A Comprehensive Guide To Double Depression

Double depression is not a diagnosable condition but may refer to when someone lives with persistent depressive disorder (PDD) and major depressive disorder (MDD) simultaneously. It can be difficult to recognize double depression, so understanding its two parts—dysthymia and major depressive disorder—can help you understand it in more significant detail. 

What is persistent depressive disorder (dysthymia)? 

According to the National Institute of Mental Health (NIMH), persistent depressive disorder affects about 1.5% of adults in the United States. The official diagnosis of PDD is a combination of several older diagnoses. It often refers to the milder form of chronic depression, which used to be labeled dysthymia in the DSM-4.  

Symptoms

One of the primary symptoms of PDD is a low mood, like a sense of melancholy that lasts for most of the day on most days over at least two years. Over these years, the symptoms can fluctuate but do not disappear for more than two months. Other symptoms of PDD can include the following: 

• Loss of interest in previously enjoyed activities 

• Sadness, emptiness, or feeling down

• Hopelessness

• Exhaustion and a lack of energy 

• Low self-esteem, self-criticism, or a belief that you are "incapable" 

• Difficulty concentrating and making decisions

• Irritability or excessive anger

• Decreased activity, effectiveness, and productivity

• Avoidance of social activities

• Feelings of guilt 

• Poor appetite or overeating

• Difficulty sleeping 

PDD often shows up early in life. However, adults can also develop this condition. 

Causes of persistent depressive disorder 

As with other depressive disorders, PDD doesn't have one cause. Instead, there are several potential contributing factors. In any person, PDD can be caused by a mix of biological, neurochemical, inherited, and situational factors.

Biology

It is possible that PDD stems from or causes changes in brain shape and size. More research about this part of PDD could be an avenue for future effective treatments. 

Neurochemistry

The human brain runs on chemicals. Neurotransmitters influence the messages the brain sends and how the brain controls mood and emotions. A lack of some of these chemicals, an imbalance in their levels, or a change in their function could prompt the development of depression. 

Inheritance 

If you have relatives with depressive disorders, you are more likely to have a depressive disorder yourself. Depression is often considered 40% to 50% hereditary. There can be disagreement in the psychological community about whether PDD is inherited through genes or social environments. Although the reasons for heritability aren't clear, depression is generally considered a condition that can be passed down in families. 

Situational circumstances

PDD may have a situational element. The stress of significant life events can cause the development of PDD, even when the events are positive. Grief or negative stress from the death of a loved one or the loss of a job could bring on depressive episodes. PDD can also be incited by positive but stressful events like having a baby, getting a job, or moving to a new house.

In addition to current events, early traumatic life events or negative family situations can leave people with a higher risk of PDD. Specifically, abusive or neglectful family situations seem to make it more likely that people will develop PDD later in life. Also, these early traumas seem to make it more likely that people will develop double depression or be more impacted by their PDD.

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

What are the effects of PDD? 

Below are some of the potential effects of a PDD diagnosis. 

Function

Part of the diagnosis of PDD is based on its effect on people's relationships, social lives, and work lives. This area may be called "function," the ability to lead a typical or desirable lifestyle. People with PDD may find it much more difficult to function within healthy parameters. 

The effects of PDD on function depend heavily on how severe other symptoms are. Mild PDD may not cause severe loss of function. Some people with PPD, however, may find it challenging to sustain family or social relationships. In some cases, PDD can impact their ability to work.

Double depression

People with PDD are more likely than those without the condition to experience a major depressive episode or double depression. This effect may be because people with PDD are potentially less likely to seek help when they experience major depressive symptoms.

Prognosis

Although PDD or dysthymia is often referred to as chronic depression, many people with PDD recover after some time. However, there can be a high relapse rate. Around 70% of people who have had PDD may develop it again. 

Treatment for PDD 

Treating PDD can be complex, as it is sometimes less responsive to antidepressants than other types of depression. Although antidepressants are effective in fewer people with PDD, they can be helpful for some. Talk therapy is also effective in managing depressive symptoms. For others, combining therapy and medication is the most effective treatment.

In addition to these treatments, self-care may be valuable in managing the symptoms of PDD at home. Building and maintaining relationships, even when difficult, can also counteract the isolating effects of PDD. 

What is major depressive disorder (MDD)?

Major depressive disorder (MDD) is the most common depressive disorder and may be the first condition people consider when hearing the word "depression." About 6.7% or 16.1 million adults in the United States are diagnosed with MDD in any given year. MDD differs from PDD in severity, timescale, and several symptoms. 

