Double Depression Research Articles

The International encyclopedia of depression

There is no more central topic to mental health professionals than depression. In the last 20 years, theory and research in depression has grown rapidly. wealth of information now available on depression is enormous, but has not been summarized into a comprehensive encyclopedia until now.The entries in this book include: behavioral treatment, cognitive theories, cognitive therapy, epidemiology, heredity, personality disorders, double depression, and prevention. In summarizing the vast amount of information on depression, The International Encyclopedia of Depression serves as an important resource for researchers, patients, students, and educated laypeople. This book presents holistic, interdisciplinary coverage of an important but misunderstood medical disorder.

Trajectories of recovery of social and physical functioning in major depression, dysthymic disorder and double depression: A 3-year follow-up

Background Depressive disorders have a large impact on psychosocial functioning. Since lower functioning predicts recurrence of a depressive episode, insight into the post-morbid course of psychosocial functioning of persons with different depressive disorders may facilitate recurrence prevention. Methods Data were derived from NEMESIS, an epidemiologic survey in the adult population in the Netherlands. Respondents, who met the CIDI criteria of major depression (MDD; n = 102), dysthymic disorder (Dysth; n = 66) or double depression (DD; n = 73) at baseline, and recovered during three year follow-up, were included; as was a control group without any diagnosis (NoDiag, n = 4140). Functioning was assessed using the Groningen Social Disability Schedule (GSDS) and the SF-36 physical health summary-scale. Linear Mixed Models were conducted to compare 3-year trajectories of functioning across depressive groups and with NoDiag group. Results Compared to NoDiag, all depressed groups were significantly impaired on social and physical functioning. Dysth and DD had a lower level of post-morbid physical functioning compared to MDD (after 1 and 3 years respectively: Dysth: B = − 13.8, p = .002 and B = − 8.11, p = .09; DD: B = − 8.9, p = .03 and B = − 9.1, p = .05). Determinants for impaired social functioning (neuroticism) and for impaired physical functioning (age, comorbid somatic disorders and neuroticism) were identified. Limitations Attrition was higher among persons with a depression. Inclusion of the drop-outs would most likely have resulted in stronger associations, since we expect lower functioning among the drop-outs. Conclusion This study indicates the long-term debilitating effects of psychopathology, even after recovery of depressive disorders. Duration of the index symptoms appears to be associated with impaired functioning, since especially those with Dysthymia (either with or without a MDD) showed slower and less recovery of functioning.

Antidepressant Medication Adherence

Nonadherence to antidepressant medication significantly contributes to the undertreatment of depression in primary care populations. The purpose of this study was to survey primary care patients' adherence to antidepressant medication to better understand factors associated with nonadherence. Participants with a history of being prescribed an antidepressant for at least 4 weeks were recruited from a primary care research network. Subjects completed a demographic survey, the Patient Health Questionnaire (PHQ), the Beck Depression Inventory-II (BDI-II), the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey, the Interpersonal Support Evaluation List, the Stages of Change Scale, the Medication Adherence Scale, and the MOS measure of adherence. Differences between adherent and nonadherent patients were compared using chi(2) for discrete variables, independent t tests for continuous variables, and Mann-Whitney U tests for rank-ordered data. Data were collected from April 1, 2001 to April 1, 2004. Approximately 80% (N = 148) of individuals approached for this study agreed to participate. The overall sample was primarily white and female. The PHQ diagnoses at study entry were dysthymic disorder (8.8%, n = 13), major depressive disorder (31.8%, n = 47), "double depression" (both dysthymic disorder and major depressive disorder, 29.7%, n = 44), and no depression (16.2%, n = 24.) The mean BDI-II score for the total sample was 19.9. Nonadherent patients reported being more careless about taking their medications, were more worried about side effects, were less satisfied with their physicians, were under the age of 40 years, and were more likely to have asked for a specific antidepressant. Nonadherent patients also indicated being at lower stages of change. Individually tailoring education to patient preference and stage of change is recommended to promote adherence.

Major depression: the importance of clinical characteristics and treatment response to prognosis

This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis. This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention. Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year. Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.

Early adversity in chronic depression: clinical correlates and response to pharmacotherapy

There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD. Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of >2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks. A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission. These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy.

