(bright music) - Let's talk about dysthymia. Is it dysthymia? That's how you say it? - Yes, and it's called persistent
depressive disorder now, in the DSM-V. - Got it, okay. So, I've heard dysthymia. I have not heard the PDD acronym before. What is that? - So, dysthymia is somebody
who has depression, but at a more lower grade level. It tends to not be as severe as a major depressive disorder
in terms of the symptoms, both in number and in terms of severity, but it does go on for much longer, and so in order to qualify for a persistent depressive
disorder diagnosis, you will have to have
had most of the symptoms most days more often than not for at least a two year period. - Goodness.
- Yes. And so in some ways, it's an almost ignored
pattern of depression. People sometimes just think that this person is being
negative, but actually, they have persistent depressive disorder, and that needs to be treated as well. I think sometimes it
also escapes diagnosis because it's actually much rarer than major depressive disorder. So the prevalence of
major depressive disorder at any given time is about
7% of the population, whereas for persistent
depressive disorder, it's more like half a percent. So I think sometimes people
aren't thinking about that, and they don't know that something like persistent
depressive disorder can actually wreak a lot
of havoc on individuals, and there's even a
smaller subset of people who have both major depressive disorder and persistent depressive disorder, and what that means is, in between the significant and more severe major depressive episodes, they also have an
underlying sort of sadness that is low grade and lasts for more than
two years at a time. - For someone who has
PDD and major depressive, how do you begin to treat that? - So, it's more difficult, and individuals who have what
we call double depression, both diagnoses, do have
a lower recovery rate, and a much higher recurrence
rate, and that's because when the major depressive
disorders resolve, they still have the persistent depressive
disorder to deal with, and so sometimes the medication strategies will have to be altered depending on which one
they're dealing with, whether it's the major depressive disorder or the persistent depressive disorder. Oftentimes, they will need more structured behavioral interventions, and they will need to
be in therapy longer, because you have to address both. So, when you're not fully depressed as in major depressive disorder, you are still having
that low grade depression that prevents you from doing things, maybe gets into the
way of your motivation, impairs your concentration
and functioning, and makes you feel bad about yourself, and so I think those require more of a long-standing treatment approach so that these individuals
are oftentimes in therapy a little longer than somebody who just has one of the conditions. - This PDD diagnosis is
really interesting to me, because especially in our current time of constantly comparing our lives to the unreal lives on
Instagram and social media, it wouldn't surprise me that a lot of people would hear PDD and think, oh, that sounds like me, because it seems like
everyone else is loving it, and never has a bad day. Meanwhile, we know that
we do have bad days, but it only is a half percent
of the population with PDD. So how can someone determine
if they really have PDD or they're just falling
into a comparison trap? - Yeah, and I think that's
really important to talk about, because sometimes people
will say, well, in general, I'm kind of a cynical person. Does that mean that I have PDD? No, when you have persistent
depressive disorder, it's actually impacting
you in a significant level. You have significant clinical distress, or it's impairing you in one
of the major areas of life, whether it's work, social relationships, romantic relationships, or the like. If you just feel like in general, you're a little bit more cynical, maybe you see the negative
side of life a bit more, but in general, you're
still able to function, get up every day, and still be able to go about
your day with little problems, you do not have PDD. It's interesting because people
have actually talked about this theory called depressive realism, that some individuals are a little bit more prone
to feeling depressed from time to time because
they're realistic, and in fact, people who are
not as prone to depression are actually a little maybe
too rose-colored glasses. Maybe it's almost like they
just expect things to work out and that's why they're not so depressed, and so it's an interesting theory that not everybody agrees with, but it's sort of this idea of, if you actually make contact with the real challenges of life, you're going to feel
depressed from time to time but that's kind of the idea, and so this is not somebody who, you know, generally kind of has a little bit more cynical view on life, or every once in a while, they have a couple of depressed days. We're talking about
somebody who, for two years, for more days than not
during those two years, that they have these symptoms of sadness and low grade depression that
impairs their functioning, or is extremely distressing
to the individual, and that's when we should
consider a PDD diagnosis. - How does... I hear all the time that depression and anxiety co-occur together almost more than any other
two mental health conditions. What is the role of anxiety
for somebody living with PDD? - The role of anxiety for
someone living with PDD is oftentimes their
judgment on themselves. You know, oftentimes,
they're feeling like, how come I'm not getting better, right? Because, again, in some ways, somebody with persistent
depressive disorder, it's even more difficult to manage, because you're always a little depressed, and so I think that sometimes
the anxiety will play a role, and in fact, that is one of the specifiers of both major depressive disorder and persistent depressive disorder, that when it's clinical enough, that there is a specifier
called "with anxious distress," and what that means is this is somebody whose
depression co-occurs the same time as their anxiety symptoms, and because the two are so interrelated, sometimes you find individuals whose depression and anxiety
are really discrete diagnoses. Like, maybe they have a
generalized anxiety disorder and a major depressive disorder, and then you have individuals who just have a few anxiety symptoms, like feeling on edge, being keyed up, having a lot of worries,
difficulty concentrating, that accompanies their depression every time they have an episode. So we talk about those individuals as a specifier of "with anxious distress" that co-occurs with their
depression condition. - If you were talking with your therapist and the therapist says, "Look, Kyle, I know you think you have PDD, but I'm telling you,
you don't, it's this," but you really believe it's PDD, at what point should you
just say, you know what, I'm not the doctor,
they're probably right, or should I move on and
get a second opinion? - I always think it's helpful
to get a second opinion. - Really? - I always do, and I think it depends on
your therapist's specialty. Some therapists really do review the DSM, keep up with the research,
and really understand these finer points of diagnoses,
and other therapists don't. Other therapists are just more focused on dealing with the symptoms, and they don't actually invest as much in the diagnostics of the condition, and so you may need to move on to somebody who does that for a specialty. So many psychiatrists would say that they are excellent diagnosticians. A neuropsychologist would be
an excellent diagnostician, but sometimes therapists
who do mostly work on an individual level,
individual basis of therapy, they may or may not
concern themselves as much with the exact diagnosis that you have. (bright music)
