Double depression: the overlap of depressive symptoms

The word depression is old knowledge not only for the field of psychology, But also for a large part of the general population. We all have more or less a rough idea of ​​what that entails (although the majority of the population identifies with things that don’t) with depression.

However, there are multiple disorders associated with this type of problem which may not be so well known, as well as complications from these conditions which can cause great suffering to those who suffer from them. This is the case, for example, with double depression.

    Some of the major depressive disorders: major depression and dysthymia

    In mood disorders, different problems appear with depressive symptoms. If we limit ourselves to these types of symptoms (without taking into account the disorders in which appear manic or hypomanic episodes), the most well-known and most common disorders are two: depression and dysthymia.

    major depression

    Major depression is the best known and most common depressive disorder, Being the most prevalent mental health problem alongside anxiety disorders.

    It is characterized by the existence most of the time almost every day for at least two weeks of a sad mood (in children it may appear rather irritable) and / or a loss of interest or the ability to experience pleasure through previously motivating activities, as well as other symptoms such as disturbed sleep or eating, hopelessness, lack of concentration, physical and mental sluggishness, and loss of energy and energy. It is also not uncommon to have thoughts of death and suicide.


      As for dysthymia, we are dealing with a disorder very similar to depression. although of lower intensity, but which, on the contrary, lasts a long time or even becomes chronic. He maintains a sad mood most of the time for at least two years, often showing hopelessness, eating and sleeping problems, fatigue, and low self-esteem.

      Although the severity of symptoms is less than in depression itself, the fact that dysthymia is prolonged over time results in a higher level of vital dissatisfaction. However, the level of interference in usual activities is lower, the subject it presents neither anhedonia nor slowing down and they usually don’t think of death.

      While there are other depressive issues, these two are among the most important and debilitating. Major depression is more severe but is more temporary while dysthymia is less severe but lasts much longer or can become chronic (in fact, it is currently called persistent depressive disorder). However, sometimes we may find that a person with dysthymia suddenly has their symptoms worsening, usually due to an external cause that exacerbates their symptoms, and may be diagnosed with double depression.

        What is double depression?

        It is called double depression in that situation in which in a subject who suffers from dysthymia appear for some reason episodes of major depression, superimposing on their usual symptomatology.

        This is a serious complication of dysthymia, because it means that in a person in a bad mood and with a series of complications already at the base, suffers from a moment of greater weakness, loses hope and desire to do things or stop feeling pleasure. In addition, the fact that dysthymia is prolonged over time facilitates the loss of long-term social support and before the major depressive episode there is a decrease in the level of activity.

        Summarizing what has been written, we have a person who has suffered for at least two years from sadness, low self-esteem, food problems such as loss of appetite and / or sleep such as insomnia and a feeling of hopelessness in the future in which in addition a greater depression appears, accentuating the previous symptoms and adding a deficit in the capacity to feel motivation or pleasure and generating a great interference in one’s daily life in areas such as work or personnel.

        These people generally recover before major depressive episodes than those who have not suffered from previous dysthymia, due to the existence of some habituation, but nevertheless it is much more common for them to relapse because they continue to suffer from dysthymia.

        the causes

        The causes of double depression can be multiple. It has been argued that the causes of depression can be found in biological factors such as depression presence of serotonin and / or dopamine deficiency or due to environmental factors such as insufficient reinforcement of one’s own activity and / or the existence of unrealistic expectations and thought patterns with perceptual biases that generate a tendency to view oneself negatively, the world and its future.

        The existence of dysthymia tends to be associated with continued suffering from stressful elements, generally next to social isolation. It is very common for there to be a chronic health problem (whether physical or mental). There is also a certain hereditary component to observing the existence of several cases of affective disorder within the same family (although in part they may be due to learning).

        The occurrence of major depressive episodes in dysthymic disorder may be related to the appearance of a stressor or a situation generating discomfort and sadness, Drug use or simply the persistence of symptoms of dysthymia.


        Treatment for double depression is virtually identical to that for depression and dysthymia. Major depression is more easily treated because dysthymia is often experienced by the patient as the way they usually function or the way they do things. However, treatment for this depression and double depression is also possible, often through a combination of psychological and pharmacological treatments.

        Medical treatment

        With regard to psychopharmacology, the use of antidepressants is common, SSRIs being mainly used today to reduce the intake of serotonin and facilitate its action in the brain.


        For the psychological, there is a wide variety of effective methodologies from very different theoretical currents. Negotiation with the patient is recommended on performing graded tasks which can test the subject but have a high probability of success, so that the subject sees that he is successful and increases his self-image.

        Carry out pleasant activities and cognitive tests of situations what can cost – can be very useful. At the cognitive level, it is recommended to first record the subject’s ideas and the type of thoughts they have to address the nuclear beliefs that generate and sustain suffering and sadness, and then stop using restructuring. cognitive to modify possible dysfunctional beliefs. Group therapy can be applied. It seeks to increase self-esteem and can also be helpful in improving the social skills of those affected.

        Finally, the use of expressive and emotional therapies can help free the patient from distressing sensations and be able to find relief in them while learning to manage them successfully. Examples that might work are a temporary projection or an empty chair.

        Bibliographical references:

        • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.

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