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Ask the Experts

Question:

What medication or medications do you think have worked the best for patients with Dysthymia?

I have Dysthymia and I have tried about 10 different anti-depressants and have found that Effexor is the only thing that has helped somewhat.

Also Adderall helped me alot but my doctor that gave it to me retired and my new doctor refuses to give it to me. What are your thoughts on this?

Is Adderall a bad drug?

Answered by: David Hellerstein

A wide variety of antidepressant medications have been shown to be effective in treating dysthymia, or chronic low-grade depression. In addition to the SSRIs, the SNRIs (like Effexor or Cymbalta), atypical agents like bupropion, and many other classes of medication have been shown to be effective. Which medicine works best for which person? This can't currently be predicted, but instead is a matter of trial and error. Effexor, which works on both serotonin and norepinephrine, two different classes of neurotransmitters, has been shown to be more effective than the single-mechanism SSRI medicines in some studies--though this applies to major depression, not dysthymia specifically. Some people benefit from having stimulants added to antidepressant medications. There are studies with many such medications, including the amphetamines and newer agents like Provigil. Stimulants are fairly effective in helping "residual" symptoms of depression such as low energy, poor motivation, poor concentration, and so on. They are also useful for those people who have 2 disorders--both dysthymic disorder and attention deficit disorder (ADD). These disorders often occur together. On the other hand, stimulants have some risk of abuse, dependence, addiction, and should be prescribed with caution. Thus, Adderall and other stimulants are not 'bad drugs' in themselves, and can be helpful--but should be prescribed with caution.