Overview
Diagnosis
To diagnose persistent depressive disorder, a healthcare professional may perform several exams and tests:
• Physical exam to review overall health and identify underlying conditions that may contribute to depressive symptoms.
• Lab tests, such as blood tests to check thyroid function and rule out conditions like hypothyroidism.
• Psychological evaluation, including discussion of thoughts, feelings, and behaviors, and possibly completing questionnaires to differentiate persistent depressive disorder from major depression, bipolar disorder, or seasonal affective disorder.
Criteria for diagnosis differ by age:
• Adults: Depressed mood most of the day for two or more years.
• Children: Depressed mood or irritability most of the day for at least one year.
Persistent depressive disorder that begins before age 21 is called early onset, while onset at age 21 or older is considered late onset.
Treatment
Treatment for persistent depressive disorder generally involves medicines and talk therapy. The choice depends on factors such as symptom severity, treatment history, personal preference, and ability to tolerate medicines.
Medicines
Common antidepressants used include:
• Selective serotonin reuptake inhibitors (SSRIs)
• Tricyclic antidepressants (TCAs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Finding the right medicine may require trying several options or combinations. Antidepressants may take several weeks to reach full effect, and side effects may ease over time. Do not stop medication without consulting your healthcare professional, as sudden discontinuation can cause withdrawal symptoms or worsening depression. Long-term use may be needed to control symptoms.
Special considerations
• Pregnancy and breastfeeding: Some antidepressants may carry risks to the baby, so discuss options with your provider.
• FDA alert: Children, teens, and young adults under 25 may have an increased risk of suicidal thoughts or behavior, particularly in the first few weeks or after dose changes. Monitor closely and seek immediate help if suicidal thoughts occur.
Talk therapy
Psychotherapy, also called talk therapy, helps treat depression by discussing thoughts, feelings, behaviors, relationships, and other relevant issues. Types such as cognitive behavioral therapy can be effective. Talk therapy can help you:
• Adjust to current difficulties or crises
• Identify and change behaviors that worsen depression
• Replace negative beliefs with positive ones
• Improve problem-solving and coping skills
• Develop healthier relationships
• Regain a sense of control and satisfaction in life
• Set realistic personal goals and reduce symptoms like hopelessness and anger
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