Efficacy of cognitive behavioral self-help therapy for depression disorder to withdraw from long-term benzodiazepine use
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摘要:
目的 探讨认知行为自助疗法(CBT-SH)在抑郁症患者撤减苯二氮䓬类药物(BZD)中的疗效和安全性。 方法 选择2020年4月—2022年3月于湖州市第三人民医院复诊的符合入组标准的抑郁症患者80例，采用随机数表法分为研究组(40例)与对照组(40例)。研究组使用催眠药物剂量递减疗法联合CBT-SH撤减BZD，对照组则单用递减疗法撤减BZD。干预前后评估患者的精神症状、睡眠质量及躯体状况，干预后评估撤药反应。整个干预过程设定为8周。比较2组撤减BZD的成功率及撤药反应的差异。 结果 8周末，研究组的成功停用率高于对照组[52.5%(21/40) vs. 27.5%(11/40)]，差异有统计学意义(P=0.017)；研究组的BZD剂量低于对照组[0.0(0.0, 3.8)mg/d vs. 3.0(0.0, 4.8)mg/d]，差异有统计学意义(P=0.035)。撤药反应主要表现为虚弱感、噪声敏感、头晕，研究组撤药反应发生率低于对照组[50.0%(20/40) vs. 77.5%(31/40)]，差异有统计学意义(P=0.011)；研究组患者苯二氮䓬类药物戒断症状问卷(BWSQ)评分低于对照组(P < 0.05)。2组患者17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、匹茨堡睡眠质量指数量表(PSQI)评分比较差异均无统计学意义(P>0.05)。所有患者躯体指标均无有临床意义的变化。 结论 催眠药物剂量递减疗法联合CBT-SH用于抑郁症患者撤减BZD药物，成功率高，撤药反应发生率低、程度轻。 -
关键词:
- 抑郁症 /
- 苯二氮䓬类 /
- 催眠药物剂量递减疗法 /
- 认知行为疗法
Abstract:Objective To evaluate the efficacy and security of tapering off long-term benzodiazepine (BZD) use for depression disorder, and to evaluate the value of additional cognitive behavioral therapy-self help (CBT-SH). Methods An 8-week randomized controlled trial was conducted in which 80 patients with depression who returned to the Huzhou Third Municipal Hospital from April 2020 to March 2022 and met the enrollment criteria were assigned to tapering off plus CBT-SH (intervention group, n=40), or tapering off alone (control group, n=40). The patients ' mental symptoms, sleep quality, and physical status were assessed before and after intervention, and the withdrawal symptoms were assessed after intervention. The discontinuation rate of BZD and withdrawal symptoms between the two groups were compared after intervention. Results At the end of 8th week, the discontinuation rate of BZD in the intervention group was higher than that in the control group [52.5% (21/40) vs. 27.5% (11/40), P=0.017]; the daily dose of BZD in the intervention group was lower than that in the control group [0.0 (0.0, 3.8) mg/d vs. 3.0 (0.0, 4.8) mg/d, P=0.035]. The withdrawal symptoms mainly showed feeling faint, noise sensitivity and dizziness. The frequency of withdrawal symptoms in the intervention group was lower than that in the control group [50.0% (20/40) vs. 77.5% (31/40), P=0.011], the scores of benzodiazepine withdrawal symptom questionnaire (BWSQ) in the intervention group were significantly lower than that in the control group (P<0.05). There were no significant differences in the scores of the 17-item Hamilton depression scale (HAMD-17), Hamilton anxiety scale (HAMA), and Pittsburgh sleep quality index (PSQI) between the two groups (P>0.05). No clinically significant changes were found in somatic indices in all patients. Conclusion In patients with stabilized depression disorder, the addition of CBT-SH can be used during the time of benzodiazepine withdrawal to enhance the discontinuation rate of benzodiazepine and reduce withdrawal symptoms. -
