Columbia University Medical Center
Ranked #1 in Psychiatry
U.S. News & World Report
Ranked #1 in Research Funding
National Institutes of Health
NewYork-Presbyterian Hospital The University Hospital of Columbia and Cornell

Ask the Experts

Question:

I am 46 and have been suffering from dysthmia for 16 years. I've tried lots of antidepressant--SSRIs, SNRIs, and tricyclics--and what happens is that after I try a new one, I feel better for about 3 months and then go back to feeling tired and depressed.

Is there any new medication or combination of medications that might help me?

Answered by: David Hellerstein

Dysthymic disorder (also known as dysthymia) is a form of low-grade chronic depression that affects millions of people in this country. It is a paradoxical disorder, in that it appears mild at any single point in time, but over time often causes significant impairment in work and social functioning. Because it has fairly mild symptoms on a day-to-day basis, it is often not properly treated.

Yet, most studies show that adequate antidepressant treatment with medication, and/or psychotherapy, can help many people achieve and keep a normal mood.

Some people, however, have difficulty getting an adequate response to treatment, and in such cases it is worth reviewing treatments to determine what the cause of poor response may be. A number of possibilities need to be considered:

**the diagnosis may need to be reconsidered;

**there may be poorly-controlled medical illnesses; or

**ongoing life stresses may require addressing.

Oftentimes, particular medication changes can lead to a better outcome. Sometimes the answer is relatively simple: one may have not received an adequate dosage of medicine, for instance, and a simple increase in dose may be effective. Beyond that, a variety of approaches are used for treatment-resistant depression, such as changing to another class of medications, combining two or more classes of medication, and so on. Therapy, exercise, and other approaches should also be considered.