In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is double depression. This post uses a lot of abbreviations, which are summarized down at the bottom of this post.
The term double depression is sometimes used to describe the state when two types of depression (major depressive disorder and dysthymia) occur at the same time. The term has been in use since 1982, but it’s not a diagnostic term in the DSM-5.
Major depressive disorder (MDD) is what most people think of when it comes to depression. It involves at least one episode that fulfills the criteria for a major depressive episode (MDE). That basic building block of an MDE can also be found in bipolar disorder and schizoaffective disorder).
Earlier DSM versions
In the DSM-III, and again in the DSM-IV, dysthymic disorder (aka dysthymia) was a distinct diagnosis from MDD. It applied when someone had depressive symptoms that didn’t meet the criteria for an MDE (in number or severity) but were pervasive and present pretty much all of the time for at least two years. Basically, it was a milder form of depression that stuck to you like glue.
Sometimes, dysthymic symptoms may worsen to the extent that they meet the criteria for an MDE, which might then be described as a double depression.
The DSM-5
Then along came the DSM-5. It created a new diagnosis, persistent depressive disorder (PDD). This encompassed both the former diagnosis of dysthymia and people with full MDD who met that 2-year stuck to you like glue criterion. Double depression would fall under that hodgepodge somewhere.
In a rather odd quirk of the DSM-5, I now technically have an additional diagnosis of PDD because my treatment-resistant MDD has persisted without a break for more than two years.
Is double depression a useful construct?
A recent meta-analysis that looked at results from previous studies showed that people with double depression don’t tend to respond to medications as those with MDD or PDD alone. I’m not sure if that’s actually indicative of a distinct population or if people fell into that double depression category because they were harder to treat in the first place.
Why the confusion? The DSM is a pretty blunt instrument. It organizes things in a broader sense pretty well, but when it comes to fine distinctions, it’s not so good. Depression is a thing, absolutely. There are different characteristic patterns of depression, absolutely. But are those patterns shades of the same thing, or do they represent distinct phenomena? Who knows.
Then there’s what feels right. To me, it feels like it misses the boat a bit that I happen to fall into an additional category by default. Especially when one of my key symptoms is only on the MDE criteria list, not the dysthymia list. It’s not like, say, a schizophreniform disorder diagnosis, which is by definition basically a placeholder until you meet the length of time for a diagnosis of schizophrenia. That’s a switch of diagnosis; this is an addition of diagnosis. I don’t actually care; my dimwit of a doctor certainly has no idea that I technically have this extra diagnosis now, and it changes nothing in my life.
What do you think of the concept of double depression? Is it something you’ve experienced?
Abbreviations:
- DSM: Diagnostic and Statistical Manual of Mental Disorders
- MDD: major depressive disorder
- MDE: major depressive episode
- PDD: persistent depressive disorder, formerly dysthymia
You can find the rest of the what is… series in the Psychology Corner.
References
- May, D. G., Shaffer, V. N., & Yoon, K. L. (2020). Treatment of double depression: A meta-analysis. Psychiatry Research, 291, 113262.
- Parker, G., & Malhi, G. S. (2019). Persistent Depression: Should Such a DSM-5 Diagnostic Category Persist?. The Canadian Journal of Psychiatry, 64(3), 177-179.
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
Thank you for posting this. I have double depression. It isn’t talked about enough. 💜💜
For sure.
Thank you, Ashley: I’d never heard of double depression.
-Shira
I have not heard of this either.
I never heard of it. I think I float in and out of mild depression…
That sucks.
Important information and the DSM has it all! 🙂
I’d never thought you could have double depression but it makes sense
Yeah
Just reading the term double depression makes me nervous. I used to have major depression, now I’m limited to seasonal depression. Every December I want to die (ugh I wish I were joking). But I’ll take seasonal depression knowing I’m capable of being much worse.
Yeah, for sure.
Shows how much conditions, diagnoses and the dsm are human-made constructs—ie imperfect though well-intentioned. Hadn’t heard of this. Trying to think of it applied to something like generalized anxiety vs panic disorder
Or perhaps panic disorder layered on top of generalized anxiety.
Yes, like that
I believe I’ve experienced double depression. Most of my life until the past 6 weeks have been like dysthymia with many “several months long” episodes of MDD self assessed with the phq 9 though it wasn’t ever formally diagnosed.
I believe I’ve had double depression at least once, and probably twice. It was never diagnosed as such, the first time as a MDE and the second as reactive depression although I personally don’t think it was solely a reactive thing, and both of those episodes happened before I got the dysthymia diagnosis, also I was a child/adolescent during both of them and I suppose dysthymia is not diagnosed in this age group. But I’ve been more or less depressed my whole life and these MDE’s just made me more depressed than I was without them so I think that would count as double depression. So, if that was it indeed, I can say that, in my view, double depression is a lot more difficult to handle, even when you’re used to feeling depressed, it takes it to a totally different level.
Yeah, some depression, more depression is worse.