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Double Depression in Children

When Dysthymic Disorder Turns into Double Depression


Updated October 17, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Double depression is a depressive disorder that typically begins with a diagnosis of dysthymic disorder (DD). Dysthymic disorder is considered a milder form of depression that is persistent, lasting at least two years. A child is considered to have double depression when his depression is exacerbated and meets the criteria for major depressive disorder (MDD), a more severe form of depression.

While you may be very concerned if your child is diagnosed with double depression, it is not a lifetime "sentence," but a current state. With treatment, recovery from depression is probable, according to the National Institute of Health (NIMH).

How Often Does Double Depression Occur in Children?

Dysthymic disorder is reported in 3% of children, and research has found that 75% of those children will go on to experience double depression.

What Are the Symptoms of Double Depression?

You may notice that your child's depression is getting worse, changing or simply not getting better with treatment. Children with dysthymic disorder tend to be more functional than children with double depression or MDD, which means that even though your child may be depressed, he can usually attend school and play with friends.

Once a child's depression changes to double depression, he may refuse to attend school or socialize as he once did. Some additional signs of double depression may be feelings of excessive guilt, losing interest in things, academic decline, avoiding social activities, withdrawal from friends and family, hopelessness about the future, irritability, excessive crying, and thoughts or acts of hurting one's self.

Physical symptoms of double depression may include problems with sleeping, significant appetite changes, persistent vague physical complaints such as headache, bellyache or generalized pain.

What Can Parents Do?

If you notice any symptoms of depression in your child, it is important to seek medical advice immediately. Dr Daniel Klein and colleagues, who published a study of long-term outcomes of patients with dysthymic disorder and double depression in 2008 in the Journal of Psychiatric Research, found that people who had a longer course of dysthymic disorder were more likely to be diagnosed with double depression and experience greater difficulty functioning in everyday life.

If your child is currently being treated for depression, but you notice that his symptoms are changing, getting worse or simply not getting better, consult with your child's physician. It is important to support your child, especially through times of depression. Involving the whole family in your child's recovery may help with treatment compliance and will aid your child in feeling loved and supported.

What are the Treatment Options?

Treating depression in children is extremely important given the potential serious short- and long-term consequences, like poor social development, substance abuse, academic decline and suicidal thoughts and behavior. Your child's physician may select antidepressant medication, therapy, or a combination of both depending on your child's specific situation. The American Academy of Pediatrics reports that medication is typically warranted in cases of moderate to severe cases of depression, and that therapy may be appropriate for mild cases of depression.

The NIMH reported in a 2007 study that a combination of the antidepressant medication, Prozac, and cognitive behavioral therapy benefited depressed children over either treatment alone. As such, a combination program should be discussed with your child's physician.


Daniel N. Klein, Ph.D., Stewart A. Shankman, Ph.D, Suzanne Rose, M.A. "Dysthymic Disorder and Double Depression: Prediction of 10-Year Course Trajectories and Outcomes." Journal of Research Psychiatry April 2008 42(5): 408-415.

Daniel N. Klein, Ph.D., Stewart A. Shankman, Ph.D, Suzanne Rose, M.A."Ten-Year Prospective Follow-Up Study of the Naturalistic Course of Dysthymic Disorder and Double Depression." American Journal of Psychiatry 2006 163: 872-880.

Depression and Suicide in Children and Adolescents. Mental Health: A Report of the Surgeon General. Accessed: July 16, 2010. http://mentalhealth.about.com/library/sg/chapter3/blsec5.htm

How Do Children and Adolescents Experience Depression? National Institute on Mental Health. Accessed: May 30, 2010. http://www.nimh.nih.gov/health/publications/depression-in-children-and-adolescents/index.shtml

S.B. Williams, E.A. O'Connor, Eder, M. Whitlock, E.P. "Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force." Pediatrics 4 Apr 09 123(4):e716-e735.

Teens with Treatment-resistant Depression More Likely to Get Better with Switch to Combination Therapy. Press Release. National Institute on Mental Health. Accessed: June 15, 2010. http://www.nimh.nih.gov/science-news/2008/teens-with-treatment-resistant-depression-more-likely-to-get-better-with-switch-to-combination-therapy.shtml

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