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Persistent depressive disorder (PDD) is characterized by at least two years of ongoing depression that does not respond to multiple treatment attempts, including medication and psychotherapy, or an extended period of time with no significant improvement in mood or functioning. Patients with PDD may struggle with symptoms of chronic sadness, guilt, or hopelessness; they may have difficulty getting out of bed or maintaining an interest in activities they used to enjoy. As many as 30% of patients who experience one major depressive episode will go on to develop persistent depression.