Persistent Depressive Disorder Case Study: 37-Year-Old Accounts Manager from Thane Who Lived With Low Mood for Nine Years and Thought It Was Her Personality
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Persistent Depressive Disorder Case Study: Patient Background
This persistent depressive disorder case study follows Neha (name changed), a composite example that reflects how long-term low mood is often missed, and how it is assessed and treated at Calida Rehab. The details are illustrative and do not describe any one identifiable person.
Neha is a 37-year-old accounts manager at a finance company in Thane. She lives with her husband and their six-year-old daughter. She is careful at work, meets her deadlines and is described by colleagues as dependable. At home, she says she feels as if she is running on empty. For about nine years, since her late twenties, a flat, heavy mood has been present on most days. She cannot name a day when it began. There was no dramatic event, only a slow slide that started after a job change and a move to a new city, and which she gradually began to treat as normal.
Because she never stopped working, nobody around her saw a problem. Her husband said she had always been “the serious type”. A family doctor, whom she saw twice for tiredness, advised rest and a change of routine. Neha herself believed that this was her personality: that she was simply a joyless person, and that other people were naturally happier. What brought her to us was a school annual day. Her daughter danced on stage, the whole hall clapped, and Neha realised she felt nothing at all. That night she told her husband that she did not want to carry on like this. He called Calida Rehab the next morning.
Before the case itself, a short note. Persistent depressive disorder, also called dysthymia, is a form of depression that lasts for years. The symptoms are often milder than in a severe depressive episode, but they are present for most of the day on more days than not, and the length of time is what wears a person down. To see how it differs from other kinds, read our guide on the types of depression. You may also want to read our depression case study and our guide to high-functioning depression.
Symptoms: How Long-Term Low Mood Showed Up
Persistent depressive disorder rarely looks dramatic. It looks like a person who is tired, quiet and getting by. In Neha’s case, these signs had been present for years:
- Low mood on most days: a grey, heavy feeling that rarely lifted, even on weekends and holidays.
- Constant tiredness: she slept nine to ten hours and still woke up exhausted.
- Appetite changes: she ate more sweet food in the evenings, which she called “the only thing I look forward to”.
- Low self-esteem: she thought she was boring, a poor mother and “not good at being happy”.
- Poor concentration and indecision: even small choices, such as what to cook, felt tiring.
- Hopelessness: she believed that this was permanent and that nothing could change it.
- Loss of enjoyment: she had stopped meeting friends and attended family events only because she had to.
In the last three months, things had got worse. She was crying in the office restroom, missing small details at work for the first time, and on bad days she had thoughts that she did not want to wake up. She had no plan and no intent to harm herself, but she told our team that the thought came more often than she liked.
Why Long-Term Low Mood Is Not Just a Personality Trait
Many people, and many families, assume that a person who has been low for years was simply made that way. This is one of the main reasons persistent depressive disorder goes untreated. A few points are worth knowing.
- It is a medical condition, not a character flaw. Changes in mood regulation, sleep and thinking patterns can build up slowly and begin to feel like “who I am”.
- Being able to work does not rule it out. Many people with this condition keep a job and a home running, and pay for it with their energy and enjoyment.
- It can sit alongside a deeper episode. A person with years of low mood can also develop a major depressive episode on top of it, which is sometimes called double depression.
- It responds to treatment. Because it is long-standing, it often needs a longer and more structured plan than a short course, but people do improve.
For Neha, the hardest step was realising that the thought “this is just me” was part of the illness.
Diagnosis: How Persistent Depressive Disorder Was Assessed at Calida Rehab
There is no blood test for persistent depressive disorder. A psychiatrist makes the diagnosis from a detailed history, a mental state examination and standard rating scales. For Neha, the assessment included:
- A timeline of mood: when it began, how it changed, and whether there were ever periods of two months or longer when she felt well.
- Symptom review against DSM-5-TR and ICD-11: in adults, low mood for most of the day on more days than not for at least two years, together with at least two other symptoms such as poor appetite or overeating, sleep change, low energy, low self-esteem, poor concentration or hopelessness.
- PHQ-9 depression scale: her score was 17, in the moderately severe range.
- Suicide risk review: a careful, direct conversation about her thoughts, her protective factors and her family’s ability to support her.
- Screening for other conditions: bipolar disorder (past highs or unusually high energy), anxiety, alcohol use and trauma. She had none of these.
- Physical checks: blood tests for thyroid function, blood count, vitamin B12 and vitamin D, because thyroid problems and other medical conditions can look like depression.
