Persistent Depressive Disorder / PDD
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How is High-Functioning Depression Diagnosed?
The Signs & Symptoms of High-Functioning Depression
What Happens During a Major Depression Episode (MDE)?
High-functioning depression is a lay term often used in clinical psychiatry, but it is not a recognized disorder in itself, unlike “major depressive disorder” – the most common form of clinical depression.
However, people with high-functioning depression – who are clinically assessed as being “depressed” and who are still able to function relatively normally – are typically diagnosed with the medical condition “persistent depressive disorder” – often abbreviated to PDD, and previously known as “dysthymia.”
Although not as severe as major depressive disorder (MDD), without a correct diagnosis and professional treatment, high-functioning depression can have serious consequences. For example, individuals with high-functioning depression still suffer many of the symptoms of MDD.
What is High-Functioning Depression?
High-functioning depression is typically diagnosed as persistent depressive disorder / PDD – a recognized mental health disorder that should be diagnosed by a qualified psychiatrist or other mental health professional.
Specific criteria, as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), exist to describe the symptoms of the disorder, and these need to be met for a formal diagnosis to be made.
As we mentioned previously, many of the symptoms are similar to those used to diagnose major depression, but are generally less severe. One notable feature of persistent depressive disorder, for example, is that the condition lasts for a minimum of 2 years.
How is High-Functioning Depression diagnosed?
The first criterion for persistent depressive disorder (PDD) is the individual experiences a depressed mood on most days, and feels that way for most of the day, and these symptoms must continue for a minimum period of two years.
In addition, the depressed mood must include 2 or more of the following symptoms:
- Decreased appetite or overeating
- Irregular sleeping patterns, such as insomnia or oversleeping
- Lack of energy and fatigue
- Lowered self-esteem
- Difficulty concentrating and making decisions, and
- Feeling sad and hopeless
Furthermore, there are a few other criteria that also have to be met to make a formal diagnosis of PDD:
- The depressed mood characterized by the above symptoms must occur on most days for at least 2 years, without any relief from the depression for longer than two months during that period
- The individual has never experienced a period of mania or hypomania – an unusually euphoric and energetic mood
- The depression symptoms cannot be better explained by another mental illness, by a medical condition, or by substance abuse
- The symptoms and depressed mood must cause some impairment in one or more areas of normal daily functioning, and must also be the cause of significant distress in the individual
- A person diagnosed with PDD can also meet the criteria for major depression disorder (MDD)
What is the difference between persistent & major depressive disorder?
According to the National Institute on Mental Health (NIMH), persistent depressive diseorder (PDD) affects around 1.5% of adults in the U.S. with women more likely to experience the disorder than men.
According to the National Institute on Mental Health (NIMH), persistent depressive disorder (PPD) affects around 1.5% of adults in the U.S. with women more likely to experience the disorder than men.
Major depressive disorder (MDD), on the other hand, is far more common. In fact, it is one of the most common mental health disorders in the U.S., affecting around 7.1% of adults across the nation.
A primary difference between the PDD and MDD is their duration. For a psychiatrist or another qualified mental health professional to diagnose PDD in an adult, symptoms must have lasted for at least 2 years, whereas adults with MDD experience major depressive episodes (often abbreviated to MDEs) with a gap of at least 2 months between them.
With regard to their actual symptoms, both disorders have many similarities, and an individual can have several symptoms of both disorders at the same time.
The signs & symptoms of High-Functioning Depression
As we have described previously, the signs and symptoms of high-functioning depression (PDD) are similar to those caused by major depressive disorder (MDD), but are less severe.
The signs and symptoms generally include changes in both eating and sleeping habits, fatigue, hopelessness, low self-esteem, and difficulty concentrating, although this can vary between individuals.
Symptoms will persist on most days, causing a near-constant depressed mood that lasts for 2 years or more. Many people with PDD can function almost normally, but their internal struggle is near-constant, too.
Known signs & symptoms of High-Functioning Depression
- Loss of interest in daily activities
- Sadness, emptiness or feeling down
- Difficulty concentrating and making decisions
- Irritability or excessive anger
- Sleep problems
- Tiredness and a lack of energy
- Low self-esteem and self-criticism
- Avoidance of social activities
- Decreased activity, effectiveness and productivity
- Feelings of guilt, worries over the past
- Poor appetite or overeating
Causes, risk factors & complications of high-functioning depression
As with many mental health disorders, the exact cause of high-functioning depression is not yet known. As with major depressive disorder, it may well involve more than just one solitary cause.
