Does this sound familiar?

You’ve felt this way for as long as you can remember. Not the kind of depression that knocks you off your feet—you’re still functioning, still showing up. But there’s a heaviness that never fully lifts. A gray filter over everything. You’ve wondered if this is just your personality.

It’s not. What you’re experiencing has a name: persistent depressive disorder, also known as dysthymia or dysthymic disorder. Unlike major depressive disorder, which comes in episodes, persistent depressive disorder is a chronic form of depression that lasts for years—often beginning so early that you have no reference point for what “normal” feels like.

At Therapy Group of DC, our therapists specialize in treating chronic depression. We understand that persistent depressive disorder requires a different approach than episodic depression—one that addresses not just symptoms but the deep-rooted patterns that have shaped how you see yourself and the world. Learn more about our Depression Therapy services →

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Is Persistent Depressive Disorder Therapy Right for You?

You might benefit from persistent depressive disorder therapy if you:

• Have experienced a depressed mood most days for two years or longer
• Feel chronically sad, empty, or hopeless without a clear cause
• Struggle with low energy and fatigue that never fully resolves
• Experience poor appetite or overeating that’s persisted for years
• Have trouble sleeping—insomnia or sleeping too much—as a long-term pattern
• Notice poor concentration and difficulty making decisions
• Feel low self-esteem or believe you’re fundamentally flawed
• Have been told “you’ve always been this way” or assumed depression is part of your character
• Notice that low self esteem colors how you see your accomplishments
• Wonder if you’re depressed or if this is just how life feels

What to know:

• Persistent depressive disorder affects approximately 1.5% of adults, with symptoms lasting at least two years in adults (one year in children and adolescents)
• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, recognizes persistent depressive disorder as a distinct diagnosis from major depressive disorder
• Many people with dysthymia don’t seek treatment because they believe their chronic low mood is simply their personality—not a treatable condition
• Effective treatment combining psychotherapy and medication can significantly reduce depressive symptoms, even after years of chronic depression
• People with depressive and anxiety disorders often benefit from treatment that addresses both conditions
• Individuals with PDD face elevated suicide risk—if you’re experiencing suicidal thoughts, please reach out for support immediately
• With proper support, persistent depressive disorder does get better

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Understanding Persistent Depressive Disorder

Persistent depressive disorder is a form of chronic depression characterized by a depressed mood lasting most of the day, for more days than not, over at least two years. Previously called dysthymic disorder (or simply dysthymia), it’s classified among mood disorders in the diagnostic manual. The diagnostic criteria require this persistent low mood plus at least two additional depression symptoms: changes in appetite, sleep disturbances, low energy, low self-esteem, poor concentration, or feelings of hopelessness.

What makes persistent depressive disorder different from major depression isn’t severity—it’s duration and constancy. Major depressive disorder typically involves intense depressive episodes that eventually lift. Persistent depressive disorder is the background hum that never stops. The symptoms may be less acute than major depression, but their chronic nature can be equally or more impairing over time—research shows functional impairments from PDD can be as severe as those from major depressive disorder. Individuals with persistent depressive disorder also face a heightened risk of suicidal thoughts and behaviors.

The Two Types of Dysthymia

Mental health professionals recognize two patterns based on when dysthymia is diagnosed:

1. 1. Early-onset dysthymia starts before age 21, often in childhood or adolescence. People with early onset dysthymia frequently can’t remember a time when they didn’t feel this way. The chronic depression becomes woven into their developing identity, making it harder to recognize as something separate from who they are.
2. 2. Late-onset persistent depressive disorder begins after age 21, sometimes following a stressful life event or period of chronic stress. Risk factors for developing dysthymia include major life transitions, chronic stress, and a family history of mood disorders. These individuals may have clearer memories of feeling different before—which can make the contrast more painful but also supports recognition that this isn’t “just who they are.”

Double Depression

Many people with dysthymic disorder also experience episodes of major depression on top of their chronic low mood—a pattern clinicians call double depression. During these periods, the persistent symptoms intensify into a full major depressive episode before eventually returning to the baseline dysthymic state.

The clinical implications are significant: dysthymic patients with double depression often need more intensive treatment and longer recovery timelines. Research confirms that persistent depressive disorder symptoms are much less likely to fully resolve on their own compared to major depressive disorder—professional treatment makes a significant difference.

