What is Persistent Depressive Disorder? 

Mental health is often misunderstood and there is an unfortunate stigma that perpetuates, especially in the Jamaican society, that a person with a mental health issue is “mad”. When many people picture someone mentally ill, their initial assumption is someone homeless, physically unkempt, talking to themselves, dirty and engaging in antisocial behaviors. This harmful stereotype couldn’t be furthest from the truth.

Mental illness does not discriminate and can affect anyone from any walk of life.  In an attempt to break one of the many stereotypes, a discussion of high functioning depression needs to happen, and we can start here. For many, when they think of depression they think of someone who doesn’t leave their bed and is extremely sad. This is the reality for many depressed people but not all. Depression is not one-size-fits-all, it can affect individuals in varied ways, and as such, high functioning depression is a very likely experience.

Another term for high functioning depression is Persistent Depressive Disorder (PDD), otherwise known as dysthymia. High-functioning depression essentially means that individuals are able to navigate their daily lives in ways that may be deemed ‘normal’. This means they get out of bed every day, go to work or school and generally appear as content. These individuals are able to put on a good show, but what many do not know is that they are actually suffering psychologically, struggling to deal with going through each day. Going further, individuals with high-functioning depression may not perceive themselves as depressed, opting out of seeking help because they do not believe that they fit the stereotype.

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What does high functioning depression look like?

High functioning depression can look like a student with high grades, an athlete doing well, a successful CEO, anyone really. This person may be popular and attends social activities every week, seemingly having everything under control in their life. The struggle for these people is generally internal.  For example, even though they attend these social events, they likely had to muster up a lot of mental strength and prepare themselves to do so.

Here are a few signs of high functioning depression:

1. Lack of joy in things you usually enjoy.
   
2. The negative self-talk that is basically impossible to turn off. This involves feeling like a failure and or feelings of worthlessness.
   
3. Decreased energy
   
4. Irritability or excess anger
   
5. Guilt and anxiety towards the future
   
6. Disproportionate stress responses – In Jamaican terms “every likkle ting a bodda yuh” if you spilled something or a minor issue occurs, you feel as though it was the most terrible thing to happen.
   
7. An inability to slow down – You don’t want to slow down and deal with your thoughts that come to you when you relax.

People with high functioning depression are more likely to believe they can “will their way” out of depression and won’t seek help. People with high functioning depression also tend to develop other disorders such as eating disorders in an attempt to cope with it.

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What is Persistent Depressive Disorder?

Persistent Depressive Disorder is referred to as a less severe, but more chronic, form of major depression. Not everyone that has PDD is high functioning, but it is strongly correlated.  In order to be diagnosed with PDD, one would have to have the symptoms for two years if they are adults, and a year if they are a child or adolescent. The symptoms are basically the same as major depressive disorder. Here is a highlight of the more prevalent signs:

The symptoms are basically the same as major depressive disorder. Here is a highlight of the more prevalent signs:

1. Low mood for most of the day and for most days. In adolescents, a sad mood may accompany irritability.
2. Problems with sleep – either sleeping too little or too much, sleep disturbances
3. Feelings of hopelessness
4. Low self-esteem
5. Low energy or fatigue
6. Problems with eating – eating too little or too much

While PDD isn’t as severe as major depressive disorder, untreated PDD is known to cause an episode of major depression. This would be called ‘double depression’.

Causality of Persistent Depressive Disorder

While there is no known root cause, PDD may be significantly linked to genetics and other predispositions, such as biochemical, environmental and psychological. Experiencing stress and trauma, especially continuously, may also provoke the occurrence of PDD. It is important to note that stress aggravates this disorder because it affects the body’s ability to regulate mood and thus, the body has issues preventing mild sadness from worsening. Isolation, as well as lack of social support, are also significant triggers.

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Treatment Options for Persistent Depressive Disorder

Treatment for PDD is strongly encouraged as it has the potential to be harmful and fatal if left untreated. The most common treatment options suggested are psychotherapy and medication. Psychotherapy is also said to be more effective than medication in the prevention of a relapse, however, both psychotherapy and medication are necessary for some individuals diagnosed with PDD.

The types of psychotherapy that can be useful are supportive therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy and interpersonal therapy (IPT).  For example, the CBT tackles negative thinking, while supportive therapy provides the patient with certain skills and provides empathy among other things. While symptoms often return, treatment is always a recommendation.

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