Persistent depressive disorder (formerly known as Chronic Depression) is defined in the DSM–5 as a depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
A confirmed episode of depression can last between six months and a year. Depression lasting longer than this is referred to as recurrent depressive disorder, followed by the chronic form which is persistent depressive disorder.
These mood problems may follow a significant event such as a bereavement or losing a job. In this case, this is the progression of reactive depression, rather than persistent. Persistent depressive disorder can arise for no apparent reason.
Confirmed episodes of depression primarily involve:
- major fatigue;
- sadness, associated with a negative outlook on life and the future;
- loss of interest and enjoyment in any type of activity;
- difficulty concentrating.
These symptoms may also be accompanied by sleep-related issues (insomnia or hypersomnia) and appetite problems (weight loss or gain), headache, feeling of guilt or even, in the more serious cases, of suicidal behavior.
PERSISTENT DEPRESSIVE DISORDER: TREATMENT
Treatment for persistent depressive disorder is similar to that for episodes of depression, but it has a number of differences. It could involve various types of therapy: therapeutic education, psychotherapy, treatment with medications and, in the most severe forms, psychiatric hospitalization.
Electroconvulsive therapy (treatment using an electrical current) is only considered as a last resort and is only performed by a specialist. Luminotherapy may be used for seasonal depression, but only subject to advice by a doctor.
Therapeutic education is crucial and aims to improve the daily life of the patient. The patient should understand their illness, the signs that it is getting worse and the importance of medicinal and non-medicinal treatments. They should certainly learn to recognize their adverse effects.
In addition, successful care for depression involves the effective monitoring of the patient, which is why psychotherapy is key. The patient leading a healthy lifestyle is also important: regular sleeping patterns and physical exercise are essential.
Ultimately, treatment with antidepressants should be adapted to the patient’s state of health. Antidepressants should only be provided following coordination between the patient’s PCP and psychiatrist. Treatment with antidepressants should be followed up regularly and particularly rigorously, and must be re-evaluated and adapted as the illness progresses. Treatment compliance is also crucial in preventing recurrence.
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