Why It Goes Unrecognized

• You’ve normalized it. When depression starts early, you may have no baseline for comparison. The chronic sadness, the fatigue, the low self-esteem—they feel like facts about yourself rather than symptoms.
• You’re still functioning. Unlike major depression, persistent depressive disorder often allows people to maintain jobs and relationships. This functioning masks the suffering underneath.
• It gets misdiagnosed. Persistent depressive disorder frequently co-occurs with anxiety disorders, substance abuse, and personality disorders—including what was once called depressive personality disorder. The depressive symptoms may be attributed to these other mental health conditions rather than recognized as a distinct mood disorder. It’s also important to distinguish PDD from bipolar disorder, which involves mood swings rather than persistent low mood, and from minor depression, which is shorter in duration.

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Persistent Depressive Disorder Symptoms

The symptoms of persistent depressive disorder share features with major depressive disorder but present differently—less intense, more constant, and often experienced as “just how I am.”

Core Symptoms

• Chronic depressed mood is the hallmark—a persistent feeling of sadness, emptiness, or hopelessness that colors most days. You may have good moments, but the baseline is always low.
• Low energy and fatigue that doesn’t resolve with rest. You’re tired before the day starts.
• Low self-esteem that feels like clear-eyed realism. The low self esteem becomes so familiar that believing you’re worthy of good things feels delusional.

Other Symptoms

Beyond the core features, other symptoms of persistent depressive disorder include:

• Poor concentration and difficulty making decisions
• Feelings of hopelessness about the future
• Poor appetite or overeating as a long-standing pattern
• Trouble sleeping or sleeping too much
• Social withdrawal or going through the motions in relationships

How It Differs from Major Depressive Disorder

Major depressive disorder involves discrete depressive episodes that eventually lift. Persistent depressive disorder is ongoing—the depressed mood never fully resolves. People with major depression often remember what it felt like to be well. People with dysthymia may not have that reference point. If you’re achieving professionally while feeling empty inside, you may also want to explore our page on High-Functioning Depression Therapy →

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Persistent Depressive Disorder in Washington DC

DC’s professional culture can both mask and intensify chronic depression. In a city full of driven professionals, continuing to work despite feeling terrible doesn’t stand out. The chronic low energy of dysthymic disorder gets absorbed into “everyone’s stressed here.”

Achievement doesn’t help the way you’d expect—accomplishments feel hollow. And DC’s demanding pace creates chronic stress that can intensify depressive symptoms and increase risk factors for developing double depression.

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Effective Treatment for Persistent Depressive Disorder

Research shows that the most effective treatment for persistent depressive disorder combines psychotherapy (talk therapy) with antidepressant medication. This combination treatment addresses both the symptoms and the underlying patterns that maintain chronic depression—and works better than either approach alone for both persistent depressive disorder and major depression.

Psychotherapy Approaches

Cognitive Behavioral Therapy (CBT) helps identify and change the negative thought patterns that maintain depressive symptoms. Cognitive behavioral approaches are among the most researched effective treatment modalities for depressive disorders.

Psychodynamic Psychotherapy explores how early experiences shaped your current patterns. For people whose dysthymia started in childhood, understanding the origins of your depressed mood can be transformative. This approach is also helpful when persistent depressive disorder co-occurs with personality disorder patterns.

Interpersonal Therapy (IPT) addresses how depression affects your relationships and how relationship patterns maintain depression. Interpersonal psychotherapy focuses on current interpersonal problems—role transitions, grief, disputes, and isolation. Mental health research consistently supports interpersonal psychotherapy as effective for mood disorders.

Internal Family Systems (IFS) works with the different “parts” of yourself that may carry depression—the inner critic, the exhausted part, the part that believes things will never change. IFS helps you develop a compassionate relationship with these parts rather than fighting them.

Existential Therapy explores the deeper questions that often accompany chronic depression: meaning, purpose, and why life feels empty despite external success. For people whose dysthymia is intertwined with existential concerns, this approach addresses the “what’s the point?” that underlies the mood.

Somatic Therapy recognizes that chronic depression lives in the body as well as the mind—the heaviness, the fatigue, the physical weight you carry. Body-based approaches help release tension and restore energy that talk therapy alone may not reach.

Medication

Antidepressant medications can be an important component of treatment for persistent depressive disorder. Research consistently shows that combining therapy with medication produces better outcomes than either approach alone for chronic depression. If medication seems appropriate for your situation, we can refer you to a psychiatrist who can evaluate your needs and discuss options.

Emerging Options

For treatment-resistant chronic depression, we can also provide referrals for newer interventions like Transcranial Magnetic Stimulation (TMS), Ketamine/Esketamine, or Intensive Outpatient Programs (IOP).