The diagnosis was persistent depressive disorder with a current major depressive episode on top of it. Her thyroid and blood counts were normal. Her vitamin D was low and was corrected.
Treatment Plan for Persistent Depressive Disorder
No single treatment suits everyone. At Calida Rehab the plan is built after the assessment and reviewed often. For chronic depression, a combination of medicine and therapy tends to work better than either alone.
- Short stabilisation stay: because of the passive thoughts of not wanting to wake up, the team advised a stay of about two weeks, so that medicine could be started safely and therapy could begin in a calm setting.
- Antidepressant medicine: the psychiatrist chose a medicine after discussing options and side effects with Neha. She was told clearly that most antidepressants take several weeks to show their full effect, that early side effects often settle, and that she should not stop the medicine without advice.
- Structured psychotherapy: regular sessions of cognitive behavioural therapy and interpersonal therapy, aimed at long-standing thinking patterns and relationships.
- Daily routine: fixed sleep and wake times, morning light and a short walk, planned activity and regular meals.
- Family sessions: her husband attended, so that he understood the condition and could help without pushing.
- Step-down plan: a move to outpatient visits with a written follow-up schedule before she left.
The team also explained that treatment for a long-standing condition is measured in months, not days, and that medicine is usually continued for a good while after a person feels better.
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Therapies Used in This Persistent Depressive Disorder Case Study
The therapies below were part of Neha’s plan and are commonly used for chronic depression.
- Cognitive Behavioral Therapy (CBT): worked on thoughts such as “I am just a boring person” and “nothing will change”, and tested them against real events. See our CBT page.
- Interpersonal Therapy (IPT): focused on the isolation and role changes that had built up over the years, and on how she communicated with her husband and colleagues. See our interpersonal therapy page.
- Behavioral therapy (behavioural activation): planned small, meaningful activities, starting with ten minutes a day, to rebuild the link between action and mood. See our behavioral therapy page.
- Family therapy: helped her husband move from “she is just serious” to understanding the illness. See our family therapy page.
- Psychoeducation: clear teaching about chronic depression, medicine, sleep and early warning signs. See our psychoeducation page.
- Meditation therapy: a short daily practice that helped her notice low mood without being pulled further into it. See our meditation therapy page.
Follow-Up Care After Discharge
For a condition that has lasted nine years, the plan does not end at discharge. Neha’s aftercare was written down before she left:
- Weekly therapy for the first two months, then every two weeks.
- Psychiatrist reviews at two weeks, six weeks and then monthly, to check response, side effects and sleep.
- PHQ-9 repeated at each review, so that progress was measured and not guessed.
- A short written list of her early warning signs (poor sleep, cancelling plans, evening sugar cravings) and who to call.
- A plan to continue medicine for many months after she felt well, with any change decided together with her psychiatrist.
Her husband also had a contact number and was told that it was fine to call if he noticed her slipping back.
Outcome: What Recovery Looks Like in Persistent Depressive Disorder
What changed for Neha over the first six months:
- Mood: her PHQ-9 score fell from 17 to 9 by week eight and to 5 by month six. For the first time in years, she had several days in a row when she felt “light”.
- Sleep and energy: she moved from ten hours of unrefreshing sleep to about seven and a half, and her morning exhaustion eased.
- Thoughts: the thoughts of not wanting to wake up stopped within the first month, and she began to challenge “this is just me” on her own.
- Work: she kept her job and said that she no longer needed to hide in the restroom to cope.
- Family: she joined her daughter’s weekend swimming class and said she remembered the day clearly, which she had not done for years.
- Medicine: she took it daily, and needed one adjustment visit when early nausea was troubling her. It settled within two weeks.
It is worth being clear about what recovery means. It does not mean that every day is good. It means that low mood no longer runs the day, a bad week is recognised early, and the person knows what to do about it.
What the first six months of treatment usually look like
- Weeks 1 and 2: assessment, physical checks, a safe start of medicine and the first therapy sessions, with a short stay where needed.
- Months 1 and 2: weekly therapy, medicine reviewed and adjusted, sleep and activity routine built up.
- Months 3 and 4: fortnightly therapy, return to full work and family routines, early warning plan practised.
- Months 5 and 6: monthly reviews if steady, medicine continued, and a plan for the next year.
This is a general guide. Every person moves at a different pace, and the length of stay and follow-up is decided by the treating team.
