Dysthymic Disorder Treatment & Management

Updated: Nov 09, 2015
  • Author: Jerry L Halverson, MD; Chief Editor: David Bienenfeld, MD  more...
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Treatment

Approach Considerations

Psychotherapy and medication management are effective treatment modalities for dysthymia, and combination treatment is common. Minimal data are available; however, a randomized trial that compared interpersonal psychotherapy, brief supportive psychotherapy, sertraline treatment alone, and sertraline treatment plus interpersonal psychotherapy found the greatest effect when sertraline and interpersonal therapy were combined.

Consultations

Close collaboration among all providers and treatment of any underlying or comorbid medical conditions are essential.

Activity

Studies suggest that individuals with depressed mood are helped by aerobic exercise 4-6 times per week and that any exercise is more helpful than none at all.

Inpatient care

Patients should be hospitalized when their psychiatric illness puts them at risk of harming themselves or another person or when it dangerously impairs their ability to care for themselves.

Follow-up and outpatient care

Because of the high rate of relapses from depression and from dysthymia, follow-up is important.

The patient who has recovered with pharmacotherapy should be encouraged to continue follow-up for at least 6 months before considering any medication taper.

Because of the chronic nature of dysthymia, long-term treatment with medications is often advisable. In cases where a medication loses its effectiveness, a new regimen should be considered.

Deterrence and prevention

No studies have focused on this issue, but social supports, adequate exercise, a rewarding occupation, and a generally healthy lifestyle may either be protective or else be evidence of a low propensity toward dysthymia.

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Psychotherapy

Several types of therapy, including psychodynamic, cognitive behavioral, and interpersonal therapy, have been demonstrated in controlled studies to be effective in the treatment of depression and dysthymia.

Short- and long-term psychodynamic psychotherapy are effective for depressive disorders; in particular, they help in developing an individual’s understanding of their relationships and decrease maladaptive interpersonal interactions. [31, 32]

Cognitive behavioral therapy (CBT) is a structured, time-limited treatment that involves recognizing and restructuring cognitive processes leading to depression and noting the relationship between depressive cognitions, mood state, and the individual’s behavior. Cognitive strategies, such as reformulating distorted thinking, and behavioral strategies, such as daily activity scheduling, are effective for depressive symptoms.

Interpersonal therapy (IPT) is also a structured, time-limited treatment. This therapy focuses on current problems and the interpersonal context in which they occur. Success in solving interpersonal conflicts in IPT is associated with improved symptoms of dysthymia. [33, 34]

Although research in this area is limited, group therapy, including CBT and IPT groups, may be helpful for people with dysthymia. [35, 36]

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