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Treatments and drugs
By Mayo Clinic staffThe two main treatments for dysthymia are:
- Medications
- Psychotherapy
As stand-alone treatments, medications appear to be more effective at treating dysthymia than psychotherapy. But, using a combination of medications and psychotherapy may be slightly more effective in treating dysthymia than using only medications or only psychotherapy.
Which treatment approach you take depends on such factors as:
- The 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
- Whether you're pregnant or breast-feeding
- The availability of mental health services in your community
- Your health insurance coverage
Medications for dysthymia
The psychiatric medications most commonly used to treat dysthymia are the same kinds used to treat depression. They include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Norepinephrine and dopamine reuptake inhibitors (NDRIs)
- Combined reuptake inhibitors and receptor blockers
- Tetracyclic antidepressants
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
SSRIs are often the antidepressant of choice because, in general, they work well and their side effects are more tolerable. MAOIs are usually last choices because they can have serious side effects and require strict dietary restrictions because of rare, but potentially fatal, interactions. Which one is best for you depends on your individual situation. When you have dysthymia, you may need to take antidepressants long term to keep symptoms under control.
All antidepressant medications have potential side effects, such as weight gain, sexual problems and diarrhea. Of particular concern is the worry that young people taking these medications might have a higher suicide risk. The Food and Drug Administration (FDA) requires that all antidepressant medications carry warnings about suicide risk in young people. The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants.
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 be especially helpful if:
- You need help learning to make decisions
- You have self-defeating behavior patterns
You and your therapist can talk about which type of therapy is right for you, your goals for therapy, and other issues, such as the number of sessions and length of treatment.
- Dysthymic disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com/content.aspx?aID=2375. Accessed May 12, 2010.
- Loosen PT, et al. Mood disorders. In: Ebert MH, et al. Current Diagnosis and Treatment: Psychiatry. 2nd ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3285019. Accessed May 12, 2010.
- Depressive disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec15/ch200/ch200b.html. Accessed May 12, 2010.
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- Imel ZE, et al. A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders. 2008;110:197.
- Mood disorders. In: Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, Pa.: Mosby; 2008. http://www.mdconsult.com/das/book/body/201023955-5/997725771/1657/636.html#4-u1.0-B978-0-323-04743-2..50071-8--cesec37_1902. Accessed May 13, 2010.
- Mead GE, et al. Exercise for depression (Review). Cochrane Database of Systematic Reviews. 2009:CD004366.
- Natural medicines in the clinical management of depression. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed May 13, 2010.
- Position of the American Dietetic Association and Dietitians of Canada: Dietary fatty acids. American Dietetic Association. http://www.eatright.org/WorkArea//DownloadAsset.aspx?id=8452. Accessed May 13, 2010.
- Smith CA. Acupuncture for depression (Review). Cochrane Database of Systematic Reviews. 2010:CD004046.
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- Subodh BN. Psychosocial impact of dysthymia: A study among married patients. Journal of Affective Disorders. 2008;109:199.
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