Double Depression (A Comprehensive Guide)

In this blog, we will discuss what Double Depression means, symptoms how it differentiates from other types of depression, prevention, and treatment.

Double Depression: an overview

Just by thinking about the term Double Depression you may be wondering, “How can I be as twice as depressed?”.

Yes, I agree, feeling already depressed and adding even more depression to the mix is not a good idea. But is this what it really means? 

Feeling depressed or experiencing deep and profound feelings of sorrow and sadness is more common than you think.

We are emotional beings so it is normal to feel sad or depressed from time to time. 

However, it becomes a problem when it interferes with our daily functioning like preventing us from going to school or work, isolating from family and friends or even having thoughts like “life is meaningless” or “I am not important, so no one is going to notice if I die”. 

What is Double Depression?

Double depression refers to the combination of Persistent Depressive Disorder or PDD (dysthymia) and Major Depressive Disorder or MDD. 

Persistent Depressive Disorder (PDD)

Persistent Depressive Disorder (PDD) also called Dysthymia, is a chronic and continuous long-term form of depression.

People with this type of depression may lose interest in daily activities, feel hopeless, may have low self-esteem and the persistent feeling of not being able to deal with situations or life itself. 

If you have this type of disorder, you can find it is really hard for you to be upbeat even when it is a happy occasion.

People might often describe you as boring, conflictive and incapable of having fun. 

Symptoms of PDD

The symptoms tend to come and go over periods of years and they can be perceived with different intensity over time and they don’t actually disappear for more than two months.

The symptoms of PDD (adults) can be very disabling causing a major impact in your life. Some of the symptoms are:

• Losing interest in daily activities.
• Feelings of emptiness, sadness or feeling down.
• Feeling constantly hopeless.
• Feeling tired and drained.
• Having low self-esteem or feeling incapable of handling life.
• Problems concentrating or making decisions.
  Irritable or anger.
• Avoidant behaviors (e.g. social activities, people like friends or family)
• Overworrying about the past or feeling guilty
• Decreased appetite.
• Sleeping problems. 

Causes of PDD

Like many other mental health disorders, the cause for PDD remains unknown, but it has been associated with:

• Brain chemistry: it has been said that imbalances in brain chemistry (neurotransmitters) can be responsible for mood instability or changes. 
• Genetics or inherited traits: it has been said that PDD could have a genetic component, meaning that if you have a relative (especially first-degree relatives) that suffers or suffered PDD there are higher risks of developing the condition.
• Life events: traumatic events such as facing the death of someone you cared or loved or highly stressful situations. 

Risk factors

The persistent depressive disorder often begins early in life and some of the following factors seem to trigger the disorder. Some of them are:

• Being related to someone with major depressive disorder or other depressive disorders.
• Traumatic life events like losing your job or the death of someone you love. 
• Personality traits as low self-esteem, being dependent or pessimistic. 
• Having other mental health disorders such as personality disorder. 

Complications

If the condition remains untreated it can reduce significantly the quality of life of the sufferer, they can develop other depression disorders, anxiety, and/or mood disorders, can be more prone to substance abuse, relationship distress, and suicidal thoughts and behavior. 

What is Major depressive disorder (MDD)?

This type of depression is characterized by the persistent and intense feeling of sadness that stays for an extended period of time.

MDD can severely affect many areas of your life if not treated on time.

People with MDD tend to lose interest in activities they used to enjoy and can affect their sleeping patterns and appetite. 

Symptoms

To be diagnosed with MDD you need to meet at  least 5 or more of the following criteria (DSM-5) and have experienced them at least once a day for more than 2 weeks:

• Feeling sad or irritable most of the day or nearly every day.
• Reduced interest in activities you once enjoyed.
• Gaining or reducing weight suddenly or having a change in appetite.
• Having trouble going to sleep or sleep more than usual.
• Feeling of restlessness.
• Feeling more tired than usual or feeling drained.
• Feeling worthless or guilty about things that wouldn’t normally make you feel that way.
• Difficulties concentrating or thinking. 
• Attempting to commit suicide or having suicidal thoughts. 

Causes of MDD

Similar to PDD the exact cause is still unknown. However, some researchers suggest that there are several factors that might trigger the condition.

As it is the case of PDD, genes and stress play an important role in affecting brain chemistry. 

Additionally, MDD can also be triggered by substance abuse (drugs or alcohol), medical conditions such as cancer or hypothyroidism and some medications like steroids. 

