What is Double Depression?

Depression can be hard to treat, and those who have double depression have a double battle to fight. This condition involves a combination of major depression and a chronic depressive condition called dysthymia. A major depressive episode and dysthymia have similar symptoms but there are distinguishing features to double depression that make it its own special condition. Easing double depression requires both ending the major depressive episode and resolving the underlying dysthymia.

Major Depression

A major depressive episode involves several behavioral and physical symptoms, which significantly differ from the patient's past behavior and experience. A person experiencing a major depressive episode will feel sad, worthless and guilty, and perhaps even think about suicide. He or she might have difficulty concentrating or be unnaturally irritable, and not take pleasure in previously enjoyable activities. There are also physical symptoms, such as sleep disturbances, lack of energy and pain such as headaches or stomach aches. The symptoms might appear gradually or suddenly, but if they last longer than 2 weeks and interfere with functioning, they officially become a major depressive episode.

Dysthymia

Dysthymia differs from depression mainly in the length of time it lasts--people who have dysthymia have many of the same symptoms as people with traditional depression, such as poor sleep, lack of energy and concentration, and a general sad mood. However, unlike a depressive episode, dysthymia is persistent, lasting 2 years or more. The condition may have milder symptoms than a major depressive episode, but dysthymia symptoms may be severe. Dysthymia tends to develop early in life, so some people may actually think that their symptoms are normal and don't seek treatment until they have an episode of major depression--which is somewhat likely, as 10 percent of people with dysthymia will develop major depression.

Double Depression

Double depression occurs when a person with dysthymia undergoes a major depressive episode. It can be hard to diagnose double depression, especially if dysthymia has not been diagnosed before. If dysthymia has been diagnosed, double depression may just seem like a worsening of dysthymic symptoms (in fact, there is some argument that "double depression" is really just an exacerbation of dysthymia). Women are more likely to develop double depression (just as they are more likely to develop dysthymia).

Hopelessness

A small study published in the Journal of Affective Disorders found that the distinguishing symptom of double depression, as opposed to a major depressive episode or dysthymia alone, seems to be hopelessness. Perhaps unsurprisingly, people with double depression have given up on ever recovering from their condition and have a bleak outlook on life. Another difference between dysthymia, double depression and major depression is that people with dysthymia or double depression feel as if they don't have control over their lives, while people who are suffering from a major depressive episode without a previous history of dysthymia feel as if they are still in control of their own fate.

Treatment

The main goal of treating someone with double depression is to resolve the major depressive episode. After the major depressive episode is over, the patient can start working on the issues that cause or exacerbate her dysthymia. Often dysthymia goes undiagnosed, and the person does not receive treatment until she experiences major depression. Both major depression and dysthymia can be treated with antidepressants and other medications, with therapy, and in severe cases with electroshock therapy (ECT), hospitalization or experimental treatments.