Prognosis
With treatment including psychopharmacology, psychotherapy, and lifestyle changes, persistent depressive disorder can remit, and psychosocial functioning can improve significantly. The goal of treatment increasingly is to attain prolonged remission, to prevent episodes of recurrent major depression, and to impact the patient’s baseline symptoms so they do not meet criteria for dysthymia. However, persistent depressive disorder is by definition a chronic condition that, even in milder instances (e.g., dysthymia), is often complicated by recurrent major depressive episodes. In some instances, particularly when PDD is not recognised and treated, patients with persistent depressive disorder may have chronic major depression. The suicide rate among patients with depression is high, but the precise suicide rate among patients with persistent depressive disorder is unknown. Persistent depressive disorder is frequently complicated by comorbid psychiatric conditions, such as anxiety disorders and substance misuse, which must be recognised and provided appropriate treatment in order to optimise outcome. Furthermore PDD is associated with significant functional impairment (including unemployment, difficulty establishing intimate relationships, greater healthcare utilisation, greater utilisation of public entitlements).[22][23][124] So the treatment of PDD should include active remediation of psychosocial functioning issues. In one study, later age of onset of depression onset was associated with worse outcomes, including greater risk of developing persistent depressive disorder, recurrent major depression, and functional impairment.[125]
Treatment effects
Treatment takes longer to show an effect compared with that for patients with more acute forms of depression. No long-term treatment studies of pure dysthymia have been reported. Studies of chronic major depression suggest that long-term treatment (2-3 years or more) is likely to reduce relapse.[42][126]
Suicide
The suicide rate for patients with persistent depressive disorder is unknown but is likely to be higher than the general population because persistent depressive disorder is a chronic and often debilitating disorder.
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