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Ask the Experts

Question:

I am a young woman who has had dysthymia for over ten years. I have tried medicines and therapy, but haven't gotten better. Do you have any suggestions on what to do next?

Answered by: David Hellerstein

Dysthymia, or chronic low-grade depression, is a common condition which may cause significant impairment in quality of life.

Many classes of antidepressant medications have been shown to be effective for treatment of this condition, including the SSRIs, the tricyclics, the MAOIs, combined serotonin-norepinephrine mechanism medications like duloxetine, and others.

About one half of dysthymics respond to any one of these medications, and many who don't respond to the first medication will respond to another class of medication.

However some people do not respond to any of the initial medication treatments. Psychiatrists have studied a number of approaches for what has been called "treatment-resistant depression." Treatment-resistant dysthymia has not been studied as much as treatment-resistant major depression, but most likely this condition responds similarly to major depression.

These approaches may include medication combinations, medication combined with psychotherapy, medication plus exercise, medication plus light treatment, and other approaches. Some studies have shown that adding medications such as atypical antipsychotics, mood stabilizers, or other classes of medicine may be helpful.

It is worth pointing out that many people have received inadequate treatments for depression and do not really have "treatment-resistant" depression or dysthymia. Instead they have had inadequate medicine doses, or too-brief treatments.

In general, the best thing to do in cases of treatment-nonresponse is to do a careful review of prior treatments (including prior medication doses, duration of treatment, benefits and side effects, as well as prior psychotherapies), and then to try to come up with a treatment plan which will include a variety of possible options--a decision tree where you can decide 'what next' if a particular treatment approach does not work.

A psychopharmacology consultation may be helpful in such instances, to review treatments and come up with a treatment plan.