The first line of pharmacotherapy is usually SSRIs due to their purported more tolerable nature and reduced side effects compared to the irreversible monoamine oxidase inhibitors or tricyclic antidepressants. Studies have found that the mean response to antidepressant medications for people with dysthymia is 55%, compared with a 31% response rate to a placebo. The most commonly prescribed antidepressants/SSRIs for dysthymia are escitalopram, citalopram, sertraline, fluoxetine, paroxetine, and fluvoxamine. It often takes an average of 6–8 weeks before the patient begins to feel these medications therapeutic effects. Additionally, STAR*D, a multi-clinic governmental study, found that people with overall depression will generally need to try different brands of medication before finding one that works specifically for them. Research shows that 1 in 4 of those who switch medications get better results regardless of whether the second medication is an SSRI or some other type of antidepressant.In a meta-analytic study from 2005, it was found that SSRIs and TCAs are equally effective in treating dysthymia. They also found that MAOIs have a slight advantage over the use of other medication in treating this disorder. However, the author of this study cautions that MAOIs should not necessarily be the first line of defense in the treatment of dysthymia, as they are often less tolerable than their counterparts, such as SSRIs.Tentative evidence supports the use of amisulpride to treat dysthymia but with increased side effects. Combination treatment
When pharmacotherapy alone is compared with combined treatment with pharmacotherapy plus psychotherapy, there is a strong trend in favour of combined treatment.
United States prevalence rates tend to be somewhat higher than rates in other countries. See also
Anhedonia, a symptom of dysthymia characterized by a decreased or absent ability to enjoy a sense of pleasure
Atypical depression
Blunted affect, a symptom of PTSD, schizophrenia, and ASPD involving decreased or absent emotional response
Dysphoria, a state of feeling unwell or unhappy
Epigenetics of depression
List of medications used to treat major depressive disorder or dysthymia

References
External links
NIMH Depression Page