Persistent Depressive Disorder (Dysthymia): Signs and Help

Clinically reviewed byMst. SwampaSenior Clinical Psychologist · MS & M.Phil in Clinical Psychology (University of Dhaka) · BCPS memberLast reviewed October 2026

Persistent depressive disorder (PDD), once called dysthymia, is a long-lasting form of depression in which low mood is present on most days for at least two years (one year in children and teens). It is often milder than a major depressive episode, but because it lasts so long, many people stop noticing it and assume it is simply their personality. It is a recognised, treatable condition, and therapy, sometimes with medication prescribed by a psychiatrist, helps most people feel noticeably better.

People living with it often describe it in very similar ways: “I have always been like this”, “ami kokhonoi khub khushi chhilam na”, “nothing is terribly wrong, but nothing feels good either”. If that sounds familiar, this guide explains what persistent depressive disorder is, how it differs from ordinary sadness and from major depression, and what actually helps in Bangladesh.

What persistent depressive disorder feels like

Unlike a major depressive episode, which can feel like falling into a hole, PDD tends to feel like living under a grey sky that never quite clears. Days are manageable. You go to work or class, you look after family, you laugh at the right moments. But underneath, a low hum of heaviness stays switched on for months and years.

Common signs include (Cleveland Clinic):

• Low or flat mood on more days than not, for two years or longer.
• Low energy or constant tiredness, even after rest.
• Poor appetite or overeating.
• Sleeping too little or too much.
• Low self-esteem and a harsh inner critic.
• Trouble concentrating or making decisions.
• A sense of hopelessness about the future, often described as “what is the point”.

To meet the clinical definition, symptoms should not have cleared for more than two months at a time during that period. Many people also notice that they cannot remember the last time they felt properly well, which is one of the strongest clues.

Dysthymia vs major depression: what is the difference?

The main differences are duration and intensity. Major depression is defined by a period of at least two weeks of intense low mood or loss of interest, plus other symptoms, that clearly breaks from how you normally are. Persistent depressive disorder is lower in intensity but far longer, and it often begins quietly in the teenage years or early adulthood.

The two can also overlap. Some people with PDD go through a full major depressive episode on top of their usual low baseline. Clinicians sometimes call this “double depression”. When the episode lifts, the person returns to the grey baseline rather than to feeling well, which is why treatment should aim for real recovery, not just getting back to “normal for me”. You can read how PDD sits alongside other forms in our guide to the types of depression.

A 2020 review in Lancet Psychiatry describes persistent depressive disorder as common and often more disabling than episodic major depression, and notes that dysthymia is frequently missed in both psychiatric and general medical settings until it intensifies into a full major depressive episode (Schramm et al., 2020). In other words, the quiet version is not the harmless version.

Persistent depressive disorder criteria, in plain words

Clinicians use the DSM-5 criteria (or ICD-11, where it is called dysthymic disorder, code 6A72; in the older ICD-10 it was F34.1). In everyday language, persistent depressive disorder is diagnosed when:

• You have felt low or depressed for most of the day, on more days than not, for at least two years (one year for children and teenagers, where the mood can look more irritable than sad).
• During that time you have had at least two of these: poor appetite or overeating, sleeping too little or too much, low energy or tiredness, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.
• You have not had a break of more than two months without these symptoms.
• The symptoms cause real distress or get in the way of work, study, family life or relationships, and are not better explained by another condition, medication or substance use.

Some people also have episodes of major depression on top of the long-term low mood, sometimes called “double depression”. This list helps you understand the diagnosis, but only a trained clinician can make it after a proper assessment.

Why it is so often missed in Bangladesh

In our clinical experience, persistent depressive disorder is one of the most under-recognised conditions we see. A few reasons come up again and again:

• It looks like personality. Families say “o to emonei, chupchap” (she has always been quiet) or “he is just a serious type”. Years of low mood get filed under temperament.
• People keep functioning. Because there is no dramatic collapse, nobody, including the person themselves, thinks of it as an illness.
• The body speaks first. Tiredness, headaches and poor sleep lead to many GP visits and vitamin tests before anyone asks about mood.
• “Be grateful” culture. If life looks fine on paper (a job, a family, a home), admitting to years of quiet misery can feel ungrateful or shameful.

