Antidepressants and Stress
NewsRx.com
May 16, 2001
Antidepressant medication and stress management therapy, alone and in combination, are effective in reducing chronic tension-type headaches, analgesic medication use, and headache-related disability, according to an article in the May 2, 2001, issue of the Journal of the American Medical Association.
Kenneth A. Holroyd, PhD, of Ohio University, Athens, and Headache Treatment and Research, Westerville, Ohio, and colleagues conducted a randomized, placebo-controlled trial from August 1995 to January 1998 at two outpatient sites in Ohio to evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for chronic tension-type headaches.
Among 203 adults diagnosed with chronic tension-type headaches, 53 were randomly assigned to receive tricyclic antidepressant medication (AM) - amitriptyline hydrochloride, up to 100 milligrams per day, or nortriptyline hydrochloride, up to 75 milligrams per day. Another group of 48 patients received placebo, and 49 received stress management therapy (SMT) - relaxation and cognitive coping (three sessions plus two telephone contacts) plus placebo. The other 53 patients received stress management therapy plus antidepressant medication.
Chronic tension-type headaches are characterized by near-daily headaches for at least six months and are often difficult to manage in primary practice. The one-year prevalence for chronic tension-type headache in the general population is about 3% in women and 1.5% in men, with just less than half of chronic tension-type headache sufferers reporting headache-related impairment in work performance. Tricyclic antidepressants are the primary drug therapy for chronic tension-type headache, with amitriptyline hydrochloride the first-line treatment. Behavioral and pharmacological therapies each have been found to be effective in previous studies, but data are lacking on their separate and combined effects, say Holroyd et al.
Headache index scores were calculated from pain ratings on a scale of 0-10, recorded by participants in a daily diary four times per day. The authors measured the number of days per month with at least moderate pain (pain rating of 5 or greater), analgesic medication use, and headache-related disability (assessed on a standard scale), compared by intervention group.
"Tricyclic antidepressant medication and stress management therapy each produced larger reductions in headache activity, analgesic medication use, and headache-related disability than placebo, but antidepressant medication yielded more rapid improvements in headache activity," the authors report.
"These results provide needed empirical support for the use of tricyclic AM in the management of chronic tension-type headaches," they write.
Among 187 participants who completed at least the first dose adjustment session, 78 (80%) of 97 participants who received AM and 27 (30%) of 90 participants who received placebo reported adverse effects. "Of nine reported adverse effects caused by AM (dry mouth, drowsiness, weight gain, dizziness, sweating, constipation, abdominal pains, nervousness, increased appetite), only dry mouth and drowsiness were reported by more than 10% of participants in either treatment group," report Holroyd et al.
The combination of tricyclic AM plus SMT produced clinically significant reductions in headache activity in a greater proportion of participants than either AM or SMT alone. "Combined therapy was more likely to produce clinically significant (50% or greater) reductions in headache index scores (64% of participants) than antidepressant medication (38% of participants), stress management therapy (35%), or placebo (29%)," the researchers continue.
"Although this finding suggests that combined therapy can improve outcomes relative to monotherapy, it must be qualified by the fact that no significant advantage for combined therapy was observed on other outcome variables," they conclude (JAMA, 2001;285:2208-2215).
This work was funded by a grant from the National Institute of Neurological Disorders and Stroke, part of the U.S. National Institutes of Health. This article was prepared by Pain & Central Nervous System Week editors from staff and other reports.
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-- Courtesy: CBN News Network
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