Persistent depressive disorder is a depressed mood that is present most days for at least two years in adults, or one year in children and teens. The symptoms are often milder than major depression, but because they last so long they wear down work, relationships and quality of life.
Key symptoms
- Low or sad mood most of the day, on more days than not
- Poor appetite or overeating
- Sleeping too little or too much
- Low energy, poor concentration and low self-esteem
- Feeling hopeless; the patient may think it is just their personality
What you find on exam
- Mental status exam: flat or sad affect, slowed speech, negative thoughts
- Direct questions about suicidal thoughts and plans
- Screen for episodes of major depression on top of the chronic mood
- Ask about mania, substance use and medical illnesses that cause fatigue
Tests
- PHQ-9 questionnaire to measure severity and follow response
- Thyroid tests (TSH) and a blood count to rule out medical causes
- Vitamin B12 and metabolic panel when the history points to them
- Diagnosis is clinical: symptoms for 2 years with no break longer than 2 months
Treatment basics
- Psychotherapy such as cognitive behavioral therapy
- An SSRI such as sertraline or escitalopram, often combined with therapy
- Give the medicine time: at least 6 to 8 weeks at a good dose before judging it
- Regular follow-up, sleep, exercise and treatment of alcohol or drug use
Red flags
- Suicidal thoughts, a plan or access to firearms
- A new episode of major depression or psychotic symptoms
- Signs of mania, which point to bipolar disorder
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.