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Double depression is a term used to describe someone who has major depressive disorder and persistent depressive disorder at the same time. It’s considered a serious condition and can be very difficult to overcome. People who experience double depression often have a harder time recovering than those who only suffer from one episode of MDD. However, there are many ways to overcome double depression and lead a healthy life. In this blog, Depression Open Talks will give you information on this mental issue like what it is, and how to prevent and overcome it.

There are various subtypes or forms of depression. You might be startled to find that between 3% and 6% of people are at risk for “double depression,” a type of chronic (long-lasting) depression. This type of depression carries a higher risk for suicidal thoughts or actions than other types of depression and can affect everyday functioning and quality of life. Treatment can be beneficial, but many people put off or refuse to seek assistance that could endanger their lives.


What Is Double Depression?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not officially recognize the phrase “double depression,” but it does accept the two disorders that constitute double depression: persistent depressive disorder (PDD), and major depressive disorder (MDD).

When PDD persons also satisfy the criteria for MDD, they are reported to have double depression. Up to 3 out of 4 persons with PDD will also suffer MDD in their lifetime. Thus, if you have PDD, there is a likelihood that you may at some point go through double depression.

Persistent depressive disorder (PDD)

PDD was formerly referred to as dysthymic disorder or dysthymia. It’s also referred to as high-functioning depression by certain people. PDD is a chronic, or long-term form of depression, which distinguishes it from other types of depression by its longevity. Those who meet the requirements for a diagnosis will have had symptoms regularly for at least two years.

PDD symptoms, in addition to a depressed mood, include:

  • either overeating or undereating
  • having trouble concentrating
  • issues with sleep and exhaustion
  • lack of confidence

Major depressive disorder (MDD)

Many symptoms of MDD and PDD are similar, including depression and a loss of enjoyment in previously enjoyable activities. However, symptoms must be persistent for at least two weeks and be more severe than those of PDD for an MDD diagnosis to be made. Other MDD symptoms include:

  • thoughts of suicide or death
  • moving slower or with more agitation than normal
  • weight loss or gain
  • energetic loss
  • strong feelings of guilt or worthlessness
  • difficulty making judgments or thinking

The difference between twofold depression and major depression without dysthymia

Here is the main distinction between a double depression and a major depression per se. In a twofold depression, low-grade chronic depression comes before a full depressive syndrome, but not in a major depression. This suggests that a person’s typical “baseline” mood is normal if they just have non-chronic major depression. However, some who suffer from double depression could not have ever experienced a non-depressive mood.

Once the other symptoms of a major depressive episode fade, the mood should return to normal. During treatment, patients frequently become aware that depression is not a permanent condition and that things can get better.

People with dysthymia also experience some major depressive symptoms. However, they are less frequent, milder, and less incapacitating. these symptoms often don’t affect a person’s ability to function on a daily basis. People who have dysthymia thus frequently think of their symptoms as being typical of them. Some people could see their bad mood as a part of their personality or as just something that happens in life and is beyond their control.

Some dysthymia patients view the occurrence of a major depressive episode on top of a chronically depressed mood as inevitable. They postpone getting treatment as a result. And they become more resistant to conventional therapy. Additionally, unless the dysthymia is treated concurrently with major depression, they are not truly cured. They resume their chronic depressive state, which carries the danger of experiencing a fresh double depression episode.

How is double depression serious?

Twofold depression tends to be more severe than other forms of depression because of experiencing symptoms of two different, overlapping conditions.

Research from 2015 found that people with double depression had the most severe symptoms of any group with a depressive disorder. The same research also found higher rates of suicidal thoughts in people with double depression — just over 1 in 2 people with double depression reported suicidal ideation, and the study considered people with double depression to also be at a higher risk of suicide attempts.

Research from 2018 suggests that people with twofold depression have a higher chance of developing heart disease than those with other depression diagnoses. Experts think this is because the longer-lasting PDD symptoms mixed with the severity of MDD can increase exposure to more of depression’s health impacts than either diagnosis on its own.

Researchers also found that people with double depression experienced more hopelessness than those with other types of depression, which could affect long-term health.