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 2ª parte: tratamento de manutenção do transtorno depressivo maior e tratamento dos transtornos depressivos crônicos e das depressões subliminares

These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of the complete spectrum of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). The first part of these WFSBP guidelines on unipolar depressive disorders covered the acute and continuation treatment of major depressive disorder (Bauer et al., 2002). This second part of the guidelines covers the management of the maintenance-phase treatment of major depressive disorder, as well as the treatment of chronic and subthreshold depressive disorders (dysthymic disorder, double depression, minor depressive disorder and recurrent brief depression). These guidelines are primarily concerned with thebiological treatment (including antidepressants, lithium, other psychopharmacological and hormonal medications, and electroconvulsive therapy) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.

The three-year naturalistic course of major depressive disorder, dysthymic disorder and double depression

Background Recent studies support a distinction between acute and chronic forms of depression, which contrasts the single-disease hypothesis for depressive disorders. Insight into the (determinants of) the 3-year naturalistic course of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD) may contribute to this debate. Methods Data were derived from NEMESIS, an epidemiologic survey in the adult population of the Netherlands. 400 Respondents who met the Composite International Diagnostic Interview (CIDI) criteria of MDD and/or Dysth were selected. Cox proportional hazards analyses and Linear Mixed Models were conducted to examine 3-year course trajectories of MDD, Dysth and DD and determinants for course. Results Adjusted analyses showed similar course trajectories for Dysth and DD, which were significantly worse than the course for MDD. Determinants of unfavorable course were neuroticism and poor functioning. Limitations Attrition was higher among persons with Dysth. However, since attrition is generally associated with poorer outcome, this would indicate that differences in course may even have been larger in reality. Conclusions Dysth and DD involve a similar course which is worse than the course of MDD only. These results do not support a distinction between Dysth and DD. Duration of symptoms and level of functioning may serve as two clinically relevant classifying dimensions within the broad category of depressive disorders.

Do major depressive disorder and dysthymic disorder confer differential risk for suicide?

BackgroundAlthough there has been a tremendous amount of research examining the risk conferred for suicide by depression in general, relatively little research examines the risk conferred by specific forms of depressive illness (e.g., dysthymic disorder, single episode versus recurrent major depressive disorder [MDD]). The purpose of the current study was to examine differences in suicidal ideation, clinician-rated suicide risk, suicide attempts, and family history of suicide in a sample of outpatients diagnosed with various forms of depressive illness. MethodsTo accomplish this aim, we conducted a cluster analysis using the aforementioned suicide-related variables in a sample of 494 outpatients seen between January 2001 and July 2007 at the Florida State University Psychology Clinic. Patients were diagnosed using DSM-IV criteria. ResultsTwo distinct clusters emerged that were indicative of lower and higher risk for suicide. After controlling for the number of comorbid Axis I and Axis II diagnoses, the only depressive illness that significantly predicted cluster membership was recurrent MDD, which tripled an individual's likelihood of being assigned to the higher risk cluster. LimitationsThe use of a cross-sectional design; the relatively low suicide risk in our sample; the relatively small number of individuals with double depression. ConclusionsOur results demonstrate the importance of both chronicity and severity of depression in terms of predicting increased suicide risk. Among the various forms of depressive illness examined, only recurrent MDD appeared to confer greater risk for suicide.

Midbrain serotonin and striatum dopamine transporter binding in double depression: A one-year follow-up study

Data on neurobiological differences between major depression (MD) and double depression (DD) are scarce. We examined the striatum dopamine (DAT) and midbrain serotonin transporter (SERT) binding of [123I] nor-beta-CIT in DD patients (n=8) and compared it to that in MD patients (n=11) and healthy controls (n=19). Drug-naïve patients and controls were imaged by single-photon emission computed tomography at baseline, and the patients also after one year of psychodynamic psychotherapy. Both DD and MD groups had lower midbrain [123I] nor-beta-CIT binding compared with the controls. Baseline 17-item Hamilton Depression Rating Scale (HAM-D-17) scores significantly decreased in both groups after one year of psychotherapy (DD: t=3.55, p=0.009; MD: t=5.86, p<0.001). No differences between the DD and MD groups were observed in age-adjusted baseline striatum or midbrain [123I] nor-beta-CIT binding or its change during psychotherapy. Age-adjusted baseline striatum [123I] nor-beta-CIT binding correlated inversely with the duration of both dysthymia (rho=-0.76, p=0.03) and MD (rho=-0.83, p=0.01) in the DD group. No such finding was observed in the MD group (rho=0.26, p=0.44). Baseline HAM-D-17 did not correlate with the change in striatum or midbrain [123I] nor-beta-CIT binding in either group. In conclusion, our findings suggest that when using midbrain [123I] nor-beta-CIT binding as a marker of SERT binding, no differences are detectable between patients with DD and MD. However, low striatum [123I] nor-beta-CIT binding, a marker of DAT binding, may be associated with a longer illness duration in dysthymia.

