Dysthymia, now clinically known as Persistent Depressive Disorder (PDD), is a condition that is often misunderstood. It is a chronic form of depression that doesn’t always knock you down, but rather wears you down.

If Major Depression is a crashing wave, PDD is a low tide that never seems to turn. It is a constant undercurrent that makes walking through life feel heavier than it should.

Here at Mark G. Agresti, MD, LLC, we see patients every day who have been carrying this weight for years, often without realizing it is a treatable medical condition. From our office here in Palm Beach, overlooking the calm Intracoastal Waterway and the lush greens of The Breakers golf course, we strive to offer something different: a sanctuary where you are heard, understood, and treated with compassion.

Whether you are greeted by our office staff or receive a friendly tail wag from Bella, my dog who often roams the office providing her own form of therapy, know that you are in a place of healing.

What is Persistent Depressive Disorder?

The defining characteristic of PDD is time. To be diagnosed, an adult must experience a depressed mood for most of the day, for more days than not, for at least two years.

Many of my patients tell me, “Dr. Agresti, I don’t feel ‘sad’ exactly. I just feel empty.” They often describe their baseline as “down in the dumps” or lacking joy. Because it lasts so long, many believe this gray cloud is just their personality. It isn’t. It is a symptom.

Common symptoms include:

• Loss of interest in daily activities.

• Feelings of hopelessness or inadequacy.

• Chronic low energy or fatigue.

• Low self-esteem.

• Poor concentration or difficulty making decisions.

• Sleep disturbances and appetite changes.

Stories of Hope: 5 Patient Vignettes

To help you understand what PDD looks like in real life—and how it can be overcome—I want to share the stories of five patients. Note: Names and identifying details have been changed to protect patient privacy.

1. The Executive: “I Have It All, But I Feel Nothing”

Before Treatment:

Jonathan, 48, was a high-functioning finance executive. On paper, his life was perfect. He had a beautiful home and a successful career. But as he sat in my office looking out at the boats on the Intracoastal, he admitted he hadn’t felt genuine joy in a decade. He functioned on autopilot. He viewed his lack of emotion as “professionalism,” but in reality, it was anhedonia—the inability to feel pleasure. He was exhausted, cynical, and felt like an imposter in his own life.

The Turning Point:

We identified that Jonathan wasn’t just “burnt out”; he had PDD. We started a regimen of Cognitive Behavioral Therapy (CBT) to challenge his cynicism and introduced a medication tailored to his neurochemistry.

After Treatment:

Six months later, Jonathan told me he laughed at a joke for the first time in years—a real, belly laugh. He wasn’t just going through the motions anymore; he was present for his family and found renewed passion in his work. He realized that success means nothing if you don’t have the emotional capacity to enjoy it.

2. The Retiree: “I Thought This Was Just Aging”

Before Treatment:

Eleanor, 72, had retired to Palm Beach to enjoy her golden years. She spent her days overlooking the golf course, but she felt a profound sense of loneliness even when surrounded by friends. She assumed her low energy and lack of appetite were just “part of getting older.” She spent most of her days sleeping and felt she had no purpose.

The Turning Point:

Eleanor came to see me after her daughter insisted. During our sessions, often with Bella sitting by her feet, Eleanor opened up about the grief she had never processed. We adjusted her sleep schedule and used talk therapy to help her find a new purpose in retirement.

After Treatment:

Eleanor now volunteers twice a week and has regained her appetite. She realized that depression is not a normal part of aging. She describes her life now as “in color” again, rather than the black-and-white movie she had been living in.

3. The Student: “I Can’t Focus on My Future”

Before Treatment:

Mia, a 22-year-old law student, was convinced she was just “lazy.” She struggled to get out of bed for class and felt a constant, low-level irritability. She was falling behind in her studies, not because she wasn’t smart, but because her brain felt like it was in a fog. She had PDD combined with episodes of acute anxiety.

The Turning Point:

Mia needed a safe space to decompress. Our office became that sanctuary. We worked on “Double Depression”—treating the chronic underlying low mood while managing the acute stress of law school. We focused heavily on lifestyle changes, including exercise and mindfulness, alongside medication management.

After Treatment:

Mia graduated with honors. She learned that her value isn’t tied to her productivity, yet ironically, treating her PDD made her more productive than ever. She still sends me updates on her career, grateful that she sought help when she did.

4. The “Nice Guy”: “I Don’t Want to Burden Anyone”

Before Treatment:

David, 35, was the person everyone relied on. He was a people pleaser who internalized all his stress. He had low self-esteem and constantly felt he wasn’t “good enough,” despite constant reassurance from his wife. He felt guilty for feeling down because he “had no reason to be sad.”

The Turning Point:

David’s breakthrough came when he realized that PDD is a biological condition, not a moral failing. Sitting in the calm atmosphere of our Palm Beach office, he finally gave himself permission to not be okay. We worked on assertiveness training and rebuilding his self-image.

After Treatment:

David is still the kind man he always was, but he now has boundaries. His energy levels have returned, and he engages in hobbies he had given up years ago. He learned that taking care of his own mental health is the best way to be there for others.

5. The Artist: “I Need My Pain to Create”

Before Treatment:

Sophia, 29, was a talented painter who feared that treating her depression would kill her creativity. She had lived with a dark mood since her teenage years. However, the depression had become so heavy she could no longer paint at all. She was paralyzed by hopelessness.

The Turning Point:

We discussed the myth of the “tortured artist.” I explained that PDD was actually stifling her voice, not fueling it. We found a medication that lifted the fog without dulling her senses.

After Treatment:

Sophia is painting more than ever. She told me, “I used to paint to escape my life. Now I paint to celebrate it.” She found that clarity and stability gave her the stamina to complete huge projects she never could have finished before.

Why Choose Dr. Mark Agresti?

Recovery from Persistent Depressive Disorder requires more than just a prescription pad. It requires a relationship. It requires a doctor who digs deep into the “why” and “how” of your specific situation.

At Mark G. Agresti, MD, LLC, we combine top-tier psychiatric expertise with a genuinely personal touch. Whether it’s the calming view of the Intracoastal, the welcoming presence of Bella, or the dedicated care of our team, we are here to help you reclaim your life.

This condition is stubborn, but so are we. You do not have to settle for a life lived at “low tide.”

Visit us at Agrestimd.com or call our Palm Beach office today to schedule your consultation.

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