Major vs. persistent depressive disorder: Understanding dysthymia Health ConditionsHealth ConditionsAlzheimer's & DementiaAnxietyArthritisAsthma & AllergiesBreast CancerCancerCardiovascular HealthCOVID-19Dermatology & SkincareDiabetesEnvironment & SustainabilityExercise & FitnessEye HealthHeadache & MigraineHealth EquityHIV & AIDSHuman BiologyInflammatory Bowel DiseaseLeukemiaLGBTQIA+Men's HealthMental HealthMultiple Sclerosis (MS)NutritionParkinson's DiseasePsoriasisSexual HealthWomen's HealthDiscoverNewsLatest NewsOriginal SeriesMedical MythsHonest NutritionThrough My EyesNew Normal HealthPodcastsHow to understand chronic painWhat is behind vaccine hesitancy?The amazing story of hepatitis C, from discovery to cureNew directions in dementia researchCan psychedelics rewire a depressed, anxious brain?Why climate change matters for human healthToolsGeneral HealthDrugs A-ZHealth HubsHealth ToolsBMI Calculators and ChartsBlood Pressure Chart: Ranges and GuideBreast Cancer: Self-Examination GuideSleep CalculatorHealth ProductsAffordable Therapy OptionsBlood Pressure MonitorsDiabetic SuppliesFitness TrackersHome GymsGreen Cleaning ProductsHow to Shop for CBDQuizzesRA Myths vs FactsType 2 Diabetes: Managing Blood SugarAnkylosing Spondylitis Pain: Fact or FictionConnectAbout Medical News TodayWho We AreOur Editorial ProcessContent IntegrityConscious LanguageNewslettersSign UpFollow UsMedical News TodayHealth ConditionsDiscoverToolsConnectSubscribe What are the differences between major and persistent depressive disorder Medically reviewed by Nicole Washington, DO, MPH — By Veronica Zambon — Updated on October 2, 2022Persistent depressive disorder (PDD) and major depressive disorder (MDD) are two forms of depression. Both conditions can affect a person’s daily life. PDD, formerly called dysthymic disorder, affects 1.5% of adults in the United States. Females are more likely to have PDD than males. MDD is one of the most common mental health disorders in the U.S., affecting 7.1% of adults in the country. It is also more likely to develop in females than males. A key difference involves the duration of symptoms. For a doctor to diagnose PDD in an adult, symptoms must have lasted for at least 2 years. Meanwhile, adults with MDD experience major depressive episodes with a gap of at least 2 months between them. Below, learn more about the differences between major and persistent depressive disorders. We describe their symptoms, causes, treatment, and more. Symptoms PDD and MDD have very similar symptoms. A person can have symptoms of both disorders at the same time. PDD symptoms The symptoms of PDD somewhat overlap with those of MDD. Not every PDD symptom needs to be present at the same time for a person to receive a diagnosis. PDD symptoms include:feeling depressed or irritablehaving a poor appetite or overeatinghaving insomnia or sleeping too muchexperiencing fatigue or low energy having low self-esteemhaving trouble concentrating or making decisionshaving feelings of hopelessness Children and adolescents with PDD may experience irritability as a symptom instead of depression. In these cases, the symptom only needs to be present for 1 year. Those with PDD may experience difficulties in fulfilling work, school, or home responsibilities. The condition can also make socializing and enjoying hobbies difficult. It may also cause an increase in overwhelming feelings during stressful situations. MDD symptoms As with PDD, not every symptom has to be present at the same time for a doctor to diagnose the issue. The symptoms of MDD are:having a depressed mood that lasts for most of the dayhaving less interest or pleasure in most or all activitiesexperiencing fatiguefeeling worthless or guilty having difficulty concentrating and making decisionsunintentionally losing or gaining a significant amount of weight having trouble sleeping — insomnia — or sleeping too much experiencing a type of restlessness called psychomotor agitation or finding it difficult to think, speak, and do other everyday things, called psychomotor impairmenthaving frequent thoughts of death Those with MDD may also experience symptoms of panic disorders, social anxiety disorder, and obsessive-compulsive disorder, as well as other mental health disorders. Many people with MDD also have substance abuse disorders. Social functioning can also become difficult with MDD. The person may find it hard to work, attend school, or take care of home and family responsibilities. They may withdraw from friends and activities they once enjoyed. Causes While some causes of MDD and PDD may be similar, there are some crucial differences. MDD causes Mood disorders have genetic and external