Persistent Depressive Disorder in Children
What is persistent depressive disorder?
Persistent depressive disorder is a type of affective disorder. It is also called
mood disorder. It 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
Depression is a mood disorder that involves a child's body, mood, and thoughts. It
can affect and disrupt eating, sleeping, or thinking patterns. It is not the same
as being unhappy or in a "blue" mood. It is also not 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 3 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% of 13- to 18-year-olds.
What are the symptoms of persistent depressive disorder?
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
Feelings of wanting to die
Difficulty with relationships
Sleep disturbances (like insomnia or hypersomnia)
Changes in appetite or weight
Irritability, hostility, aggression
A decrease in the ability to make decisions
Suicidal thoughts or attempts
Frequent physical complaints (like 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 last for at least 1 year in children or adolescents. It must be accompanied
by at least 2 other major depressive symptoms. The symptoms of persistent depressive
disorder may resemble other medical problems or psychiatric conditions. Always talk
with your adolescent's health care provider for a diagnosis.
How is persistent depressive disorder diagnosed?
Depression has been shown to often coexist with other psychiatric disorders, like
substance abuse or anxiety disorders. 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 complete 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 decided 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 medicines 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 complete evaluation of the adolescent
and family. Treatment may include 1, or more, of the following:
Antidepressant medicines. These have been shown to be very effective in the treatment
of depression in children and teens, especially when combined with psychotherapy.
Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the
adolescent. This should focus on changing the adolescent's distorted views of himself
or herself and the environment around him or her. It should also help him or her work
through difficult relationships. Identifying stressors in the adolescent's environment
and learning how to avoid them should be another goal of the adolescent's psychotherapy.
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 another depressive episode.
Because episodes of persistent depressive disorder may last for longer than 5 years,
long-term, continued treatment may help to prevent the depressive symptoms from returning.