Help For Irritable Bowel Syndrome (IBS) - Education, Support, & Self Help for Irritable Bowel Syndrome   
Heather & Company View Cart  
Shop for IBSIBS Message BoardsIBS News & ReviewsStore Finder  
Home
IBS Diet & Recipes
IBS Books
IBS Supplements
Yoga for IBS
Hypnosis for IBS
Tummy Teas

All Boards >> Irritable Bowel Syndrome Research Library

HeatherAdministrator

Reged: 12/09/02
Posts: 7417
Loc: Seattle, WA
Cognitive-Behavioral Therapy Vs. Education and Desipramine Vs. Placebo
      09/16/03 03:52 PM

Gastroenterology
July 2003 (Volume 125, Number 1)

Cognitive-Behavioral Therapy Versus Education and Desipramine Versus Placebo for Moderate to Severe Functional Bowel Disorders
Drossman DA, Toner BB, Whitehead WE, et al.
Gastroenterology. 2003;125(1):19-31

Despite the fact that the use of antidepressants and other psychologic strategies may seem intuitive in the setting of moderate to severe functional bowel disease, conclusive data from well-designed trials have been lacking.

In this setting, Drossman and colleagues have conducted the largest randomized trial to evaluate the effectiveness of desipramine, a tricyclic antidepressant, as well as cognitive-behavioral therapy vs their control conditions (placebo and education, respectively) in women with moderate to severe functional bowel disorders. Additionally, these investigators assessed the clinical benefits of the active treatment regimens (desipramine or cognitive-behavioral therapy) in clinically meaningful patient subgroups (ie, with/without history of depression; with/without history of sexual or physical abuse; predominant diarrhea; predominant constipation; moderate vs severe disease).

This randomized, comparator-controlled, multicenter trial involved 431 adult women from the University of North Carolina and the University of Toronto who had moderate to severe symptoms of functional bowel disorders. Subjects received either psychologic (cognitive-behavioral therapy vs education) or antidepressant (desipramine vs placebo) therapy for a period of 12 weeks. Assessment of physiologic, clinical, and psychosocial parameters were conducted before and after end of therapy.

Overall, results suggest that the active psychologic treatment (ie, cognitive-behavioral therapy) was effective for women with functional bowel disorders, including irritable bowel syndrome, whereas the active antidepressant treatment (desipramine) appeared to only be effective in the management of those patients who were adherent (ie, able to stay on their medication). Specifically, by intention-to-treat analysis, cognitive-behavioral therapy was found to be significantly more effective than its placebo condition (education; P = .0001; responder rate, 70% vs 37%, respectively; number needed to treat [NNT], 3.1). By contrast, desipramine did not demonstrate significant efficacy vs placebo in the intention-to-treat analysis (P = .016; responder rate, 60% vs 47%, respectively; NNT, 8.1) but did show a statistically significant benefit in the per-protocol analysis (P = .01; responder rate, 73% vs 49%, respectively; NNT, 5.2). The latter was especially significant when subjects with nondetectable blood levels of desipramine were excluded.

Results of subgroup analyses demonstrated that cognitive-behavioral therapy had benefit over its control condition for all subgroups except those patients with depression. By contrast, subgroup analyses indicated that active antidepressant therapy (desipramine) was more beneficial than placebo for women with moderate vs severe symptoms, a history of abuse, without comorbid depression, and with predominant diarrhea.

The investigators highlighted several limitations associated with this study that should be considered. First, at least moderate side effects were observed in up to 25% of subjects taking desipramine, and thus some participants may have become unblinded. However, it should be noted that similar side effects occurred in up to 15% of participants receiving placebo as well. Additionally, dropouts occurred in 23% of patients allocated to treatment; therefore, data that anticipated treatment responses were "imputed" for several of these individuals. Finally, the fact that all patients fulfilling Rome I or II criteria for functional bowel disorders were included also warrants some consideration. Overall, however, as the study authors emphasize, these findings may be generalized to any patient who fulfills the selection criteria used in this trial, who is treated by their standardized psychologic protocol, or who is compliant in taking desipramine as prescribed.

