Double depression: overlapping depressive symptoms

This clinical picture consists of a mixture of symptoms typical of major depression and dysthymia.

The word depression is an old acquaintance not only for the field of psychology, but also for a large part of the general population.but also for a large part 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 multiple disorders linked to this type of problem that may not be so well known, as well as complications of these conditions that can cause great suffering for those who suffer from them. This is the case, for example, of double depression..

Some of the main depressive disorders: major depression and dysthymia

Within mood disorders there are different problems that appear with depressive symptomatology. 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 common mental health problem in the world.It is 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 loss of interest or ability to feel pleasure through previously motivating activities, along with other symptoms such as sleep or eating disturbances, hopelessness, lack of concentration, physical and mental slowing, and loss of energy and sexual appetite. Thoughts of death and suicide are also not uncommon.

Dysthymia

With regard to the dysthymia we are in front of a disorder very similar to the depression although of smaller intensity, but that on the other hand remains during long time or even becomes chronic. A sad mood is maintained for most of the time for at least two years, often appearing hopelessness, eating and sleeping problems, fatigue and low self-esteem.

Although the severity of 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 in the usual activities, the subject does not present anhedonia or slowing down. does not present anhedonia or slowing down and they do not usually have 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 can find that a person with dysthymia suddenly has a worsening of their symptoms, usually due to 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, for some reason, episodes of major depression appear in a subject suffering from dysthymia, superimposed on their usual symptomatology..

It is a serious complication of dysthymia, since it means that a person with a low mood and a series of basic complications suffers a moment of greater weakness, loses hope and the desire to do things or ceases to feel pleasure. In addition, the fact that dysthymia is prolonged over time facilitates the loss of social support in the long run and already before the major depressive episode there is a decreased level of activity.

Recapitulating from what has been written above, 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 problems such as insomnia and a feeling of lack of hope in the future in which in addition to this appears a major depression, accentuating the previous symptoms and adding a deficit in the ability to feel motivation or pleasure and generating a great interference in their day to day in areas such as work or personal.

These people usually recover earlier from major depressive episodes than those who did not suffer from a previous dysthymia, due to the existence of certain habituation, but nevertheless it is much more frequent that they suffer relapses again 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 insufficient such as an insufficient reinforcement of one's own activity and/or the existence of unrealistic expectations and thought schemes with perceptual 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 stressors, generally together with social isolation. It is very common that there is a chronic health problem (either physical or mental). There is also a certain hereditary component as several cases of affective disorders have been observed within the same families (although they may be partly due to learning).

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

Treatment

The treatment of double depression is practically identical to that of depression and dysthymia. Major depression is more easily treated, since dysthymia is often experienced by the patient as his or her usual mode of functioning or behavior. However, treatment of this and dual depression is equally possible, often through a combination of psychological and through a combination of psychological and pharmacological treatments..

Drug treatment

As far as psychopharmacology is concerned, the use of antidepressants is common, with SSRIs being especially used nowadays in order to reduce serotonin reuptake and facilitate its action in the brain.

Psychotherapy

In the psychological field there is a wide variety of effective methodologies from very diverse theoretical currents. It is recommended to negotiate with the patient The performance of graded tasks that may test the subject but that have a high probability of success, so that the subject can see that he/she is successful and increase his/her self-concept.

The performance of pleasurable activities and cognitive rehearsals of situations that may be costly to the subject can be of great help. that may be difficult for the subject can be very useful. At the cognitive level, it is recommended to first record the subject's ideas and the type of thoughts he/she has in order to get closer to the core beliefs that generate and maintain the suffering and sadness, and then stop by means of 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 contribute to the patient's relief from distressing feelings and help him or her learn to manage them successfully. Examples that might work are temporal projection or the empty chair.

Bibliographical references:

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