That persistent “meh” feeling has a name

By the time Amanda Stern was in her mid-forties, she no longer suffered from clinical depression. And her panic attacks, which had started in childhood, had largely disappeared. But instead of feeling happier, she said, “I felt surrounded by an endless, flat sadness.”

Confused, she turned to her therapist, who suggested she had dysthymia, a mild version of persistent depressive disorder, or PDD.

Ms. Stern, an author based in New York City, often writes about mental health, but she had never heard the term. She soon realized that she had been suffering from dysthymia on and off for decades. “Right now it doesn’t bother me,” she added, “but I imagine I’ll live with it again.”

She decided to write about it in her newsletter, How to livein which she described what it felt like to live in a “constant state of ’emptiness’” and shared the tools that ultimately helped her feel better.

It’s not well understood why some cases of depression persist, but The New York Times asked experts to share what they know about PDD

What is persistent depressive disorder?

Persistent depressive disorder is chronic depression that lasts for at least two years in adults. As with many types of mental illness, there are varying levels of severity.

The term “dysthymia,” a Greek word that can mean “low spirits,” “moodiness,” or “dejection,” is no longer included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), but is still used by some mental health organizations . practitioners to refer to the milder form of PDD

Marnie Shanbhag, senior director of independent practice at the American Psychological Association, said that less severe PDD is often diagnosed when people come to therapy for another problem, such as marital problems or stress at work, and reveal that they are persistently at a low feel level. sadness, flatness or emotional numbness.

There may seem to be no reason behind it. “You’re just kind of ‘meh,’” said Dr. Shanbhag. “And you get used to being that way.”

For Ms. Stern, “clinical depression knocks me out. I can’t get out of bed, shower, eat or walk my dog.” However, with dysthymia she can still function. For example, she may not want to do the dishes, but she “won’t feel exhausted” by the task.

Those who suffer from the more severe form of PDD, historically called chronic depressive disorder, may not be able to get out of bed after a night of insomnia, lose their appetite, have so much trouble concentrating that they can’t get work done, or you feeling too exhausted to clean the house or prepare dinner, said Dr. Paul S. Appelbaum, a professor of psychiatry at Columbia University and the leader of the group that oversees revisions to the DSM

It is estimated that approx 2 percent of adults in the United States have had some form of PDD in the past year, and the condition is thought to be more common in women than men. However, it’s difficult to know its full extent because experts say the condition is often underdiagnosed.

How is the diagnosis made?

PDD is diagnosed in adults who report feeling depressed “most of the day, more days than not” for at least two years, said Dr. Appelbaum. And if they do find relief from their symptoms, he added, it won’t last more than two months.

Children and adolescents can also have PDD (to make a diagnosis, Dr. Appelbaum said, symptoms must have lasted for at least a year.)

“Like other forms of depression, depression causes significant problems or impairment and is associated with an increased risk of suicide,” said Dr. Appelbaum.

Patients with the condition will also experience at least two of the following symptoms:

• Poor appetite or eating too much

• Insomnia or excessive daytime sleepiness

• Low energy or fatigue

• Low self-esteem

• Poor concentration or difficulty making decisions

• Feelings of hopelessness

How is it treated?

PDD is usually treated with therapy and antidepressants.

There is no cure, but people can become “symptom-free and the intensity of any recurrences can be minimized,” said Dr. Appelbaum.

Because PDD can last long-term – and does not always interfere with a patient’s daily life – people with the disorder may assume that their milder depressive symptoms are simply character traits.

“It’s hard to convince people that they’re not just the negative person in their family, or the Debbie Downer,” says Dr. Jessi Gold, a psychiatrist in St. Louis. But if someone is bothered or experiences symptoms that interfere with daily life, then it makes sense to seek treatment rather than simply saying, “this is how I am,” she added.

Ms. Stern agrees. When people she was close to asked how she was doing, she told them she was doing well, but, she said, “a deep sadness came to the top and let me know that things were not well at all.” me went.’

She urged those who consistently feel unmotivated, apathetic or without interest in things they once enjoyed to seek help.

“You may feel alone, but you are not,” she said.