Symptoms

Unlike PDD, which is characterized by a low mood or pervasive sadness, the symptoms of MDD are overwhelming sadness or a loss of interest in everyday life. MDD can also include symptoms like the following: 

• Appetite changes

• Sleep disturbances

• Hyperactivity or lethargy

• Fatigue

• Guilt 

• Thoughts of worthlessness

• Disconnect 

• "Recurrent thoughts of death" and suicidal ideation

• Cognitive difficulties (including difficulty with decision-making)

If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.

MDD presentations in different groups 

There can be differences in the ways that MDD presents in different groups. Men tend to display more irritability, fatigue, and anger. They are also more likely to self-medicate with substances or risky activities. As a group, women are more likely to have sadness-related symptoms. They may feel worthless or experience guilt and shame more often. 

Children with MDD often worry about separation from their parents. They might not want to go to school and could have nightmares. Teens with symptoms of MDD may also be more likely to experience eating disorders, substance use disorders, or anxiety disorders alongside depression. 

Dysthymia vs. depression

One of the primary differences between PDD and MDD is time. To be diagnosed with PDD, a person must experience depressive symptoms for at least two years. PDD also lasts longer than MDD. MDD can be diagnosed after two weeks of daily symptoms. Another difference between PDD and MDD is the severity of the symptoms. Often, the symptoms of PDD are less severe than those of MDD. 

Since MDD and PDD are both depressive disorders, their causes are similar. As with PDD, MDD does not have a single cause but can be caused by various challenges, including brain chemistry and genetics. 

Not all the causes of PDD and MDD are the same. MDD is more likely to be caused by hormonal challenges. Thyroid issues and hormonal changes related to pregnancy, childbirth, and menopause can all factor in MDD. In these cases, treating hormonal imbalances may be effective. 

As with PDD, MDD is often treated with medication, therapy, or a combination. People respond differently to different types of medication, and when one medication doesn't work another might. Doctors often try multiple medications within one category before moving to another category. 

How is double depression different from these two conditions? 

Double depression happens when a major depressive episode (MDE) occurs at least two years after the onset of PDD—the symptoms of MDD layer on top of PDD rather than replacing them. Double depression can share some symptoms in common with MDD and PDD but differs in the following ways. 

Hopelessness

The symptoms of MDD and PDD can both contribute to double depression. However, double depression is often characterized by more severe thoughts of hopelessness. People who have PDD often believe they are not in control of their lives. Double depression can worsen this thought pattern. In addition, individuals may believe they are unable to get better. 

Loss of function

PDD and MDD can cause a loss of function or decrease a person's ability to lead healthy professional, social, and self-sufficient lives. Double depression has a more significant impact on functioning than PDD or MDD.

Relapse

People with double depression may be more likely to experience relapse than those without double depression. People with MDD are somewhat likely to experience more than one episode during their lifetime. However, those who have double depression may be more likely to experience more episodes of MDD than people who only have one diagnosis of PDD or MDD. 

Anxiety disorders

Anxiety disorders are somewhat common alongside any diagnosis of depression. However, people with double depression are more likely to have an anxiety disorder alongside their depression.

Treatment for double depression

Below are some of the most commonly recommended treatment options for double depression. 

Medication and therapy

The same treatments for PDD and MDD are used for double depression. Depending on the individual case, it may be more effective to focus on treatments for one or the other of the two depressive disorders present. Although a combination of medication and therapy is the most helpful treatment for both PDD and MDD, double depression may be more likely than either condition to require extensive care. 

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) teaches people to recognize false or unhelpful thought patterns and change them. The hopelessness that often accompanies double depression is a negative thought pattern that can be changed. People with double depression, like those with PDD, may believe they do not have control over their lives. CBT can target that sense of hopelessness and help people with double depression replace those thought patterns. 

Alternative treatment 

Depressive disorders like PDD, MDD, and double depression are common. If you have been diagnosed with one of these conditions, reaching out for professional help can be beneficial. However, some people with depressive disorders may struggle to leave home or commit to appointments. In these cases, online therapy through a platform like BetterHelp may be beneficial. 

The rise of online therapy provides individuals with a convenient, effective way to speak to a mental health professional without having to travel to an office or meet a therapist in person. Online platforms can match you with a trained therapist who can provide a course of treatment for the depressive symptoms you may be experiencing.

Studies also support the effectiveness of online therapy. One review of 17 studies found that online therapy could be more effective than in-person therapy in treating depression symptoms for some individuals. In addition, online therapy was found to be convenient and cost-effective.