causes. In the case of MDD, scientists do not yet know how these factors interact, and they believe that each symptom of MDD may have different causes. However, researchers believe the part of the brain called the hippocampus plays a large part in MDD. In a person with MDD, the hippocampus is smaller than it is in a person without the disorder.The hippocampus helps make memories, adapt to stressful situations, and process emotions. A reduction in the size of this part of the brain can affect its ability to function. MDD also reduces the amount of gray matter in the brain. Gray matter is involved in numerous processes, including speech, decision-making, and self-control. The neurotransmitters serotonin, dopamine, and norepinephrine travel through gray matter. When MDD reduces the amount of gray matter, this disturbs the passage of these neurotransmitters, leading to the disorder’s symptoms. Factors that increase the chances of developing MDD include:having had depressive episodesexperiencing a stressful life eventhaving a family history of MDDhaving chronic medical conditionshaving dementiahaving anxietyengaging in substance misuse PDD causes Research into the causes of PDD is ongoing, but scientists believe that the disruption of the neurotransmitters serotonin, epinephrine, norepinephrine, and glutamate plays a role. Researchers have also found that certain parts of the brain, such as the orbitofrontal cortex and the hippocampus, are smaller in people with PDD than in those without. Other causes of PDD are genetic, environmental, and psychological. Some of these include:serious medical conditions, such as diabetes and cancera personal or family history of depressiontrauma or chronic stresscertain medications that can cause depression as a side effect Diagnosis The diagnostic processes for PDD and MDD are similar. MDD diagnosis Doctors, including psychiatrists, use the symptoms of MDD to diagnose it.For a doctor to recognize MDD, a person must have at least five symptoms, one of which must be feeling depressed often or experiencing a loss of interest or pleasure in life.The symptoms have to adversely affect a person’s social well-being, job, or other important aspects of their life. The symptoms that doctors use to diagnose MDD are symptoms of major depressive episodes. For a doctor to recognize the disorder, a person must also have experienced at least two of these episodes separated by at least 2 months. PDD diagnosis Doctors likewise use the symptoms of PDD to diagnose the disorder. To receive the diagnosis, a person must have at least two PDD symptoms, as well as depression or irritability that has lasted for at least 2 years, in adults, or at least 1 year, in children and teens. These symptoms need to adversely affect a person’s social well-being, job, or other important areas of their life. For a person to receive a diagnosis of PDD, the symptoms cannot have been absent for more than 2 months at a time during a 2-year period, in adults, or a 12-month period, in younger people. Treatment Psychiatrists and other doctors use very similar approaches to MDD and PDD treatment. MDD treatment There are several treatment options for MDD. Doctors, including psychiatrists, help determine the most appropriate treatment plan based on the severity and type of symptoms. For mild MDD, they often recommend psychotherapy and monitoring symptoms. However, a doctor may recommend medication for a person with MDD symptoms of any severity.Treatments for moderate MDD often include psychotherapy and medication. Psychotherapy-based treatments include:cognitive behavioral therapy (CBT)behavioral activation interpersonal psychotherapy Medications for MDD include:selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) and citalopram (Celexa)serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) and duloxetine (Cymbalta)other medications, such as bupropion (Wellbutrin) and mirtazapine (Remeron) Medication usually starts at a low dosage, to be increased if needed. MDD symptoms could improve in as few as 2 weeks. However, a person may not be symptom-free before 8–12 weeks have passed. Using medication and psychotherapy can be more effective than medication alone. PDD treatment Treatment for PDD is not significantly different from treatment for MDD. It tends to involve:methods of psychotherapy, such as CBTmedication, including SSRIs or SNRIs An SSRI is usually the first medication that a psychotherapist prescribes because this type causes slightly fewer side effects than SNRIs. However, a number of factors go into decisions about medication. Doctors work with people to ensure that the choice and dosage of medication best suit their