O objetivo deste estudo foi realizar uma analises econômica dos fármacos antidepressivos aplicáveis no tratamento da distimia, objetivando o uso racional de fármacos. O debate a cerca da competição alegada aos novos fármacos antidepressivos (SSRI e atípicos) e os antigos, menos dispendiosos como TCAs e IMAOs têm implicações para a prática clínica e prescrições. Distimia é uma depressão de natureza crônica mas de menor severidade que a depressão maior. Vários tratamentos com diferentes fármacos têm sido propostos, mas em decorrência de muitas variáveis, não é possível até o presente momento determinar qual o tratamento de escolha . A conclusão foi que a escolha do fármaco deve ser realizada levando-se em conta características individuais, efeitos colaterais e custos. / The objective of this study was to do the economic analyses of antidepressant drugs support for the treatment of dysthymia for the rational use perspective of antidepressants d rugs. The debate over the competing claims newer antidepressants drugs (SSRIs and atypical) and the older, cheaper TCAs and IMAOs has implications for clinical practive and prescribing expenditure. Dysthymia is a depressive disorder of chronic nature but of less severity than major depression. Many d rug treatments have been proposed for the treatment of dysthymia, but with so many potencial comparisons it is not possible at the present time to determine which is the treatment of choice. The conclusion was that the choice of drug must be made maching patient individual characteristics, side-effects and costs.

Este estudo tem por objetivo apresentar uma abordagem etiológica das depressões distímicas, a partir de uma perspectiva que contempla aspectos culturais e metapsicológicos. Frente ao surgimento recente da categoria de Distimia dentro do campo das depressões, o trabalho visa articulá-la às mudanças das condições de subjetivação e aos ideais dominantes da cultura. A moral das sensações e a renúncia às tradicionais referências doadoras de identidade são os dois eixos de transformação da norma cultural aqui enfatizados. Considera-se que a emergência das distimias é favorecida pela articulação entre condições culturais e psicológicas. Esta relação é fundamentada na concepção interacional da constituição subjetiva, baseada na teoria winnicottiana da transicionalidade. / The purpose of this study is to present an ethiological approach of dysthimic depressions, from cultural and metapsychological perspectives. Considering the recent development of the concept of dysthimias in the field of depressions, this work articulates this nosological category in the light of subjective conditions and prevalent cultural ideals. The moral of sensations and the refusal of the traditional references for the constitution of identities are the two axes upon which rest the changes of cultural patterns here emphasized. This work assumes that the emergence of dysthimias is a result of a link between cultural and psychological conditions. This conection is based upon an interactional conception of the subjective constitution as described by Winnicott in his theory of transitional phenomena.

Este estudo tem por objetivo apresentar uma abordagem etiológica das depressões distímicas, a partir de uma perspectiva que contempla aspectos culturais e metapsicológicos. Frente ao surgimento recente da categoria de Distimia dentro do campo das depressões, o trabalho visa articulá-la às mudanças das condições de subjetivação e aos ideais dominantes da cultura. A moral das sensações e a renúncia às tradicionais referências doadoras de identidade são os dois eixos de transformação da norma cultural aqui enfatizados. Considera-se que a emergência das distimias é favorecida pela articulação entre condições culturais e psicológicas. Esta relação é fundamentada na concepção interacional da constituição subjetiva, baseada na teoria winnicottiana da transicionalidade. / The purpose of this study is to present an ethiological approach of dysthimic depressions, from cultural and metapsychological perspectives. Considering the recent development of the concept of dysthimias in the field of depressions, this work articulates this nosological category in the light of subjective conditions and prevalent cultural ideals. The moral of sensations and the refusal of the traditional references for the constitution of identities are the two axes upon which rest the changes of cultural patterns here emphasized. This work assumes that the emergence of dysthimias is a result of a link between cultural and psychological conditions. This conection is based upon an interactional conception of the subjective constitution as described by Winnicott in his theory of transitional phenomena.

