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| |  Imipramine and Cognitive-Behavioral Therapy Effective For Panic Disorder CHICAGO, IL -- May 16, 2000 -- Imipramine (a tricyclic antidepressant), cognitive-behavioral therapy (a particular form of psychotherapy) and the combination of the two provide effective treatment for individuals who experience panic disorder, according to an article in the May 17 issue of The Journal of the American Medical Association (JAMA). David H. Barlow, Ph.D., from the Center for Anxiety and Related Disorders, Boston University, and colleagues analyzed data from a multicenter clinical trial of 312 patients diagnosed with panic disorder. The participants were randomly assigned to receive one of five possible treatment courses: imipramine alone, cognitive-behavioral therapy alone, placebo (inactive pills) alone, a combination of imipramine and cognitive-behavioral therapy or cognitive-behavioral therapy with placebo. Participants were treated weekly during the acute phase (first three months of treatment). If they responded to treatment they were seen monthly during the maintenance phase (six months following the acute phase) and then followed up for 6 months after the treatment was discontinued. Using the Panic Disorder Severity Scale (PDSS), the researchers found that both imipramine and cognitive-behavioral therapy were significantly more effective than placebo during the acute phase. Using the Clinical Global Impression (CGI) Scale, they found no significant difference for the treatments compared to placebo during the acute phase. The researchers found that the treatments were both significantly more effective than placebo during the maintenance phase using both scales (PDSS and CGI). More patients dropped out from the group assigned to imipramine alone than the cognitive-behavioral therapy alone, due to adverse effects of the treatment. By the end of the maintenance phase, the combination of imipramine and cognitive-behavioral therapy was superior to either treatment alone. "Our results demonstrate that both imipramine and CBT [cognitive-behavioral therapy] are better than pill placebo for treatment of panic disorder," the authors write. "Imipramine produced a superior quality of response but CBT had more durability and was somewhat better tolerated." According to background information cited in the article, "Panic disorder (PD) is a chronic condition associated with substantial reduction in quality of life, and lifetime prevalence rates are approximately three percent. Role functioning is substantially lower in patients with PD than in patients with diabetes, heart disease or arthritis. Individuals with PD frequently use both emergency department and general medical services, presenting with high rates of unexplained cardiac symptoms, dizziness and bowel distress." Related Link: The Journal of the American Medical Association (JAMA).
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