Thus for women with moderate to severe functional bowel disorders, cognitive-behavioral therapy is effective and desipramine may be effective when taken adequately. It is important to note, however, that certain clinical subgroups are more or less amenable to these relative treatments.


web page

--------------------
Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

Post Extras Print Post   Remind Me!     Notify Moderator

Entire thread
Subject Posted by Posted on
* Hypnosis / Hypnotherapy/Cognitive-Behavioral Therapy HeatherAdministrator 07/14/03 01:52 PM
. * Is tummy trouble keeping your child out of school? It could be Irritable Bowel Syndrome. HeatherAdministrator   09/25/13 12:56 PM
. * Gut-directed hypnotherapy improves remission for Ulcerative Colitis HeatherAdministrator   09/11/13 11:24 AM
. * MP's support for pioneering IBS work by Michael Mahoney HeatherAdministrator   04/18/13 05:42 PM
. * Gut-directed group hypnotherapy improved quality of life in patients with IBS HeatherAdministrator   03/18/13 01:22 PM
. * Hypnosis effective in treating irritable bowels HeatherAdministrator   04/06/12 11:14 AM
. * Effects of Gut-Directed Hypnotherapy on IBS HeatherAdministrator   10/21/11 12:53 PM
. * Hypnosis as IBS health care quietly gains ground HeatherAdministrator   08/22/11 12:59 PM
. * Brain Imaging Illustrates How Meditation Reduces Pain HeatherAdministrator   04/20/11 03:16 PM
. * IBS Patient's Response To Hypnotherapy Can Be Predicted By Color Test HeatherAdministrator   12/09/10 11:10 AM
. * Even The Most Severe Symptoms Rapidly Relieved By Self-Directed Behavioral IBS Treatment HeatherAdministrator   05/13/10 10:47 AM
. * Rapid Response to Cognitive Behavior Therapy Predicts Treatment Outcome in Patients With Irritable Bowel Syndrome HeatherAdministrator   03/11/10 01:55 PM
. * Hypnotherapy for IBS - systematic review of patients shows long-lasting symptom relief HeatherAdministrator   11/24/09 01:09 PM
. * Hypnotherapy relieves more than just IBS symptoms HeatherAdministrator   05/28/09 01:31 PM
. * Using art to help understand the imagery of irritable bowel syndrome and its response to hypnotherapy HeatherAdministrator   03/05/09 02:52 PM
. * Hypnotherapy for IBS HeatherAdministrator   09/26/08 03:06 PM
. * Gastroenterologists are calling for hypnotherapy to be used more widely in treating IBS HeatherAdministrator   07/16/08 01:36 PM
. * Irritable Bowel Syndrome Audio Program Celebrates 10 Years of Success HeatherAdministrator   05/08/08 11:05 AM
. * Mind/Body psychological treatments for irritable bowel syndrome HeatherAdministrator   03/14/08 10:31 AM
. * Hypnosis and behavioral therapy ease irritable bowel syndrome HeatherAdministrator   02/14/08 02:15 PM
. * Gut-Directed Hypnotherapy Effective for Persistent IBS in Children HeatherAdministrator   12/06/07 03:09 PM
. * Short- and long-term benefit of relaxation training for irritable bowel syndrome HeatherAdministrator   10/10/07 12:46 PM
. * Hypnotherapy significantly helps IBS in both men and women - but differently HeatherAdministrator   09/24/07 11:41 AM
. * Cognitive Behavior Therapy Improves Symptoms in Irritable Bowel Syndrome HeatherAdministrator   09/13/07 12:32 PM
. * How Does Cognitive Behavior Therapy for Irritable Bowel Syndrome Work? HeatherAdministrator   08/08/07 01:12 PM
. * Hypnotherapy for IBS HeatherAdministrator   07/17/07 12:23 PM
. * Barriers to Mind-Body Medicine for IBS HeatherAdministrator   06/11/07 04:21 PM
. * Hypnotherapy Called a Cure for Pediatric Irritable Bowel Syndrome HeatherAdministrator   05/23/07 02:56 PM
. * A Comparative Analysis of Clinical Outcomes in the Refractive IBS Patient vs. the Newly Diagnosed HeatherAdministrator   01/21/07 03:35 PM
. * Hypnosis eases irritable bowel syndrome HeatherAdministrator   10/26/06 11:08 AM
. * Biofeedback for Functional Constipation HeatherAdministrator   07/05/06 05:46 PM
. * Mind-Body Treatments Ease Irritable Bowel HeatherAdministrator   05/29/06 01:43 PM
. * Gut-directed hypnotherapy upon health-related quality of life in patients with IBS HeatherAdministrator   05/13/06 12:34 PM
. * Dutch Study on IBS Hypnotherapy for Children HeatherAdministrator   04/02/06 03:46 PM
. * Hypnotherapy an effective treatment for IBS HeatherAdministrator   10/11/05 01:24 PM
. * Biofeedback Helpful in Outlet Dysfunction Constipation HeatherAdministrator   09/01/05 11:26 AM
. * Hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care HeatherAdministrator   11/08/04 04:26 PM
. * Cognitive-behavioral therapy, hypnosis can help soothe irritable bowel syndrome HeatherAdministrator   08/08/04 02:41 PM
. * Hypnosis May Help Non-Responsive Irritable Bowel Syndrome Patients HeatherAdministrator   04/27/04 08:32 PM
. * Hypnosis treatment for severe irritable bowel syndrome HeatherAdministrator   04/27/04 04:59 PM
. * The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders HeatherAdministrator   03/09/04 11:42 AM
. * Neuroscience looks at tthe remarkable effects of meditation on the brain HeatherAdministrator   12/16/03 11:48 AM
. * Long term benefits of hypnotherapy for irritable bowel syndrome. HeatherAdministrator   11/04/03 02:57 PM
. * Hypnosis for IBS HeatherAdministrator   10/20/03 03:27 PM
. * Cognitive-Behavioral Therapy Vs. Education and Desipramine Vs. Placebo HeatherAdministrator   09/16/03 03:52 PM
. * Long-term improvement in functional dyspepsia using hypnotherapy. HeatherAdministrator   07/18/03 12:46 PM
. * Hypnotherapy in irritable bowel syndrome: a large-scale audit HeatherAdministrator   07/15/03 06:27 PM
. * Overview of Published Research To Date on Hypnosis for IBS HeatherAdministrator   07/14/03 03:32 PM

