CBT for pharmacotherapy non-remitters—a systematic review of a next-step strategy

Rodrigues, Helga; Figueira, Ivan; Gonçalves, Raquel; Mendlowicz, Mauro V.; Macedo, Tânia; Ventura, Paula

doi:10.1016/j.jad.2010.08.025

Cited by 30 publications

(24 citation statements)

References 34 publications

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“…It should be discussed in order to define antidepressant treatment-resistant SAD in terms of the differentiation between nonresponse, loss of efficacy, and resistance [8]. There is a wide variety of terminology (and its use) for this phenomenon, with the use of such different words as ‘refractory', ‘nonresponsive', ‘incompletely responsive', and ‘nonremitter' [11]. Therefore, we needed to describe the phenomenon of ‘patients who remain symptomatic following antidepressant treatment' in this study because no agreed-upon definition existed.…”

Section: Discussionmentioning

confidence: 99%

“…In the depression literature, a large-scale randomized controlled trial has recently demonstrated the effectiveness of augmenting pharmacotherapy with CBT in treatment-resistant depression [10], marking a milestone in the use of CBT for managing patients who remain symptomatic despite adequate antidepressants; however, a systematic review has revealed no such studies in the literature on SAD [11]. Some studies of individual CBT (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Yoshinaga

Matsuki²,

Niitsu

et al. 2016

Psychother Psychosom

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Background: Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. Methods: This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. Results: Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. Conclusions: Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Yoshinaga

Matsuki²,

Niitsu

et al. 2016

Psychother Psychosom

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“…Treatment of anxiety disorders with antidepressants and/or cognitive behavior therapy, although effective in most patients, often leads only to partial remission and furthermore takes weeks for onset of action (Ravindran and Stein, 2009;Furukawa et al, 2006;Rodrigues et al, 2011). By contrast, benzodiazepines act very fast, but are nevertheless improper as long-term anti-anxiety medications owing to their high abuse potential (Ravindran and Stein, 2009;Tan et al, 2010;Cloos and Ferreira, 2009).…”

Section: Discussionmentioning

confidence: 99%

Intranasally Administered Neuropeptide S (NPS) Exerts Anxiolytic Effects Following Internalization Into NPS Receptor-Expressing Neurons

Ionescu

Dine

Yen

et al. 2012

Neuropsychopharmacol

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Experiments in rodents revealed neuropeptide S (NPS) to constitute a potential novel treatment option for anxiety diseases such as panic and post-traumatic stress disorder. However, both its cerebral target sites and the molecular underpinnings of NPS-mediated effects still remain elusive. By administration of fluorophore-conjugated NPS, we pinpointed NPS target neurons in distinct regions throughout the entire brain. We demonstrated their functional relevance in the hippocampus. In the CA1 region, NPS modulates synaptic transmission and plasticity. NPS is taken up into NPS receptor-expressing neurons by internalization of the receptor-ligand complex as we confirmed by subsequent cell culture studies. Furthermore, we tracked internalization of intranasally applied NPS at the single-neuron level and additionally demonstrate that it is delivered into the mouse brain without losing its anxiolytic properties. Finally, we show that NPS differentially modulates the expression of proteins of the glutamatergic system involved inter alia in synaptic plasticity. These results not only enlighten the path of NPS in the brain, but also establish a non-invasive method for NPS administration in mice, thus strongly encouraging translation into a novel therapeutic approach for pathological anxiety in humans.

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“…Instead, most treatment-refractory studies are pharmacological in nature, both in terms of the original treatment and the alternative response [5]. Even when psychological treatments are examined, they are usually administered either directly following or in combination with pharmacology [6]. The problem of nonresponse is particularly challenging when state-of-the-art psychological interventions fail, such as CBT for patients with panic disorder and agoraphobia.…”

Section: Introductionmentioning

confidence: 99%

Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial

Gloster

Sonntag²,

Hoyer

et al. 2015

Psychother Psychosom

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Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed.

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CBT for pharmacotherapy non-remitters—a systematic review of a next-step strategy

Cited by 30 publications

References 34 publications

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Intranasally Administered Neuropeptide S (NPS) Exerts Anxiolytic Effects Following Internalization Into NPS Receptor-Expressing Neurons

Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial

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