Treatments for Dysthymic Disorder
Mercedes Capillo
Hartnell College
November 18, 2013

Author Note
This paper was prepared for Psychology-22 (Abnormal Psychology), Section 3485, taught by Dr.
Yoshiko Matsushita-Arao. Beating the Blues: New Approaches to Overcoming Dysthymia and Chronic Mild Depression by Michael Thase M.D. and Susan Lang, was a very enjoyable and enlightening book to read. Some of the qualities the book included were a clear, direct tone and style which was positive yet assertive at the same time. I also enjoyed the format the book was arranged in because it helped with further organizing a lot of the detailed information it provided. Overall, I would give this book a grade of an A-. The tones in which the authors composed the book were positive and assertive. Thase and Lang assert that people’s lives are not either full of joy or full of sorrow and even people who are subjected to the most awful traumas do not always become depressed, instead a lot of people are just victimized by their self-incriminating thoughts or the absolute blame they place towards the rest of the world for their suffering (59). Even though this is portrayed as the bitter truth in the book, Thase and Lang reassure the reader that there are solutions and resources that can assist someone who tends to follow this downward spiral of thinking. The first positive solution that they uphold is for the sufferer to refuse to do absolutely nothing because it is the main way of living for people who suffer from dysthymia (Thase and Lang, 76). They argue, “…Behave purposefully [even if it is] just one small step at a time,” because taking such small steps, or what I like to call “baby steps”, still have value upon the individual and the world due to their increase of effectiveness (Thase and Lang, 76). After all, doing something constructive even to smallest degree is still better than doing nothing, especially for someone who is suffering from dysthymia because it can help increase their sense of purpose in life. The organization of the book is impeccable considering the type of audience Thase and Land want to target, specifically people who are suffering from dysthymia and chronic mild depression. It is clear that they are fully aware that a person suffering from depression most likely will not have the attention span to read a whole book about their disease in detail. Instead, they divide the book into parts, in addition to even smaller more specific sections. For instance, part one is called “Understanding Dysthymia and Its Milder Forms” (Thase and Lang, vii). Below part one are listed sub-topics like “What Is Dysthymia?,” “The Spectrum of Dysthymia and Depression,” and, “Who Gets Dysthymia and Why: Causes and Risk Factors” (Thase and Lang, vii). This helps with further ease in reading the book, and also saves time in gathering information, as well as catering to those who are experiencing different levels of recovery. After reading the book, I decided to assign it the grade of an A-, due to further information I think they should have included. For instance, when writing a self-help book about a very sensitive and difficult topic, it is crucial that the authors try to win the trust of the reader by having a short description of the authors and their qualifications. This creates an informal way for the reader to become acquainted with the authors, which could help them to confide to the information that is being presented in the book. All I know is that the qualifications of Thase include a medical degree. There is no further information in the book to what specific medical degree he has, as well as any other additional qualifications. Even worse, the reader has no idea of who Lang is, in addition to what qualifications she has to be taking part in a book about a chronic mental illness. This can be considered a huge negative towards someone whose personality embodies skepticism, distrust towards other people, and even depression itself. Another thing I did not like was that they did not include any pictures. Since the book went in depth with many herbal remedies and their effectiveness with depression I think it would have made sense to include pictures of these herbs, or at least the most commonly used ones. Before reading Beating the Blues, I wanted to investigate on what kinds of treatments there are that address dysthymic disorder. I discovered that there are many options that can both help and prevent someone from getting dysthymia. Thase and Lang repeatedly emphasize how an individual thinks is a central component of having great mental health (58). They explain that people who suffer from dysthymia generally have “faulty perceptions,” which results in a destructive way of thinking towards oneself and the world (Thase and Lang, 63). To resolve this, the authors provide a technique. The first step an individual needs to take is to recognize and to admit the negative emotion, as well as take control of their following action (Thase and Lang, 64). Next, the person needs to notice what elicited their negative thought and consult all the information pertaining to the event to make sure that they are not downplaying or blowing out of the proportion on what actually occurred (Thase and Lang, 64). When the individual is able to determine these impulsive thoughts, it is easier for them to recognize their slant way of thinking (Thase and Lang, 64). After, they must challenge their negative thought by finding sensible and accurate information (Thase and Lang, 64). Once this is done, the person can now reframe their judgment so that it is not so permeating, particular, and cynical (Thase and Lang, 64). In addition to reframing the author’s suggest to think to themselves like as though they are talking to the person they love most (Thase and Lang, 64). The author’s also explain that psychotherapy helps with strengthening this technique and can be as effective as taking medication (Thase and Lang 89). Another treatment is the implementation of medication and supplements under the supervision of a physician. Medications mentioned, included selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), thyroid supplements, and estrogen (Thase and Lang, 105-110). Amongst the SSRIs, the drug sertraline, or Zoloft, is considered the most researched drug that can help those diagnosed with dysthymia (Thase and Lang, 106). When an SSRI is not helping the patient a TCA is often implemented. Studies have theorized that the tricyclic imipramine, also known as Tofranil and SK-Pramine, can be more effective than Zoloft, specifically in men suffering from dysthymia (Thase and Lang, 108). The author’s also mentioned that studies have shown that MAOIs can help the sufferer if other commonly used drugs have not worked (Thase and Lang, 108). At the time this book was published only three MAOIs were available in the U.S., they included: phenelzine (Nardil), tryanycypromine (Parnate), and isocarboxazid (Marplan) (Thase and Lang, 108). Making lifestyle changes also plays a significant role in people diagnosed with dysthymia, specifically implementing an exercise regimen and a healthy diet (Thase and Lang, 112). Thase and Lang recommend someone who is suffering from dysthymia should exercise four to six times a week for at least 20 minutes (113). The author’s champion exercise because it is not costly, has always shown effectiveness if other therapies have failed, it is diverse in that any type of exercise produce beneficial effects in mood, and it works as soon as ten days if an individual exercises at least 30 minutes per day (Thase and Lang, 113). Exercise should always be practiced alongside therapy (Thase and Lang, 113). A healthy diet consists of consuming a lot of fruits, vegetables, fiber, whole grains, iron, protein, and essential vitamins and minerals (Thase and Lang, 114). A daily multi-vitamin is also recommended if an individual cannot get all the nutrients their body needs through their daily diet (Thase and Lang, 115). In regards to supplements that help an individual with dysthymia, there is hardly any research (Thase and Lang, 115). Only a small handful of studies have claimed that specific nutrients such as, vitamin B complex, folate, amino acids, vitamin D, omega-3 fatty acids, and NADH (nicotinamide adenine dinucleotide) have shown to impact depression (Thase and Lang, 115-117). However, studies have confirmed that there is a direct link between symptoms of depression reflecting low amounts of iron in individuals (Thase and Lang, 116). After reading the book I was enlightened and empowered about information regarding all-natural products, the effects of exercise, and how focusing on the present can positively impact the mind. The term “all-natural” infers that the chemicals found within them come from substances found in nature, like various herbs, plants, minerals, and nutrients; which are already found and produced by the body (Thase and Lang, 118). However, this should never infer that such products are safer than a FDA approved synthetic drug (Thase and Lang, 119). FDA approved substances undergo rigorous testing and regulations before sold and used to the general public (Thase and Lang, 119). Whereas “all-natural” substances that are not FDA approved, do not have any guarantees, especially towards their claims, when it comes to its ingredients, quality, potency, pre-cautions, and hazards (Thase and Lang, 118). Thase and Lang also mention additional research about exercising. A review paper, published in 1999, analyzed three decades of studies which concluded that exercise is never ineffective towards those have mild to moderate depression and can be just as useful as cognitive-behavioral therapy (Thase and Lang, 113). Thase and Lang also mention that a person suffering from dysthymia should , “Free [themselves] from [their] past” (72). They also add that constantly thinking of the future can also cause feelings of worry and apprehension and the best point in time to focus on is the present since it can provide “a fresh start or another try” (Thase and Lang, 72). This is why they emphasize that having a “peace of mind” is central to a good mentality (Thase and Lang, 72). The authors also perceive perfectionism as a faulty way of thinking since an individual can place such high standards that they have to meet in order to consider themselves as successful (Thase and Lang, 74). Even if these standards are met by the individual they will most likely not feel content with their achievements and if this does not occur the person will consider themselves as a complete failure (Thase and Lang, 74). As a result, a person who is suffering from dysthymia should abandon perfectionism as a philosophy to live by. However, I learned this does not imply that they should be apathetic or lazy, instead it is just inefficient to adopt such a black-and-white way of thinking. Consequentially, not thinking through a black-and-white perspective can help boost someone’s chances for success and daily efficiency in their life. What I found surprising is the popularity of St. John’s wort, despite findings in studies. For instance, St. John’s wort made about $400 million in revenue in 1998, but a study published by the Journal of the American Medical Association found that it is just effective as a placebo (Thase and Lang, 119-120). Also, it is absolutely not recommended to take this herb along with medications, specifically anti-depressants, since it can make enzymes in the liver become more reactive and decreases the effectiveness of medications (Thase and Lang, 121). In addition , a study conducted by Mayo Clinic revealed that sixty percent of people who use herbal supplements do not notify their physicians (Thase and Lang, 122). Some medications that are affected by Saint John’s wort are tetracycline antibiotics, cancer medications, birth control pills, seizure drugs, and protease inhibitors for HIV infection (Thase and Lang, 121). I learned from these findings that even though herbs are seemingly “all-natural” they can still pose danger towards a person’s health, especially if they are prescribed medication. References Comer, R. J. (2013). AbnormalPpsychology (8th ed.). New York, NY: Worth Publishers.
Thase, M., Lang, S. (2004). Beating the Blues: New Approaches to Overcoming Dysthymia and Chronic Mild Depression. New York, New York: Oxford University Press.