Double depression is a term used to describe the occurrence of two separate depressive disorders. While any type of depression can be formidable, the symptoms and outlook for double depression may feel even more bleak. Though the presence of both major depressive disorder and persistent depressive disorder is impactful, double depression can be well-treated with a combination of therapy and medications.
What Is Depression?
Depression is a serious mental health issue which can cause symptoms such as withdrawal from people and places, excessive sleep, no appetite, and low mood. Depression can impact people of any age, and often leaves people feeling no interest in their hobbies and other aspects of life that used to bring them joy.
What Is Double Depression?
Double depression describes the existence of co-occurring depressive disorders, although the phrase is not typically used in clinical settings. Depression encompasses a group of mental health disorders that are separate and unique due to the way they emerge, the symptoms they trigger, and the duration of effects. A person with persistent depressive disorder (dysthymia) as well as major depressive disorder (MDD) is said to have “double depression” due to the way these separate conditions combine.1 When these disorders combine, they create a mix of chronic and acute symptoms.
Some of the conditions that may trigger depression symptoms include:2
- Major depressive disorder (MDD)
- Bipolar disorder
- Disruptive mood dysregulation disorder (DMDD)
- Premenstrual dysphoric disorder (PMDD)
- Depressive disorder due to substance use disorder or a medical condition
- Persistent depressive disorder (PDD)
Some of these conditions may overlap while others are mutually exclusive. For example, a person cannot have bipolar disorder and MDD because bipolar disorder includes periods of major depression.2 With double depression, a person has persistent depressive disorder, which persists for at least two years, and episodes of major depression.
How Is Double Depression Different From Major Depression Without PDD?
The major difference between MDD on its own and MDD with persistent depressive disorder is what happens during the time between depressive episodes. Someone with MDD will have episodes that last at least two weeks. When symptoms are low, a person with MDD can report good moods, energy, and motivation, just like someone without depression.
Someone with double depression will continue to feel chronic symptoms like sadness and low motivation between major depressive episodes. In this way, the person will always experience some level of depression and may feel like they are never happy. About 25% of people with MDD will note some duration of dysthymia symptoms during their lifetime.1
Symptoms of Double Depression
In terms of diagnosis, the symptoms of double depression will involve separate diagnostic criteria for each disorder. When a person meets the depression symptom standards for both MDD and PDD, they will have double depression.
The symptoms of MDD include:2
- A depressed or irritable mood most of the day on most days
- Less interest or pleasure in activities that were previously seen as fun and engaging
- Significant and unintended weight changes or appetite changes
- Sleeping too much or too little
- Feeling very sped up or slowed down behaviorally
- Low energy and motivation
- Feeling very guilty or worthless
- Limited ability to think clearly, focus, and concentrate
- Thinking about death, dying, and suicidal ideation
A person will need to display five or more of these symptoms during a two-week period to receive the MDD diagnosis.
The symptoms of PDD include:2
- Low mood more often than not over a two-year period
- Low appetite or overeating
- Too little or too much sleep
- Fatigue
- Low self-esteem
- Poor decision-making skills
- Feeling hopeless
Someone would need only two or more symptoms to meet the criteria for PDD, but as mentioned, the duration of symptoms is the most critical element of the condition. When enough symptoms for MDD and PDD are present, the person can be diagnosed with double depression.
Outward Signs of Double Depression
Some people with double depression could show symptoms like irritability and even physical health symptoms that seem to have little to do with depression. A person with double depression could show drastic changes to their weight, diet, sleep schedule, and exercise routine. This shift could occur all at once or gradually over time.
The age of the person with double depression could also influence what it looks like:3
- Adolescent: due to the chronic nature of double depression, it would be rare for an adolescent to have a persistent depressive disorder diagnosis, but teen depression does occur. They could show signs like low frustration tolerance, restlessness, and low self-esteem linked to their depression.
- Younger adults: more likely to show irritability, depression & weight gain, and oversleep. They could complain of depression & anxiety or try to conceal their depression with substances like alcohol or other drugs.
