1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Combined Therapy Effective for Panic Disorder

Panic disorder is common and debilitating, but the best strategies for treatment are unclear. In this randomized, double-blind, placebo-controlled trial, researchers assessed various combinations of imipramine and cognitive-behavioral therapy (CBT) in 312 patients with panic disorder. The patients were assigned to imipramine alone (up to 300 mg/day), CBT alone, placebo alone, imipramine plus CBT, or placebo plus CBT.

In an intent-to-treat analysis, CBT alone and imipramine alone each led to better acute responses than placebo alone (46 percent, 49 percent, and 22 percent, respectively, as measured by the Panic Disorder Severity Scale) and to better maintenance responses at 6 months (38 percent, 40 percent, and 13 percent). As measured on the same scale, imipramine plus CBT led to acute responses in 60 percent of patients and 6-month maintenance responses in 57 percent. Patients who responded to imipramine plus CBT had higher-quality responses than those who responded to CBT alone.

Comment: These data demonstrate that drug therapy combined with CBT appears to be the optimal treatment for panic disorder. These findings are especially compelling because a rigorous, placebo-controlled protocol was used in this trial.

— TH Lee

Published in Journal Watch General Medicine May 30, 2000

Citation(s):

Barlow DH et al. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA 2000 May 17 283 2529-2536.

• Original article (Subscription may be required)
• Medline abstract (Free)