Asenapine in the treatment of acute mania in bipolar I disorder: Outcomes from two randomized and placebo-controlled trials

chronicity and frequent recurrences. We investigated the long-term outcome of a regionally representative psychiatric MDD cohort comprising mainly outpatients. Method: The Vantaa Depression Study included 163 patients with DSM-IV MDD (71.8% of those eligible) diagnosed using structured and semistructured interviews and followed up at 6months, 18months, and 5 yearswith a life-chart. The effects of comorbid disorders and other predictors on outcomewere comprehensively investigated. Results: Over the 5-year follow-up, 98.8% of patients achieved a symptom state below major depressive episode (MDE) criteria and 88.4% reached full remission, with themedian time to full remission being 11.0months. Nearly one-third (29.3%) had no recurrences, whereas 30.0% experienced one, 12.9% two, and 27.9% three or more recurrences. Double depression, cluster C personality disorder, and longer MDE duration prior to entry were the most significant predictors of longer time in achieving full remission. Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences. Conclusion: Previous literature on mostly inpatient MDD may have, by generalizing from patients with the most severe psychopathology, overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric care is variable, with about one-tenth of patients having poor, one-third intermediate, and a half favorable outcomes. In addition to known predictors, cluster C personality disorders and social phobia warrant further attention as predictors of MDD outcome among outpatients.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

P.6.e.004 CSF amino acids in pathological gamblers and healthy controls

The aim of the study was to explore possible differences in temperament and character dimensions between 2 monodiagnostic adolescent groups of depression, namely, one with a present episode of major depression and subjects with the other being their dysthymic peers.From a multisite Western Hungarian sample of consecutively referred 14- to 18-year-old new psychiatric adolescent outpatients, 2 groups were compared: group I, n = 56 (9 males, 47 females), with major depressive disorder (MDD) and group II, n = 27 (6 males, 21 females), with a diagnosis of dysthymic disorder (DD). All other comorbid diagnoses including bipolar and double depression (MDD + DD) cases were excluded. Present suicide events, if the attempter had an underlying diagnosis of depression, were not causes for exclusion. Assessment methods used were the adapted Hungarian versions of the Mini International Neuropsychiatric Interview and the Junior Temperament (Cloninger) Character Inventory.The only difference between the major depressive and dysthymic adolescents was harm avoidance, adolescents with major depression having a higher level practice of harm avoidance, whereas the temperament type of MDD vs DD seems to differ only in the aspect of avoiding painful stress. Expectations regarding a worse degree of self-directedness and lower levels of persistence and cooperativeness in the MDD sample were not proved.No essential temperament differences were found between the 2 adolescent depressive groups. Scarce differences between temperament qualities of MDD and DD may support Akiskal's continuum theory of depressive disorders. More research and the use of closer clinical personality typologies are warranted to explore possible personality trait differences (if they exist) between clinical diagnostic groups of adolescent patients.

Acute Worsening of Chronic Depression During a Double-Blind, Randomized Clinical Trial of Antidepressant Efficacy

Acute worsening of depression can negatively impact the outcomes of clinical trials of antidepressants and patient compliance to treatment. We hypothesized that acute worsenings would be more frequent in premenopausal women, relative to men or postmenopausal women, and in women who had demonstrated premenstrual symptom exacerbations (PMEs) prior to treatment, relative to those who had demonstrated no PMEs. Subjects diagnosed with DSM-III-R chronic major depressive disorder or double depression (dysthymia with concurrent major depressive episode) were randomly assigned between February 1993 and December 1994 to 12 weeks of double-blind treatment with flexibly-dosed sertraline or imipramine, with crossover to the alternate drug in the absence of response. A 6-point or more increase in the 17-item Hamilton Rating Scale for Depression relative to the (7-14 day) previous visit defined worsening. PME was assessed through daily diaries prior to treatment. There were 3582 evaluable visits attended by 554 subjects. Premenopausal women had a deteriorating depressive presentation at a greater proportion of their visits (8.6%) than did postmenopausal women (4.5%, p < .01) or men (5.9%, p < .01). The presence of PME at baseline was associated with more worsenings than the absence of PME (12.0% vs. 7.3%, p < .05). Results were similar whether the subject was treated with sertraline or imipramine. Nonresponse at treatment completion was more likely among subjects with worsening (p < .01). Dropouts were more likely than completers to have had an exacerbation at their terminal visit (p < .05). Acute worsening of depression was associated with reproductive variables and negatively affected clinical trial outcomes including early treatment discontinuation and nonresponse.

