Dysthymia (Persistent Depressive Disorder)

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is the treatment for persistent depressive disorder? Are there any home remedies for persistent depressive disorder?

For people with mild persistent depressive disorder who want to try treatment without medication, there are a number of lifestyle changes and home/natural remedies that may be useful for coping with the condition. Healthy lifestyle changes that may help alleviate persistent depressive disorder include getting enough sleep, establishing a healthy diet, getting regular physical exercise, setting small goals for oneself, limiting alcohol intake and abstaining from abusing any other drug. Some natural remedies that have found some success in treating mild depression include St. John's wort and SAM-e. However, these treatments have variable results and may result in side effects so should only be taken in cooperation with a physician.

The treatment of moderate to severe persistent depressive disorder 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 medical treatments used to address persistent depressive disorder since brain serotonin levels are often thought to be low in depression. The selective serotonin reuptake inhibitor drugs (SSRIs) work by maintaining high serotonin levels 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 message to continue making serotonin keeps on being sent. It is thought that this, in turn, helps stimulate (activate) cells that have been deactivated by persistent depressive disorder, 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, significant 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 persistent depressive disorder. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), escitalopram (Lexapro), vortioxetine (Brintellix), and vilazodone (Viibryd).

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 adequate results 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), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima). While generally well tolerated, side effects of these medications can include flu-like symptoms (body aches, tiredness, dizziness), especially 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 trazodone (Desyrel or Oleptro) 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 engagement in 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 ways for dealing with problems.
Medically Reviewed by a Doctor on 4/8/2016
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