12-Month Follow-Up of Fluoxetine and Cognitive Behavioral Therapy for Binge Eating Disorder
12-Month Follow-Up of Fluoxetine and Cognitive Behavioral Therapy for Binge Eating Disorder
复制标题
DOI：
10.1037/a0030061
复制
发表时间：
2012-12-01
影响因子：
5.9
通讯作者：
Masheb, Robin M.
中科院分区：
文献类型：
--
作者：
Grilo, Carlos M.;Crosby, Ross D.;Masheb, Robin M.
目的：药物治疗暴食症（BED）的长期疗效尚不清楚。本研究通过对氟西汀（CBT +氟西汀）或安慰剂（CBT +安慰剂）治疗BED的12个月随访，考察了氟西汀和认知行为疗法（CBT）的长期效果。方法：在一项随机双盲安慰剂对照急性治疗试验中，对81例超重BED患者进行治疗前、治疗中、治疗后以及治疗完成后6个月和12个月的评估，这些患者被分配到氟西汀单组、CBT +氟西汀组和CBT +安慰剂组。结果变量包括暴饮暴食的缓解（28天内无暴饮暴食发作）和暴饮暴食频率、饮食失调精神病理、抑郁和体重的持续测量。结果：意向治疗缓解率（缺少编码为非缓解的数据）在治疗后、6个月和12个月的随访中显著不同。随访12个月时，氟西汀组缓解率为3.7%，CBT +氟西汀组为26.9%，CBT +安慰剂组为35.7%。治疗后和6个月和12个月随访（控制基线评分）的所有可用连续数据（无输入）的混合效应模型显示，治疗在所有临床结果变量上都存在差异，除了体重。CBT +氟西汀和CBT +安慰剂在大多数临床结果上都明显优于氟西汀。结论：这是BED的随机安慰剂对照试验中首次报告了在完成一个疗程的药物治疗后的随访数据。CBT +安慰剂优于氟西汀，并且在CBT中加入氟西汀与在CBT中加入安慰剂相比并没有增强结果。研究结果证明了CBT的长期有效性，但氟西汀在治疗完成后的12个月内没有效果。
Objective: The longer term efficacy of medication treatments for binge-eating disorder (BED) remains unknown. This study examined the longer term effects of fluoxetine and cognitive behavioral therapy (CBT) either with fluoxetine (CBT + fluoxetine) or with placebo (CBT + placebo) for BED through 12-month follow-up after completing treatments. Method: 81 overweight patients with BED within a randomized double-blind placebo-controlled acute treatment trial allocated to fluoxetine-only, CBT + fluoxetine, and CBT + placebo were assessed before treatment, during treatment, posttreatment, and 6 and 12 months after completing treatments. Outcome variables comprised remission from binge eating (0 binge-eating episodes for 28 days) and continuous measures of binge-eating frequency, eating disorder psychopathology, depression, and weight. Results: Intent-to-treat remission rates (missing data coded as nonremission) differed significantly across treatments at posttreatment and at 6- and 12-month follow-ups. At 12-month follow-up remission rates were 3.7% for fluoxetine-only, 26.9% for CBT + fluoxetine, and 35.7% for CBT + placebo. Mixed-effects models of all available continuous data (without imputation) at posttreatment and at 6- and 12-month follow-ups (controlling for baseline scores) revealed the treatments differed on all clinical outcome variables, except for weight, across time. CBT + fluoxetine and CBT + placebo did not differ and both were significantly superior to fluoxetine-only on the majority of clinical outcomes. Conclusions: This represents the first report from any randomized placebo-controlled trial for BED that has reported follow-up data after completing a course of medication-only treatment. CBT + placebo was superior to fluoxetine-only, and adding fluoxetine to CBT did not enhance findings compared to adding placebo to CBT. The findings document the longer term effectiveness of CBT, but not fluoxetine, through 12 months after treatment completion.