How is Dysthymia in Children Treated?

• Children's Health • • Psychiatry / Psychology • Nov 01, 10

Dysthymia is a mood disorder which is less severe than depression. Children diagnosed with dysthymia can be treated using medications, therapy, or both approaches together.

Introduction:

Dysthymia is considered a chronic mood disorder which falls under the category of depression. Like adults, children also suffer from this type of mood disorder. While chronic depression is a very serious condition, dysthymia in children is treatable. Treatments which are considered to be effective include medications and non-medicated therapy such as psychotherapeutic approaches. The main goals for treating this condition include decreasing symptoms of depression, decreasing risk of the development of other mood disorders, and reinforcement of psychosocial functioning.

Medications:

Antidepressant medications have been shown to be effective when treating children with dysthymia. Antidepressants fall into different divisions and after careful evaluation of the patient, the mental health professional may choose one to treat their client. These antidepressant medications may include:

* Selective serotonin reuptake inhibitors (SSRIs): Selective serotonin reuptake inhibitors alleviate indications of depression by blocking serotonin from being reabsorbed by brain cells. High levels of serotonin in the body lead to an improvement in mood. Common SSRIs include Celexa, Lexapro, Prozac, Paxil, and Zoloft.
* Serotonin norepinephrine reuptake inhibitors: Serotonin norepinephrine reuptake inhibitors are similar to SSRIs as they block serotonin from being absorbed by nerve cells in the brain. This antidepressant also blocks the reabsorption of norepinephrine. The increased levels of norepinephrine and serotonin are theorized to create better moods. Common serotonin norepinephrine reuptake inhibitors include Effexor and Cymbalta.
* Monoamine oxidase (MAO) inhibitors include Marplan, Nardil, Parnate, and EMSAM. : These types of antidepressants block common monoamine oxidase (MAO)
* Tricyclic Antidepressants (TCAs): These types of antidepressants block the reabsorption of not only serotonin and norepinephrine but also dopamine.

Selective serotonin reuptake inhibitors (SSRIs) are the first antidepressants prescribed for children diagnosed with dysthymia as they have shown to be not only effective but safer for children. (Nobile, Cataldo, Marino, & Molteni, 2003).

Cognitive Behavioral Therapy:

Cognitive behavioral therapy integrates cognitive therapy and behavioral therapy. This kind of therapeutic approach aims to change the unhealthy thought patterns (cognitive) which can in turn change the unhealthy actions (behavioral).

CBT techniques can include:

* Keeping a journal: The patient will write down his or her thoughts and actions, especially noting when they are feeling depressed. The mental health professional and patient can evaluate the journal entries together to find patterns of why the patient may be feeling sad.

* Modeling: This technique is a form of role playing. The therapist uses role playing to help the patient understand suitable ways of coping and getting through difficult situations.
* Systematic Positive Reinforcement: This reward system is used to reinforce positive behaviors. The positive reinforcement promotes positive behavior and positive thinking.
* Cognitive Rehearsal: The mental health professional asks the patient to remember a challenging situation. The therapist and patient then work together to figure out a solution and better way of coping with the situation if it were to arise again.

Cognitive behavioral therapy is a short term therapy and range in number of sessions when treating dysthymia in children. It all depends on the severity of the dysthymia.
References:

Mayo Clinic. (2008). Selective serotonin reuptake inhibitors (SSRIs). Retrieved from, http://www.mayoclinic.com/health/ssris/MH00066.

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by Jacqueline Chinappi

Medicine Net. (2010). Chronic depression (Dysthymia). Retrieved from, http://www.medicinenet.com/dysthymia/article.htm.

Nobile, M., Cataldo, G., Marino, C., & Molteni, M. (2003). Diagnosis and treatment of dysthymia in children and adolescents. CNS Drugs, 17 (13); 927-946.