Dysthymia Treatment

By John M. Grohol, Psy.D.

There are a number of effective treatment approaches to help treat dysthymic disorder (also known as dysthymia). Often times a person with dysthymia will seek out treatment because of increased stress or personal difficulties which may be situationally-related. Only after a careful diagnostic interview is conducted (or after a few therapy sessions) may the chronic nature of the problem become apparent.

The best treatment approach for people with dysthymia appears to be a combination approach — psychotherapy combined with antidepressant medication. One large multisite study in the New England Journal of Medicine by Keller and colleagues (2000), for instance, had patients randomly assigned to one of three treatments: a depression-focused cognitive-behavioral therapy (CBT) program, the antidepressant Serzone (nefazodone), or to a combination of the two. About three-quarters responded to the combination, compared with about 48 percent for each individual condition.

“The combination of the two was whoppingly more effective than either one alone,” noted the researchers. “People suffering from chronic depression often have longstanding interpersonal difficulties, and the virtue of combined treatment in this case may be that it simultaneously targets both depressive symptoms and social functioning.”

Psychotherapy

There are many different types of psychotherapy available to help someone with dysthymia.

Before psychotherapy beings, a mental health professional will conduct a thorough evaluation to evaluate the individual’s current state of functioning, to assess mood type and severity, check for suicidal ideation and plan, etc. No matter which specific type of psychotherapeutic approach is utilized, a supportive, change-oriented environment and good rapport should be established by the therapist. A cognitive-behavioral therapy (CBT) that is client-centered should generally be considered, as it offers a therapy environment tailored to the patient’s need for unconditional acceptance and support. Non-specific factors will like be an important component of therapy. Therapy should be generally conducted with respect to the client’s pace and level of functioning. Attempts to focus on change too early in therapy could lead to early termination of therapy. This likely occurs because the patient feels the therapist didn’t respect or care enough about him or her to move at their rate.

Psychotherapy approaches for this disorder vary widely. Short-term approaches are preferred, however, because they emphasize realistic, attainable goals in the individual’s life which can usually bring them back to their normal level of functioning. This level, however, may be markedly less than what is expected in the average person. A person who suffers from dysthymic disorder has generally learned to live with a fair amount of chronic unhappiness in their lives. Realistic goals should be established early-on and the focus of therapy, instead of focusing on the person’s mood state.

Group therapy has been shown to be an effective modality for individuals suffering from this disorder. A group can be more supportive an individual than any one therapist can and help point out inconsistencies in the patient’s thinking and behavior. It should be considered, if not initially, then later on in treatment as the client regains his or her own self-confidence and can interact in a social context. Issues of self-esteem often accompany individuals who have dysthymic disorder, so care must be employed not to place the person into a group situation (where failure may be imminent) too soon. Family therapy may also be helpful for some individuals. Couples therapy can bring the individual’s spouse or significant other into the therapeutic relationship to create a therapeutic (and more powerful) triad.

Goals will vary according to type of therapy. Cognitive therapy emphasizes changes in one’s faulty or distorted way of thinking and perceiving the world. Interpersonal therapy focuses on an individual’s relationships with others and how to improve and strengthen existing relationships while finding new ones. Solution-focused therapy looks at specific problems plaguing an individual’s life in the present and examines how to best go about changing the person’s behavior to solve these difficulties. Social skills training focuses on teaching the client new skills on how to become more effective in social and work relationships. Usually, psychoanalytic and other insight-oriented approaches will be less effective because of their focus on the past and emphasis on lengthy therapy. While incorporation of therapy into a person’s chronic condition might be quite financially lucrative for the therapist, it is not the most change-effective and timely approach to help the individual overcome his or her difficulties.

Because the clinician must move at the client’s pace, progress with any type of therapy can be slow. Therapists should resist the temptation to try and “speed up” the process or force the client in a direction he or she is not yet ready to try. Closely related to this issue of the pace of therapy is being aware of the clinician’s frustration with lack of progress or boredom within the therapy session. It can be an emotionally draining experience for some therapists.

Medications

People with dysthymia often take an antidepressant medication, one that they find helps keep their energy levels up and keep them from reaching the lowest depressive moods. A class of antidepressants called selective serotonin re-uptake inhibitors (SSRIs) are the most commonly prescribed medication for chronic depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Luvox (fluvoxamine) are the most commonly prescribed brand names. SSRI medications should not be prescribed in conjunction with the older MAOIs (more popular in Europe than in the U.S.).

The large-scale, multi-clinic government research study called STAR*D found that people with depression and who take a medication often need to try different brands and be patient before they find one that works for them.

Results from the STAR*D study indicate that if a first treatment with one SSRI fails, about one in four people who choose to switch to another medication will get better, regardless of whether the second medication is another SSRI or a medication of a different class. And if people choose to add a new medication to the existing SSRI, about one in three people will get better. It appears to make some — but not much — difference if the second medication is an antidepressant from a different class (e.g. bupropion) or if it is a medication that is meant to enhance the SSRI (e.g. buspirone).

The most commonly prescribed antidepressants generally take 6 to 8 weeks before a person will start feeling their therapeutic effects.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Adjunctive community support groups in concurrence with psychotherapy is usually beneficial to most people who suffer from dysthymic disorder. Caution should be utilized, however, if the person also suffers from social anxiety. A group like A.A. or N.A. may also be appropriate, if the underlying cause of the dysthymia is a substance abuse problem. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.

Patients can be encouraged to try out new coping skills, assertiveness skills, cognitive restructuring, etc. within such a support group. They can be an important part of expanding the individual’s skill set and develop new, healthier social relationships.

Since this is a chronic disorder, your mental health professional should be sensitive to not using previous treatment approaches (especially medication) which have proven ineffective in the past. A careful and thorough history should be conducted at the onset of treatment to ensure this is evaluated. Specific attention should also be given to diagnostic issues, such as the existence of an alcohol or substance abuse problem, or social anxiety or other phobia, underlying or causing the dysthymic condition.

 

APA Reference
Grohol, J. (2008). Dysthymia Treatment. Psych Central. Retrieved on November 23, 2014, from http://psychcentral.com/lib/dysthymia-treatment/0001522
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.