Persistent Depressive Disorder

Persistent depressive disorder, or PDD, is a common form of depression characterized by a mild, ongoing depressed mood. PDD is often referred to as chronic depression, due to the long-lasting nature of the symptoms. If you experience depression symptoms lasting longer than 2 years, you may have persistent depressive disorder. Bespoke Treatment provides expert diagnoses and highly personalized treatment plans for individuals with chronic depression. We offer a number of alternative therapy options, including transcranial magnetic stimulation, ketamine treatment, and neurofeedback, in addition to more traditional psychotherapies. Our mental health professionals work with each client to develop a treatment plan that suits their individual needs and goals.

What is Persistent Depressive Disorder?

Persistent depressive disorder is a chronic mood disorder that is characterized by ongoing low or sad mood. Individuals with PDD may lose interest in normal daily activities, have low self-esteem, and have general feelings of inadequacy. Although symptoms of PDD tend to be milder than major depression, the disorder can be significantly debilitating, and individuals may find it difficult to carry out day-to-day activities or enjoy hobbies and pleasurable activities. PDD can impact one’s eating and sleeping habits, personal relationships, and performance in work or school life. Mild degrees of PDD can lead to avoiding opportunities for failure and withdrawing from stress, and more severe cases may lead to withdrawal from daily activities and loved ones.

The subtle and constant nature of symptoms can make the diagnosis of chronic depression difficult. Individuals will often hide their symptoms in social situations and may attribute depressive symptoms to their personality. Chronic depression often co-occurs with other illnesses, including major depression, generalized anxiety disorder, panic disorder, personality disorders, and substance use disorders. Overlapping symptoms of comorbid disorders can also make PDD more difficult to identify or diagnose.

The specific causes of chronic depression are unknown, but the disorder is thought to be related to decreased levels of serotonin, a natural hormone in our brains that regulates emotion and feelings of well-being. Some people may have a genetic predisposition to developing PDD, or the disorder may be triggered by traumatic life events. It is common for people to develop depression after losing a loved one, witnessing a crime, or going through a breakup.

Symptoms of Persistent Depressive Disorder

In order to be diagnosed with persistent depressive disorder, individuals must experience a depressed mood along with two other depression symptoms on most days for a period of at least 2 years. Depression signs and symptoms can include:


  • Feelings of worthlessness or hopelessness
  • Fatigue or lack of energy
  • Low self-esteem
  • Changes in appetite or eating habits
  • Insomnia or hypersomnia
  • Irritability or excessive anger
  • Reduced concentration or difficulty making decisions
  • Difficulty at work or school


The intensity of depression symptoms can change over time, and individual symptoms usually come and go over a period of years. Most individuals with chronic depression have also experienced a major depressive episode at least once in their life. This is known as “double depression”.


How is persistent depressive disorder different from major depressive disorder?

Persistent depressive disorder is commonly confused with MDD or major depression. The symptoms of the two disorders greatly overlap; the key difference is the duration and severity of symptoms. As described above, individuals with PDD experience a long lasting dark mood or depression, and experience symptoms most days for 2 years or more. Individuals with major depression will have depressive episodes that last around a few months, with periods of relief in between. Symptoms of MDD tend to be more severe — this can make major depression more noticeable. The mild and ongoing nature of PDD symptoms can make it harder to diagnose or notice, which can make it more difficult for individuals to seek help or get support from family and friends. Individuals with chronic depression typically face greater stigmatization, and may be described as just having a “dark” or “depressive” personality. 

What are the treatment for Persistent Depressive Disorder?

Luckily, there are numerous treatment options for those with major depressive disorder. Various treatment forms will have a different effect on every individual; recovery is a personal experience. There is no standard for how long it should take to overcome depression – it’s all about finding the right treatment plan for you.

Also called talk therapy or counseling, psychotherapies are the front-line recommended treatment for depression. Talk therapy can teach patients new ways of thinking or behaving and techniques for changing habits and patterns that contribute to depression symptoms. There are many evidence-based therapy approaches to treating depression. These include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal therapy (IPT), and many more.

