The efficacy of drug treatments for dysthymia: a systematic review and meta-analysis

Background. Dysthymia is a common mental disorder, associated with consider able disability and high co-morbidity. This review assessed the role of pha rmacological treatment. Methods. All randomized-controlled trials that compared active drug versus placebo for dysthymic patients were included. Pooled relative risks (RR) an d 95% confidence intervals (CI) were calculated with the Random Effect Mode l method. Where possible, number needed to treat and number needed to harm were estimated. Results. Fifteen trials were included for the main comparisons. Similar res ults were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoam ine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and r itanserin). The pooled RR treatment response was 0.68 (95 % CI 0.59-0.78) f or TCA, 0.64 (95% CI 0.55-0.74) for SSRIs, 0.59 (95% CI 0.48-0.71) for MAOI s. Other drugs (amisulpride, amineptine and ritanserin) showed similar resu lts. Patients treated on TCA were more likely to report adverse events, com pared with placebo. There were no differences in response to active treatme nt when dysthymia was compared to either dysthymia plus major depression or briefer nonmajor depressive states. Conclusions. Drug treatment appears to be effective in the short-term manag ement of dysthymic disorder. The choice of drug should take into account sp ecific side-effects profile of each drug.