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What to Expect in Treatment

Persistent depressive disorder took years to develop, and treatment takes time. Most people need at least 6-12 months of consistent therapy to see substantial change.

Early sessions focus on understanding your history, assessing symptoms, and determining whether medication evaluation might help.

Ongoing work involves both symptom management and deeper exploration—developing skills for challenging negative thoughts while understanding where these patterns came from.

Progress often feels gradual. You may notice more good days, activities feeling slightly less effortful, the baseline shifting. Trust the process even when change feels slow.

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Our Persistent Depressive Disorder Therapists

Our therapists bring expertise in mood disorders and understand the unique challenge of treating depression that feels like personality.

Dr. Keith Clemson, Ph.D., LPC

Dr. Clemson helps clients develop self-compassion while addressing chronic depression. His psychodynamic approach explores the roots of low mood that has persisted for years. View Dr. Clemson’s full profile →

Dr. Tyler Miles, Psy.D.

Dr. Miles specializes in depression using ACT, client-centered therapy, and cognitive behavioral therapy. Her focus on high-performing clients helps those who look “together” outside but feel empty internally. View Dr. Miles’s full profile →

Dr. Jennifer Melo, Psy.D.

Dr. Melo integrates psychodynamic and trauma-focused approaches, with attention to how early experiences shape chronic depression. View Dr. Melo’s full profile →

Dr. Dana Treistman, Ph.D.

Dr. Treistman uses CBT and mindfulness to help clients identify and change thought patterns that maintain dysthymia. Her approach helps clients recognize depression as treatable, not fixed personality. View Dr. Treistman’s full profile →

Dr. Rose Medcalf, Psy.D.

Dr. Medcalf integrates client-centered, feminist, and psychodynamic approaches to help clients feel more confident and in tune with themselves. Her warm, curious style works well for people ready to understand how chronic low mood has shaped their sense of self. View Dr. Medcalf’s full profile →

Dr. Robert Drinkwater, Ph.D.

Dr. Drinkwater helps clients recognize and change patterns in thoughts, feelings, and behaviors that keep them feeling stuck. His focus on building self-esteem and confidence addresses the core of what chronic depression erodes. View Dr. Drinkwater’s full profile →

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Begin Persistent Depressive Disorder Therapy in Washington DC

You’ve carried this for years—maybe as long as you can remember. You’ve told yourself this is just who you are, that you should be able to handle it, that it’s not bad enough to need help.

But persistent depressive disorder is a real condition with effective treatment options. You don’t have to keep living under this gray cloud. The chronic sadness, the low energy, the feeling that nothing will ever really change—these aren’t fixed features of your personality. They’re symptoms of a treatable depressive disorder.

With the right support, dysthymia does get better.

Schedule an Appointment →

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Frequently Asked Questions

How do you treat persistent depressive disorder?

Effective treatment typically combines psychotherapy and medication. Psychotherapy approaches include cognitive behavioral therapy (CBT), psychodynamic psychotherapy, interpersonal psychotherapy, Internal Family Systems (IFS), and somatic therapy. SSRIs and SNRIs are commonly prescribed antidepressants. This combination treatment is considered the gold standard by most mental health professionals.

Does persistent depressive disorder ever go away?

Yes, with proper treatment, persistent depressive disorder can improve significantly. However, without treatment, symptoms are unlikely to resolve on their own. Many people experience substantial improvement, though some benefit from ongoing treatment to maintain gains.

Can CBT help dysthymia?

Yes, cognitive behavioral therapy is effective for persistent depressive disorder. CBT helps identify and change negative thought patterns that maintain chronic depression. Some people also benefit from combining CBT with other approaches like interpersonal psychotherapy or Internal Family Systems.

What’s the difference between persistent depressive disorder and major depressive disorder?

Major depressive disorder (major depression) involves discrete depressive episodes that eventually lift. Persistent depressive disorder (dysthymic disorder) is chronic—a depressed mood lasting most days for at least two years. Major depression is often more intense but episodic; dysthymia is less acute but constant. Many people experience both: major depressive episodes on top of chronic dysthymia (called double depression). Unlike bipolar disorder, neither condition involves manic episodes.

What are the two types of dysthymia?

Dysthymic disorder is classified by age of onset. Early onset dysthymia begins before age 21, often in childhood. Late onset begins after age 21. Early onset often feels indistinguishable from personality—which is why some older literature discussed depressive personality disorder as a related concept.