Antidepressants are daily medications commonly prescribed to treat depression. They alter the levels and interactions of neurotransmitter chemicals within the brain that control mood and stress. There are many different types of antidepressants, such as SSRIs, SNRIs, TCAs, NASSAs, and SARIs. Sometimes antipsychotics are also prescribed to treat depression. Antidepressant and antipsychotics must be taken daily, often come with various side effects, and are not effective for all individuals.

ECT is an alternative option for severe cases of treatment-resistant depression in which electrical impulses are administered to the brain. During ECT, the patient is given muscle relaxant and anesthesia. Side effects of ECT can include disorientation, confusion, and memory loss. Despite its bad reputation, ECT is much more safe and effective now with modern advances in ECT devices and methods. We do not offer ECT at Bespoke Treatment.

FDA-approved for depression in 2008, TMS is a non-invasive brain stimulation process that triggers neural activity with magnetic pulses. This treatment is extremely effective for treatment-resistant depression and is used to treat a variety of other conditions as well. Side effects of TMS can include feeling a knocking sensation or scalp sensitivity during treatment, as well as mild headache that subsides within a few hours. At Bespoke Treatment, we specialize in Express TMS, an optimized form of TMS that can treat depression in as little as 3 minutes per session. 

Ketamine is a relatively new alternative medication for depression that is extremely safe and can cause lasting changes in brain chemistry that lead to long-term relief from depression symptoms. Spravato, the esketamine nasal spray, became FDA-approved as a depression treatment in 2019, and all forms of ketamine administration are found to be highly effective in offering lasting depression relief. At Bespoke Treatment, we offer a variety of ketamine forms, including infusions, Spravato, intramuscular shots, and rapid-dissolve tablets.

Neurofeedback or biofeedback is another alternative treatment option for MDD. Biofeedback is a non-invasive process that helps the patient learn how to regulate their own brain waves. By monitoring brain activity in real time, individuals can receive feedback based on the brain waves they produce and can learn how to control their brain waves on their own in response to different feelings and stimuli.

In addition to formal treatments, there are a variety of ways individuals can adjust their lifestyle or daily habits to improve symptoms of MDD or to complement treatment. These can include physical activity, maintaining a regular sleep schedule, healthy eating habits, avoiding drugs and alcohol, and establishing a strong social network or support system. Many individuals may decide to postpone important life decisions during recovery, such as changing jobs, getting married, or getting divorced.

The conventional treatment for major depressive disorder is a combination of antidepressant medication and therapy. When someone is diagnosed with depression, this is typically the first treatment they will try. While this is effective for some, as many as one-third of people with MDD do not respond to these treatment methods. This is referred to as treatment-resistant depression. While it is not a formal diagnosis, an individual may be classified as having treatment-resistant depression if they have tried at least two months of evidence-based talk therapy, such as CBT, in conjunction with an antidepressant. If this does not initially work, some physicians may decide to try a number of different medications or combinations with a patient. Other physicians may decide to send someone to a facility such as Bespoke Treatment. Our personalized treatment plans can include traditional forms of therapy as well as alternative treatment options that are highly effective for individuals with treatment-resistant depression.

Bespoke Treatment Helps You Overcome Depression

At Bespoke Treatment, we employ a holistic approach to mental health treatment. To start, we conduct a thorough evaluation of your symptoms, overall health, and lifestyle. We then create a customized treatment plan that is tailored to your specific goals and needs to alleviate your symptoms and restore your health and wellness.

We offer FDA-approved and alternative treatments for depression if the traditional approach hasn’t worked for you. If you have experienced side-effects from medication, or just haven’t found the relief that you desire, we have a variety of innovative, short-term options for you, including transcranial magnetic stimulation and ketamine therapy. 

The alternative treatment options we offer, such as TMS and ketamine infusions, are also applicable to other mental disorders. For instance, if you suffer from anxiety, OCD, or PTSD, we want you to know that our treatment methods show promise for those conditions as well.

Call Bespoke Treatment or request a consultation online today for expert, personalized treatment for your depression.


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