Background There is growing interest in Internet-delivered cognitive behavioural therapy (ICBT) as an alternative to face-to-face therapy for anxiety and depression because it reduces barriers to accessing traditional treatment (e.g., travel distance, cost, stigma). Extensive research has demonstrated that ICBT is an effective treatment for anxiety and depression and that it produces effect sizes comparable to medication and face-to-face therapy. In routine practice, however, ICBT patients commonly receive simultaneous pharmacological treatment, and few studies have examined how medication affects patient outcomes. Objective The objective of this study was to explore whether use of psychotropic medications predicts outcomes or adherence among patients receiving ICBT for depression and anxiety in a large community sample. Methods This study used data from 1201 patients who received an 8-week course of ICBT for anxiety and depression that included weekly therapist support as part of routine care. Patients reported medication usage and completed measures of depression and anxiety before treatment, after treatment, and at three-month follow-up. Results 60% of patients at pre-treatment reported regularly taking psychotropic medication. Common classes of medication reported included: (i) selective serotonin reuptake inhibitors (34%); (ii) anxiolytics (15%); (iii) serotonin and norepinephrine reuptake inhibitors (14%); (iv) antipsychotics (8%); and (v) norepinephrine-dopamine reuptake inhibitors (7%). At post-treatment and three-month follow-up, overall medication usage reduced slightly to 55%, with the greatest reduction seen in anxiolytics. Logistic regression revealed that none of the classes of medication commonly reported at pre-treatment were associated with study completion rates. A recursive partitioning algorithm found that usage of tetracyclic medication was related to smaller pre-to-post reductions in anxiety symptoms and did not identify any medication types that were related to differences in depressive symptom change. Patients on medication tended to report higher levels of anxiety symptoms at intake and experienced somewhat more modest symptom reductions than patients not taking medications; nevertheless, they still experienced large reductions in depression and anxiety over the course of treatment. Conclusions These results show that medication usage is very common in a diverse community sample of patients seeking ICBT for anxiety and depression. Patients reporting medication usage at intake are likely to benefit from treatment approximately as much as patients not taking medication. These results support the continued referral of patients receiving psychotropic medication to ICBT programs for anxiety and depression. Program designers might also consider providing information about the common medications (SSRIs, SNRIs, anxiolytics) used by this population alongside CBT materials.

中文翻译：

---

同时使用药物是否会影响患者对通过互联网提供的抑郁和焦虑认知行为疗法的反应？

背景 人们越来越关注互联网提供的认知行为疗法 (ICBT) 作为面对面治疗焦虑和抑郁的替代方法，因为它减少了获得传统治疗的障碍（例如，旅行距离、成本、耻辱感）。广泛的研究表明，ICBT 是治疗焦虑和抑郁的有效方法，它产生的效果可与药物治疗和面对面治疗相媲美。然而，在常规实践中，ICBT 患者通常同时接受药物治疗，很少有研究检查药物如何影响患者的预后。目的 本研究的目的是探讨在大型社区样本中，精神药物的使用是否可以预测接受 ICBT 治疗抑郁症和焦虑症的患者的结局或依从性。方法 本研究使用了 1201 名患者的数据，这些患者接受了为期 8 周的 ICBT 治疗焦虑和抑郁治疗，其中包括每周治疗师支持作为常规护理的一部分。患者在治疗前、治疗后和三个月的随访中报告了药物使用情况并完成了抑郁和焦虑的测量。结果 治疗前 60% 的患者报告定期服用精神药物。报告的常见药物类别包括：（i）选择性血清素再摄取抑制剂（34%）；(ii) 抗焦虑药 (15%)；(iii) 血清素和去甲肾上腺素再摄取抑制剂（14%）；(iv) 抗精神病药 (8%)；(v) 去甲肾上腺素-多巴胺再摄取抑制剂 (7%)。在治疗后和三个月的随访中，总体药物使用量略有下降至 55%，其中抗焦虑药的降幅最大。逻辑回归显示，治疗前通常报告的药物类别均与研究完成率无关。递归划分算法发现，四环类药物的使用与焦虑症状的前后减少有关，并且没有发现任何与抑郁症状变化差异相关的药物类型。与不服药的患者相比，服用药物的患者倾向于报告更高水平的焦虑症状，并且症状减轻程度略低；尽管如此，在治疗过程中，他们的抑郁和焦虑仍然大大减少。结论 这些结果表明，在寻求 ICBT 治疗焦虑和抑郁的患者的多元化社区样本中，药物使用非常普遍。报告服用药物使用情况的患者可能从治疗中受益的程度与未服用药物的患者大致相同。这些结果支持继续将接受精神药物治疗的患者转诊至 ICBT 项目以治疗焦虑和抑郁。项目设计者还可以考虑提供有关该人群使用的常见药物（SSRIs、SNRIs、抗焦虑药）的信息以及 CBT 材料。