Double depression disorder is a diagnosis of two concurrent mental health issues: major depressive disorder and persistent depressive disorder. The term is exclusive to a diagnosis of these two conditions together; a diagnosis of two different depressive disorders or two unrelated mental health issues with mood symptoms is not always called double depression.
Double depression is not a formal diagnosis and doesn’t exist in diagnostic manuals like the DSM-V, for example. It is an informal term for a diagnosis of both major and persistent depressive disorders. In most cases, someone with double depression is diagnosed with persistent depressive disorder (a low-severity, long-term depression) and later on develops symptoms of major depressive disorder (severe or “clinical” depression).
Does Double Depression Exist?
Yes, absolutely. Just because it isn’t called double depressive disorder in committee-approved medical or psychiatric literature doesn’t mean that there aren’t any professionals who don’t recognize the phenomenon. Double depression is more common than other combinations of mood disorders and is heavily researched.
There are numerous research articles and studies that center around the phenomenon of acute depressive episodes in clients with previously diagnosed chronic depression, dating back to the early 1980s.
Double depression disorder occurs when someone has a chronically low mood and eventually develops symptoms of full-blown severe depression, which may return episodically, before continuing to experience long-term symptoms of low mood. Dysthymia is a condition with some contention around its treatment and the differences it might have next to “conventional” depression-like MDD, but as of the latest psychiatric and medical consensus, it is definitely a separate condition from major depression.
Signs of Double Depression Disorder
Double depression requires a formal diagnosis of persistent depressive disorder, followed by a formal diagnosis of major depressive disorder.
Persistent depressive disorder requires an adult to exhibit signs and symptoms of low mood (or depressive mood) for at least two full years. This is what makes it a chronic diagnosis. In teens and children, the requirements may be lower but are typically still over a year.
Must be Accompanied by Two Other Symptoms
In addition to “low mood,” which may sound vague as a symptom, the person must also have at least two other concrete signs of depression, such as restlessness, chronically low mental and physical energy, low self-esteem, poor decision-making, and repeated feelings of hopelessness.
Persistent depressive disorder is not easily diagnosed – not just because it might be difficult to identify whether a person has been consistently depressed for two years, but because one of the consequences of being depressed for a long time is that it becomes a new baseline – your sense of “normal” mood perception and emotional regulation becomes warped, and it feels impossible to feel any other way than consistently low and tired.
Characteristics of Major Depressive Disorder
Major depressive disorder is the most commonly diagnosed form of depression and also the most common mood disorder. It is sometimes known as clinical depression or severe depression. One of the main characteristics of a “severe” depressive episode is that it is debilitating. It will impact a person’s work performance, ability to host guests, talk to people, engage in habits and hobbies, or even tend to their children.
The time period criteria for major depressive disorder is much, much lower – just two weeks of consecutive and severe depressive symptoms, which include severe changes in appetite, loss of interest in most activities, feelings of worthlessness, sluggish thoughts, and recurring thoughts about suicide or dying.
Ruling Out Other Mental Health Conditions
For example, someone with PDD experiencing more severe symptoms of depression immediately before or after the birth of their child is not necessarily facing a traditional double depression disorder – instead, they may be experiencing post-partum or peripartum depression. Similarly, if their increase in depressive symptoms can be explained by withdrawal from going through treatment for drug use, it’s unlikely that they would be considered “double depressed.”
Is Treatment for Double Depression Disorder Different?
Persistent depressive disorder and major depressive disorder follow similar treatment plans, but every treatment plan for a depressive condition is ultimately unique. Yes, the building blocks are the same: most people will experience a first-line treatment consisting of talk therapy (usually cognitive behavioral therapy) and an antidepressant (usually starting with the most tolerated antidepressant class, SSRIs).
Cognitive Behavioral Therapy
But even here, treatments diverge. CBT as a therapy structure has a rigid definition, but every instance of therapy between a professional and a client is different.
Every person needs their own approach to identifying with the goals of a cognitive and behavior therapy program. For example, CBT centers around the convergence of cognitive therapy methods (helping people contend with their negative thoughts and positively affect them) and behavioral therapy methods (helping people contend with their negative behaviors and positively affect them).
This is generally easier said than done. But some people respond better to certain methods, analogies, and thought experiments than others. Therapists use a multitude of affirmative statements and therapeutic homework exercises to help individuals affect their mental cycle.
Antidepressants and Pharmacology
Pharmacology also plays an important role here. In many cases, therapy hits a hard wall where no matter how much someone else tries to break through to you, your own thoughts are overwhelmingly negative and self-deprecating. Antidepressants can mellow these thoughts, allowing therapeutic sessions to begin taking a more long-term effect.
But it takes time for these drugs to work, and not everyone responds the same way to any given drug. Some people take to the first or second drug they try with little to no side effects just a few weeks into treatment. Other people need months to work through several selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and maybe even tricyclic antidepressants before finally experiencing relief from depressive symptoms.
Then, there are cases of treatment-resistant depression, which can also happen in cases of double depression disorder. In these cases, the person in question is not responding well to conventional therapy or antidepressants. This is when other mental health treatment modalities may come into play, including vagus nerve stimulation, transcranial magnetic stimulation, and alternative therapies such as acupuncture and hypnosis.
Depression Treatment in Malibu
Treatments for double depression disorder are not necessarily different from those of only a persistent depressive disorder or only a major depressive disorder, but they are still unique from person to person.