- Middle-aged adults: complain of digestive issues linked to depression, like constipation or diarrhea. They could have lower libido, wake up in the middle of the night or too early in the morning.
- Older adults: feel numb instead of sad or depressed. When depression is severe enough, it could impact their memory and thinking abilities.
What Causes Double Depression?
A variety of causes and risk factors contribute to the formation and expression of depressive disorders like double depression, including genetics, hormones, and a history of trauma or other mental health conditions.
Common causes of double depression include:4
- Physiological brain differences: some people may have differences in the structure or functioning of their brain. These differences could make depression more likely.
- Hormonal changes: the way the body balances hormones could cause depressive symptoms, which is why teens and women who have recently had children experience increased depressive symptoms.
- Heredity causes: people with close family members who have depression may have depression themselves. This connection leads to genetic depression.
Risk Factors for Double Depression
Other risk factors for depression include:4
- Traumatic or overly stressful life events
- Having a history of other mental health conditions
- Abuse of or addiction to alcohol or other drugs
- Chronic physical health conditions like cancer, pain, or heart disease
- Having a chaotic or unstable childhood
- Lack of parental support
How Is Double Depression Diagnosed?
Double depression is diagnosed when someone has the recurrence of repetitive low moods and the negative impact of this poor effect on a person’s life. People with depression are typically treated for an extended period of time and symptoms are monitored to help justify a diagnosis for multiple types of depression. It can be found that those with depression of any kind can be supported by medication intervention in addition to talk therapy. The way someone responds to treatment can also influence someone’s diagnosis—for instance, someone who is not responding well to talk therapy alone may benefit from medication.
7 Ways to Cope With Double Depression
Ways to cope with double depression include identifying the depression, communicating your experience, confronting your negative thoughts, shifting your negative behaviors, focusing on health, finding fulfillment, and seeking professional help.
Here are seven ways to minimize the symptoms of double depression:
1. Identify the Depression
Some people spend so much time trying to escape or avoid their own thoughts, feelings, and behaviors that they don’t even realize they are depressed. Spend some time each day thinking about your life while being sure to attend to issues like energy levels, mood, motivation, and views of the future. If something seems undesirable or dangerous, take quick action.
2. Communicate Your Experience
Starting a conversation with a loved one about depression and other mental health concerns can be complicated and uncomfortable, but doing so can trigger tremendous benefits. Always begin by communicating with your most trusted resource and expand the conversation from there. Communicating your experience can also help relieve the burden of feeling alone.
3. Confront Your Negative Thoughts
In depression, negative self-talk seems like the norm. You may find the worst of every situation while minimizing any positive qualities or experiences you have. The more that these distorted views are allowed to exist, the more power they have. Start paying attention to your thoughts and challenge the incorrect information your depression is contributing. Remember, these perspectives are not yours. They are your depression’s opinions.
4. Shift Your Negative Behaviors
Just as you must address your unhealthy thoughts, you have to address your unhealthy behaviors. Once depression takes hold, it will manipulate you into engaging only in behaviors that make symptoms worse. To reduce this trend, consider the people, places, and things that are best for you and seek them out. Engage in the activities you love with the people you care about to gain control of your behaviors.
5. Focus On Your Physical Health
As physical health improves, mental health will follow, so placing an increased value on physical health can result in tremendously positive mental health impacts. You don’t have to change all facets of your physical health at once, but inspect your diet, exercise, and sleep habits. Pick one or two elements to address and form a plan.
6. Find a Level of Fulfillment
Being fulfilled may feel foreign as depression has a way of wiping away any sense of accomplishment. It remains a worthwhile goal, though. So much of depression is focused on yourself that you begin losing sight of others. Many people find a strong sense of purpose by giving back to the community or people who are struggling with their own issues. Something powerful happens when you give to others, and this fulfillment could push depression out of the way.
7. Seek Professional Treatment
The finest lifestyle changes and the most valuable coping skills do well to support the battle against depression, but making the decision to start professional therapy or medication services is the best coping skill someone with double depression could make. Starting treatment is important, but sticking to it long-term is even more valuable, so don’t get scared or frustrated if symptoms don’t rapidly improve.
