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Double depression: the superposition of depressive symptoms

Double depression: the superposition of depressive symptoms

May 3, 2024

The word depression is an old acquaintance not only for the field of psychology , but also for a large part of the general population. We all have a more or less approximate idea of ​​what it implies (although the majority of the population identifies with depression things that are not).

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

  • Related article: "Are there several types of depression?"

Some of the main depressive disorders: major depression and dysthymia

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

Major depression

Major depression is the most well-known and frequent depressive disorder , being the most prevalent mental health problem next to anxiety disorders.

It is characterized by the existence during most of the time almost every day over at least two weeks of a sad mood (in children it may appear rather as 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 slowness and loss of energy and sexual appetite. It is not uncommon for there to be thoughts of death and suicide.

  • Related article: "Major depression: symptoms, causes and treatment"


With regard to dysthymia we are facing a disorder very similar to depression although of less intensity, but that against it remains for a long time or even becomes chronic. A sad mood is maintained for most of the time for at least two years, with despair often appearing, feeding and sleeping problems, fatigue and low self-esteem.

Although the severity of symptoms is less than in depression itself, the fact that dysthymia lasts over time causes a higher level of life dissatisfaction. However, there is a lower level of interference in the usual activities, the subject does not present anhedonia or slowness and they do not usually have thoughts of death.

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

  • Maybe you're interested: "Dysthymia, when melancholy takes over your mind"

What is double depression?

It is called double depression to that situation in which in a subject suffering from dysthymia appear for some reason episodes of major depression, superimposing itself on its habitual symptomatology .

It is a serious complication of dysthymia, since it supposes that in a person with a low emotional state and with a series of complications already basic suffer a moment of greater weakness, lose hope and the desire to do things or stop feeling pleasure . In addition, the fact that dysthymia lasts over time makes it possible to lose social support in the long run, and there is a reduced level of activity before the major depressive episode.

Summing up from what was previously written, we have a person who has been suffering for at least two damages sadness, low self-esteem, feeding problems such as loss of appetite and / or sleep like insomnia and a feeling of hopelessness in the future in which, in addition to that, 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 their day to day in areas such as the labor or the personnel.

These people usually recover before depressive episodes greater than those who did not suffer from a previous dysthymia, due to the existence of certain habituation, but nevertheless it is much more frequent to relapse again since they continue to suffer from dysthymia.


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 presence of a deficit of serotonin and / or dopamine or environmental factors such as an insufficient reinforcement of the activity itself and / or the existence of unrealistic expectations and thinking schemes with perceptive biases that generate the tendency to negatively consider oneself, the world and one's future.

The existence of a dysthymia tends to be associated with the continued suffering of stressors, generally next to social isolation. It is very common that there is a chronic health problem (be it physical or mental). There is also a certain hereditary component when one observes the existence of several cases of affective disorders within the same families (although in part they may be due to learning).

The occurrence of episodes of major depression within a dysthymic disorder may be linked to the appearance of some stressor or situation that generates discomfort and sadness , the consumption of drugs or simply the persistence of the symptoms of dysthymia.


The treatment of double depression is practically identical to that of depression and dysthymia. Major depression is treated more easily, since dysthymia is often experienced by the patient as its normal functioning or procedure. However, treatment of this 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, and SSRIs are especially used nowadays to reduce the reuptake of serotonin and facilitate its action in the encephalon.


In psychological terms, there is a wide variety of effective methodologies coming from very different theoretical currents. Negotiation with the patient is recommended on the accomplishment of graduated tasks that can put to test to the subject but that have a high probability of success, so that the subject is seeing that it is successful and is increasing his self-concept.

The realization of pleasant activities and cognitive tests of situations that can cost you can be very useful. At the cognitive level it is recommended to first record the ideas of the subject and the type of thoughts he has to go closer to the core beliefs that generate and maintain suffering and sadness, then stop by means of cognitive restructuring to modify possible dysfunctional beliefs. Group therapy can be applied. It seeks to increase self-esteem and can also be useful to improve the social skills of those affected.

Finally, the use of expressive and emotional therapies can contribute to the patient's freedom from distressing sensations and can find relief in it 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.

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