Læknablaðið - 15.11.2013, Blaðsíða 22

RANNSÓKN
ENGLISH SUMMARY
The effect of antidepressants and sedatives on the efficacy of transdiagnostic
cognitive behavioral therapy in groups in primary care
Eriksson EBS1'2, Kristjansdottir H2A4, Sigurdsson JF2-4, Agnarsdottir A2, Sigurdsson E24
Background: 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. Benzodia-
zepines 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 monot-
herapy. 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.
Key words: Group-CBT, transdiagnostic CBT, antidepressants, benzodiazepines, anxiety, depression.
Correspondence: Engilbert Sigurdsson, engilbs@landspitali.is
’lnstitute of Psychiatry, King’s College University, 2MentaI Health Services, Landspitali-The Nationai University Hospital of lceland., ’Reykjavík University,4Facuity of Medicine, University
oflceland
510 LÆKNAblaðið 2013/99