Quick answer
Persistent depressive disorder (PDD), once called dysthymia, is a long-lasting type of depression. In adults, it means a low mood on most days for at least 2 years. The symptoms are usually less severe than in major depression, but they last much longer, so it can start to feel like just part of who you are. It's treatable, and care often includes medication, talk therapy or both.
Key takeaways
- In adults, persistent depressive disorder means a low mood on most days for at least 2 years.
- Its symptoms are usually less severe than major depression, but they last much longer.
- Most people with it also have an episode of major depression at some point.
- Medication is often effective, though it can take longer to work than it does for major depression.
What persistent depressive disorder looks like
Persistent depressive disorder is a chronic (ongoing) type of depression. The main sign is a low, dark or sad mood on most days, for at least 2 years in adults. It usually starts gradually, often in the teen years, and it can last for years.
Because it's steady rather than dramatic, it's easy to mistake for your personality. You may still be working and showing up for others, while everything takes more effort than it should.
Common signs, in plain language
- A low or sad mood most days, for a long time
- Low energy or feeling tired
- Sleeping too little or too much
- A poor appetite, or overeating
- Low self-esteem
- Trouble concentrating or making decisions
- Feeling hopeless, or seeing yourself, your future and other people in a negative light
These signs are a general guide, not a checklist for diagnosis.
Long-lasting depression can also raise the risk of suicide. If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.
How it's evaluated
There's no single test for persistent depressive disorder. A careful evaluation looks at your mood over time, not just how you feel today:
- How long the low mood has been there, and whether it has ever lifted for a while
- How it affects your energy, sleep, appetite, focus and daily life
- Whether there have also been periods of more severe depression
- Any past periods of unusually high energy or mood, which can point toward bipolar disorder
- Your health and medications, since some medical conditions (such as thyroid problems) and some medications can cause similar symptoms
- Past treatment and how it went, and overlap with conditions such as anxiety
This is part of a comprehensive psychiatric evaluation. Your provider may also suggest lab tests to check for medical causes. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.
How we help
Medication, when appropriate. Medication for depression is mainly antidepressants. For persistent depressive disorder, medicines are often effective, though they sometimes don't work as well as they do for major depression and may take longer to work. We explain each option, its side effects and what to expect, so you can decide together with your provider.
Real work in visits. Depending on your clinician, visits may draw on supportive, motivational interviewing, CBT-based, or DBT-based skills. We also talk through practical steps that help mood, such as regular sleep, physical activity, and making time for things you used to enjoy, even when you don't feel like it.
Therapy, when it would help. Talk therapy, such as cognitive behavioral therapy (CBT), can also help with persistent depressive disorder. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.
Regular follow-ups. Because this condition is long-lasting, change is often gradual. Many people recover fully, while others keep some symptoms even with treatment. Regular follow-ups let us see what's working and adjust carefully over time. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.
Is it this or that?
Persistent depression, or major depression?
| Persistent depressive disorder | Major depression | |
|---|---|---|
| How long it lasts | A low mood on most days for at least 2 years (in adults). | Symptoms most of the day, nearly every day, for at least 2 weeks. |
| How intense it is | Usually less severe symptoms that last much longer. | Can cause severe symptoms that affect how you feel, think and handle daily life. |
| How it starts | Gradually, often in the teen years. It can last for years or decades. | Often in the mid-teens, 20s or 30s, though it can begin at almost any age. |
| Can they overlap? | Yes. Most people with persistent depressive disorder also have an episode of major depression at some point. | Yes. An episode of major depression can happen on top of long-lasting low mood. |
Persistent depressive disorder
- How long it lasts
- A low mood on most days for at least 2 years (in adults).
- How intense it is
- Usually less severe symptoms that last much longer.
- How it starts
- Gradually, often in the teen years. It can last for years or decades.
- Can they overlap?
- Yes. Most people with persistent depressive disorder also have an episode of major depression at some point.
Major depression
- How long it lasts
- Symptoms most of the day, nearly every day, for at least 2 weeks.
- How intense it is
- Can cause severe symptoms that affect how you feel, think and handle daily life.
- How it starts
- Often in the mid-teens, 20s or 30s, though it can begin at almost any age.
- Can they overlap?
- Yes. An episode of major depression can happen on top of long-lasting low mood.
Both are treatable, and the line between them isn't always obvious, which is why a careful evaluation matters. This comparison is general information, not a diagnosis. Sources: NIMH: Depression · MedlinePlus: Persistent depressive disorder · Merck Manual: Depression
Medication quick facts
Medications for persistent depression
Medication for depression is mainly antidepressants. In persistent depressive disorder they're often effective, though they can take longer to work than in major depression. Our depression guide lists the antidepressants your provider may talk with you about, with facts from each FDA label. Your provider will talk with you about which options fit you.
