https://www.healthcentral.com/condition/chronic-depression
DepressionDepression TypesChronic Depression

Let's Talk About Chronic Depression

Learning what makes this type of long-term depression unique can alleviate some self-blame—no, you’re not just “negative”—and help you stay focused till you find the best treatment.

    Our Pro PanelChronic Depression

    We asked some of the nation’s top depression experts to bring you the most up-to-date information possible.

    Charles B. Nemeroff, M.D., Ph.D.

    Charles B. Nemeroff, M.D., Ph.D.Chief Medical Officer of the Anxiety and Depression Association of America, Professor and Chair of Psychiatry at Mulva Clinic for the Neurosciences

    Dell Medical School, The University of Texas
    Austin, TX
    Seema Desai, M.D. headshot.

    Seema Desai, M.D.Clinical Assistant Professor, Psychiatrist

    Department of Child and Adolescent Psychiatry, NYU School of Medicine; NYU School of Medicine WTC Health Program Clinical Center of Excellence
    New York, NY
    Carol A. Bernstein, M.D.

    Carol A. Bernstein, M.D.Psychiatrist, Vice Chair for Faculty Development and Well-Being in the Departments of Psychiatry and Obstetrics and Gynecology

    Montefiore Medical Center/Albert Einstein College of Medicine
    The Bronx, NY

    Frequently Asked QuestionsChronic Depression

    What’s the difference between major depressive disorder and chronic depression?

    Just the duration, really. For a diagnosis of MDD, depressive symptoms must last a minimum of two weeks (though research puts the median duration at six months). Chronic depression (a.k.a. persistent depressive disorder, or PDD) lasts a minimum of two years, but often lingers much longer and is quick to return. Many people with chronic depression tend to slog through life with smoldering low-level symptoms all the time. Contrast that with people who have MDD. Their baseline mood is normal, interrupted by a depressive episode. After treatment, they return to a symptom-free life. (You can also have both, which docs call “double depression.”) However your depression presents itself, know that it can hang around—or keep coming around—forever, if it’s left untreated.

    Does chronic depression last forever?

    It certainly doesn’t need to. Let’s do the depressed-person thing and look at this in a glass-half-empty manner: Research shows that 12% of people with chronic depression did not recover after five years. That sucks! But what if you focus on the people who did get better? That’s 78% of chronically depressed people who actually reached remission after five years. And though it took a while to get there, that’s not too shabby. We’ve yet to speak to the doctor or mental health professional who considers PDD (persistent depressive disorder) a life sentence. The only way to ensure that your chronic depression stays chronic is to avoid dealing with the issue—so be sure to get in treatment, and stay in treatment, for as long as it takes.

    People say my negative attitude is what’s making me depressed. How can I fix it?

    Look, a negative attitude can’t make someone depressed, but depression can give someone’s worldview a negative spin. If simply telling someone to have a positive attitude worked, every depressed person would magically be cured by a pep talk from a well-meaning friend. That said, there are ways to challenge irrational thoughts and beliefs (docs call them “cognitive distortions”) that lead to negative thinking. Next time you catch yourself in a pessimistic loop (i.e., “Nobody loves me”), ask yourself how true that statement is. Maybe your mom or dad or other relative loves you. Maybe your dog or cat does. Maybe you make your lonely neighbor’s day by saying hello. If anyone loved you at any point, that means you are loveable. Once you recognize how much of your negative self-talk is actually false, it becomes easier to give it less weight. That results in a more balanced and realistic outlook. You might never be a smiley, chirpy optimist, but you can manage your negativity with a little legwork. To learn lots of great ways to reframe negative or inaccurate automatic thinking, consider CBT (cognitive behavioral therapy).

    What’s the best treatment for chronic depression?

    Combination treatments like psychotherapy plus antidepressant medications (usually SSRIs, SNRIs, MAOIs, TCAs, atypical antipsychotics) or psychotherapy plus another FDA-approved treatment such as Electroconvulsive Therapy (ECT) or Repetitive Transcranial Magnetic Stimulation (rTMS) are the best treatments for Persistent Depressive Disorder (PDD). Beyond that, there are a bunch of complementary approaches that can also lift your mood. Start by making your bed when you wake up in the morning. For a depressed person, knowing you’ve already accomplished one thing can provide the mini confidence boost you need to get out the door. A half hour of exercise releases endorphins, the body’s natural antidepressant, and provides a little added pep. Finally, get to bed on time and get a good night’s rest every night. Sleep deprivation causes irritability and stress, which is the last thing you need right now.

    Meirav Devash

    Meirav Devash

    @MeiravDevash

    Meirav Devash is a writer, editor, and beauty, health, and wellness expert, reporting on topics from mental health to goth fitness and cannabis law.