When sadness won't go away: What to know and what you can do

⏱ 2 min read, 2 min video

Everyone has days when they feel down. But if those feelings linger for years, it might be something more. Persistent depressive disorder (PDD) — formerly called dysthymia — is a chronic form of depression that often goes unnoticed, especially among older adults who may think it’s simply part of aging or their personality. In this short video, clinical psychologist Dr. Danielle Rice discusses what persistent depressive disorder is, why it’s easy to miss, and how treatment can help.

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What is persistent depressive disorder?

Persistent depressive disorder is a mental health condition where low mood lasts for at least two years and symptoms are never absent for more than two months at a time. While symptoms may be less intense than they are with major depression, they are chronic and can make everyday life difficult. People with persistent depressive disorder often:

• Feel sad or hopeless most days
• Struggle with low energy and poor sleep
• Have trouble concentrating or making decisions
• Lose interest in activities they once enjoyed

These feelings can make even simple tasks feel overwhelming.

Special considerations for older adults

• Symptom differences: Symptoms may appear as physical complaints (aches, fatigue, appetite changes), memory problems, or withdrawal from social activities rather than obvious sadness.
• Late-life onset: PDD can develop for the first time in older age, sometimes with fewer early psychiatric symptoms, but with a significant impact on daily functioning.
• Grief vs. PDD: Bereavement is common in later life, so healthcare providers must distinguish normal grief from PDD. 
• Comorbidity: PDD often coexists with chronic health conditions or other mental disorders, though some older adults may experience a “pure” form without other psychiatric diagnoses.
• Underdiagnosis: Depression in late life is frequently missed because symptoms are mistaken for aging or physical illness, or there is reluctance to seek help.

Why its easy to miss

What can help?

The good news: persistent depressive disorder is treatable. Evidence-based options include:

• Lifestyle strategies like regular exercise and connecting with supportive communities or groups.
• Cognitive behavioural therapy (CBT) to change negative thought patterns.
• Antidepressant medications prescribed by a doctor.

If you or someone you know is struggling, reach out to a healthcare provider or mental health professional. Organizations like the Canadian Mental Health Association and the Mood Disorders Society of Canada also offer resources and support.

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