To understand double depression, we first have to understand depressive disorders.
Depressive disorders are a group of mental health disorders that carry with them some or all of the following symptoms: low moods, extensive or extreme sadness, insomnia (or hypersomnia), fatigue, poor concentration, reduced appetite, guilt, slow movements, and/or suicidal thoughts.
While there are a few depressive disorder types, one of them is dysthymia, or persistent depressive disorder (PDD), which is an ongoing, low-grade depression that lasts for two years or more. Another type is major depressive disorder, or MDD, and that’s a more severe kind of depression. When these two are present in an individual, that’s called double depression.
Double depression is not an official term, but it’s what many use when a person has persistent depressive disorder that is combined with and complicated by episodes of major depressive disorder. More than 75% of those with PDD have moments during which their depression symptoms escalate, meeting the criteria for MDD.
You can have major depressive disorder without persistent depressive disorder, but when an individual has both, they are at a higher risk of relapse after treatment. In addition, when a person has double depression, it’s also more likely that they will experience other mental health disorders at the same time.
Just as with most depressive disorders, there are overlapping symptoms, but the most common ones include feeling worthless, hopeless, and pessimistic. The individual with double depression also likely has extremely low self-esteem that worsens considerably as the double depression becomes more complicated. They may not be able to sleep, eat, and may no longer want to partake in activities that once interested them.
It’s thought that genetic factors play a part in a person developing double depression, but environmental circumstances can cause it as well. They may be undergoing extreme life changes or are battling substance abuse; they may have a history of other mental health disorders; they may be unemployed, have a lower education or socioeconomic status, or simply lack social and familial support. They may be female. They may have a family history of mental health disorders.
The trouble with diagnosing double depression is that so many people who have it don’t reach out for assistance, because they’re feeling so bad and so sad that they’ve lost interest not only in what they used to love, but in themselves and in getting better. They may not even realize anything is wrong because they’ve been living this way for so long, and it’s started to feel normal.
But because depression is such a serious condition – and most certainly, double depression – it’s so important people seek help.
There are treatments for double depression – it’s not hopeless. It could be a psychotherapy approach, or it could be medication. It could be a combination. And because different things work for different people, the individual may undergo a few different medications or therapists before finding the right treatment.
Fortunately, health lifestyle choices and even small changes can have a drastic and positive effect on depression. Even the most severe of depressive states can be improved; a slow response to therapy is still a response.