O objetivo deste estudo foi realizar uma analises econômica dos fármacos antidepressivos aplicáveis no tratamento da distimia, objetivando o uso racional de fármacos. O debate a cerca da competição alegada aos novos fármacos antidepressivos (SSRI e atípicos) e os antigos, menos dispendiosos como TCAs e IMAOs têm implicações para a prática clínica e prescrições. Distimia é uma depressão de natureza crônica mas de menor severidade que a depressão maior. Vários tratamentos com diferentes fármacos têm sido propostos, mas em decorrência de muitas variáveis, não é possível até o presente momento determinar qual o tratamento de escolha . A conclusão foi que a escolha do fármaco deve ser realizada levando-se em conta características individuais, efeitos colaterais e custos. / The objective of this study was to do the economic analyses of antidepressant drugs support for the treatment of dysthymia for the rational use perspective of antidepressants d rugs. The debate over the competing claims newer antidepressants drugs (SSRIs and atypical) and the older, cheaper TCAs and IMAOs has implications for clinical practive and prescribing expenditure. Dysthymia is a depressive disorder of chronic nature but of less severity than major depression. Many d rug treatments have been proposed for the treatment of dysthymia, but with so many potencial comparisons it is not possible at the present time to determine which is the treatment of choice. The conclusion was that the choice of drug must be made maching patient individual characteristics, side-effects and costs.

D.Litt. et Phil. / Although rapid progress was made in the past decade in the development of short term treatment approaches, relatively little attention was given to the treatment of Dysthymic Depression as a separate disorder. It is therefore important that medical doctors and other health professionals recognize this disorder as a separate disorder from Major Depression and adjust their treatment of this disorder accordingly (Keller, 1994). Although Dysthymia is seen as 'n low grade disorder and not as severe as Major Depression, this disorder also has a hampering effect on the quality of the individual's life. It affects relationships with meaningful others, mental and physical well - being as well as productivity (Keller, 1994; Klerman & Weissman, 1992). With the hampering effect on the individual's life, Dysthymic Depression is also costly and is a substantial burden for the family and the community. According to Rupp (1995) appropriate treatment of individuals with affective disorders will be costeffective. , The prevalence of depression in primary care make this disorder an ideal target for treatment-(Robinson, 1995). In this regard, Robinson (1995) mentions that treatment for these disorders is less intensse and'more short term that specialized treatments. In the past few years there have been a.shift from long term treatment strategies to short term structured handbook orientated treatment programs for disorders like depression. Pantalon, Lubetkin & Fishman (1995) emphasize the need for objective and •knowledgeable guides for the treatment of mental disorders. According to these researchers selfhelp books and guides are effective together with cognitive behavioral therapy. The aim of this study was therefore the development of a short term cost effective handbook orientated treatment program for Dysthymic Depression as well as the effectiveness of the treatment program. Antoher aspect of this treatment program that makes it unique, is the exercise component that is incorporated into the program with the cognitive behavioral approach. A group of 23 Dysthymic patients have been evaluated to establish the degree of depression, personality pathology that is present and the course of the therapeutic intervention. This group , received treatment over a period of 8 weeks. A second group of 22 patients served as a control group. The control group received medication and other therapy. The results of this study indicate that not only 'did the intensity of the depression lift, but certain indexes of psychopathology were also reduced. The indexes of psychopathology that indicated an reduction, were the Avoidant, Self-defeating, Schizotypal, Borderline, Anxiety, Somatoform, Dysthymic as well as Major Depression disorders. The effectiveness of the therapy sessions were also monitored over the , period of 8 weeks and indicated a reduction in certain negative factors, namely: Aggression, Anxiety, Fatigue, Sadness and Skepticism. While these factors indicated a reduction in prevalence the following factors indicated an increase in preValence over the 8 therapy sessions: . Surgency, Elation, Concentration, Social Affect, Egotism and Vigor. Although the test sample were relatively small, it is accepted that it was representative of the universum of the Gauteng region where this sample was taken from. From the results obtained from this study it seems that - this handbook orientated treatment program was not only effective for Dysthymic Depression, but also for certain indexes of psychopathology over the 8-week therapy sessions. From the analysis of the components of the therapy sessions, is clear that the model of the Dysthymic individuals showed an improvement with the handbook orientated treatment program.