Clinical vignette of persistent depressive disorder

John Smith is a $30$‍ year old married male who feels down most of the time. He experiences frequent, intrusive thoughts that he is not good enough, despite personal and professional successes. He tries to overcompensate for his thoughts by taking on more than he can handle, which leads to failure and furthers his feelings of inadequacy. His wife suggests that he seek help after finding him crying. The following is an excerpt from his intake interview with his psychiatrist.

“I feel pretty worthless and have felt that way for a long time - for over ten years. It feels normal to be down. Sometimes I start to feel better, but it never lasts - I feel bad about my life most of the time. I don’t think that I’ll amount to anything and l might never be successful at work. I feel exhausted all of the time. I have trouble sleeping. I’ve been waking up in the middle of the night and can’t stop thinking about all of my failures. I’ve lost weight in the past few months. Food just doesn’t taste as good as it used to. I feel hopeless and often have trouble concentrating when I’m with my family and friends. Maybe I’m just pessimistic.”

John’s psychiatrist tells him that his experience isn’t normal and diagnoses him with persistent depressive disorder. He prescribes an antidepressant and begins to conduct therapy with John. John begins to feel better after therapy sessions and a month on the medication.