Editing Double depression (section)

==Presentation==

Individuals with double depression meet the [[DSM-5]] classification criteria for both [[Major depressive disorder|MDD]] and [[Persistent depressive disorder|PDD]].<ref name="auto10">{{cite journal | doi=10.1023/A:1023030431552| year=1998| last1=Dixon| first1=Danny R.| journal=Journal of Psychopathology and Behavioral Assessment| title=Double Depression in Men: Does It Exist?| volume=20| issue=2| pages=187–198| last2=Thyer| first2=Bruce A.| s2cid=141425236}}</ref> Goldney and Fisher (2004) determined that, in a sample of 3,010 individuals from southern portions of Australia calculated a [[prevalence]] rate of double depression of 2.2%.<ref name="auto11">{{cite journal | doi=10.1007/s00127-004-0832-7| pmid=15549246| title=Double depression in an Australian population| journal=Social Psychiatry and Psychiatric Epidemiology| volume=39| issue=11| pages=921–926| year=2004| last1=Goldney| first1=Robert D.| last2=Fisher| first2=Laura J.| s2cid=7864016}}</ref> Jonas et al. (2003) reported a prevalence rate of double depression in the United States of 3.4%—based upon an assessment of 7,667 Americans.<ref name="auto12">{{cite journal | doi=10.1007/s00127-003-0682-8| pmid=14614549| title=Prevalence of mood disorders in a national sample of young American adults| journal=Social Psychiatry and Psychiatric Epidemiology| volume=38| issue=11| pages=618–624| year=2003| last1=Jonas| first1=Bruce S.| last2=Brody| first2=Debra| last3=Roper| first3=Margaret| last4=Narrow| first4=William E.| s2cid=22591288| url=https://zenodo.org/record/1232607}}</ref> The prevalence rate of double depression can be compared to rates of PDD at 6.2%, [[major depressive episode]] (MDE) at 8.6%, and major depressive episode with severity (MDE-s) at 7.7%. Keller and Shapiro (1982) found that 26% of patients within a sample of 101 met the criteria for both MDD and PDD; however, the aforementioned sample is much smaller—and much more inclined to inaccuracies—than the samples (3,010 and 7,667) described above.<ref>{{cite journal | doi=10.1176/ajp.139.4.438| pmid=7065289| title="Double depression": Superimposition of acute depressive episodes on chronic depressive disorders| journal=American Journal of Psychiatry| volume=139| issue=4| pages=438–442| year=1982| last1=Keller| first1=M.| last2=Shapiro| first2=R}}</ref> Thus, double depression is less common than other forms of [[depression (mood)|depression]], but it is still a form of depression that warrants medical attention in the form of behavioral therapies; pharmaceutical treatments; or, both (Miller, Norman, and Keitner, 1999).<ref name="auto7" />

The characteristics of those with double depression tend to be more severe in nature than those associated with those who have either MDD or PDD.<ref>{{cite journal | doi=10.1016/j.jad.2005.03.019| pmid=17475340| title=Double depression in older adult psychiatric outpatients: Hopelessness as a defining feature| journal=Journal of Affective Disorders| volume=101| issue=1–3| pages=235–238| year=2007| last1=Joiner| first1=Thomas E.| last2=Cook| first2=Joan M.| last3=Hersen| first3=Michel| last4=Gordon| first4=Kathryn H.}}</ref> Levitt, Joffe, and MacDonald (1991) found that those with double depression experience fluctuations in mood at an earlier point in life, a more substantial number of depressive episodes, as well as [[co-morbid]] disorders of anxieties more often than their MDD-alone counterparts.<ref name="auto"/> Goldney and Fisher (2004) reported that individuals with double depression seek medical attention more often than those with either MDD or PDD alone.<ref name="auto11"/> Leader and Klein (1996)<ref name="auto8"/> found that individuals with double depression experience a more substantial level of social impairment, which includes factors such as leisure pursuits and relationship characteristics, than those with either MDD or PDD. Dixon and Thyer (1998) concluded that individuals with double depression experiences recoveries on a more frequent basis than their counterparts who have MDD alone (88% to 69%); however, individuals with double depression experience the most substantial rates of [[relapse]] of all of those who suffer from chronic depression.<ref name="auto10"/> In addition, [[remission (medicine)|remission]] from MDD tends to happen faster than remission from PDD (Dixon & Thyer, 1998).<ref name="auto10"/>

Miller, Norman, and Dow (1986) reported that individuals with double depression endure a more severe path of illness, but experience few differences with respect to social impairment compared to their MDD-alone counterparts.<ref name="auto2"/> In addition, McCullough et al. (2000) found that, with the exception that patients with double depression tended to experience of more severe illness, few differences were apparent.<ref name="auto3"/> Therefore, the conclusions drawn in previous research that are associated with the nature of the clinical presentation of double depression are mixed. Multiple scientists<ref name="auto11"/> emphasize the need for additional research to determine adequate treatments for those with double depression, as depression is a disease that places a considerable burden upon communities and societies; furthermore, those researchers predict depression will be, in an economic sense, the second-most burdensome disease on societies come 2020.