How is treatment resistance managed in patients with persistent depressive disorder (dysthymia)?

Updated: Oct 01, 2019
  • Author: Jerry L Halverson, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Treatment resistance is common in depression and dysthymia. Patients should be closely tracked for residual symptoms and, if symptoms have not remitted, a medication change or an augmentation should be considered to target full remission. [15] Data guiding antidepressant augmentation are drawn from studies in treatment-resistant major depression. The strongest data exists for lithium and thyroid hormone augmentation.

While thyroid dysfunction is common among people with depression and must be treated, thyroid hormone supplementation is an effective augmentation strategy even for patients with normal thyroid function. [33, 34] Buspirone, bupropion, stimulants, and mirtazapine are commonly used in clinical practice.

Bright-light therapy may be considered as an adjunct treatment, especially for patients who experience an exacerbation of symptoms during the winter. This therapy has been best studied in patients with seasonal affective disorder, but limited evidence supports its use in other depressive disorders. [35]


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