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How to Recognize Double Depression

Depressed WomanDouble depression is a condition that occurs when an individual suffering from mild depression falls into a major depressive state. New research identifies hopelessness as a key feature of double depression.

Thomas Joiner, Florida State University Distinguished Research Professor and the Bright-Burton Professor of Psychology, believes his finding could help therapists diagnose and treat the mood disorder.

Double depression occurs when an individual who suffers from dysthymia, a persistent case of mild depression marked by low energy, falls into a major depressive state.

It is not a new concept, but psychologists know little about the characteristics that distinguish double depression from dysthymia or major depression alone, according to Joiner.

“It’s clinically important because it is under-recognized and harder to treat than either dysthymia or major depression by themselves,” Joiner said.

“The hopelessness result is significant, and it suggests that therapists should especially focus on this feature early and often in the treatment of double-depressed patients.”

Joiner, along with FSU doctoral student Kathryn Gordon, Joan Cook from the Veterans Affairs Medical Center in Philadelphia and Michel Herson from Pacific University in Oregon, studied the psychological assessments of 54 adults who entered a community-based psychiatric outpatient facility for non-psychotic adults ages 55 and older.

Questionnaires were given to patients before starting treatment to measure depression, hopelessness, anxiety and their sense of control over their own lives.

They found that double-depressed patients had high levels of hopelessness, whereas patients with either major depression or dysthymia alone showed more moderate levels of hopelessness.

“A patient who is hopeless has really just given up,” Joiner said. “They feel that the world is against them, the future is bleak and they are incapable of fighting back.”

This entrenched sense of hopelessness is one likely reason why double depression is so hard to treat, according to Joiner. The chronic nature of the underlying dysthymia is another.

“Any chronic condition is harder to treat than a less chronic one, and that is true for medical and psychiatric conditions alike,” he said.

“Second, people with dysthymia come to view depression as just part of who they are, and so they don’t come in to treatment as often, even when they dip down into a major depression. When they do come in, issues of motivation to do the treatment are common.”

In addition to differences in the level of hopelessness, the researchers found that people with dysthymia alone and those with double depression felt little control over their own lives.

People with these conditions felt that external forces — other people or fate — determined their future. Those suffering from major depression alone did not have this characteristic. For people with double depression, this feeling of little or no control in their lives left them more hopeless and less able to cope with everyday life issues and challenges. For many, everyday activities like taking a shower, getting dressed, or eating a meal could seem overwhelming.

Joiner cautioned that the study’s findings must be interpreted in light of the study’s limitations, namely its small sample size. Followup studies are needed to determine whether people with double depression exhibit the characteristics this study found.

Still, the results could have important implications for treatment of double depression. Double depression is a serious, sometimes life-threatening disorder when left untreated. Early detection and treatment of the disorder can help alleviate the most serious symptoms of clinical depression more quickly than if left untreated.

Some people who suffer from double depression also suffer from thoughts of suicide.

Cognitive therapy, which focuses on changing negative thinking patterns, and antidepressant drugs are particularly helpful in treating symptoms of hopelessness and perceptions of a lack of control over one’s own life, he said. You can learn more about the different types of psychotherapy here.

The research paper was published in the Journal of Affective Disorders.

Source: Florida State University

How to Recognize Double Depression

This article has been updated from the original version, which was originally published here on July 24, 2007.

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2019). How to Recognize Double Depression. Psych Central. Retrieved on November 29, 2020, from
Scientifically Reviewed
Last updated: 3 May 2019 (Originally: 24 Jul 2017)
Last reviewed: By a member of our scientific advisory board on 3 May 2019
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