All Boards >> Irritable Bowel Syndrome Research Library

View all threads Posts     Flat     Threaded

Cognitive-Behavioral Therapy Vs. Education and Desipramine Vs. Placebo
      09/16/03 03:52 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7790
Loc: Seattle, WA

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 is 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!

Print     Remind Me     Notify Moderator    

Entire thread
* Hypnosis / Hypnotherapy/Cognitive-Behavioral Therapy
HeatherAdministrator
07/14/03 01:52 PM
* At-Home Cognitive Therapy Relieves IBS Symptoms
HeatherAdministrator
01/19/18 01:56 PM
* Relaxation intervention improves symptoms, may help treat IBS, IBD
HeatherAdministrator
07/16/15 04:41 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 30 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: 629908

Jump to

| Privacy statement Help for IBS Home

*
UBB.threads™ 6.2


McAfee SECURE sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams

HelpForIBS.com BBB Business Review