Extra information
0 registered and 0 anonymous users are browsing this forum.

Moderator:  Heather 



Permissions
      You cannot post until you login
      You cannot reply until you login
      HTML is enabled
      UBBCode is enabled

Thread views: 169777

Jump to

| Privacy statement Help for IBS Home

*
UBB.threads™ 6.2



LEGAL DISCLAIMER - This website is not intended to replace the services of a physician, nor does it constitute a doctor-patient relationship. Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. If you have or suspect you have an urgent medical problem, promptly contact your professional healthcare provider.

Any application of the recommendations in this website is at the reader's discretion. Heather Van Vorous, HelpForIBS.com, and Heather & Company for IBS, LLC are not liable for any direct or indirect claim, loss or damage resulting from use of this website and/or any web site(s) linked to/from it. Readers should consult their own physicians concerning the recommendations on these message boards.



Home | Shop for IBS | IBS Message Boards | IBS News & Reviews | IBS Support Groups
IBS Diet & Recipes | IBS Books | IBS Supplements | Yoga for IBS | Hypnosis for IBS
IBS Tummy Teas™ | Irritable Bowel Syndrome Glossary

About Us | IBS Links | Search this Site | Site Map | Shipping & Returns | Privacy & Security
Contact Us | For Doctors & Dietitians | Wholesale | Co-packing Services

© 1999-2009, Heather Van Vorous, HelpForIBS.com, Heather & Company for IBS, LLC.
All information & art is proprietary and may not be duplicated.
All rights reserved.

Legal & Medical Disclaimer

Website Design