needs. Frequently asked questions Below are some frequently asked questions about major and persistent depressive disorder. Is PPD the same as MDD PPD is a form of depression that lasts for 2 years or more. MDD, on the other hand, is characterized by episodes of major depression that are separated by at least 2 months. While similar and sometimes diagnosed together, PPD and MDD are two distinct conditions. PPD diagnosis requires at least two PDD symptoms, as well as depression or irritability that has lasted for at least 2 years. MDD diagnosis requires at least five symptoms of major depression with each episode at least 2 months apart. Can you have MDD and PPD A person can have both MDD and PPD. For a person to be diagnosed with both disorders, they must meet the diagnostic criteria for each. Can I pass on my diagnosis to my children Research suggests that genetic factors may play a role in the development of depressive disorders. However, it is not fully known exactly how these factors work together to cause depression. Children of a person with a depressive disorder may be at an increased risk for developing one as well. However, this does not mean they will definitely develop a depressive disorder. There are many other factors, such as social and physical factors, that can also influence the development of depression. Summary PDD and MDD are two forms of depression that have similar symptoms and treatment methods. The main difference concerns the duration of symptoms. PDD symptoms last for at least 2 years, in adults, while people with MDD experience depressive episodes that are separated by at least 2 months. Genetic, social, and physical factors cause PDD and MDD. Various parts of the brain play important roles in the development of these disorders. Treating PDD and MDD may involve methods of psychotherapy, such as CBT, and medications, including SSRIs and SNRIs. These may be especially effective in combination. Last medically reviewed on October 2, 2022DepressionMental Health 10 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Bains, N., et al. (2022). Major depressive disorder.https://www.ncbi.nlm.nih.gov/books/NBK559078Chung, W. M. N., et al. (2016). Major depression in primary care: Making the diagnosis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331132/Depression. (2018).https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145396Major depression. (2019).https://www.nimh.nih.gov/health/statistics/major-depression.shtmlNübel, J., et al. (2020). Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011512/Park, L. T., et al. (2019). Depression in the primary care setting.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736516/Patel, R. K., et al. (2019). Persistent depressive disorder (dysthymia).https://www.ncbi.nlm.nih.gov/books/NBK541052/Persistent depressive disorder (dysthymic disorder). (2017).https://www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder.shtmlSaltiel, P. F., et al. (2015). Major depressive disorder: Mechanism-based prescribing for personalized medicine.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386790/Struck, N., et al. (2020). Social cognition and interpersonal problems in persistent depressive disorder vs. episodic depression: The role of childhood maltreatment.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873909/FEEDBACK:Medically reviewed by Nicole Washington, DO, MPH — By Veronica Zambon — Updated on October 2, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhat are the types of depression?Medically reviewed by Timothy J. Legg, PhD, PsyD There are several different types of depression, which is a common mental health condition. Learn about their symptoms and who is at risk in this…READ MOREWhat is smiling depression?Medically reviewed by Timothy J. Legg, PhD, PsyD Smiling depression is a term that describes people who mask their symptoms of depression behind a smile, appearing happy on the outside. Learn more…READ MOREBrain fog and depression: What's the link?Medically reviewed by Timothy J. Legg, PhD, PsyD Depression can cause a range of symptoms, including cognitive changes known as brain fog. These symptoms often occur during depressive episodes. Learn…READ MOREWhat is the link between depression and headaches?Medically reviewed by Deena Kuruvilla, MD Some people experience headaches as a symptom of depression, while others report headaches causing them to feel depressed. Learn more here.READ MOREIs there a cure for depression?Medically reviewed by Timothy J. Legg, PhD, PsyD Depression is a lifelong mental health condition. There is no cure for depression, but many different treatments are available to manage the symptoms.READ MORE