Up Close With Dr. E

Understanding double depression


In today’s column, two new terms — double depression and dysthymia — will be introduced. The key to understanding both is to see how healthy positive thinking patterns can be changed into unhealthy ones. Negative thoughts, acting like spark plugs, ignite the engine of depression. As the engine revs up, the suffering person is taken to a place where they lose the ability to feel happiness, pleasure, or fulfillment. Basic body functions ­— sleeping, eating, sex drive — shut down, and a full-blown episode of major depressive illness occurs.

MDI is the most severe form of depression and can lead to hospitalization. But what happens if a person’s depression is less severe than MDI? This is the topic of today’s column. A clinical depression which is less severe than MDI, and which lasts longer than two years, is called dysthymia, or dysthymic disorder.

Dysthymia, also called “a minor depression,” has historically been dismissed as unimportant. Due to this, it is often undiagnosed. New research findings on how depressions begin, develop, and progress have revealed important findings:

Clinical depression, like a river, ebbs and flows. When a person who has dysthymia begins to experience severe stressors (job loss, divorce, financial problems), the river overflows and a major depression can occur. When stressors go away, the river recedes back down its bank, but the undetected minor depression persists. Watch how a young girl’s thinking patterns become increasingly negative as she goes from age 6 to 26.

Age 6: Lisa lives with her parents on a small farm, 10 miles from town. She is a shy, sensitive girl with one passion in life ­— riding her horse, Beauty. September sunlight paints autumn colors ­— auburn, bronze and yellow — upon Lisa’s long hair, which, like a proud and living flag, streams and flows in the wind. As she gently nudges Beauty from a trot to a canter, Beauty’s long mane merges and melts into Lisa’s form, creating one image of horse and rider. While riding Beauty, Lisa daydreams about her future: “I’m going to be a mother, and always have a farm and horses for my children.”

Age 8: Lisa’s parents argue about her dad’s drinking. Lisa tells herself, “If my grades were better, Dad wouldn’t be so mad.” She begins to make daily lists like this — make all A’s, help mom with dishes, keep the barn clean and try to be perfect.

Age 10: Lisa’s parents now fight daily. Unable to be “perfect,” Lisa’s thinking changes: “I’m not a good kid, I don’t fit in or belong, and the only time I’m happy is when I am riding Beauty.”

Age 16: Lisa’s parents, now separated, are openly hostile to each other. Lisa’s boyfriend tells her he doesn’t like her long hair and he wants her to cut it. Lisa thinks, “I’ll lose my boyfriend if I don’t cut my hair, so no big deal.”

Age 18: Lisa stopped riding her horse, and told her mother, “Sell Beauty.” Lisa’s mind keeps going to the same place: “No matter how hard I try; it never works out. What is the point of trying?” She begins, secretly, to cut her upper arms with a razor blade.

Age 22: Lisa is accepted into graduate school, but tells herself, “This program must be a bad one — why else would they have accepted me?” She begins to think about not wanting to live. “What’s the point,” she asks, “nothing good lasts for me.”

Age 26: Lisa’s negative thinking reaches a peak where she takes an overdose of pills and ends up in a hospital. While in the hospital, she looks back on her life: “I was six and I would ride Beauty every day. I loved my life. What happened to me?”

Here is what Lisa’s story teaches us:

1. Each time Lisa went through this ebb and flow, her negative thinking patterns worsened. That is, she become increasingly negative.

2. Undetected and untreated dysthymic disorder allowed the “stealth” or hidden depression to remain active in Lisa’s life.

3. The term “double depression” refers to Lisa suffering from both a major and a minor depression.

4. A new generation of treatments for depression now go after the dysthymic disorder by removing the spark plugs (negative thinking patterns) and replacing them with skills so Lisa can deal effectively with the stressors, or hardships in her life.

The content of this article is for educational purposes only, not treatment. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.