Dysthymia (cont.)

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What is the treatment for dysthymia?

The treatment of dysthymia is found to be most effective when it includes both medication treatment and at least 18 sessions of talk therapy (psychotherapy), but medications tend to be more effective compared to therapy alone.

Medications that increase the amount of the neurochemical serotonin in the brain are the most common group of medications used to address dysthymia since brain serotonin levels are often thought to be low in depression. The SSRIs work by keeping serotonin present in high concentrations in the synapses (spaces between nerve cells across which nerve signals are transmitted). These drugs do this by preventing the reuptake of serotonin back into the sending nerve cell. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. It is thought that this, in turn, helps arouse (activate) cells that have been deactivated by dysthymia, thereby relieving the person's symptoms.

SSRIs tend to have fewer side effects than the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), two other classes of antidepressant drugs. SSRIs do not interact with the chemical tyramine in foods, as do the MAOIs, and therefore do not require the dietary restrictions of the MAOIs. Also, SSRIs do not cause orthostatic hypotension (sudden drop in blood pressure when sitting up or standing) and heart-rhythm disturbances, like the TCAs do. Therefore, SSRIs are often the first-line treatment for dysthymia. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).

SSRIs are generally well tolerated, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Some patients experience tremors with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a serious neurologic condition associated with the use of SSRIs. It is characterized by high fevers, seizures, and heart-rhythm disturbances. This condition is very rare and tends to occur only in very ill psychiatric patients taking multiple psychiatric medications.

All patients are unique biochemically. Therefore, the occurrence of side effects or the lack of a satisfactory result with one SSRI does not mean that another medication in this group will not be beneficial. However, if someone in the patient's family has had a positive response to a particular drug, that medication may be the preferable one to try first.

Dual-action antidepressants (SNRIs) are thought to affect both serotonin and norepinephrine in the brain. Examples of that class of medications include venlafaxine (Effexor) and duloxetine (Cymbalta). While generally well tolerated, side effects of these medications can include flu-like symptoms (body aches, tiredness, dizziness), particularly when doses are missed.

Atypical antidepressants are not TCAs, SSRIs, MAOIs, or SNRIs, but they are effective in treating depression for many people nonetheless. More specifically, they increase the level of certain neurochemicals in the brain synapses. Examples of atypical antidepressants include nefazodone (Serzone), trazodone (Desyrel), and bupropion (Wellbutrin).

Cognitive behavioral therapy (CBT): This has been found to be effective as part of treatment for depression. This approach helps to alleviate depression and reduce the likelihood it will come back by helping the dysthymia sufferer change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to accomplish these goals:

  • Didactic component: This phase helps to set up positive expectations for therapy and promote the person's cooperation with the treatment process.
  • Cognitive component: This helps to identify the thoughts and assumptions that influence the dysthymic individual's behaviors, particularly those that may predispose the sufferer to being depressed.
  • Behavioral component: This employs behavior-modification techniques to teach the person more effective strategies for dealing with problems.
Medically Reviewed by a Doctor on 2/5/2014

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Dysthymia - Symptoms Question: What were your symptoms of dysthymia?
Dysthymia - Diagnosis Question: How was your dysthymia diagnosed?
Dysthymia - Causes Question: What caused your dysthymia?
Dysthymia - Psychotherapy Question: If you have depression (dysthymia), have you tried psychotherapy? Please share your experience.
Dysthymia - Antidepressants Question: Please discuss your experience with any medications you've been prescribed for depression (dysthymia).
Dysthymia - Additional Support Question: Besides medication and talk therapy, what other ways have helped you deal with dysthymia?

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