What You Need to Know About Persistent Depressive Disorder and ‘Double Depression’

You wake up at 6:30 a.m.; you go for a quick jog and you head to work. You have a graduate job at one of the top accounting firms in the city. The hours are long and the work is hard but you were lucky to get it and your boss is impressed with the progress you’ve made. The other grads usually go out for a drink after work, and you try to join them every now and again, but most days you just head straight home.

To the outside world, you’re a successful, social, intelligent and put-together young woman… but on the inside, it’s a whole other story. Waking up is always a struggle no matter how much sleep you got the night before; your motivation is low and the thought of the day ahead fills you with apprehension. At work, you fight against the feeling you’re a fraud and don’t deserve to be there. You question every decision you make and wonder how everyone else gets by so easily. By the end of the day, you feel so drained that all you can really do is go straight to bed and prepare to do it all over.

This is one example of what high-functioning depression, more commonly referred to persistent depressive disorder or dysthymia, looks like. These are people who can function relatively well in society, however, and whose underlying feelings of depression often prevail for years on end. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), persistent depressive disorder is thought to be present when one experiences a depressed mood for most of the day, for more days than not for at least two years. It is characterized by poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions and feelings of hopelessness.

Persistent depressive disorder can often be difficult to spot, as many people who experience it often function relatively well in society, maintain a daily routine, hold down a job and form meaningful relationships. It is considered somewhat of a lower grade depressive disorder and many people with this disorder can often go years without being diagnosed or receiving any sort of formal (or informal) support. Furthermore, many individuals with persistent depressive disorder also experience what is commonly referred to as double depression.

Over a period of time, most individuals who experience persistent depressive disorder may find their symptoms worsening. This can lead to the onset of a major depressive episode on top of their persistent depressive disorder, otherwise known as double depression. This spike in depressive symptoms can often be quite debilitating and could last anywhere from a few weeks to years on end.

Fortunately, treatments for persistent depressive disorder are very similar to those for major depressive disorder (MDD) and these have been widely documented for years. Depending on the circumstances, there are a number of talk therapies — cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT) etc. — medications or a combination of both that may be useful in treating this disorder. Friends, family and other informal supports are also incredibly valuable resources to draw upon.

Many people go years without engaging with these services, while their symptoms become progressively worse in the meantime. If you or someone you know is living with any form of depressive disorder, it is important that you reach out for help. There are a number of health professionals, resources and tools available that can provide great assistance throughout your recovery process, you just have to be willing to reach out and use them.

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