Pervasive depressive disorder

Persistent depressive disorder (dysthymia) - Symptoms and causes


Persistent depressive disorder, also called dysthymia (dis-THIE-me-uh), is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.

Because of the chronic nature of persistent depressive disorder, coping with depression symptoms can be challenging, but a combination of talk therapy (psychotherapy) and medication can be effective in treating this condition.

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Persistent depressive disorder symptoms usually come and go over a period of years, and their intensity can change over time. But typically symptoms don't disappear for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression.

Symptoms of persistent depressive disorder can cause significant impairment and may include:

  • Loss of interest in daily activities
  • Sadness, emptiness or feeling down
  • Hopelessness
  • Tiredness and lack of energy
  • Low self-esteem, self-criticism or feeling incapable
  • Trouble concentrating and trouble making decisions
  • Irritability or excessive anger
  • Decreased activity, effectiveness and productivity
  • Avoidance of social activities
  • Feelings of guilt and worries over the past
  • Poor appetite or overeating
  • Sleep problems

In children, symptoms of persistent depressive disorder may include depressed mood and irritability.

When to see a doctor

Because these feelings have gone on for such a long time, you may think they'll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.

Talk to your primary care doctor about your symptoms. Or seek help directly from a mental health professional. If you're reluctant to see a mental health professional, reach out to someone else who may be able to help guide you to treatment, whether it's a friend or loved one, a teacher, a faith leader, or someone else you trust.

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

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The exact cause of persistent depressive disorder isn't known. As with major depression, it may involve more than one cause, such as:

  • Biological differences. People with persistent depressive disorder may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
  • Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
  • Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people

Risk factors

Persistent depressive disorder often begins early — in childhood, the teen years or young adult life — and is chronic. Certain factors appear to increase the risk of developing or triggering persistent depressive disorder, including:

  • Having a first-degree relative with major depressive disorder or other depressive disorders
  • Traumatic or stressful life events, such as the loss of a loved one or financial problems
  • Personality traits that include negativity, such as low self-esteem and being too dependent, self-critical or pessimistic
  • History of other mental health disorders, such as a personality disorder


Conditions that may be linked with persistent depressive disorder include:

  • Reduced quality of life
  • Major depression, anxiety disorders and other mood disorders
  • Substance abuse
  • Relationship difficulties and family conflicts
  • School and work problems and decreased productivity
  • Chronic pain and general medical illnesses
  • Suicidal thoughts or behavior
  • Personality disorders or other mental health disorders


There's no sure way to prevent persistent depressive disorder. Because it often starts in childhood or during the teenage years, identifying children at risk of the condition may help them get early treatment.

Strategies that may help ward off symptoms include the following:

  • Take steps to control stress, to increase your resilience and to boost your self-esteem.
  • Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
  • Get treatment at the earliest sign of a problem to help prevent symptoms from worsening.
  • Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

By Mayo Clinic Staff


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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

Elon Musk has Asperger's Syndrome. What is this disease? Is she being treated? Answering questions

Elon Musk speaks at the presentation of the Tesla Model Y in Hawthorne, California on March 14, 2019

AP Photo/Jae C. Hong

"I know I say or post weird things online from time to time, but that's how my brain works... Did you really think I'd be a simple guy?" With these words, Elon Musk announced that he had Asperger's syndrome - a mental developmental disorder associated with the difficulties of socialization and non-verbal communication. We tell you what it means, how it is diagnosed and how it is treated.


What is Asperger's Syndrome?

Asperger's Syndrome is an autism spectrum disorder. He was named after the Austrian educator Hans Asperger. In 1944, he observed boys who found it difficult to communicate and interact with other people, although they did not lag behind their peers in terms of development and intelligence.

In the 1980s, as human development research grew, scholars returned to Asperger's work. At first, his syndrome was diagnosed as a separate disease, but in 2013, in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, it was classified as an autism spectrum disorder.

This means that now there is no separate diagnosis of "Asperger's syndrome" - there is precisely an autism spectrum disorder, and Asperger's and some others (autism, childhood disintegrative disorder, Rett's syndrome and non-specific pervasive developmental disorder) are already distinguished within it.

