The difference between major depressive disorder and persistent depressive disorder

Life can be unpredictable and challenging with financial stress, relationship issues, and work pressures. While it’s normal to go through rough patches, persistent feelings of sadness and hopelessness lasting two weeks or more can be a sign of depression.

Major depressive disorder (MDD) and persistent depressive disorder (PDD) are two common forms of depression that can impact all aspects of a person’s life, including their physical health.

It’s important to understand that depression is an illness and not a sign of weakness. Those affected by mood disorders can’t just “shake off” their symptoms. Effective treatments — including talk therapy, lifestyle changes, and medication — can help people with depression address underlying causes, develop coping strategies, and lead happy and fulfilling lives.

What’s the difference between MDD and PDD? 

While MDD and PDD share some symptoms, the main differences between the two are duration and severity of symptoms. For example, people with MDD will typically cycle through periods of depression and then be free of symptoms for periods of time. On the other hand, people with PDD experience persistent depression symptoms that last for years. 

MDD is a common mood disorder that affects 22.5 million Americans each year. With MDD, severe symptoms occur in periodic episodes that last at least two weeks. More women than men are diagnosed with MDD.

People with PDD have ongoing, long-term symptoms of depression that aren’t as severe as MDD symptoms. To receive a diagnosis of PDD, you must have experienced a combination of symptoms for two years or more if you’re an adult (a year or more for children) and not been symptom free for more than two months at a time. 

PDD is more common in women than in men and occurs more frequently in those with a family history of PDD. PDD symptoms can begin in childhood and continue into adulthood. An estimated 2.5% of adults in the U.S. experience PDD at some point in their lives.           

How to tell symptoms apart

Although PDD and MDD are both types of depression that share an overlap in symptoms, there are subtle differences. Someone with PDD may experience being easily overwhelmed during stressful situations consistently, while this would only be true for those with MDD during a depressive episode. 

The symptoms of MDD include: 

• Feeling depressed for most of the day
• Having less interest and pleasure in activities you previously enjoyed
• Feeling worthless or guilty
• Experiencing fatigue
• Losing or gaining a significant amount of weight unintentionally
• Having problems sleeping or sleeping too much
• Experiencing a type of restlessness called psychomotor agitation or finding it difficult to think, speak, and do everyday things (psychomotor impairment)
• Having frequent thoughts of death

The symptoms of PDD include: 

• Feeling depressed or irritable
• Having a poor appetite or overeating
• Sleeping too much or experiencing insomnia
• Experiencing fatigue or low energy
• Feeling low self-esteem
• Having trouble concentrating or making decisions
• Feeling hopeless

Comparing the causes 

MDD and PDD are two forms of depression, each with distinct causes and characteristics. Research indicates that experiencing adverse childhood experiences (ACE) may increase your risk of developing MDD or PDD. ACEs include experiencing abuse, losing a loved one, or having a severe illness or injury in childhood.

While experts aren’t sure of all the causes of MDD and PDD, there’s some evidence that genetic, biological, environmental, and psychological factors play a role. 

Genetics

There is strong evidence that genetics play a role in MDD, with about 40% to 50% of the risk being inherited from family members. People who have a first-degree family member with MDD are at an increased risk of developing the condition.  

While genetics also play a role in PDD, the risk inherited from family members is lower than with MDD. However, people with a family history of mood disorders are still at a higher risk of developing PDD.

Onset 

For MDD, a sudden onset of symptoms can be triggered by a significant life event (like the death of a loved one, abuse, or divorce), with symptoms that are severe but episodic, lasting at least two weeks.

The onset of symptoms is more gradual with PDD than MDD. While the symptoms of PDD are milder than with MDD, this lower level of depression lasts at least two years in adults.

Personality traits

The inability to manage stress well can increase your risk of developing MDD. Low-self esteem, a reliance on others, and a pattern of negative thinking are more common with PDD.

Which condition is more severe? 

Although MDD is considered a more severe form of depression, PDD can also be disabling because the symptoms are never gone for longer than two months. People with PDD often report that their symptoms negatively impact their work and social lives. 

MDD is defined by the severity of the symptoms and the ways that these symptoms impact the day-to-day life of those in a depressive episode. One of the distinct aspects of MDD is that physical symptoms are common with MDD and can include chronic pain, fatigue, gastrointestinal problems, and changes in appetite.  

Distinctions in treatment 

Treatment for both MDD and PDD is tailored to address the severity of symptoms. Psychotherapy, also known as talk therapy, is an effective treatment for both conditions and is sometimes combined with medication.

Types of psychotherapy that may be used include:

• Cognitive behavioral therapy (CBT) is used to treat both MDD and PDD. This type of therapy helps people reshape negative thoughts and behaviors that negatively affect mood.
• Dialectical behavior therapy (DBT) can help manage the constant low-level symptoms of PDD by teaching mindfulness and distress-tolerance skills.
• Interpersonal therapy (IPT) can help people who develop MDD after a major life event, like losing a job or going through a divorce, better understand and manage their depression triggers.

Your therapist may also recommend group therapy as a source of support and suggest lifestyle changes, like regular exercise, a healthy diet, and healthy sleep habits. These approaches can complement talk therapy and help you manage your depression symptoms. 

Can you have both MDD and PDD? 

In some cases, MDD and PDD can occur together. Some people refer to this as “double depression,” and it occurs when someone meets the depression symptom standards for both MDD and PDD. People with PDD are at a greater risk of developing MDD, so some people with PDD experience periodic episodes of major depression. 

For those experiencing MDD and PDD, instead of returning to a status quo between depressive episodes, they go from a severe depressive episode and return to their baseline low mood. Having both MDD and PDD can lead to more severe depression symptoms. It can also cause a worsening of symptoms like sleep and appetite disturbances, fatigue, and loss of energy. 

Find care with Rula 

If depression is taking a toll on your overall health and well-being and impacting your daily life, consider working with a mental health professional.

At Rula, our extensive network includes therapists who specialize in treating mood disorders, including MDD and PDD. In less than a minute, you can match with a therapist who understands your specific needs. With just a few clicks, you can choose a provider who accepts your insurance and schedule your first appointment for as soon as tomorrow.

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