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let's talk about dysthymia is it
dysthymia
yeah and it's called persistent
depressive disorder now in the dsm-5
got it okay so i've heard dysthymia i
have not heard the pdd
uh acronym before what is that so
dysthymia is somebody who has depression
but at a more
lower grade level it tends to not be as
severe
as a major depressive disorder in terms
of the symptoms
both in number and in terms of severity
but it does go on for much
longer and so in order to qualify for a
persistent depressive disorder diagnosis
you will have to have had most of the
symptoms most days
more often than not for at least a two
year
period goodness yes and so in some ways
it's a almost ignored pattern of
depression people sometimes just think
that this person's being negative
but actually they have persistent
depressive disorder and that needs to be
treated as well
i think sometimes it also escapes
diagnosis because it's actually much
rarer
than major depressive disorder so the
prevalence of major depressive disorder
any given time is about seven percent of
the population
whereas for persistent depressive
disorder it's more like half a percent
so i think sometimes people aren't
thinking about that and and they they
don't know that
something like persistent depressive
disorder can actually wreak a lot of
havoc on individuals
and there's even a smaller subset of
people who have both major depressive
disorder
and persistent depressive disorder and
what that means is
in between the significant and more
severe major depressive
episodes they also have an underlying
sort of sadness
that is low-grade and lasts for more
than two years at a time
for someone who has pdd and major
depressive
how do you begin to treat that so
it's more difficult and individuals who
have what we call double depression
both diagnoses do have a lower recovery
rate
and a much higher recurrence rate and
that's because when the major depressive
disorders resolve they still have the
persistent depressive disorder to deal
with
and so sometimes the medication
strategies will have to be altered
depending on
which one they're dealing with whether
it's the major depressive disorder
or the persistent depressive disorder
oftentimes they will need
more structured behavioral interventions
and they will need to be in therapy
longer because you have to address
both so when you're not fully depressed
as in a major depressive
disorder you are still having that low
grade depression that prevents you from
doing things maybe gets into the way of
your motivation
impairs your concentration and
functioning it makes you feel bad about
yourself
and so i think those require more of a
long-standing treatment approach so that
these individuals are oftentimes
in therapy a little longer than somebody
who just has one of the conditions
this pdd diagnosis is really interesting
to me
because especially in our current time
of
constantly comparing our lives to the
unreal lives on instagram and social
media
it wouldn't surprise me that a lot of
people would hear
pdd and think oh that sounds like me
because it seems like everyone else is
loving it never has a bad day meanwhile
we know that we do have
bad days but it only is a half
percent of the population with pdd so
how can someone
determine if they really have pdd or
they're just falling into a comparison
trap
yeah and i think that's really important
to talk about because sometimes
people will say well in general i'm kind
of a cynical person does that mean that
i have pdd
no when you have persistent depressive
disorder
it's actually impacting you at a
significant level you have significant
clinical distress
or it's impairing you in one of the
major areas of life whether it's work
social relationships romantic
relationships or the like
if you just feel like in general you're
a little bit more cynical maybe you see
the negative side of life a bit more
but in general you're still able to
function get up every day and still be
able to go about your day with little
problems you do not have pdd
it's interesting because people have
actually talked about this theory called
depressive realism
that some individuals are a little bit
more prone to feeling depressed from
time to time
because they're realistic and in fact
people who are not as prone to
depression are actually
a little maybe too rosy colored glasses
maybe it's almost like
they just expect things to work out and
that's why they're not so depressed
and so it's an interesting theory that
not everybody agrees with but it's sort
of this idea of
if you actually make contact with the
real challenges of life you're going to
feel depressed from time to time
right that's kind of the idea and so
this is not somebody who you know
generally kind of has a little bit more
cynical view to life or or every once
while they have a couple of depressed
days
we're talking about somebody who for two
years
for more days than not during those two
years that they have these symptoms of
sadness
and low-grade depression that impairs
their functioning or is extremely
distressing to the individual
and that's when we should consider a pdd
diagnosis how does
i i hear all the time that depression
and anxiety co-occur
together almost more than any other two
mental health conditions
what is the role of anxiety for somebody
living with pdd
the role of anxiety for someone living
with pdd is oftentimes their judgment on
themselves you know oftentimes they're
feeling like how come i'm not getting
better
right because again in in some ways
somebody with persistent depressive
disorder
it's even more difficult to manage
because you're always a little depressed
and so i think that sometimes the
anxiety will play a role and in fact
that is one of the specifiers of both
major depressive disorder and persistent
depressive disorder that when it's
clinical enough that there is a
specifier called with
anxious distress and what that means is
this is somebody who
suppression co-occurs the same time as
their anxiety symptoms
and because the two are so interrelated
sometimes you find individuals whose
depression and anxiety are really
discrete diagnoses like maybe they have
a generalized anxiety disorder
and a major depressive disorder and then
you have individuals who just have a few
anxiety symptoms like feeling on edge
being keyed up
having a lot of worries difficulty
concentrating that accompanies their
depression
every time they have an episode so we
talk about those individuals as
a specifier of with anxious distress
that co-occurs with a depression
condition
if you are talking with your therapist
and the therapist says look kyle i know
you think you have
pdd but i'm telling you you don't it's
this
but you really believe it's pdd at what
point should you say you know what i'm
not the doctor
they're probably right or should i move
on and get a second opinion
i always think it's helpful to get a
second opinion i always do and i think
it depends on your therapist specialties
some therapists
really do review the dsm keep up with
the research and really
understand these finer points of
diagnoses and other therapists
don't other therapists are just more
focused on dealing with the symptoms and
they don't
actually invest as much in the
diagnostics
of the condition and so you may need to
move on to somebody
who does that for a specialty some so
many psychiatrists would say that they
are
excellent diagnosticians a
neuropsychologist would be an excellent
diagnostician
but sometimes therapists who do mostly
work
on an individual level individual basis
of therapy they may or may not
concern themselves as much with the
exact diagnosis that you have
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