See the antidepressant listGeneral information, not medical advice; talk with your provider.
Medication quick facts
Also commonly used (off-label)
No medication is FDA-approved for persistent depressive disorder, but several are commonly used to help with specific symptoms. Your provider will talk with you about what fits you.
Not FDA-approved for this condition
These are FDA-approved for major depression and are commonly used for persistent depression. They're a few of several options. “Off-label” means a medication approved for something else is used because research supports it for this condition.
- Sertraline (Zoloft). An SSRI that beat placebo in trials for long-lasting depression, with fewer people stopping it than older options. Source: Kriston et al., 2014 (network meta-analysis)
- Fluoxetine (Prozac) or paroxetine (Paxil). SSRIs that beat placebo in trials for long-lasting depression. Source: Kriston et al., 2014 (network meta-analysis)
- Imipramine. An older tricyclic antidepressant that beat placebo in these trials, though more people stopped it because of side effects. Source: Kriston et al., 2014 (network meta-analysis)
Antidepressant warning: In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
General information, not medical advice; talk with your provider.
What to expect
What to expect with treatment
1Start your intake packet
Fill out our secure intake packet. Once it's submitted, we'll verify your insurance and call you to schedule your appointment.
2A careful evaluation
A longer video visit about what you're experiencing, how long it has lasted, your history, your health and your goals.
3Understanding the picture
We explain what we think is going on, and why, including whether it looks like persistent depression, major depression or something else.
4A plan you understand
If medication could help, we talk through the options, side effects and what to expect, and decide together. If you'd benefit from therapy, we help you find it.
5Regular follow-ups
We check how you're doing and adjust carefully over time. Progress is often gradual, and regular follow-ups keep it on track.
Bring this to your visit
Questions to ask your provider
Tick the ones you want to ask, then copy your list. Nothing is saved or sent.
Before your first visit
Information your provider will want to know
Tick what you have ready, then copy the list to fill in your notes. Nothing is saved or sent.
Frequently asked questions
Is this just my personality?
Not necessarily. Persistent depressive disorder starts gradually and can last for years, so it's easy to mistake for who you are. It's a recognized condition, and it responds to treatment.
How long does medication take to help?
Antidepressants usually take 4 to 8 weeks to work, and sleep, appetite and concentration often improve before mood lifts. In persistent depressive disorder, medication can take longer. Your provider will check in with you regularly along the way.
Do I need therapy too?
Many people benefit from talk therapy, such as CBT, along with medication. Our visits include real therapeutic work. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.
Can you treat this by video?
Yes. Most visits are by secure video, anywhere in New Jersey. Our office is in Mount Laurel, NJ, and in-person visits there are limited and by appointment only; ask our office.
Can I stop my medication once I feel better?
Talk with your provider first. If it makes sense to come off a medication, your provider can plan a slow, careful taper. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.
Is a psychiatric nurse practitioner the same as a psychiatrist?
Both diagnose psychiatric conditions and prescribe psychiatric medication. Ours are board-certified psychiatric nurse practitioners (PMHNP-BC), focused on careful evaluation and medication management.
Check your understanding
Three quick questions
1In adults, how long does low mood last in persistent depressive disorder?
In adults, the low mood is there on most days for at least 2 years.
2How do its symptoms usually compare with major depression?
Symptoms are usually less severe than in major depression, but they last much longer.
3What's true about medication for persistent depressive disorder?
Medicines are often effective, though they can take longer to work than they do for major depression.
Myth or fact? Persistent depression
Choose an answer for each to see the explanation. Nothing is saved.
1If you've felt low for years, that's just who you are.
Myth. Long-lasting low mood can be persistent depressive disorder, a recognized condition that responds to treatment.
2You can have persistent depression and major depression at the same time.
Fact. Most people with persistent depressive disorder also have an episode of major depression at some point.
3Milder symptoms mean it isn't worth treating.
Myth. The symptoms may be less severe, but they last much longer and can weigh on your whole life. Many people recover fully with treatment.
The science: how we checked this
Sources
- MedlinePlus: Persistent depressive disorder
- NIMH: Depression
- Merck Manual (consumer version): Depression
- NHS: Depression in adults
How we checked this
- Written in our own words from MedlinePlus, NIMH, the Merck Manual and the NHS, checked October 25, 2026.
- Signs are described in plain language and aren't a diagnostic checklist.
