Hiding in Plain Sight: Persistent Depressive Disorder

To the outside world, you’re a productive citizen. You might even be considered highly successful. But when work or school is over, your internal resources are spent. You turn down hanging out with friends because all you want to do is sink onto the couch or dive into bed and cut yourself off from the outside world. The energy you had was once again spent getting through the day. You have nothing left for anything else.

This is what it’s like to suffer from what is  sometimes called high-functioning depression, or persistent depressive disorder (formerly dysthymia or PDD). Your through the day and appear to be handling things but inside you’re suffering. 322 million people worldwide live with depression (Our World Data) and among this population are approximately 3.3 million people who suffer from persistent depressive disorder, a relatively new diagnosis that combines the symptoms of both dysthymia and chronic major depressive episode.

Children showing symptoms of a depressed mood or irritability most of the time for over one year could be suffering from persistent depressive disorder. Young people with PDD exhibit chronic feelings of sadness or worthlessness and an inability to take pleasure or participate fully in the daily activities. With PDD, the symptoms of depression may go unnoticed for some time since they are less acute signs than in other forms of depression but longer lasting.

A child with PDD appears irritable, moody, sad or pessimistic over an extended period of time. Other symptoms can include behavior problems, poor performance at school, low self-esteem, and difficulty interacting with other children in social situations. The intensity of individual symptoms may ebb and flow over a period of years, but typically symptoms do not disappear for over two months at a time. PDD is difficult to diagnose in kids since it coincides with other developmental stages which can bring similar symptoms but not necessarily result in a depression diagnosis or can be masked by other diagnosed disorders such as anxiety or substance abuse. There’s a difference between a young person being “moody” or “depressed” and to detect this difference is difficult even for professional caretakers.

For a child to be diagnosed with PDD, he or she must exhibit a depressed mood or irritability most of the day for at least one year. Also, he or she must exhibit two of the following symptoms:

  • The symptoms cause distress or interfere with the ability to function well at home, in school, or in other areas of daily life
  • Poor appetite or overeating
  • Trouble sleeping
  • Persistent tiredness or lack of energy
  • Low self-esteem
  • Hopelessness
  • Trouble concentrating
  • Difficulty making decisions.

The good news is PDD is treatable–there is hope for any young person suffering from this disorder. But in order to get help, our young people need to be identified and helped by professionals skilled at advising on things such as counseling and possible medication options. PDD may sound new but it isn’t new at all. This disorder requires of us all the same thing any disorder affecting a young person’s mental health demands: for people around them to take notice and speak up. Don’t be silent. Don’t ignore the signs. Help our young people start getting help by speaking up.

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