A 36-year-old woman has had chronically depressed mood for most of the day, more days than not, for seven years, meeting criteria for Persistent Depressive Disorder. Over the last month she has developed pronounced anhedonia, early morning awakening, psychomotor retardation, and feelings of worthlessness that clearly exceed her baseline state. This clinical picture is best termed:

• A Double depression ✓
• B Cyclothymic disorder
• C Recurrent brief depression
• D Adjustment disorder with depressed mood

Explanation

Double depression describes a major depressive episode superimposed on antecedent Persistent Depressive Disorder (dysthymia). These patients have a chronic depressive substrate punctuated by full syndromal episodes that worsen functioning above baseline, carry higher relapse rates, and typically require combined pharmacotherapy and psychotherapy. Cyclothymia requires alternating hypomanic and depressive periods below syndromal thresholds for at least two years, recurrent brief depression requires episodes under two weeks, and adjustment disorder follows an identifiable stressor within three months.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.