Key Takeaways from This Persistent Depressive Disorder Case Study
- Persistent depressive disorder is long-term low mood that lasts for at least two years in adults. It is a medical condition and not a personality trait.
- A person can work, parent and look fine on the outside while living with it, which is why it is often missed for years.
- Diagnosis needs a careful history, rating scales such as the PHQ-9, a suicide risk review and physical checks to rule out other causes.
- A combination of antidepressant medicine and structured psychotherapy tends to work better than either alone.
- Improvement is gradual, and treatment is measured in months. Medicine should not be stopped early without advice.
- Family understanding and written follow-up plans help protect recovery.
When Should You See a Doctor?
Please speak to a doctor or psychiatrist if you or someone you know:
- Has felt low, empty or flat on most days for two years or more
- Has been told “it is just your nature” but feels exhausted, hopeless or unable to enjoy anything
- Keeps going to work but is struggling with sleep, appetite, concentration or decisions
- Has had thoughts of not wanting to wake up, or of ending their life
- Has tried medicine or counselling before and stopped without a clear plan
- Is using alcohol, sleeping tablets or cannabis to cope with low mood
If someone talks about ending their life, has made a plan or cannot stay safe, do not wait. Call 112 or Tele-MANAS on 14416 and stay with the person until help arrives. You can also call our 24-hour helpline for a confidential conversation. To check how you have been feeling, read our guide on when to take a depression test.
Persistent Depressive Disorder Case Study: Frequently Asked Questions
What is persistent depressive disorder?
Persistent depressive disorder, also called dysthymia, is a long-term form of depression. In adults it means feeling low, empty or flat for most of the day, on more days than not, for at least two years, along with other symptoms such as poor sleep, low energy, low self-esteem, poor concentration or hopelessness.
How is it different from major depression?
Major depression usually comes as distinct episodes that are more intense and last weeks or months. Persistent depressive disorder is steadier and often milder, but it lasts for years. The two can occur together, and a person with long-term low mood may also have a major depressive episode on top of it.
How long do symptoms need to last for a diagnosis?
In adults, at least two years. In children and teenagers, at least one year, and the mood may show up as irritability rather than sadness. The person should not have been free of symptoms for more than two months at a time during this period.
Can I have persistent depressive disorder and still work normally?
Yes. Many people keep their jobs and look fine from the outside, which is why the condition is often missed. They often cope by using up energy that they would otherwise spend on relationships, rest and enjoyment.
Is it just my personality?
No. Long-standing low mood can feel like part of who you are, but it is a treatable medical condition. A person who starts treatment often finds that traits they thought were fixed, such as being serious or joyless, change as mood improves.
How is persistent depressive disorder treated?
Treatment usually combines an antidepressant with structured psychotherapy such as cognitive behavioural therapy, interpersonal therapy or a therapy designed for chronic depression. A combination tends to work better than either alone. Sleep, activity, family support and regular follow-up are also part of the plan.
How long do antidepressants take to work?
Most take several weeks to show their full effect, and a trial of six to eight weeks at a suitable dose is usually needed before judging a medicine. Early side effects often settle. Do not stop or change the dose without speaking to your psychiatrist, and expect treatment to continue for many months after you feel better.
Does therapy really help with chronic depression?
Yes. Studies show that psychotherapy helps in chronic depression and dysthymia. It works well alongside medicine, and it helps with the thinking patterns, relationship difficulties and habits that built up over the years.
Can persistent depressive disorder come back after treatment?
It can, because it is a long-term condition. The risk is lower when treatment continues for long enough, when early warning signs are known and when follow-up visits are kept. Many people stay well with ongoing care.
Is my information kept private?
Yes. Assessment and treatment details are confidential and are shared with family or employers only with your consent.
Sources and Further Reading
This page is for information and is not a substitute for medical advice. The case described is a composite example, and details are illustrative. If you think you or someone you know may have depression, please see a doctor or psychiatrist for a full assessment. If anyone is at risk of self-harm, call 112 or Tele-MANAS on 14416 at once.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.
- World Health Organization. International Classification of Diseases, 11th Revision (ICD-11), 6A72 Dysthymic disorder.
- Klein DN, Schwartz JE, Rose S, Leader JB. Five-year course and outcome of dysthymic disorder: a prospective, naturalistic follow-up study. American Journal of Psychiatry, 2000; 157(6): 931-939.
- Cuijpers P, van Straten A, Schuurmans J, et al. Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clinical Psychology Review, 2010; 30(1): 51-62.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 2001; 16(9): 606-613.
- National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022.