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| |  DG DISPATCH - ECNP: Triple Therapy Best For Panic Disorder With Agoraphobia By Olwen Glynn Owen Special to DG News LONDON, UK -- September 24, 1999 -- People suffering from panic disorder with agoraphobia (PDA) respond best to a triple therapy combination including cognitive-behavior therapy (CBT), high-potency benzodiazepine and the serotonin reuptake inhibitor fluoxetine (FLX), new research shows.
These findings, from a Yugoslavian-US study, were presented by Dr. Vladan Starcevic, from the Belgrade Institute of Mental Health, Belgrade, Yougoslavia, at the 12th congress of the European College of Neuropsychopharmacology, being held this week in London, UK. In the unrandomised, open label, 10-week study, researchers compared three treatment approaches in 88 patients with a DSM-IV diagnosis of PDA. Patients received, either CBT alone, CBT plus a benzodiazepine or CBT plus benzodiazepine + fluoxetine. Severity of the patients’ condition was scored at baseline and study end using the Panic Disorder Severity Scale (PDSS) and the Panic and Agoraphobia Scale (P&A). Patients with more severe disease at baseline tended to be allocated the triple therapy. Choice of benzodiazepine agents selected were alprazolam 1-4 milligrams/day or clonazepam 0.5-4 milligrams/day with mean doses of 1.86 mg/day or 1.30 mg/day respectively. The dose range for fluoxetine was 20-30mg/day with a mean dose of 20.48 mg/day administered. Dosages were titrated up over the initial two weeks of treatment. CBT was administered via twice-weekly office sessions. The scores for the three groups, evaluating change from baseline to study end over the 10 weeks revealed the triple combination was significantly superior (p<0.01) to either the dual therapy or CBT alone. The authors commented that adding a benzodiazepine to CBT added little or no benefit to outcome whereas the further addition of an SRI produced a substantial reduction in symptom severity. "The addition of fluoxetine to CBT may be beneficial, particularly because of the effect of fluoxetine on agoraphobia," Dr. Starcevic. This study did not investigate the dual therapy combination of CBT + FLX.
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