What Are The Signs And Symptoms Of Double Depression?

Double depression occurs when a person with dysthymia, a type of mild but long-lasting depression, experiences an episode of major depression, which is more severe.

Understanding what double depression is can be tricky. So here we discuss what double depression is, how it occurs, and what makes it different from other forms of depression. 

What is double depression?

Double depression is essentially two types of depression occurring at the same time. As mentioned, these two types are dysthymia and major depressive disorder (MDD). 

Before getting started, it's important to note that health professionals may use the terms dysthymia and persistent depressive disorder (PDD) interchangeably. That's because PDD and dysthymia are different names for the same condition. In fact, PDD is the newer name for the condition. Dysthymia is an older term, but it’s still commonly used.

Likewise, MDD is sometimes called clinical depression. Therefore, it can be rather confusing to understand which type of depression is being discussed.

But in terms of double depression, the take-home message is that two particular types of depression are present simultaneously. As a result, this causes the symptoms of depression to compound and worsen. 

If you feel that your symptoms of depression are worsening, never hesitate to ask for help. 

Is double depression the same as dysthymia disorder?

Dysthymia, also called PDD, is a depressed mood that persists for two years or longer. However, there can be short periods of normal mood during this time. The person also has a few additional symptoms of depression, but not enough to be diagnosed with major depression.

Double depression occurs in people who already have dysthymia. This means dysthymia is one component of double depression. However, double depression also consists of major depression, so it's not the same as dysthymia.

How does double depression present?

Double depression occurs when dysthymia becomes exacerbated. A person with dysthymia already has some symptoms of depression on a long-term basis. These include depressed mood as well as one or two other symptoms. When double depression develops, the person will experience more symptoms of depression, and their depressed mood may be more severe.

The symptoms of depression include:

• Feelings of emptiness

• Feeling sad

• Loss of interest in favorite activities

• Lack of appetite or overeating

• Fatigue or tiredness

• Hopelessness

• Irritability 

• Anxiety 

• Feelings of guilt 

• Digestive disturbances

• Body aches or pain

• Headaches

• Thoughts about death or suicide

People with major depression have at least five of these symptoms.

What is dysthymia?

Dysthymia causes a low-grade depressive mood, and it persists for some time. To be diagnosed with dysthymia, this low-grade depressive mood must have lasted for two years or longer. 

Symptoms of dysthymia include:

• Persistent depressed mood, with some fleeting periods of normal mood

• Poor appetite or overeating 

• Insomnia (trouble sleeping) or hypersomnia (sleeping too much) 

• Low energy and fatigue

• Low self-esteem

• Difficulty concentrating 

• Difficulty making decisions 

• Feelings of hopelessness

Major depressive episodes are not classified as a symptom of dysthymia. Therefore, the low mood you experience will be relatively mild but chronic, and you may experience some brief moments where your mood appears fine.

However, after you’ve had dysthymia for some time, you’re at greater risk of experiencing a major depressive episode. You’re more likely to develop major depression if you already have dysthymia. 

But due to the relatively mild and chronic depressive symptoms related to dysthymia, it commonly goes unnoticed for some time. Hence, it can be difficult to diagnose, and some people aren’t aware of their condition until it worsens.

How is double depression different from major depression without dysthymia?

Major depression disorder (MDD), also called clinical depression, is characterized by a persistent low and chronic mood. However, MDD's symptoms are severe and significantly impact daily life. 

The symptoms of major depression include: 

• Chronic low mood

• Anhedonia (the inability to feel pleasure) 

• Decreased interest in favorite activities 

• Feelings of guilt 

• Feelings of worthlessness

• Low energy

• Tiredness

• Appetite changes

• Agitation 

• Sleep disturbances

• Suicidal thoughts

The same symptoms are associated with major depression as with dysthymia. However, the difference is in severity. People with MDD have more symptoms of depression and more severe symptoms than those with dysthymia. These symptoms can interfere with daily life and prevent someone from achieving the things they usually would. 

If you have MDD, it's essential to get treatment for this condition so it doesn’t worsen. Never hesitate to ask for support from a healthcare professional.

Does double depression have other characteristics that make it hard to treat?

Double depression can be harder to treat because the symptoms are sometimes more severe and typically persist for a considerable amount of time. For example, a ten-year prospective follow-up study found that participants with double depression had significantly higher levels of depression and spent more time in depressive episodes than those with major depression.¹

This suggests that double depression may be more challenging to treat than other types of depression. However, there are still treatments available that work for many people.

