The word depression is an old one known not only to the field of psychology , but also to much of the general population. We all have a more or less approximate idea of what it implies (despite the fact that most of the population identifies with depression things that are not).

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

Some of the major depressive disorders: major depression and dysthymia

Within mood disorders there are different problems that appear with depressive symptoms. If we limit ourselves only to this type of symptoms (not taking into account those disorders in which manic or hypomanic episodes appear), the best known and most prevalent disorders are two: depression and dysthymia.

Major depression

Major depression is the best known and most frequent depressive disorder , being the most prevalent mental health problem along with anxiety disorders.

It is characterized by the existence for 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 the loss of interest or ability to feel pleasure through previously motivating activities, along with other symptoms such as sleep or eating disorders, hopelessness, lack of concentration, physical and mental sluggishness, and loss of energy and sexual appetite. Thoughts of death and suicide are also not uncommon.

Dysthymia

As far as dysthymia is concerned, we are dealing with a disorder very similar to depression although of lesser intensity, but which on the contrary remains for a long time or even becomes chronic. A sad state of mind is maintained most of the time for at least two years, with frequent appearance of hopelessness, eating and sleeping problems, fatigue and low self-esteem.

Although the severity of the symptoms is less than in depression itself, the fact that dysthymia is prolonged over time causes a higher level of life dissatisfaction. However, there is a lower level of interference with usual activities, the subject has no anhedonia or slowing down and usually has no thoughts of death.

Although there are other depressive problems, these two are some of the most important and disabling. Major depression is more severe but more temporary, while dysthymia is less severe but lasts much longer or may become chronic (in fact, it is now called persistent depressive disorder). However, sometimes we may find that a person with dysthymia suddenly has a worsening of their symptoms, usually from some external cause that exacerbates their symptoms, and may be diagnosed with double depression.

What is double depression?

Double depression is a situation in which episodes of major depression appear in a subject suffering from dysthymia for some reason , overlapping with his or her usual symptoms .

It is a serious complication of dysthymia, since it means that a person with a low mood and a series of complications and suffer a moment of greater weakness, lose hope and desire to do things or stop feeling pleasure. In addition, the fact that dysthymia is prolonged over time makes it easier to lose social support in the long run, and even before the major depressive episode there is a decreased level of activity.

Recapitulating from what was previously written, we have a person who has been suffering for at least two years from sadness, low self-esteem, eating problems such as loss of appetite and/or sleep such as insomnia and a feeling of lack of hope for the future in which, in addition to this, a major depression appears, accentuating the previous symptoms and adding a deficit in the capacity to feel motivation or pleasure and generating a great interference in their daily life in areas such as work or personal life.

These people usually recover before the major depressive episodes than those who did not suffer from previous dysthymia, due to the existence of a certain habituation, but nevertheless it is much more frequent for them to suffer from relapses as they continue to suffer from dysthymia.

Causes

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

The existence of dysthymia tends to be associated with the continuous suffering of stressful elements, usually together with social isolation. It is very common for there to be some chronic health problem (whether physical or mental). There is also a certain hereditary component when several cases of affective disorders are observed within the same families (although in part this may be due to learning).

The appearance of episodes of major depression within a dysthymic disorder may be linked to the appearance of some stressor or situation generating discomfort and sadness , drug use or simply the persistence of the symptoms of dysthymia.

Treatment

The treatment of double depression is virtually identical to that of depression and dysthymia. Major depression is more easily treated, since dysthymia is often experienced by the patient as their usual functioning or course of action. However, the treatment of both major depression and double depression is equally possible, often through a combination of psychological and pharmacological treatments .

Drug treatment

With regard to psychopharmacology, the use of antidepressants is common, with SSRIs being especially used at present to reduce the reuptake of serotonin and facilitate its action in the brain.

Psychotherapy

In the psychological field, there is a wide variety of effective methodologies coming from very diverse theoretical currents. It is recommended to negotiate with the patient about the performance of graduated tasks that can test the subject but that have a high probability of success, so that the subject sees that he is successful and increases his self-concept.

The performance of pleasant activities and cognitive testing of situations that may cost you can be very useful. At a cognitive level, it is recommended to first record the subject’s ideas and the type of thoughts he has in order to get closer to the nuclear beliefs that generate and maintain suffering and sadness, stopping later through cognitive restructuring to modify possible dysfunctional beliefs. Group therapy can be applied. The aim is to increase self-esteem and it can also be useful to improve the social skills of those affected.

Finally, the use of expressive and emotional therapies can help the patient to free himself from distressing feelings and to find relief from them while learning to manage them successfully. Examples that could work are the temporary projection or the empty chair.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.