disorder. 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. working with a psychotherapist to address the causes and effects of the disorder, in addition to taking antidepressants to help eliminate the symptoms, can be extremely beneficial. this combination is often the preferred method of treatment for those who have dysthymia. looking at various studies involving treatment for dysthymia, 75% of people responded positively to a combination of cognitive behavioral therapy (cbt) and pharmacotherapy, whereas only 48% of people responded positively to just cbt or medication alone. a 2019 cochrane review of 10 studies involving 840 participants could not conclude with certainty that continued pharmacotherapy with antidepressants (those used in the studies) was effective in preventing relapse or recurrence of persistent depressive disorder. the body of evidence was too small for any greater certainty although the study acknowledges that continued psychotherapy may be beneficial when compared to no treatment. treatment resistance because of dysthymia's chronic nature, treatment resistance is somewhat common. in such a case, augmentation is often recommended. such treatment augmentations can include lithium pharmacology, thyroid hormone augmentation, amisulpride, buspirone, bupropion, guanfacine, stimulants, and mirtazapine. additionally, if the person also has seasonal affective disorder, light therapy can be useful in helping augment therapeutic effects. epidemiology globally dysthymia occurs in about 105 million people a year (1.5% of the population). it is 38% more common in women (1.8% of women) than in men (1.3% of men). the lifetime prevalence rate of dysthymia in community settings appears to range from 3 to 6% in the united states. however, in primary care settings the rate is higher ranging from 5 to 15 percent. united states prevalence rates tend to be somewhat higher than rates in other countries.