Antidepressants for Dysthymia

Dysthymia, or dysthymic disorder, is often referred to as a mild form of depression. However this is only when compared with major depressive disorder. Dysthymia is actually a chronic mood disorder that sometimes manifests as a life-long depression and, in adults, last no less than two years.

Physical symptoms may include low energy and fatigue. Sleep disturbances are common. Low self-esteem and feelings of hopelessness are common emotional responses. Concentration and decision making may also be affected. People with dysthymia will feel depressed for most of the day and for most days.

SSRI Antidepressants

Antidepressants for dysthymia are relatively effective (55% compared with 31% on placebo). The antidepressants of choice fall into the selective serotonin re-uptake inhibitor (SSRI) category. Serotonin is a naturally occurring neurotransmitter. It is found in abundance around areas of the brain known to influence and regulate mood. When levels of serotonin change, mood changes accordingly, therefore the aim of SSRI medication is to inhibit depletion of serotonin from the brain.

These often take a few weeks to reach their therapeutic potential. Once a course has started it is important to maintain the dosage and not discontinue abruptly as this can cause a rapid slump in mood. Commonly prescribed SSRIs are:

• Celexa
• Lexapro
• Luvox
• Paxil
• Prozac
• Zoloft

SSRI medication is not without its critics. In 1997, Fisher & Greenburg conducted a meta-analysis of studies to that point and concluded the true effects of medication for any other than major depressive disorder was negligible. They suggest the act of given and receiving medication is a complex social interaction in which patients may be responding to issues other than pharmaceutical effects.

Alternatives to SSRIs

There is a recognition that antidepressants for dysthymia do not work as well as for depression. However, those who do find benefit report that SSRIs have fewer side effects in terms of their sedative effects and this helps to maintain energy for work and other activities. Some people find however find they respond better to a different type of antidepressant. Prior to the availability of SSRI’s, tricyclic antidepressants (first generation) were most commonly prescribed. Such drugs include:

• Adapin
• Anafranil
• Asendin
• Elavil
• Sinequan
• Tofranil

These drugs are still available as treatment options but their side effects, most commonly dry mouths and sedation, tend to be more extreme and are more likely to prevent people sticking to a treatment regime. Despite this, tricyclic antidepressants may be suggested in cases where SSRI drugs seem to be having little or no effect. SSRI drugs have a very specific action whereas tricyclic antidepressants have broader effect on a variety of neurotransmitters, and this may be sufficient to tip the balance away from depression.

Prognosis

Dysthymia is not an easy condition to treat even when medication is combined with psychotherapy. Lack of treatment however can lead to a situation where dysthymia tips into a major depressive episode.

References

De Lima M.S., Hotopf, M (2003) Benefits and Risks of Pharmacotherapy for Dysthymia: a systematic appraisal of the evidence. Drug Saf. 26(1): 55-64.

Fisher, S & Greenburg, R.P. (1995) Prescription for Happiness? Psychology Today, 28, 32-37.

Klein, D.N., Shankman, S.A., Rose, S. (2006) Ten-year prospective follow up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry. May 2006; 163(5): 872-80.

Markowitz, J.C., Kocsis, J.H., Bleiberg, K.L., Christos, P.J., Sacks, M.A.(2005) A Comparative Trial of Psychotherapy and Pharmacotherapy for “pure” Dysthymic Patients. J Affect Disord. Dec: 89(1-3): 167-75.