Psychotherapy
Many people with dysthymia do not get the treatment they need, in many cases because they only see their family doctors, who often fail to diagnose the disorder. Part of the problem is that people suffering from dysthymia believe their symptoms are an inevitable part of life. In older people, dementia, apathy, or irritability can disguise dysthymia. Asking open-ended questions—such as "How are things at home?"—can help a physician begin to notice the signs of dysthymia.
Like major depression, dysthymia can be treated with supportive therapy that provides advice, reassurance, sympathy, and education. Like the process of learning, which involves the formation of new connections between nerve cells in the brain, psychotherapy works by changing the way the brain functions. Certain types of psychotherapy including supportive therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy and interpersonal therapy (IPT), can help relieve dysthymia. Supportive therapy provides advice, reassurance, sympathy, and education about the disorder. CBT helps identify and change the negative styles of thinking that promote self-defeating attitudes and behaving that improves social skills and teaches ways to manage stress and unlearn learned helplessness. Psychodynamic therapy helps patients resolve emotional conflicts, especially those derived from childhood experience. IPT helps patients to cope with personal disputes, loss and separation, and transitions between social roles. Preliminary evidence from an ongoing NIMH-supported study indicates that IPT, in particular, may hold promise in the treatment of this disorder.
Medication
As with other forms of depression, there are a number of medication options for people with dysthymia. The most common drug treatments include selective serotonin reuptake inhibitors like fluoxetine (Prozac) and sertraline (Zoloft), or one of the newer dual-action antidepressants such as venlafaxine (Effexor). Some patients may respond to tricyclic antidepressants such as imipramine (Tofranil). Antidepressant drugs have a number of side effects that can complicate treatment. For example, SSRIs may cause stomach upset, mild insomnia, and reduced sex drive.
For many patients, a long-term combination of medication and psychotherapy that includes a solid relationship with a mental health professional is the most effective course of treatment. Recovery from dysthymia can take a long time, and the symptoms often return. For this reason, many patients are encouraged to continue doing whatever made them well—whether it was a drug, therapy, or a combination of the two—after recovery.
Research Findings
- Nearly half of people with dysthymia have a symptom that also occurs in major depression: early onset of REM, the rapid eye movements that usually began later in the night.
- A survey commissioned by the Depression and Bipolar Support Alliance found that doctors and patients often have poor communication about the symptoms and treatment of depressive disorders, including information about the side effects of medication and the need for routine follow-up visits. This can result in poor patient compliance with treatment.
- Another recent telephone survey found that of more than 800 adults with dysthymia, only 20 percent had seen a mental health professional; only 25 percent had received medication and only one-third had received some kind of counseling, usually brief.
Dysthymia. Last reviewed 10/14/2008
Sources:
- American Psychiatric Association
- National Library of Medicine
- Harvard Medical School (2005). Dysthymia. Cambridge, MA: Harvard Health Publications.
