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Persistent Depressive Disorder in Children

What is persistent depressive disorder?

Persistent depressive disorder is classified as a type of affective disorder (also called mood disorder) that often resembles a less severe, yet more chronic form of major (clinical) depression. It was previously referred to as dysthymia or dysthymic disorder. However, people with persistent depressive disorder may also experience major depressive episodes at times.

Depression is a mood disorder that involves a child's body, mood, and thoughts. It can affect and disrupt eating, sleeping, or thinking patterns, and is not the same as being unhappy or in a "blue" mood, nor is it a sign of personal weakness or a condition that can be willed or wished away. Children with a depressive illness cannot merely "pull themselves together" and get better. Treatment is often necessary and many times crucial to recovery.

There are three primary types of depression, including:

  • Major depression (clinical depression)

  • Bipolar disorder (manic depression)

  • Persistent depressive disorder (dysthymia)

Who is affected by persistent depressive disorder?

Persistent depressive disorder occurs in about 11 percent of 13- to 18-year-olds.

What are the symptoms of persistent depressive disorder?

Although less severe, yet more chronic than major depression, the following are the most common symptoms of persistent depressive disorder. However, each adolescent may experience symptoms differently. Symptoms may include:

  • Persistent feelings of sadness

  • Feeling hopeless or helpless

  • Having low self-esteem

  • Feeling inadequate

  • Excessive guilt

  • Feelings of wanting to die

  • Difficulty with relationships

  • Sleep disturbances (for example, insomnia or hypersomnia)

  • Changes in appetite or weight

  • Decreased energy

  • Difficulty concentrating

  • Irritability, hostility, aggression

  • A decrease in the ability to make decisions

  • Suicidal thoughts or attempts

  • Frequent physical complaints (for example, headache, stomachache, or fatigue)

  • Running away or threats of running away from home

  • Loss of interest in usual activities or activities once enjoyed

  • Hypersensitivity to failure or rejection

For a diagnosis of persistent depressive disorder to be made, a depressed or irritable mood must persist for at least one year in children or adolescents and must be accompanied by at least two other major depressive symptoms (noted above). The symptoms of persistent depressive disorder may resemble other medical problems or psychiatric conditions. Always consult your adolescent's health care provider for a diagnosis.

How is persistent depressive disorder diagnosed?

Because depression has shown to often coexist with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of your adolescent.

A child psychiatrist or other mental health professional usually diagnoses persistent depressive disorder following a comprehensive psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers may also be helpful in making a diagnosis.

Treatment for persistent depressive disorder  

Specific treatment for persistent depressive disorder will be determined by your adolescent's health care provider based on:

  • Your adolescent's age, overall health, and medical history

  • Extent of your adolescent's symptoms

  • Your adolescent's tolerance for specific medications or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Mood disorders, including persistent depressive disorder, can often be effectively treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment may include one, or more, of the following:

  • Antidepressant medications (especially when combined with psychotherapy has shown to be very effective in the treatment of depression in children and teens)

  • Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the adolescent (focused on changing the adolescent's distorted views of himself or herself and the environment around him or her; working through difficult relationships; identifying stressors in the adolescent's environment and learning how to avoid them)

  • Family therapy

  • Consultation with the adolescent's school

Parents play a vital supportive role in any treatment process.

Persistent depressive disorder is associated with an increased risk for major depression if a child or adolescent does not receive appropriate treatment. Persistent depressive disorder also increases the risk for a child or adolescent to develop other mental health disorders. Appropriate treatment helps to reduce the severity of symptoms and the risk for relapse of a depressive episode.

Because episodes of persistent depressive disorder may last for longer than five years, long-term, continued treatment may help to prevent reoccurrence of the depressive symptoms.

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