Double Depression Treatment
Treating depression often involves a two-prong approach that utilizes a combination of mental health psychotherapy and one or more medications to address and relieve the symptoms of each condition. People who incorporate healthy lifestyle changes may complement the benefits of professional depression treatment options.
Therapy
In therapy, a psychotherapist will utilize various techniques and strategies to combat depression by helping the individual create a sense of control and well-being. Therapy is available in numerous settings like schools, doctors’ offices, community mental health centers, hospitals, and private practice locations across the country.
Effective forms of double depression therapy include:3,7,8
- CBT: cognitive behavioral therapy (CBT) examines thoughts, feelings, and behaviors to limit shift thoughts and create healthy actions
- IPT: interpersonal therapy (IPT) is a therapy style grounded in the idea that having healthy relationships will push back on depressive disorders
- PST: problem solving therapy (PST) aims to teach clients new ways to identify and resolve problems, ratchet than allowing them to grow out of control
- ACT: acceptance and commitment therapy (ACT) is a style of therapy that helps people find acceptance of some issues and discover commitment towards change other problems
- CBASP: Designed specifically for people with chronic depression, cognitive behavioral analysis system of psychotherapy (CBASP) helps by challenging the client’s damaging perceptions and behaviors and searching for places where changed actions could have resulted in different outcomes1
Medication
Many people choose to use medication for depression, either alone or in combination with therapy, as a way to reduce symptoms linked to double depression. Prescribers like primary care doctors, psychiatrists, and nurse practitioners, will discuss the potential benefits and risks of any medication recommended.
What Makes Double Depression More Difficult to Treat?
As double depression is the emergence of both major depressive and persistent depressive disorders, the treatment must focus on addressing and resolving each of these conditions. The presence of double depression is more difficult to treat than either condition separately.
Managing symptoms, moving past pessimism, and promoting happiness will be a longer process for those with double depression vs. those with MDD alone. People with double depression are also more likely to have a symptom relapse. Among people who respond well to double depression treatment, half will see a return of symptoms within two years, indicating that people with double depression may need ongoing therapy for maintenance and monitoring.1
How to Get Help For Double Depression
If a person wants help for double depression, they only have to reach out for treatment. Some simple ways to access mental health care are to talk to your primary care physician, ask a trusted friend or family member, or find a therapist in an online therapist directory where you can search by location and specialty.
How to Get Help For a Loved One
Due to issues with privacy and consent to treatment, a person cannot simply sign a loved one up for mental health care. A great strategy is to compile a list of available service providers who treat double depression as well as the types of care they provide. You can also offer to attend appointments with your loved one or to provide transportation as needed, since the commute to and from services can present challenges.
Perhaps most of all, a loved one can help by planning things to say to someone who is depressed, gently and consistently noting the potential benefits of professional treatments and the risks of not taking advantage of treatment.
What’s the Outlook For People With Double Depression?
When people have MDD only, about 40% will see improvement in three months while 80% will see improvement within one year. Unfortunately, with the addition of PDD, people with double depression are much less likely to see their symptoms resolve in a short amount of time.2 Instead, people with double depression typically see a need for long-term therapy as a way to manage symptoms.
It seems that one of the biggest influences on double depression is the patient getting the treatment form and style they want. Research suggests that an easy way to improve outcomes is when providers offer the type of therapy preferred by the individual.1
Double Depression Statistics
The available numbers linked to double depression paint the picture of a challenging mental health disorder.
Depression statistics on double depression show:1,2
- More than 75% of people with dysthymic disorder will experience double depression
- 25% of people with major depressive disorder will have periods of double depression
- Only between 25% to 35% of people with chronic depression note symptom remission to their first antidepressant medication
- Major depressive disorder is about three times more common than persistent depressive disorder
- About 12% of people with chronic depression have not recovered after five years of treatment
Final Thoughts On Double Depression
The coexistence of PDD and MDD, or double depression, can be extremely difficult, but you are not alone. Remember, help is out there, all you have to do is ask for it.
Double Depression Infographics
