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Diagnosis and clinical terms

Persistent depressive disorder

Shariq Refai, MD, MBA, board-certified psychiatrist and the reviewer of this article.

Reviewed by Shariq Refai, MD, MBA·Updated March 15, 2026·About 3 minutes

About this term

Quick definition
A long-running form of depression with depressed mood most of the day, more days than not, for at least two years in adults. Also called dysthymia.
Full clinical definition
In the DSM-5-TR, persistent depressive disorder requires depressed mood for most of the day, more days than not, for at least two years in adults, with a shorter one-year duration in children and adolescents, along with at least two of the following: poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem, poor concentration, or feelings of hopelessness. In children and adolescents, the mood criterion can be met by irritable mood rather than depressed mood. Symptom-free periods of more than two months at a time exclude the diagnosis. The 2013 DSM revision combined chronic major depression and dysthymia into this single diagnosis.
Epidemiology
About 1.5 percent of U.S. adults meet criteria in a given year. Lifetime prevalence is near 2.5 percent (NIMH). Rates are higher in women and in people with early onset.
What it can feel like
A person who has felt low energy and low motivation for as long as they can remember. A person who assumes everyone feels this tired. A person who has built a life around managing a constant baseline of effort. Many describe themselves as having always been a little down.
Double depression
A substantial share of patients with persistent depressive disorder also have one or more major depressive episodes layered on top, which is sometimes called double depression. Recognizing the underlying chronic pattern matters because treatment often needs to continue past the resolution of a single episode.
How clinicians assess it
A careful history is the central tool. Questions ask about how the person felt in their teens, their twenties, and the years since. Because persistent depressive disorder often starts early in life, it can be missed if the conversation only covers the past few months.
Treatment
Persistent depressive disorder responds to the same general treatments as major depressive disorder. Antidepressants and structured psychotherapy both have evidence. CBASP (Cognitive Behavioral Analysis System of Psychotherapy) was developed specifically for chronic depression and has evidence in this group. Because the pattern is long-standing, treatment often takes longer to show its full effect, and most patients benefit from continuing both therapy and medication well after they feel improved.
Related terms
Major depressive disorder. Relapse. Remission.
Related articles
Persistent depressive disorder (Types).

Sources

  • American Psychiatric Association. DSM-5-TR.
  • Schramm E, et al. Review of dysthymia and persistent depressive disorder. Lancet Psychiatry. 2020.

Frequently asked questions

What is persistent depressive disorder?
Persistent depressive disorder (PDD), formerly called dysthymia, is depressed mood most of the day, more days than not, for at least two years in adults (one year in children and adolescents), along with at least two other symptoms. Symptom-free periods of more than two months at a time exclude the diagnosis.
How is PDD different from major depressive disorder?
Major depressive disorder is defined by discrete episodes lasting at least two weeks. PDD is defined by a chronic, lower-grade pattern lasting years. A meaningful share of patients have both at once, which is sometimes called double depression. Recognizing the underlying chronic pattern matters because treatment usually needs to continue past the resolution of any single episode.
How common is persistent depressive disorder?
About 1.5 percent of U.S. adults meet criteria in a given year. Lifetime prevalence is near 2.5 percent (NIMH). Rates are higher in women and in people with early onset.
What treatments work for PDD?
PDD responds to the same general treatments as major depressive disorder: antidepressants and structured psychotherapy. CBASP (Cognitive Behavioral Analysis System of Psychotherapy) was developed specifically for chronic depression and has evidence in this group. Because the pattern is long-standing, treatment often takes longer to show its full effect.
Can persistent depressive disorder be missed?
Yes. Because PDD often starts early in life, patients often assume the way they feel is just who they are. A careful clinical history that asks about how a person felt in their teens, twenties, and the years since is the central tool for catching it.

Last reviewed March 15, 2026.

Every clinical page on DepressionResource.org is written in plain language, dated, and reviewed by a board-certified psychiatrist against current clinical guidelines. See our editorial standards and medical review process.