Treatment of MDD: Medication and Psychotherapy

A doctor can prescribe antidepressants such as:

• Selective serotonin reuptake inhibitors or SSRIs: someone with MDD will have low levels of serotonin so SSRIs work by inhibiting the breakdown of serotonin in the brain, increasing the amount of this neurotransmitter.
• Other medications:  tricyclic antidepressants are also prescribed when treating MDD but they can cause several side effects such as weight gain and insomnia. 

In the case of psychological therapy, doctors usually recommend talk therapy.

This consists of meeting the therapist on a regular basis to talk about your condition and related issues.

Your doctor might also recommend Cognitive Behavioral Therapy, interpersonal therapy or assisting to group therapy sessions. 

Treatment for Depression 

The treatment plan for someone with depression is usually unique to their history and symptoms and many mental health professionals tend to recommend a combination of psychotherapy and medication. 

Medication

Doctors usually prescribe antidepressants such as the following:

• Selective serotonin reuptake inhibitors or SSRIs, examples are fluoxetine (Prozac) and sertraline (Zoloft). 
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), examples are desvenlafaxine and levomilnacipran. 
• Tricyclic antidepressants or TCAs, examples are amitriptiline, clomipramine and imipramine. 

Cognitive Behavioral Therapy

This is a type of therapy that helps to target patterns of thoughts in order to modify behaviors.

It is based on the theory that negative feelings or actions are the results of distorted beliefs and thoughts from the past.

CBT has a cognitive therapy component and a behavioral component. 

The first component focuses on your thoughts and the second component targets actions and behaviors.

As part of CBT, your therapist will help you identify patterns of negative thoughts and the behavioral responses they elicit when in stressful or challenging situations.

Once they have been identified, your therapist can help you target those thoughts and behaviors to modify/replace them.

Alternative depression treatment Tips

In addition to using medications or therapy, you can add more value to it by making some adjustments to your lifestyle. 

• Eating better: consider including into your diet omega-3 fatty acids such as salmon. Additionally, try adding foods that contain B vitamins, like beans or whole grains. 
• Try to avoid alcohol consumption and processed foods such as deep-fried foods (omega-6 fatty acids) which have been linked to contributing to MDD. 
• Exercising: try to stay active, this has been proven to release certain chemicals in the brain that will make you feel happy and energized. 
• Sleeping better: get at least 6 to 8 hours of sleep when possible. 

What are my chances of improving my condition?

Sure, you can feel hopeless at times, but this doesn’t mean that you cant improve or get better.

As debilitating as depression is with the appropriate motivation and some treatment you can expect good results. 

When going to therapy, try not to miss any appointments.

If necessary, make them call you 1 or 2 days prior to your appointment to remind you.

Also, you can try writing it on a sticky note were you can easily see it or set an alarm in your smartphone. 

Additionally, it is recommended for you to keep taking your medication and don’t suspend it unless your doctor has instructed you to. 

If you feel your depression is too overwhelming try getting the support you need from family, friends or organizations that specialize in depression. 

Behavioral Activation

Behavioral Activation (BA) is considered one of the most important cognitive-behavioral therapies used to treat depression making sense of how behaviors and feelings can influence each other.

This technique is designed for you to increase contact with possible rewarding activities by setting specific weekly goals and working towards achieving them.

These goals (short, medium and long-term life goals) need to be as specific as possible and consistent with the life you’d like to start living.

The rationale is that depression is a consequence of avoiding certain people, activities or situations.

Moreover, the National Institute for Health and Research (NICE) highly recommends behavioral activation for mild to moderate cases of depression.

The NIHR provided evidence about the effectiveness of Behavioral Activation.

In this large trial, they recruited over 400 adults that were suffering from depression and randomly divided them into two groups, one for Cognitive Behavioral Therapy treatment and the other one for Behavioral Activation treatment.

Subsequently, they received therapy for a period of 16 weeks (up to 20 sessions) and after 12 months patients from both groups reported an important reduction in their depression symptoms.

Why is this blog about Double Depression important?

This guide is important because it provides a different approach to comprehend what depression is, types of depression and their related symptoms, treatment options and how debilitating depression can be for some people. Next time, instead of judging you might have the possibility to help.

Please feel free to comment in the comments section below!

Recommended Reading

1. Reasons to Stay Alive 
2. Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions
3. Overcoming Depression – Get Happy Again: The Self-Help Workbook for Understanding Depression, Anxiety and Panic Attacks
4. Overcoming Depression 3rd Edition: A self-help guide using cognitive behavioural techniques (Overcoming Books)
5. The Depression Cure: The Six-Step Programme to Beat Depression Without Drugs

References

Mayo Clinic

HealthLine:dysthymia-vs-depression

HealthLine:clinical-depression

WebMD