at least two of the following six symptoms. These symptoms should be caused by emotions not by dieting or working long hours, etc.
  3. Change in appetite either up or down.
  4. Changes in sleep either too much or too little.
  5. Felt low in energy or fatigued a lot.
  6. Low self-esteem.
  7. Difficulty deciding things or poor concentration.
  8. Hopeless.
  9. Most of the usual exclusions. This has to be causing problems with work, school, relationships, should interfere with important activities or upset the client. It should not overlap Bipolar Disorder or Psychotic Disorder but may overlap Major Depressive Disorder. These symptoms should not be the result of medical or substance use issues.
  10. These symptoms have been constant and not gone away for two months or more over the required two-year period.

Be careful with the PDD label.

Calling Persistent Depressive Disorder by the label PDD could be problematic. In the past, we had another PDD – Pervasive Developmental Delay which is now recognized as a part of the Autism Spectrum. Persistent Depressive Disorder – PDD is about depression and has nothing to do with Autism. Be careful in reading articles that if they use the label PDD you know which of these two they are talking about. From here on I will call Persistent Depressive Disorder – PDD.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is a personal characteristic, not a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem these symptoms need to be more than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

More “What is” posts will be found at “What is.”  and Depression  

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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How do you find a counselor for Depression or Dysthymia?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Looking for help for your depression.

Reader question, thought I should share this with all counselorssoapbox.com readers as you might miss it as an answer to an older post. This was a comment on the Dysthymia post.

“I have a question: How do you find a professional who specializes in the treatment of Dysthymia? Someone who is really good. Searching for such a person in Michigan. Medications, by the way, are a waste of time. They don’t work for me. Can you suggest someone for me? Thanks!”

Great question. Let me make some suggestions. I am out in California and do not know professionals back there in your area. But the process is likely the same everywhere.

1. If you have not done so see a medical doctor first, there are some medical conditions that can look like depression or Dysthymia.

2. If you have a history of substance abuse, alcohol or drugs, get that treated first or concurrently with the Dysthymia  Even after people stop using they still have the old thinking and it does not change without help.

3. Interview the counselor you are considering seeing.  Picking a therapist is kind of like dating, you may find the right person the first time, but you need to get to know them a little before you make the commitment.  Progress in therapy is all about the relationship.

4. Look for someone who treats depression. The process is very similar in treating Depression or Dysthymia  If the depression comes from a recent bad event this is more like adjustment disorder. If you are depressed because you lost your job you need someone who can work on career counseling. Dysthymia is generally more long-term and you may need to look at things you learned as a child that no longer are helpful. I prefer to work from a Cognitive Behavioral or Rational Emotive perspective. Narrative therapy can also work.

5. Avoid a counselor who advertises things that do not fit you. Men should generally avoid a therapist that advertises they use a “feminist” perspective. Don’t see a Muslim counselor if you are a Christian or vice versa. Most good counselors work with everyone and do not put that sort of thing in their advertising.

6. Expect to do a lot of work on yourself. A good therapist is like a good tour guide, they can tell you about the trail but you need to take the hike.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Is Dysthymia better in the morning or worse?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Which depression is worse in the morning? – Morning Question #14

Having more depressive symptoms in the morning is a characteristic of “Atypical features” of a mood disorder. Atypical does not mean unusual it means “not melancholy.”

Atypical features include the hibernating-like-a-bear symptoms, overeating, sleeping too much and being tired and grouchy in the morning. With atypical features, the person may be able to feel better temporarily if something they really like happens, but the happiness does not last long. They may also feel better in the evening but by morning the depression comes back.

Atypical features can occur during episodes of Dysthymia, Bipolar one or two Disorders and Major Depressive Disorder. In practice, the only time I remember seeing this on a file is as part of the diagnosis of a Major Depressive Disorder but having atypical features increases the risk that this will eventually turn into a Bipolar disorder.

If your mood is customarily worse at a particular time of day, make sure you are eating and sleeping well, that there are not environmental problems like relationship issues that are causing this and then seriously consider consulting with a medical doctor or psychiatrist. If the doctor rules out any medical problems then some counseling should help.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is double depression?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Double Depression – Morning Question #12.

Double Depression is a common term, not a recognized mental health diagnosis. In Double Depression, someone who has Dysthymia, a profound sadness and depressed mood which does not quite meet the criteria for Major Depressive Disorder moves from a little sad and depressed to a lot sad and depressed. They develop a case of Major Depressive Disorder superimposed upon the Dysthymia. People with this condition may see the Major Depression respond to treatment but they are still generally sad. Continued treatment for the Dysthymia is recommended.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.