“Double depression” is not a formal clinical term. Instead, it refers to having symptoms of two different depression diagnoses. Diagnosis and treatment may be challenging for double depression, but leaving it untreated may worsen symptoms over time.
The term “double depression” is commonly used for diagnoses involving the coexistence of persistent depressive disorder (PDD) and major depressive disorder (MDD).
Although the diagnostic handbooks that most mental health professionals use don’t include criteria for double depression, there are specific guidelines to aid the diagnosis of these two disorders separately. This helps in developing a management plan.
If you have double depression, a mental health professional may give you two separate diagnoses: PDD and MDD. The main difference between these two conditions is that to receive a PDD diagnosis, you must experience symptoms for at least 2 years, while MDD requires symptoms to be present for at least 2 weeks.
Most mental health professionals in the United States use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) to diagnose mental health disorders. While some researchers and professionals call it double depression, the DSM-5-TR does not list it as an official stand-alone diagnosis.
Not everyone experiences depression in the same way. You may have a combination of symptoms that someone else with double depression may not. In general, a doctor will base their diagnosis on how many of your symptoms fit the criteria for both MDD and PDD.
In some cases, you may experience symptoms of MDD first and then develop PDD while still having major depressive episodes. In other cases, you may have PDD first and then start experiencing episodes of MDD at the same time. In either case, you might receive a diagnosis of co-occurring PDD and MDD (double depression).
Read about the common symptoms of depression.
Symptoms of persistent depressive disorder
PDD is a fairly new diagnosis. In previous versions of the DSM-5-TR, symptoms of PDD were under dysthymia and chronic major depression. PDD consolidates these symptoms into one condition.
The main characteristic of PDD is that low mood (sadness) has been present most of the day, most days, for at least 2 years in an adult or 1 year in a child or adolescent.
In addition, for a diagnosis to be met, two or more of the following symptoms must also be present:
- changes in appetite (eating significantly more or less than usual)
- changes in sleep patterns (difficulty falling and staying asleep or sleeping more hours than usual)
- otherwise unexplained fatigue and low energy
- low self-esteem
- difficulty with attention, concentration, and decision-making
- persistent sense of hopelessness
The diagnosis of PDD means these symptoms affect how you navigate your world, causing distress or other impairments in work, school, and social situations. The symptoms have also been persistent for most of the 2 years before diagnosis and never absent for more than 2 months at a time during that period. In some cases, the symptoms have been present for so long that you may believe they are part of your personality.
Finally, these symptoms could not be explained by another mental health or physical condition or by the effects of an external substance.
Depending on your experience, a mental health professional may determine the severity of your symptoms as mild, moderate, or severe. They may also determine if they need to use a specifier. This is a diagnostic note they may add to the main diagnosis to clarify specific characteristics of your experience.
For example, they may give you a PDD diagnosis with the specifier “with persistent major depressive episode” to note that you also meet the full diagnostic criteria for a major depressive episode during the previous 2-year period.
Read about the differences between sadness and depression.
Symptoms of major depressive disorder
MDD is a mood disorder that involves episodes of low mood and a general loss of interest. Although symptoms may range from mild to severe, MDD may have a profound effect on how you feel about yourself, others, and the world in general.
For someone to receive the diagnosis of MDD, five or more of the following symptoms must be present for 2 weeks or longer:
- depressed or low mood (or irritability in children and teens)
- diminished interest or loss of pleasure in things you used to enjoy
- changes in appetite or weight
- difficulty sleeping or sleeping more than usual
- changes in movement patterns, like moving faster (agitation) or slower than usual
- low energy and fatigue
- intense feelings of guilt, shame, and worthlessness
- difficulty concentrating and making decisions
- recurring thoughts of death or self-harm, including suicide ideation or attempts
Either loss of interest, difficulty experiencing pleasure, or low mood (sadness and emptiness) must be present for at least 2 weeks to meet MDD diagnostic criteria.
These symptoms would not be explained by a recent traumatic experience, significant loss, effects of a substance you’ve consumed, or another mental or physical condition.
Read about the physical symptoms of depression.
You’re not aloneIf you have thoughts of suicide and need help right now, support is available.
- Call the National Suicide Prevention Lifeline 24 hours a day at 988 or 800-273-8255.
- Text “HOME” to the Crisis Text Line at 741741.
Not in the United States? Find a helpline in your country with Befrienders Worldwide.
Treatment for depression may involve psychotherapy, medication, or a combination of the two. Because double depression means you may have overlapping symptoms of different severity levels, finding the right combination for your needs may take a while.
Untreated depression usually leads to more severe symptoms and complications. Treatment can help improve your mood and self-image.
Many types of psychotherapy exist that may help with symptoms of all types of depression. For example, cognitive behavioral therapy (CBT) may help you cope with patterns of thought that cause you distress and lead you to harmful behaviors. Other options may include:
Medications for depression may include:
It may take a few weeks to months to experience the full therapeutic effects of these medications, and you may also experience some side effects. Additionally, it could take some trial and error to find the correct medication and dosage for your needs. The prescribing doctor may make adjustments as needed until you start to feel the effects.
A doctor may also decide on combination medication therapy — using more than one type of drug to treat different symptoms. For example, they may prescribe trazodone for sleep disturbances and sertraline for low mood.
Lifestyle changes may also help you manage symptoms of double depression, including:
- adjusting your eating plan
- increasing daily exercise
- getting more sunlight
- engaging in stress management strategies like meditation
Read about the type of doctors who treat depression.
Double depression is not a formal diagnosis, but it refers to having two types of depression at the same time: persistent depressive disorder and major depression.
Both PDD and MDD can be effectively treated and managed. Leaving these conditions untreated may lead to more severe and persistent symptoms over time.
Help is available for double depression. You’re not alone.