### Instruction:  Disease name:

    Persistent depressive disorder (dysthymia)

: Treatment

The best treatment is a combination of psychotherapy and medication. The most helpful type of psychotherapy depends on a number of factors, including the nature of any stressful events, the availability of family and other social support, and personal preference. Therapy will usually include emotional support and education about depression. Cognitive behavioral therapy is designed to examine and help correct faulty, self-critical thought patterns. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms. People with persistent depressive disorder who think that "feeling blue" is just part of their life may be surprised to learn that antidepressant medication can be very helpful. Antidepressants recommended for this disorder are the selective serotonin reuptake inhibitors (SSRIs such as fluoxetine), serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine), mirtazapine and bupropion. Side effects vary among these choices. Problems with sexual functioning are common in most except bupropion. Anxiety may increase in the early stages of treatment, although that feeling usually subsides. Although it is relatively uncommon, any psychoactive medication can make a person feel worse rather than better. Based on concerns that in rare cases these drugs can cause the onset of suicidal thinking, the U.S. Food and Drug Administration required antidepressant manufacturers to put prominent warning labels on their products. The scientific community continues to debate how great the risk of suicide is when antidepressant treatment is started. Many experts take the position that — in the population as a whole — antidepressant treatment has reduced the number of suicides. They worry that the black box warnings have scared off people who might otherwise benefit from the drugs. Others note that doctors and patients should stay alert to the possibility that suicidal thinking can be triggered by an antidepressant. Both arguments have merit. In fact, the risk of leaving depression untreated is probably far greater than the risk of treatment with an antidepressant. But a small number of people using the medications do feel strikingly worse rather than better when they take them. The best way to avoid danger is to monitor your response to any medication carefully. You should therefore keep all follow-up appointments and immediately report any troubling changes to your doctor. Older antidepressants — tricyclic antidepressants and monoamine inhibitors — are still in use and can be very effective for those who do not respond to the newer medications. In all, there are dozens of antidepressants available. Any may be worth trying depending on the situation. It usually takes two to six weeks of antidepressant use to see improvement. The dose usually must be adjusted to find the right dose for you. It can take up to a few months for the full positive effect to be seen. Also, the first medication may not work for you. You may need to try several different antidepressants before finding one that provides relief. Sometimes, two different antidepressant medications are prescribed together, or your doctor may add a drug from a different class to your treatment, for example, a mood stabilizer or antianxiety medication. Antipsychotic medication in low doses is occasionally very useful for symptoms that have otherwise been resistant to treatment. It can sometimes take persistence to find the combination that works best.