During his lifetime, Asperger was not a famous doctor or scientist. And in 2018 it became known that he collaborated with the Nazi regime, sending children with disabilities to cruel euthanasia experiments.


How does Asperger's syndrome manifest itself and what difficulties do people face?

Asperger's syndrome appears at an early age. To the non-specialist, it may seem that a child with this disorder is just behaving strangely. The main difference between Asperger's syndrome and other autism spectrum disorders is well-developed speech skills; but they may present differently in children with the syndrome than in children without it.

Children with Asperger's Syndrome often do not respond to obvious facial expressions, gestures, or figures of speech. For example, they do not recognize that crossed arms are a sign of displeasure. They won't laugh at a joke or smile when they feel joy. They speak in a monotonous voice, without intonations. Do not maintain eye contact with others.

This doesn't mean that people with Asperger's can't empathize with others or don't feel emotions—rather, they don't know how to show it.

Another sign is obsession with one particular topic. Children with Asperger's Syndrome may collect specific items or talk about only one topic, often repeating themselves as if talking to themselves. Such children may have a well-developed rote memory, but have problems understanding abstract things.

On the other hand, fixation and attention to detail makes it easy for people with Asperger's to solve complex problems, especially long-term ones.

People with Asperger's may appear clumsy to others. They may also struggle with changes, even the smallest ones, such as having to move to a different classroom while studying, or being given something different for breakfast.


How common is Asperger's syndrome in the world?

There is no single test to diagnose Asperger's syndrome. A child psychologist, psychiatrist, or developmental psychologist may not immediately detect a disorder in a child because the child does not show clear signs of it in one-on-one conversations with adults. Since Asperger's Syndrome is diagnosed predominantly in childhood, it is rarely diagnosed in adults, but it does happen.

The cause of the disorder is not exactly known. It is believed that heredity plays a role (about a third of the parents of a child with Asperger's syndrome have symptoms close to it), as well as the impact on the body of certain chemicals and viruses.

Due to the difficulties of diagnosing, there is no unified statistics on the prevalence of Asperger's syndrome, and indeed autism spectrum disorders in general.

According to 2015 estimates, about 37.2 million people on Earth had Asperger's syndrome (this is about 0.5% of the world's population). The British National Autistic Society notes that in a country where 700,000 adults have autism spectrum disorders - this is more than 1% of the total population. Almost 90% of all people with Asperger's Syndrome are men, while in women it is usually detected at a later age.


Is there any special treatment required?

Autism Spectrum Disorder is not a curable disease, but specific therapy can improve a person's social skills and, depending on the severity of the disorder, enable them to live fully in society.

There is no one-size-fits-all therapy for Asperger's syndrome, but in general it aims to solve three problems: developing communication skills, getting out of obsessive situations, and controlling body clumsiness.

Therapy is developed, as a rule, by several specialists at once, based on the characteristics of a particular person. There are both individual and group therapies (the latter often used for adults with obsessive-compulsive disorder or depression).

The earlier Asperger's is diagnosed, the more effective the treatment will be. People with the disorder may still have difficulty communicating or interacting as adults, in which case they will need further psychological support to lead an independent life.


Is there any special way to interact with people with Asperger's?

It should be understood that people with Asperger's syndrome are just as eager to socialize as everyone else, but it may be difficult for them to understand and distinguish the emotions of others, as well as to participate in familiar social rituals.

Here are some tips on how to properly treat people with Asperger's:

  • Do not focus on the diagnosis, especially with words like "you can't say you have Asperger's."
  • Do not criticize facial expressions and appearance and do not focus on the "strange" behavior of a person.
  • Don't take too closely what people with Asperger's say, but take them seriously.
  • If you are going out with a person with Asperger's Syndrome, prepare him for meeting other people or unexpected situations by talking about those present and what will happen.
  • Don't make fun of the hobbies of people with Asperger's.
  • If you want to hug someone, ask their permission.

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