Duloxetine Treatment of Dysthymia and Double Depression

Although not as common as major depressive disorder, dysthymia is not rare and is associated with substantial impairment. Antidepressants and some psychotherapies are often effective. We explored the efficacy of the antidepressant duloxetine, a serotonin and norepinephrine reuptake inhibitor. Between February 2005 and April 2006, we recruited 24 adults with DSM-IV dysthymia or dysthymia and concurrent major depression ("double depression") who had an entry score of > or = 17 on the clinician-rated Inventory for Depressive Symptomatology (IDS-C). We excluded subjects with significant medical illnesses and those requiring other psychotropic agents or undergoing psychotherapy. Subjects received duloxetine 60 mg/day for 6 weeks, increased as tolerated to 120 mg/day for the remainder of the 12-week trial for those with an inadequate treatment response. The subjects' mean +/- SD IDS-C scores decreased significantly from baseline (27.3 +/- 6.3) to endpoint (7.8 +/- 7.4, Student t = 12.38, df = 23, p < or = .001). The IDS-C response rate (intent-to-treat [ITT]) was 83% (20/24); the remission rate (ITT) was 79% (19/24). Among study completers, these rates were 89% (17/19) and 84% (16/19). Five subjects (21%) discontinued for side effects. Duloxetine appears to be an effective and well-tolerated treatment for dysthymia and double depression. A double-blind, placebo-controlled study is under way. If duloxetine is found to be effective, studies powered to detect potential, clinically important differences between duloxetine and other antidepressants will be needed. ClinicalTrials.gov identifier NCT00185575.

Double depression in older adult psychiatric outpatients: Hopelessness as a defining feature

Background There is a paucity of research on the distinguishing features of double depression, particularly in older adults. Preliminary studies have revealed that individuals with double depression diagnoses tend to have more severe depression than individuals with major depression or dysthymia alone, but few other distinctions between the diagnostic categories have been found. Method We examined the possibility that hopelessness particularly characterizes double depression, by comparing older adults with double depression, dysthymia alone, or major depression alone, on hopelessness, as well as on internal and external locus of control. The sample included 54 older psychiatric outpatients who completed a battery of cognitive and symptom measures, and underwent structured clinical interviews. Results Double depressed patients showed high levels of hopelessness, whereas patients with either major depression or dysthymia alone showed more moderate levels of hopelessness. Low internal locus of control characterized both groups with a dysthymia diagnosis (dysthymia alone and double depression), and differentiated them from the group with major depression alone. Limitations The sample size was modest, and the results may not generalize to older adults with different demographic characteristics. Conclusions Hopelessness may be important in understanding the phenomenology of double depression in older adults, and may inform diagnostics and psychotherapeutics as well.

Dysthymic disorder and double depression: Prediction of 10-year course trajectories and outcomes

We sought to identify baseline predictors of 10-year course trajectories and outcomes in patients with dysthymic disorder and double depression. Eighty-seven outpatients with early-onset (<21 years) dysthymic disorder, with or without superimposed major depression, were assessed five times at 30-month intervals for 10 years. Baseline evaluations included semi-structured diagnostic interviews for Axis I and II psychopathology and childhood adversity. Direct interview and family history data were collected on first-degree relatives. Follow-up assessments included the Longitudinal Follow-up Evaluation and Hamilton Depression Rating Scale. Using mixed effects growth curve models, univariate predictors of depression severity and functional impairment at 10-year outcome included older age, less education, concurrent anxiety disorder, greater familial loading for chronic depression, a history of a poorer maternal relationship in childhood, and a history of childhood sexual abuse. In addition, longer duration of dysthymic disorder also predicted greater impairment 10 years later. Predictors of a poorer trajectory of depressive symptoms over time included ethnicity and personality disorders; predictors of a poorer trajectory of social functioning included familial loading of chronic depression and quality of the childhood maternal relationship. Thus, demographic, clinical, family history, and early adversity variables all contribute to predicting the long-term trajectory and outcome of DD. These variables should be routinely assessed in clinical evaluations and can provide clinicians with valuable prognostic information.