Can double depression be prevented?

All types of depression can be unpredictable, and it’s not always possible to prevent episodes of depression. One way to try to prevent double depression is by treating dysthymia. When the underlying chronic depression is addressed, you’re less likely to experience an episode of double depression. 

Some studies have looked at preventative strategies for depression overall. These techniques aim to equip people with coping mechanisms and life skills to help them endure stressors that are potential triggers of depression. There have been several therapy programs that have been shown to reduce the likelihood of major depression.²

In addition, there are lifestyle changes that can help reduce the likelihood of depression. These include exercising, getting enough high-quality sleep, eating a healthy diet, and maintaining close relationships. Paying attention to these factors is important to decrease the chances of experiencing double depression.

Although there are ways to reduce the likelihood of experiencing an episode of major depression, it’s not always possible to prevent it from occurring. If you have dysthymia, it’s important to keep an eye on your symptoms and seek help quickly if you develop signs of double depression.

Diagnosis

Only a doctor or a trained mental health professional (such as a psychologist) can diagnose you with double depression or any other type of depression.

Double depression can be challenging to diagnose because it involves two different types of depression. If you meet the diagnostic criteria for dysthymia and MDD, you may have double depression.

How should double depression be treated?

Like most other types of depression, double depression can be treated with cognitive therapy or medication. In people with double depression, the duration of treatment may need to be extended compared with the duration used for other types of depression.

Baseline evaluation 

Before deciding which treatment is right for you, a healthcare professional will conduct a baseline evaluation. This type of evaluation establishes the correct diagnosis and assesses the severity of your depression. Doing so ensures that you receive the proper treatment or intervention if required. 

Baseline evaluations typically consist of questionnaires. At the end of the questionnaire, a score is calculated based on your answers to determine how severe your depression is.

Follow-up evaluations

A follow-up evaluation assesses the progression of your depression. In general, a follow-up will generally be performed after you spend a period trying out a new treatment. If you experience a significant worsening or improvement of your depression, then a follow-up evaluation may also be performed.

Medication

Treatment for double depression may include cognitive behavioral therapy (CBT) and/or medication. 

Your doctor may prescribe an antidepressant, which is a medication that’s been found to be effective for depression. There are a few different types of antidepressants, with the most common ones being:

• Tricyclic antidepressants (TCAs)

• Selective serotonin reuptake inhibitors (SSRIs)

• Selective serotonin noradrenaline reuptake inhibitors (SNRIs)

While the above medications are usually the first-line treatments, other options are available if those don’t work. These include:

• Adrenergic alpha-2 receptor antagonists

• Monoamine oxidase (MAO) inhibitors

• Selective noradrenaline reuptake inhibitors

• Selective noradrenaline/dopamine reuptake inhibitors

It may require trial and error until your healthcare provider finds the right medication, or combination of medications, to treat your depression. If you notice that your symptoms have worsened after beginning treatment, you should contact your doctor for further advice.

Alternatively, if you see no improvement within the recommended timeframe that your doctor provided, you should also seek another evaluation. Your doctor may consider switching your treatment or adding another treatment.

Therapy

Cognitive behavioral therapy is a form of psychotherapy or talk therapy. It takes the approach that depression can be treated by changing thought patterns or learned behaviors. The therapist helps an individual identify unhealthy beliefs and thought patterns and replace them with healthier ones. 

The lowdown

Double depression is a combination of dysthymia (chronic depression) and major depression. Therefore, two types of depression are present at the same time. If you’re looking for treatment or therapy for double depression, a range of options are available.

Any time you experience any symptoms of depression, it's always best to seek medical advice. This will not only help you feel better but will allow for a proper diagnosis of the type of depression that you have. The symptoms of depression can worsen when they’re left untreated for too long, and that's why it's essential to find help.

Frequently asked questions

Can you have both dysthymia and major depressive disorder? 

Yes, you can have dysthymia and major depressive disorder simultaneously. 

What’s it called when major depression and dysthymia happen at the same time?

When major depression and dysthymia occur at the same time, it's called double depression.

Can you have two types of depression at the same time?

Yes, it is possible to have two types of depression at the same time.

Can dysthymia turn into major depression?

When dysthymia is left untreated for too long, you’re more likely to develop major depression.