Definition of Double Depression

Depression is a debilitating and costly condition. Depressive disorders affect nearly 35 million Americans at some point in their lives. An estimated 80 percent of people who suffer from depression do not seek professional help, even though the cost of employee absenteeism and lost productivity due to depressive disorders has been estimated as high as $51 billion annually. Depression can take several forms, including mild depression, major depression and bipolar disorder. Double depression combines the effects of a chronic mild depression with periodic bouts of major depression. Treatment seeks to first address the major depression and then relieve the underlying and ongoing mild depression.

Double Depression

• Double depression is a condition in which someone experiences symptoms of minor depression (also known as dysthymia) and major depression together. Dysthymia is a long-term condition, marked by mild symptoms such as continued feelings of sadness, which may begin as early as childhood. When an episode of major depression is experienced, bringing with it more intense and severe symptoms along with dysthymia, double depression may be diagnosed. Although symptoms of dysthymia are "mild," they are nonetheless serious as they take a long-term toll on self-worth and mental health. When experienced in combination with a bout of major depression, treatment is likely necessary.

Dysthymia

• Dysthymia causes depression that usually lasts most of the day and occurs every day. Dysthymia can only be diagnosed if the depression is experienced for the better part of two years, although the diagnosis in children and adolescents only requires one year of symptoms. Within this period of time, depression-free episodes cannot last longer than two months.
  The following symptoms are associated with dysthymia, although only two symptoms must be present for a diagnosis to be made: changes in appetite often accompanied by weight gain or weight loss, changes in sleep patterns causing insomnia or excessive sleep, fatigue, feelings of hopelessness, low self-esteem, and difficulty concentrating or making decisions.

Major Depression

• Major depression, which is also known as unipolar or clinical depression, is characterized by severe episodes of depression that are not chronic in nature as in dysthymia. Five or more symptoms of depression must be reported for at least two weeks for a diagnosis to be made.
  The symptoms of major depression are irritability or restlessness; insomnia or excessive sleep; dramatic changes in appetite that can be accompanied by changes in weight; difficulty concentrating; lack of energy; hopelessness or helplessness; self-hate, worthlessness or feeling guilty for no reason; an inability to feel pleasure in activities that were once enjoyed or a loss of interest in such activities and thoughts of death or suicide.

Treatment

• Treatment for double depression usually requires a combination of psychotherapy and antidepressant medication. Psychotherapy can consist of advise, counseling, cognitive therapy, behavioral therapy or other forms of therapy. Medications commonly used are SSRIs such as Zoloft or Prozac. Some people do better on MAOIs or the older tricyclic antidepressants. Finding the right therapy or medication can take some time, and not every treatment is right for every person.

Time Frame

• Because double depression is a chronic condition, it does not self-resolve. Treatment can also take some time to work. For example, medications may take a few weeks to a few months to to have a positive affect on mood. For this reason, patients may be tempted to discontinue medication or therapy due to the slow manifestation of results.