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Treatments and drugs
By Mayo Clinic staffThe two main treatments for dysthymia are medications and talk therapy (psychotherapy). Medications appear to be more effective at treating dysthymia than psychotherapy when either is used alone. Using a combination of medications and psychotherapy may be slightly more effective.
Which treatment approach your doctor recommends depends on factors such as:
- Severity of your dysthymia symptoms
- Your desire to address emotional or situational issues affecting your life
- Your personal preferences
- Previous treatment methods
- Your ability to tolerate medications
- Other emotional problems you may have
Medications for dysthymia
Types of antidepressants most commonly used to treat dysthymia include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs)
Finding the right medication
SSRIs are often the antidepressant of choice because, in general, they work well and their side effects are more tolerable. Which antidepressant or a combination of medications is best for you depends on your individual situation.
If you're bothered by side effects, don't stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off, and quitting abruptly may cause a sudden worsening of depression. Don't give up until you and your doctor find a medication that's suitable for you. Talk with your doctor or pharmacist about possible side effects to weigh the benefits and risks. In some cases, side effects may go away as your body adjusts to the medication.
When you have dysthymia, you may need to take antidepressants long term to keep symptoms under control.
Antidepressants and increased suicide risk
Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, children, adolescents and young adults under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, people in these age groups must be closely monitored by loved ones, caregivers and health care providers.
Psychotherapy for dysthymia
Psychotherapy can help you learn about your condition and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy coping skills and stress management. Psychotherapy can also help you:
- Learn to make decisions
- Reduce self-defeating behavior patterns, such as negativity, hopelessness and a lack of assertiveness
- Improve your ability to function in interpersonal social and work situations
You and your therapist can discuss which type of therapy is right for you, your goals for therapy, and other issues, such as the length of treatment.
- Dysthymic disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Oct. 23, 2012.
- Ebert MH, et al. Current Diagnosis & Treatment: Psychiatry. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=10. Accessed Oct. 24, 2012.
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- VonWolff A, et al. Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: A systemic review and meta-analysis. Journal of Affective Disorders. In press. Accessed Oct. 24. 2012.
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- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 26, 2012 & Nov. 18, 2012.
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