Major depressive disorder (MDD) and persistent depressive disorder (PDD) are two types of depression. They may seem similar, but each condition has unique characteristics. PDD affects around 1.5% of American adults, and women more than men. MDD, however, is more common, affecting 7.1% of American adults, and is also more common in women. 

The biggest difference between the two conditions is the duration of symptoms. PDD symptoms last at least two years, while MDD symptoms are seen in major depressive episodes with a gap of at least two months between them. Understanding the differences between these two conditions can help you find the right support and care for you or someone you know who’s dealing with depression. 

Symptoms of major depressive disorder vs. persistent depressive disorder

The symptoms of MDD and PDD can overlap but also have symptoms unique to each condition. Major depressive disorder symptoms can include:

• Intense sadness
• Loss of interest or pleasure
• Drastic changes in appetite or weight
• Sleep disturbances
• Fatigue or low energy
• Feelings of worthlessness or guilt
• Difficulty concentrating
• Difficulty making decisions
• Social withdrawal
• Suicidal thoughts or behaviors

Persistent depressive disorder symptoms can include:

• Persistent sadness
• Feelings of worthlessness
• Lack of interest or pleasure
• Drastic appetite changes
• Sleep disturbances
• Difficulty concentrating
• Social withdrawal
• Low self-esteem
• Feelings of hopelessness
• Irritability

People struggling with major depressive disorder may also experience symptoms of panic disorders, social anxiety disorder and obsessive-compulsive disorder.

Risk factors for persistent depressive disorder vs. major depressive disorder

The risk factors for MDD and PDD can be similar, but they also have distinct differences. 

Scientists don’t know the exact cause of MDD; however, it can be develop as a result of many risk factors, such as:

• Chemical imbalance in the brain
• Previous depressive episodes
• Traumatic or stressful events
• Chronic medical conditions
• Parent or sibling with a history of MDD
• Anxiety
• Substance abuse

Research is still ongoing into the causes of PDD, but risk factors that are linked to developing PDD can include:

• Chemical imbalance in the brain
• Diabetes
• Cancer
• Parent or sibling with a history of PDD
• Trauma or chronic stress
• Certain medication side effects 

How are major depressive disorder and persistent depressive disorder diagnosed?

The diagnostic process for the conditions is similar. Both conditions are diagnosed based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Your health care provider will evaluate your symptoms and how they affect your life. The main difference between the diagnostic process between the two is the duration of symptoms. 

For an MDD diagnosis, a person has to have two depressive episodes of at least five symptoms with two months between them. For a PDD diagnosis, a person has to have at least two symptoms for at least two years without symptoms being absent for longer than two months. 

It’s important to note that these lengths of time are diagnostic criteria. They do not mean that you should wait to seek help for depression from a mental health professional. Rather, you should seek support for depression symptoms as soon as possible. 

Can you have both conditions?

It is possible to have MDD and PDD and is called “double depression.” Being diagnosed with both conditions requires meeting the diagnostic criteria for both. This can lead to more severe and chronic depressive symptoms.

Treatment options for major depressive disorder and persistent depressive disorder

While they are distinctly different types of depression, the treatment approaches for MDD and PDD can be similar. The treatment approach for both disorders typically involves a combination of psychotherapy, medication, and lifestyle changes. However, the emphasis and duration of treatment may vary. For example, individuals with PDD may require longer-term treatment due to the chronic nature of the disorder, while those with MDD may focus more on managing episodic depressive episodes.

Your health care provider will determine the best treatment plan based on the severity and type of your symptoms. Treatment options can include:

• Psychotherapy — Psychotherapy for PDD may focus more on addressing long-standing patterns of negative thinking and behavior, as well as coping with ongoing stressors. In MDD, psychotherapy may focus more on identifying and challenging negative thoughts and behaviors associated with acute depressive episodes.

A licensed clinical therapist can use a unique, compassionate and focused treatment approach with process-based therapy for MDD and PDD. The framework of this technique uses evidence-based, clearly defined, data-driven components from therapies like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). The most effective aspects of these therapeutic modalities will be chosen based on the drivers behind your MDD and PDD. This helps your therapist provide you with whole-person-centered care to help you experience long-term, sustainable changes for better mental health. 

• Medications — Your health care provider may prescribe medications to help manage the symptoms of your MDD or PDD. While both disorders can be treated with antidepressant medications, the choice of medication and duration of treatment may vary. For example, individuals with PDD may benefit from longer-term use of antidepressants to manage symptoms, while those with MDD may use medication more acutely during depressive episodes.

Antidepressants work by affecting the chemicals in your brain. You may need to take your medication for a few weeks before you notice any changes. Your health care provider will likely start you on a low dosage and increase it if it’s needed. It’s essential that you continue taking your medication, even if it feels like it isn’t working at first. It’s also crucial to never stop taking your medication without first discussing it with your health care provider. It may take some trial and error to find the right dosage or medication to provide you with the best results. Your health care provider should also be willing to listen to your concerns to ensure that your choice and dosage best suit your needs. 

Some people may respond well to only psychotherapy treatment or medications to help manage MDD or PDD. However, it can be more effective to have a combined approach of medication and psychotherapy for you to see the best results and symptom reduction. 

Lightfully Behavioral Health is here to help you navigate major depressive disorder and persistent depressive disorder

At Lightfully, we understand the struggles you face with depression. Major depressive disorder and persistent depressive disorder are serious mental health conditions that can wreak havoc on your life, but can respond well to treatment like process-based therapy. No matter where you are in your mental health journey, we can help you work toward a happier and healthier future. 

Change is possible. When you’re ready to take the first step, reach out to our Admissions Concierge Team. We’ll take the next steps together, toward the fullest, brightest version of you.