How is double depression diagnosed?

Double depression cannot be diagnosed using any particular tests. To determine whether you previously met the criteria for dysthymia and if you currently meet the criteria for major depressive disorder, your doctor will take a thorough history of your mood symptoms.

The Diagnostic and Statistical Manual of Mental Disorders presently lacks diagnostic criteria for twofold depression. Typically, the diagnosis is made using both the MDD and PDD diagnostic criteria from the DSM-5. Double depression frequently goes undiagnosed and might be more challenging to treat than MDD or PDD alone because there is no set criterion for its diagnosis.

People with chronic depression frequently don’t seek care presents another challenge for the diagnosis of twofold depression. They can assume it’s just the way they are and fail to realize they have a major medical problem that needs to be treated effectively. 

Causes of twofold depression

The core causes of double depression are the same as those that contribute to PDD and MDD. There is still no single, well-defined etiology. The following elements may raise your risk of developing this kind of depression, according to the DSM-5:

  • Family history: If you have a first-degree relative who suffers from it, such as a biological father.
  • Early life: Early parent loss or childhood trauma.
  • Brain differences: Your amygdala, hippocampus, prefrontal cortex, and other brain regions may affect whether you acquire PDD.
  • Other mental health issues: Having another mental health issue, like an anxiety disorder, may make you more likely to experience depression.

Can Double Depression Be Prevented?

Treatment of dysthymia is the strongest defense against this kind of depression. Although antidepressants might take longer to start working and be less effective for dysthymia than for acute severe depression, they can be beneficial.

Dysthymia can be effectively treated with cognitive therapy. However, it is frequently necessary to use both cognitive therapy and antidepressants together. The effects of either cognitive therapy or an antidepressant should be observed for a few months before switching to or incorporating the other treatment if the results are insufficient, according to experts.

Exercise has been demonstrated in certain trials to have an additive impact on antidepressants in terms of mood improvement. Additionally, since persistent sleep deprivation can make depression symptoms worse, it may be beneficial to modify sleep habits.

Physical exercise

What’s the treatment for double depression?

A two-pronged approach is used to treat twofold depression, combining mental health counseling with one or more drugs to target and treat the symptoms of each disorder. Making positive changes to one’s lifestyle can help professional depression treatment options work better for a person.


For the person with depressive symptoms, there are numerous pharmaceutical choices. The medication that can be used to treat double depression is often the same for all types of depression. Antidepressants such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are frequently among them. Most people won’t immediately notice a difference in their depression symptoms after taking medication. The expected benefits might not be seen for a few weeks or perhaps months.


The treatment for twofold depression that is most frequently employed is cognitive-behavioral therapy. This treatment focuses on assisting you in identifying erroneous thought patterns, assumptions, and actions that are causing your depression and assisting you in challenging them.

A person with twofold depression finds it easier to manage their depressive symptoms and perceive themselves in new ways as a result. However, for therapy to be most successful, medication and therapy are frequently required.

Cognitive behavioral therapy


Though it can be challenging to manage, double depression need not be a crippling condition. The depressive symptoms that characterize this disorder can be cured with the appropriate care and treatment. There are more coping strategies you can use in addition to medical advice from your doctor.

Your depression symptoms can be greatly reduced by adopting healthy lifestyle habits including regular exercise, a proper diet, and better stress management. The prevention of relapse and recurrence in twofold depression can also be aided by appropriate treatment and coping mechanisms.


Gans, S. (2020, December 29). Double Depression: Symptoms, Diagnosis & Treatment. Verywell Mind. Retrieved December 18, 2022, from https://www.verywellmind.com/double-depression-symptoms-diagnosis-and-treatment-5089417

Kubala, K., & Taft, T. (n.d.). What Is Double Depression? I Psych Central. Psych Central. Retrieved December 18, 2022, from https://psychcentral.com/depression/double-depression#home-remedies

Saling, J. (2021, August 19). Double Depression: Definition, Symptoms, Treatment, and More. WebMD. Retrieved December 18, 2022, from https://www.webmd.com/depression/double-depression

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