表 1 2组抑郁症患者基线时临床资料比较
Table 1. Comparison of clinical data at baseline between the two groups of patients with depression
项目 研究组(n=40) 对照组(n=40) 统计量 P值 性别[例(%)] 0.672a 0.412 男性 10(25.0) 7(17.5) 女性 30(75.0) 33(82.5) 年龄(x±s，岁) 50.80±12.73 51.60±10.68 0.305b 0.762 病程[M(P25, P75)，月] 12.0(5.3, 48.0) 18.0(12.0, 28.5) -0.622c 0.534 受教育程度[例(%)] 4.298a 0.117 文盲及小学 11(27.5) 16(40.0) 中学 18(45.0) 20(50.0) 大学及以上 11(27.5) 4(10.0) 婚姻状况[例(%)] 0.347a 0.841 未婚 3(7.5) 3(7.5) 已婚 36(90.0) 35(87.5) 离异或丧偶 1(2.5) 2(5.0) BZD使用时间[M(P25, P75)，月] 9.5(4.0, 20.0) 10.0(8.3, 12.0) -0.063c 0.950 BZD剂量[M(P25, P75)，mg/d] 6.0(4.0, 10.0) 6.0(4.0, 10.0) -0.117c 0.907 HAMD-17评分(x±s，分) 3.83±1.60 4.18±1.81 0.916b 0.362 HAMA评分(x±s，分) 3.73±1.43 4.15±1.56 1.269b 0.208 PSQI评分(x±s，分) 8.85±2.26 9.58±1.88 1.560b 0.123 注：a为χ2值，b为t值，c为Z值。 
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表 2 2组抑郁症患者8周末BZD成功停用率、撤药有效率、BZD剂量比较
Table 2. Comparison of discontinuation and effective withdrawal rates of BZD and BZD dose between the two groups of patients with depression at the end of 8th week
组别 例数 成功停用[例(%)] 撤药有效[例(%)] BZD剂量[M(P25, P75)，mg/d] 研究组 40 21(52.5) 31(77.5) 0.0(0.0, 3.8) 对照组 40 11(27.5) 19(47.5) 3.0(0.0, 4.8) 统计量 8.147a 7.680a -2.104b P值 0.017 0.006 0.035 注：a为χ2值，b为Z值。
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表 3 2组抑郁症患者BWSQ评分比较(x ±s，分)
Table 3. Comparison of BWSQ scores between the two groups of patients with depression (x ±s, points)
组别 例数 第2周末 第4周末 第6周末 第8周末 研究组 40 4.98±1.37 3.58±1.04 2.65±0.83 1.28±0.75 对照组 40 5.68±0.83 4.15±0.66 3.10±0.74 1.68±0.62 F值 2.768 2.960 2.547 2.606 P值 0.007 0.004 0.013 0.011
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表 4 2组抑郁症患者各随访时点HAMD-17、HAMA、PSQI量表评分比较(x±s，分)
Table 4. Comparison of scores of HAMD-17, HAMA, and PSQI scales between the two groups of patients with depression at each follow-up point (x±s, points)
组别 例数 HAMD-17 基线 第2周末 第4周末 第6周末 第8周末 研究组 40 3.83±1.60 4.45±2.35 4.33±2.20 4.38±1.93 3.90±1.85 对照组 40 4.18±1.81 4.78±1.37 4.70±1.59 4.53±1.65 4.33±1.37 F值 0.916 0.755 0.874 0.374 1.168 P值 0.362 0.453 0.385 0.710 0.246 组别 例数 HAMA 基线 第2周末 第4周末 第6周末 第8周末 研究组 40 3.73±1.43 4.10±1.68 3.90±1.30 3.90±1.37 4.00±1.55 对照组 40 4.15±1.56 4.48±1.45 4.40±1.46 4.35±1.35 4.30±1.44 F值 1.269 1.070 1.617 1.478 0.897 P值 0.208 0.288 0.110 0.144 0.372 组别 例数 PSQI 基线 第2周末 第4周末 第6周末 第8周末 研究组 40 8.85±2.26 9.70±2.26 9.43±2.36 9.20±2.57 8.70±3.40 对照组 40 9.58±1.88 10.40±1.68 10.35±2.34 9.70±2.26 9.40±2.38 F值 1.560 1.575 1.760 0.924 1.067 P值 0.123 0.119 0.082 0.358 0.289
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