Parsing the clinical phenotype of depression: the need to integrate brief depressive episodes

To expand the concept of recurrent brief depression (RBD) to brief depression (BD) and to test its clinical relevance. Subjects (N = 591) were studied prospectively six times from ages 20/21 to 40/41 years. RBD was defined according to DSM-IV as episodes under 2 weeks with about monthly recurrence and work impairment. BD embraces RBD and brief depressive episodes with a frequency of 1-11 per year. Pure BD and pure major depressive episodes (MDE) did not differ in treatment rates, family history of mood and anxiety disorders or comorbidity with bipolar spectrum and anxiety disorders but they differed in work impairment, suicide attempt rates and distress self-ratings. The combination of BD + MDE identified a very severe group of MDE, comparable with combined depression (MDE + RBD) and double depression (MDE + dysthymia). Our data argue for the use of BD as a diagnostic specifier for severe MDE. RBD remains an important independent subgroup.

Childhood depression: a place for psychotherapy

Although considered clinically effective, there is little systematic research confirming the use of Individual Psychodynamic Psychotherapy or Family Therapy as treatments for depression in children and young adolescents. A clinical trial assessed the effectiveness of these two forms of psychotherapy in treating moderate and severe depression in this age group. A randomised control trial was conducted with 72 patients aged 9-15 years allocated to one of two treatment groups. Significant reductions in disorder rates were seen for both Individual Therapy and Family Therapy. A total of 74.3% of cases were no longer clinically depressed following Individual Therapy and 75.7% of cases were no longer clinically depressed following Family Therapy. This included cases of Dysthymia and "Double Depression" (co-existing Major Depressive Disorder and Dysthymia). There was also an overall reduction in co-morbid conditions across the study. The changes in both treatment groups were persistent and there was ongoing improvement. At follow up six months after treatment had ended, 100% of cases in the Individual Therapy group, and 81% of cases in the Family Therapy group were no longer clinically depressed. This study provides evidence supporting the use of focused forms of both Individual Psychodynamic Therapy and Family Therapy for moderate to severe depression in children and young adolescents.

Differences in the clinical characteristics of adolescent depressive disorders

Our objective was to analyze differences in clinical characteristics and comorbidity between different types of adolescent depressive disorders. A sample of 218 consecutive adolescent (ages 13-19 years) psychiatric outpatients with depressive disorders was interviewed for DSM-IV Axis I and Axis II diagnoses. We obtained data by interviewing the adolescents themselves and collecting additional background information from the clinical records. Lifetime age of onset for depression, current episode duration, frequency of suicidal behavior, psychosocial impairment, and the number of current comorbid psychiatric disorders varied between adolescent depressive disorder categories. The type of co-occurring disorder was mainly consistent across depressive disorders. Minor depression and dysthymia (DY) presented as milder depressions, whereas bipolar depression (BPD) and double depression [DD; i.e., DY with superimposed major depressive disorder (MDD)] appeared as especially severe conditions. Only earlier lifetime onset distinguished recurrent MDD from first-episode MDD, and newly emergent MDD appeared to be as impairing as recurrent MDD. Adolescent depressive disorder categories differ in many clinically relevant aspects, with most differences reflecting a continuum of depression severity. Identification of bipolarity and the subgroup with DD seems especially warranted. First episode MDD should be considered as severe a disorder as recurring MDD.

Double depression: its morbidity and management in a community setting.

Double depression, the combination of major depression and dysthymia, is associated with poor health-related quality of life (HRQoL) and increased health service utilization. To determine the prevalence of double depression, its associated morbidity and use of health services and antidepressants. A random and representative sample of the South Australian general population was interviewed. The mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD), the Short-Form Health Status Questionnaire (SF-36) and Assessment of Quality of Life (AQoL) instruments were administered, and data relating to health service utilization, antidepressant use and role functioning were collected. Double depression was present in 3.3% of the population. The use of health services was significantly higher in this group than those with no depression, or dysthymia or major depression alone. Only 15.2% had attended a community health service, 18.2% had seen a psychiatrist, 10.1% a psychologist, 16.2% a social worker and 9.1% any other counsellor in the last month. While 41.4% were currently taking an antidepressant, the average doses of the two most commonly prescribed antidepressants were below the maximum recommended doses, and the use of antidepressant augmentation strategies was also minimal. While double depression is associated with increased morbidity and use of health services, the optimum use of both pharmacological and nonpharmacological treatments is clearly lacking in this community sample.