If you recognise yourself in this list, it is worth knowing that a long-standing low mood is not a character flaw and it is not something you simply have to accept.

How it looks in children and teenagers

In young people, persistent depressive disorder can be diagnosed after one year rather than two, and it often does not look like sadness at all. The more common picture is irritability: a child who snaps at everyone, sulks for days, and is labelled “badmejaji” or rude. Other signs include constant tiredness, complaints of headaches or stomach aches before school, slipping marks, giving up on hobbies and saying things like “I am useless” or “nobody likes me”.

Because it builds slowly, parents often read it as attitude, laziness or too much phone use, and respond with more pressure. If your child’s mood has been low or prickly for most of the past year, a calm conversation and an assessment are better first steps than stricter rules. Our parents’ guide to teenage depression explains how to raise it at home.

What causes persistent depressive disorder?

There is rarely one cause. Most people have a mix of factors:

• Biology and family history: depression and other mood conditions often run in families.
• Early adversity: a difficult childhood, harsh criticism, neglect or loss can set up a low baseline that lasts into adulthood.
• Chronic stress: long-running pressures such as financial hardship, a difficult marriage, caring for an ill parent or years of exam and job pressure.
• Thinking patterns: deep-rooted beliefs such as “I am not good enough” or “things never work out for me” that keep mood low.
• Physical health: thyroid problems, anaemia and some long-term illnesses can mimic or worsen low mood, so a basic medical check-up is sensible.

How persistent depressive disorder is treated

The good news is that PDD responds to treatment, even after many years. The usual approach includes:

Psychological therapy

Talking therapies such as Cognitive Behavioural Therapy (CBT) help you spot and change the long-practised thinking habits that keep mood low, and rebuild routines that bring back some pleasure and energy. Interpersonal approaches help with the relationship patterns and losses that often sit underneath. Because the pattern is long-standing, therapy for PDD usually takes a little longer than for a single episode, often several months of regular sessions.

Medication, when needed

For many people with persistent or double depression, a combination of therapy and antidepressant medication works better than either alone. Medication is always assessed and prescribed by a psychiatrist (a medical doctor), who will explain the options and monitor how you respond. If you are new to this, our guide on starting antidepressants explains what the first weeks are usually like. Never start, change or stop a medicine on your own, and never stop suddenly; any change should be planned with your doctor.

Everyday supports

Regular sleep and wake times, daylight and movement, steady meals, and reconnecting with even one or two trusted people all support recovery. They are not a replacement for treatment, but they make treatment work better. Our guide on what recovery from depression really looks like describes the gradual, uneven way improvement usually arrives.

Staying well after you improve

Because persistent depressive disorder has usually been around for years, the old habits of thought and routine can creep back once life gets busy again. It helps to plan for that from the start:

• Know your early signs. For many people the first clue is sleep slipping, withdrawing from friends, or the inner critic getting louder. Write yours down while you feel well.
• Taper sessions, do not stop abruptly. Moving from weekly to fortnightly to monthly check-ins gives you a safety net while you practise the skills alone.
• Keep the basics that worked during treatment, such as fixed wake times, daylight and regular contact with people you trust.
• Return early, not late. A booster session when the grey starts returning is far easier than waiting for a full episode.

When your mood is low, even small things feel big. This tool helps you pick one small, doable step for today.

When to seek help

Consider speaking to a licensed psychologist if you have felt low, flat or hopeless on most days for a long time, if you cannot remember feeling properly well, or if the low mood is quietly costing you at work, in your studies or in your relationships. You do not need a crisis to deserve support. A short self-check or a structured depression assessment can be a useful first step.

If the heaviness ever turns into thoughts of ending your life or harming yourself, treat it as an emergency: call 999 or go to the nearest hospital emergency department right away.

Chum Wellness offers confidential depression treatment and counselling in Dhaka and online across Bangladesh, in Bangla or English, with psychiatrists available when medication needs to be considered. Book a confidential session when you feel ready.

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