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Depression is a group of mood disorders that can cause feelings of sadness and fatigue for extended periods of time. Persistent depressive disorder (PDD) and major depressive disorder (MDD) sometimes overlap to create a disorder called double depression. There are effective clinical treatments and ways an individual can manage double depression in their daily lives. 

What Is Double Depression?

Double depression is a combination of two distinct depressive disorders: persistent depressive disorder — also known as dysthymic disorder and chronic major depression — and major depressive disorder. 

Persistent Depressive Disorder

PDD is a mood disorder marked by long-term depressive symptoms that may not be experienced as intensely as MDD. Individuals who have PDD may not know any other way of feeling. They often believe that being sad all the time is normal. Nevertheless, PDD can still reduce the quality of a person’s life and put them at risk for medical conditions and suicide. 


A depressed mood occurs on most days for at least two years. Temporary periods of normal mood do occur, but they don’t last longer than two months at a time. Individuals with PDD will also have at least two of the following symptoms: 

  • Low self-esteem
  • Low energy or fatigue
  • Feelings of hopelessness
  • Insomnia or hypersomnia
  • Poor appetite or overeating
  • Poor concentration or difficulty making decisions

Major Depressive Disorder

The symptoms of MDD are very similar to PDD. The major differences between them are the duration in which depressive symptoms present themselves. Depressive episodes tend to last for a minimum of two weeks. 

The onset of these symptoms can be so severe and unexpected that it is debilitating. Episodes are felt in stark contrast to interim periods of high energy, motivation, and happiness. MDD may prevent a person from getting out of bed or taking care of responsibilities. 


According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, a person with MDD has a “Depressed mood or anhedonia causing social or occupational impairment,” as well as five of the following symptoms:

  • Lack of energy
  • Suicidal thoughts
  • Appetite changes
  • Poor concentration
  • Sleep disturbances
  • Feelings of guilt or worthlessness
  • Psychomotor retardation or agitation

What Happens When PDD & MDD Co-occur?

When a person has PDD and MDD simultaneously, they not only experience extended periods of depression but major episodes of depression as well. This is a relatively common occurrence amongst individuals with dysthymia, as studies report three-quarters of individuals with the disorder have or will experience a major depressive episode. 

More Severe Health Outcomes

Depressive disorders on their own can be challenging to deal with, but when two conditions overlap, it can complicate treatment. Individuals with double depression may be more resistant to treatment given the chronicity of the disorder and higher risk of substance abuse as a result. Rarely getting a break from the turmoil can cause undue stress on the body and mind and lead a person to feel like nothing will ever help. Somatic pain caused by double depression can make it unbearable. 

How Can Someone Get Help?

Double depression can be treated. The way in which this is done depends on the client and their circumstances. One method may be all that’s needed to help someone improve their mood. Other times, it is more effective to use multiple methods in combination.

Classical Approaches 

Classical treatments for depressive disorders include medication and/or psychotherapy. Classes of commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). 

Cognitive-behavioral therapy (CBT) can help a client change the way they think about negative emotions related to depression. CBT can aid in reducing thought patterns that contribute to low mood. The client works one-on-one with a therapist to develop skills that help them behave in ways that support their well-being rather than take from it. This therapeutic relationship itself can lead a person to feel supported and avoid feelings of loneliness.  

Holistic Methods 

Holistic therapies, such as mindful-based stress reduction, creative arts, and adventure therapy, are gaining traction in treatment programs for depression and substance abuse.

Mindfulness-based therapies have demonstrated effectiveness in reducing depressive symptoms like stress, anxiety, and depression. Music and art therapy facilitate the creative expression and processing of difficult emotions by way of non-verbal tools. Musical vibrations, in particular, have been found to reduce depression, anxiety, and somatic pain and improve mood. Art facilitates enhanced self-awareness and self-esteem.

Adventure therapy often involves experiences in nature and can also reduce depressive symptoms by making individuals feel more connected to their environment. This can also be a spiritual experience, facilitating a search for one’s purpose in the world. In some places, doctors actually “prescribe” nature for mental health disturbances. 

Focus on Lifestyle

Depressive disorders are likely caused by a number of biological, social, and environmental factors. A person can’t change the past, nor can they change their biology. However, they can make positive, healthy decisions today to improve their baseline quality of life to reduce the impact of double depression. This includes incorporating activities into their daily routine, such as exercise, healthy meals, and personal time.

Social Support

Human beings are social creatures, and social connection is a huge part of mental and emotional wellness. Staying connected with friends, even if a person doesn’t feel like it, and participating in mental health support groups can remind them that they are not alone and they are loved. 

Double depression is a combination of dysthymia and major depressive disorder. Persons with double depression experience long periods of low-grade mood with episodes of severe depression. High risks are associated with this condition, like substance abuse and addiction. West Coast Recovery Centers is an outpatient treatment center in Oceanside, CA. We are accredited by the Joint Commission to administer treatment to adults for a variety of substance use disorders and mental health conditions. We know how painful depression can be to experience and how challenging it can be to reach out for help. Our compassionate team of clinicians is here to tell you that there is hope, and they are ready to guide you through a therapeutic process that will help you find your happiness. Learn more about our individualized approach to treating depression using traditional and holistic modalities. Call (760) 492-6509 today. 

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