To compare the frequency of anxiety/depressive symptoms and use of anxiolytic-hypnotics/antidepressants in smokers with and without COPD and to identify characteristics associated with having unmedicated symptoms. Cross-sectional analysis of ambulatory, current/former smokers ≥10 pack years enrolled in the COPDGene study. We measured anxiety/depressive symptoms using the Hospital Anxiety and Depression Scale (subscales ≥8), recorded anxiolytic-hypnotic/antidepressant use, and defined unmedicated symptoms as elevated anxiety/depressive symptoms and not on medications. Regression analysis identified characteristics associated with having unmedicated symptoms. Of 5331 current/former smokers (45% with and 55% without COPD), 1332 (25.0%) had anxiety/depressive symptoms. Anxiety symptoms were similar in frequency in smokers with and without COPD (19.7% overall), while depressive symptoms were most frequent in severe-very severe COPD at 20.7% (13.1% overall). In the entire cohort, 1135 (21.2%) were on medications. Anxiolytic-hypnotic use was highest in severe-very severe COPD (range 7.6%–12.0%), while antidepressant use showed no significant variation in smokers with and without COPD (range 14.7%–17.1%). Overall, 881 (66% of those with symptoms) had unmedicated symptoms, which was associated with African American race (adjusted OR 2.95, 95% CI 2.25–3.87), male gender (adjusted OR 1.93, 95% CI 1.57–2.36), no health insurance (adjusted OR 2.38, 95% CI 1.30–4.35), severe-very severe COPD (adjusted OR 1.48, 95% CI 1.04–2.11), and higher respiratory symptoms/exacerbation history (adjusted OR 2.21, 95% CI 1.62–3.02). Significant unmet mental health care needs exist in current and former smokers with and without COPD. One in five have unmedicated symptoms, identified by key demographic and clinical characteristics. National Institutes of Health and The COPD Foundation.
Many hypnotic users make repeated unsuccessful attempts to discontinue their hypnotics. This study is testing blinded tapering protocols to reduce anxiety and help patients discontinue their hypnotics. This study is enrolling users of benzodiazepine and benzodiazepine receptor agonists. Enrollees complete a two-week baseline including sleep diaries, actigraphy, the Insomnia Severity Index (ISI) and Benzodiazepine Withdrawal Questionnaire (BWQ). They then complete 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they are randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage is either reduced by 25% or 10% every two weeks, or remains unchanged (CTRL). During tapering, all enrollees are seen biweekly by the study physician for support and guidance. At the end of the 20-week period the study blind is eliminated and those who completed one of the two tapering protocols enter a 3-month follow-up period whereas CTRL participants are offered an open label taper before completing follow-up. A total of 60 (M age = 55.8 ± 12.6 yrs.; 37 women) hypnotic users have been enrolled and started treatment. Thirty-eight have completed the CBTI phase, 22 have reached the end of the tapering, and 14 have completed the 3 month follow-up. Baseline ISI scores suggested moderately severe insomnia complaints (ISI=15.9 ± 0.73). These scores declined to the sub-clinical range by the post CBTI (10.92 ± 0.78) and tapering (9.50±.75) phases and into the normative range by follow-up (7.64 ± 1.65). BWQ scores remained fairly stable from baseline (3.00 ± 0.45) to post CBTI (3.51±.68) but declined by the end of tapering (1.67 ± 0.81). Of the 14 who completed one blind tapering protocols, 12 (86%) totally discontinued their medication use by the end of tapering whereas none in the CTRL group had chosen to do so. At follow-up 7 of 9 (78%) who completed blinded tapering remained medication free whereas 2 of 5 (40%) in the CTRL who underwent open-label tapering remained medication free. CBTI combined with blinded hypnotic tapering seems a promising treatment approach to help hypnotic users overcome their medication dependence and improve insomnia symptoms. National Institute of Drug Abuse, R34 DA042329-01.
