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There is more than one type of depression, according to the diagnostic manual that therapists and psychologists in Brooklyn use to diagnose depression. As we review your symptoms and try to gain a better understanding of your struggles, we’re often looking at both subtle and clearer differences between these disorders in order to determine how to effectively treat them.

Major depressive disorder (MDD) is a more urgent, more powerful form of depression with symptoms considered to be severe. Persistent depressive disorder (PDD) is a “milder” but no less problematic form of depression. It was previously referred to as “Chronic Depression” or “Dysthymia.” These conditions have many similarities, and it is possible to cycle in between the conditions – showing symptoms of major depression at times, and persistent depression at others – but they are distinctive conditions.

Diagnostic Differences

Before we get into the symptomatic differences between the two conditions, let’s talk about the diagnostic ones. Persistent depressive disorder can only be diagnosed if the patient has struggled with it for over one to two years depending on the patient’s age. It is the term for a low level of chronic depression that is essentially constant throughout the day and night.

Though the symptoms are considered less severe compared to MDD, their long term presence puts patients at higher risk for self-harm the longer they struggle with it. Major depression, on the other hand, can be diagnosed in as little as two weeks and “episodes” are often severe in nature, which makes treating it more urgent.

Symptomatic Differences Between MDD and PDD

It’s easy to say “less severe than major depression” or “low level of depression.” But because depression is always a struggle, it important to identify what “less severe depression” means.

Both PDD and MDD will have feelings of helplessness, negative self-talk, loss of interest in pleasurable activities, and depressed mood. But what makes them different is the following:

  • Function – Patients with PDD are typically able to function in some form with most of their daily tasks. They may not be able to give activities their full energy, or enjoy those activities, or focus as easily as those without depression. But they can typically go to work, address some of their family’s needs, and take care of a pet. Their ability to function may be compromised, but they are capable of it. Patients with Major Depressive Disorder often find depression so debilitating, it dramatically interferes with their ability to function.
  • Intensity – Patients with persistent depression will describe a low mood and feeling “down.” They may show changes in appetite, sleep, energy, and concentration, but they are more capable of pushing through it with a bit of effort. Patients with major depressive disorder typically are *extremely* sad or down to the point of being overwhelmed by it. Engaging in daily tasks feels nearly impossible, and in some cases may not be possible. They feel impaired by their condition with more persistent thoughts of self-harm.

While someone with PDD may feel “low” and unhappy or passionless and tired throughout the day, a patient with MDD could, depending on the severity of their symptoms, be unable to even leave their bed. Despite MDD being more severe, however, it should be noted that chronic depression can both cycle into MDD at times, and also lead to significant life alterations that cause people to consider self-harm in the future, especially as they no longer experience joy for such a long period of time.

Patients with PDD also may experience what is sometimes called “Double Depression.” These are more severe forms of depression that resemble MDD that come at different times or after different triggers. These periods of “Double Depression” can increase the risk of self-harm considerably. But they may not qualify as MDD because they may not last the requisite two weeks or display all of the same symptoms.

How Does Recognizing These Two Different Conditions Affect Treatment

Therapy for depression – both MDD and PDD – can be very similar. Both benefit from many of the same therapeutic techniques, such as CBT. Both benefit from treatment from an experienced therapist. Both respond well to professional intervention. Many of the same techniques are used as well, such as cognitive restructuring and behavioral activation.

However, there are differences as well. First, duration and frequency of therapy may change. MDD may require more immediate and frequent meetings to help address the episode in the moment and reduce the risk of worsening symptoms. PDD may benefit from ongoing treatment that helps continue to address its symptoms over time.

In addition, In MDD, CBT often focuses on identifying and challenging negative automatic thoughts and cognitive distortions that contribute to the development and maintenance of depressive symptoms. The emphasis is on modifying maladaptive thinking patterns during acute episodes and targeting specific negative thoughts related to the current episode. In PDD, cognitive restructuring may also be utilized, but the focus is broader and may involve addressing deeply ingrained negative beliefs and schemas that contribute to the chronic nature of depressive symptoms.

Similarly, in MDD, CBT may include specific techniques to recognize early warning signs of relapse and develop coping strategies to prevent future depressive episodes. In PDD, since the condition is chronic, relapse prevention may involve ongoing monitoring and management of symptoms to minimize their impact and prevent exacerbations.

While the therapy techniques are similar, the way that they are approached is different.

If you feel like you’re struggling with depression, contact Flourish Psychology in Brooklyn today to learn more.

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