These are the most common of the known potential causes of high-functioning depression:
- Inherited / Genetic: High-functioning depression appears to be more common in people whose blood relatives also have the condition. However, researchers are still trying to find and identify the specific genes that may be involved.
- Trauma / Stressful Life Events: As with major depression, traumatic events, such as the loss of a loved one, family issues, financial problems or anything else that exacts overwhelming stress on the individual, can cause types of depression in some people.
- Biological / Changes in Brain Structure: People with high-functioning depression may have experienced physical changes in their brains, such as a structural alteration. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
- Brain Chemistry: Another potential brain-related cause is the chemistry of the brain. Neurotransmitters are naturally occurring brain chemicals that likely play a significant role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters may play a significant role in depression, and therefore, its treatment.
Known Risk Factors:
Persistent depressive disorder is a chronic condition, often beginning early in an individual’s life – childhood, adolescence or young adult life. According to mental health researchers, specific factors appear to increase the risk of developing high-functioning depression.
These factors include:
- A first-degree relative, ie. a parent, sibling or child, with major depressive disorder (MDD) or another type of depressive disorder
- Traumatic or stressful life events, such as family bereavement, abuse or violence
- Personality traits such as constantly low self-esteem, or being too self-critical or pessimistic
- A history of other mental health disorders, such as a personality disorder
High-Functioning Depression: Potential Complications
- Major depression, anxiety disorders and other mood disorders
- Reduced quality of life
- School or work-related issues and decreased productivity
- Chronic pain and general medical illnesses
- Personality disorders or other mental health disorders
- Relationship difficulties and family conflicts
- Suicidal ideation (thoughts of suicide) or behaviors
Living with High-Functioning Depression
Anyone living with high-functioning depression / persistent depressive disorder (PDD) is also at significant risk of experiencing episodes of major depression, known in short as MDEs.
In fact, most people with high-functioning depression will have one such episode at least once in their lives. For some people with this type of depression, it may feel as though the persistent, low-level depression could take a turn into severe depression at any time.
While the two conditions are similar, and can even occur in the same person, there are some significant differences, as we discussed earlier – most notably in duration and severity.
These differences normally result in someone with high-functioning depression being able to function at a higher, less restricted level than someone with major depression, which in severe cases can be completely debilitating.
What Happens During a Major Depression Episode (MDE)?
A major depressive episode (MDE) is a period of 2 weeks or longer in which a person experiences certain symptoms of major depression, which include:
- Feelings of sadness and hopelessness
- Weight gain or weight loss
- Changes in sleeping habits
- Loss of interest in activities, and
- Suicidal ideation ( thoughts of suicide)
These symptoms are constant for the 2 weeks or so, and cannot be easily changed, even if they are seemingly contradictory to a person’s circumstances. MDEs recur periodically in people diagnosed with major depression, and less frequently for those with high-functioning depression.
Although there are normally slight differences between those suffering a MDE, there are more obvious differences between men and women. Men are more likely to express anger and irritability, and will often make risky choices and decisions, whereas women are more likely to feel sad, guilty, and ashamed.
In rare cases, a MDE can even cause psychotic symptoms, such as delusions and paranoia.
For an individual with high-functioning depression, the only periods in their lives when their level of functionality drops significantly are during major depressive episodes (MDEs). In practical terms, this can mean:
- Poor performance at work / in school
- Unable to complete normal responsibilities
- Drop out of activities they usually participate in and enjoy
- Drop in their level of self-care and personal hygiene, and
- Become socially withdrawn
It is important for someone to take the following steps to cope with a MDE, even if they feel like nothing will work. These steps can limit the severity of the symptoms, and can even reduce the MDE’s duration:
- Therapy Sessions: Just like a car, sometimes people need tune-ups. When there are signs of worsening depression, it is important to talk to a professional.
- Medications: Antidepressants should never be discontinued without a doctor’s guidance, as quick cessation can cause a harmful withdrawal process. Patients should always be consistent with medications, even as they begin to feel better.
- Social Support: During an episode of major depression, reaching out may be the last thing a person wants to do, but it does help significantly.
- Self-care: Extra attention to self-care is so important as soon as a MDE begins. This may include attending therapy or support groups, avoiding alcohol, practicing meditation or yoga, actively challenging negative thoughts, or simply doing activities that are relaxing or enjoyable.
- Healthy Habits: Eat a healthy diet, try to get enough sleep, get plenty of exercise, and avoid drugs and alcohol.
- Go Outside: Sunlight and being outside in nature are proven mood boosters. While this won’t cure depression, it can certainly help a little.