What is “double depression”?

Double depression describes the overlay of an episode of major depression on top of low grade chronic depressive symptoms that are called dysthymia. Typically the person has experienced the symptoms of dysthymia for at least 2 years, and then a period of time with more intense symptoms of depression, that are more debilitating - causing more problems with work, social functioning, and general functioning, and a magnification of the usual low grade symptoms. It is absolutely critical that a person experiencing double depression get treatment, if they are already receiving medications and therapy, an uptick in treatment may be needed, and if no treatment has been received it is essential that it be started at such a time. 

Atypical Depression is a form of major (clinical) depression. Approximately 15% of people suffering with depression have this version of the disorder. Atypical depression has many symptoms that are common to all depressions, e.g. pessimistic and negative thinking, low self-esteem or lack of confidence, suicidal ideas or impulses,  loss of sex drive, diminished ability to experience vitality and a sense of aliveness, withdrawal from normal life activities, mood changes: sad, despair, irritability and low frustration. The unique features of atypical depression are: hypersomnia (excessive sleeping; e.g. sleeping 10-12 hours a day, most nights), very pronounced fatigue, and increased appetite (with subsequent weight gain). The hallmark symptom is hypersomnia.

Atypical depressive episodes range from mild to very severe (as is the case with all depressive disorders). Moderate to severe episodes may make normal life functioning difficult; people may find it extremely hard to get out of bed, to go to work, to attend school, or engage in usual life activities (e.g. going out to eat, going to church services, attend parties, etc.).

The majority of people suffering from seasonal depression (seasonal affective disorder) have atypical symptoms. And, it is very important to note that up to 4 out of 5 people experiencing atypical depression symptoms turn out to have bipolar disorder. And, many people with bipolar disorder will suffer from atypical symptoms when in a depressive episode.

It is well known that antidepressant medications, while being effective in treating unipolar major depression (often referred to as clinical depression) can be harmful to those who have bipolar disorder. Antidepressants given to people with bipolar disorder can provoke severe manic episodes, can intensify depressive symptoms (especially irritability) and are generally ineffective. There are specific bipolar medications that can treat bipolar depressive episodes. Because of the risk of bipolar disorder, people who have atypical symptoms should see a mental health professional who can carefully evaluate and diagnose the disorder.

Double depression is an expression used to define a condition in people who experience long-term mild-to-moderate depression (dysthymia) and eventually progress to having episodes of major depression superimposed on the dysthymia. Almost always experiencing depressed mood, these individuals cycle between the mild-to-moderate lows of dysthymia and the deep lows of major depression.

To be diagnosed as having double depression, a person must have experienced at least two years of mild-to-moderate depression -- thus qualifying for the dysthymia diagnosis -- prior to the onset of major depression episodes.

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