Children - Dysthymia

What is persistent depressive disorder?

Persistent depressive disorder is a type of affective disorder. It is also called mood disorder. It often resembles a less severe, yet more chronic form of major (clinical) depression. It was previously referred to as dysthymia or dysthymic disorder. However, people with persistent depressive disorder may also experience major depressive episodes at times.

Depression is a mood disorder that involves a child's body, mood, and thoughts. It can affect and disrupt eating, sleeping, or thinking patterns. It is not the same as being unhappy or in a "blue" mood. It is also not a sign of personal weakness or a condition that can be willed or wished away. Children with a depressive illness cannot merely "pull themselves together" and get better. Treatment is often necessary and many times crucial to recovery.

There are 3 primary types of depression, including:

  • Major depression (clinical depression)

  • Bipolar disorder (manic depression)

  • Persistent depressive disorder (dysthymia)

Who is affected by persistent depressive disorder?

Persistent depressive disorder occurs in about 11% of 13- to 18-year-olds.

What are the symptoms of persistent depressive disorder?

The following are the most common symptoms of persistent depressive disorder. However, each adolescent may experience symptoms differently. Symptoms may include:

  • Persistent feelings of sadness

  • Feeling hopeless or helpless

  • Having low self-esteem

  • Feeling inadequate

  • Excessive guilt

  • Feelings of wanting to die

  • Difficulty with relationships

  • Sleep disturbances (like insomnia or hypersomnia)

  • Changes in appetite or weight

  • Decreased energy

  • Difficulty concentrating

  • Irritability, hostility, aggression

  • A decrease in the ability to make decisions

  • Suicidal thoughts or attempts

  • Frequent physical complaints (like headache, stomachache, or fatigue)

  • Running away or threats of running away from home

  • Loss of interest in usual activities or activities once enjoyed

  • Hypersensitivity to failure or rejection

For a diagnosis of persistent depressive disorder to be made, a depressed or irritable mood must last for at least 1 year in children or adolescents. It must be accompanied by at least 2 other major depressive symptoms. The symptoms of persistent depressive disorder may resemble other medical problems or psychiatric conditions. Always talk with your adolescent's health care provider for a diagnosis.

How is persistent depressive disorder diagnosed?

Depression has been shown to often coexist with other psychiatric disorders, like substance abuse or anxiety disorders. Early diagnosis and treatment is crucial to the recovery of your adolescent.

A child psychiatrist or other mental health professional usually diagnoses persistent depressive disorder following a complete psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers may also be helpful in making a diagnosis.


Specific treatment for persistent depressive disorder will be decided by your adolescent's health care provider based on:

  • Your adolescent's age, overall health, and medical history

  • Extent of your adolescent's symptoms

  • Your adolescent's tolerance for specific medicines or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Mood disorders, including persistent depressive disorder, can often be effectively treated. Treatment should always be based on a complete evaluation of the adolescent and family. Treatment may include 1, or more, of the following:

  • Antidepressant medicines. These have been shown to be very effective in the treatment of depression in children and teens, especially when combined with psychotherapy.

  • Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the adolescent. This should focus on changing the adolescent's distorted views of himself or herself and the environment around him or her. It should also help him or her work through difficult relationships. Identifying stressors in the adolescent's environment and learning how to avoid them should be another goal of the adolescent's psychotherapy.

  • Family therapy

  • Consultation with the adolescent's school

Parents play a vital supportive role in any treatment process.

Persistent depressive disorder is associated with an increased risk for major depression if a child or adolescent does not receive appropriate treatment. Persistent depressive disorder also increases the risk for a child or adolescent to develop other mental health disorders. Appropriate treatment helps to reduce the severity of symptoms and the risk for relapse of another depressive episode.

Because episodes of persistent depressive disorder may last for longer than 5 years, long-term, continued treatment may help to prevent the depressive symptoms from returning.

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