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Áhrif þunglyndislyfja og róandi lyfja á árangur af ósértækri hugrænni atferlismeðferð hópa í heilsugæslu

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Authors
Erik Brynjar Schweitz Erikssonr
Hafrún Kristjánsdóttir
Jón Friðrik Sigurðsson
Agnes Agnarsdóttir
Engilbert Sigurðsson
Issue Date
2013-11

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Other Titles
The effect of antidepressants and sedatives on the efficacy of transdiagnostic cognitive behavioral therapy in groups in primary care.
Citation
Læknablaðið 2013, 99 (11):505-10
Abstract
Rannsóknir á hugrænni atferlismeðferð (HAM) og þunglyndislyfjum sýna marktækan árangur í meðferð kvíða og þunglyndis. Samþætting þessara meðferða hefur í sumum tilvikum sýnt fram á árangur umfram einþátta meðferð. Hins vegar virðast benzódíazepín-lyf geta haft neikvæð áhrif á árangur af HAM-einstaklingsmeðferð. Í rannsókn á HAM á námskeiðsformi í heilsugæslu var árangur metinn með tilliti til notkunar á þunglyndislyfjum (SSRI/SNRI) annars vegar og benzódíazepínum og z-svefnlyfjum hins vegar. Efniviður og aðferðir: Árangur af meðferðinni var mældur með Becks-þunglyndis- (BDI-II) og kvíðakvörðum (BAI). Notast var við “last observation carried forward”- aðferð (LOCF) þar sem fyrsta og síðasta mæling voru bornar saman óháð því hvenær síðasta mælingin var gerð. Breyting var mæld á meðaltalsskori milli einstaklinga á lyfjum úr tilteknum lyfja-flokkum og borin saman við skor þeirra sem ekki voru á slíkum lyfjum. Niðurstöður: Á því þriggja ára tímabili sem gögnunum var safnað tóku 557 einstaklingar þátt í 5 vikna HAM-námskeiðum í heilsugæslunni. Af þeim skiluðu 355 einstaklingar BDI-II kvarða og 350 einstaklingar BAI-kvarða tvisvar eða oftar. Meðaltalsskor beggja lyfjahópanna lækkaði marktækt á báðum kvörðum. Lækkun á meðaltalsskori þeirra sem tóku SSRI/SNRI-þunglyndislyf og fengu HAM var marktækt meiri en hinna sem einungis sóttu HAM-námskeiðin. Einnig náðist marktækt meiri árangur hjá þeim sem voru á slíkum þunglyndislyfjum en hjá hinum sem einnig voru á benzólyfjum og/eða z-svefnlyfi. Í öðrum tilvikum var ekki marktækur munur á árangri milli hópa. Ályktun: HAM á námskeiðsformi í heilsugæslunni dregur marktækt úr einkennum kvíða og depurðar, óháð notkun þunglyndis- og benzólyfja og/eða z-svefnlyfja. Slík lyfjanotkun er því ekki frábending fyrir HAM-hópmeðferð. Við meðferð þunglyndis gefur samþætt þunglyndislyfjameðferð þó aukinn árangur en sá árangur er minni hjá þeim sem einnig taka benzó- og/eða z-svefnlyf.---------------------------------------------------------------------------------
Cognitive behavioral therapy (CBT) and SSRI/SNRI antidepressants have proven to be effective treatments for anxiety and depression. The gain from combined CBT and antidepressant therapy has in some studies been greater than from monotherapy. Benzodiazepines may interfere with the efficacy of individual CBT-treatment. We examined the effects of SSRI/SNRI antidepressants and the effects of benzodiazepines/z-drugs on the efficacy of group CBT (gCBT) in primary care. Material and methods: Primary outcome measures were the Beck's Depression Inventory II (BDI-II) and the Beck's Anxiety Inventory (BAI) scores before treatment and after the last session. The last observed score was carried forward and compared to the initial score for each individual, irrespective of the timing of the last score (LOCF). Mean change of scores was compared between groups of individuals on or not on SSRI/SNRI antidepressants and/or benzodiazepines/z-drugs. Results: Over three years 557 subjects participated in a 5 week-long gCBT. Of these 355 returned BDI-II and 350 returned BAI at least twice. The mean score on SSRI/SNRI or benzo/z-drugs fell significantly both for those on combined treatment (medication and gCBT) and those who only received gCBT. Combined treatment with SSRI/SNRI and gCBT led to a greater fall in depressive symptoms compared to gCBT monotherapy. The efficacy of such combined treatment was less for those who also were prescribed benzodiazepines and/or z-drugs. Conclusions: Group CBT significantly improved symptoms of anxiety and depression in primary care. The improvement was not reduced by concomitant use of SSRI/SNRI antidepressants nor of benzodiazepines/z-hypnotics. The use of such medication is therefore not contraindicated for gCBT participants, at least not short term. Adding SSRIs or SNRIs to gCBT led to greater efficacy in reducing depressive symptom though the efficacy of such combined treatment was less for those who were also prescribed benzodiazepines and/or z-hypnotics.
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Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn
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Icelandic Journal Articles (Peer Reviewed)

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