Medications, including tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and benzodiazepines, as well as cognitive-behavioral therapy (CBT) have demonstrated efficacy for treatment of panic disorder in multiple double-blind, placebo-controlled studies. Common concerns have also surfaced in some of these studies (Nagy et al., 1989; Noyes et al., 1989; 1991; Pollack et al., 1993; Barlow et al., 2000). Because of the narrower definition of panic disorder that was used prior to 1994 (Shear and Maser, 1994), very few panic studies to date have assessed broader quality of life aspects of treatment response. Many patients have persistent, though frequently less intense, symptoms that may cause persistent morbidity and functional impairment following completion of treatment (Nagy et al., 1989; Noyes et al., 1991; Pollack et al., 1993). For example, in the most recent large-scale, multicenter, highly controlled outcome study of patients with panic disorder, patients treated with imipramine demonstrated only a 45.8 percent full remission rate while those treated with CBT had a remission rate of 48.7 percent (Barlow et al., 2000).
Combination treatments of antipanic medications and psychotherapy have shown mixed results. In the multicenter panic study referred to above, CBT imparted little additional benefit to imipramine treatment of panic disorder (Barlow et al., 2000). Other studies have found benefits from adding CBT to pharmacotherapy, but this has not yet been demonstrated in a randomized trial (Otto et al., 1999). Marks et al. (1993), in a study of benzodiazepines and CBT for treatment of panic, found that patients receiving the combination treatment did less well than those treated with CBT alone.
There is also evidence that CBT can aid in withdrawal from other medications (Otto et al., 1993).
Psychodynamic psychotherapy has undergone very little in the way of systematic study. However, in a randomized, controlled trial, Wiborg and Dahl (1996), employing a manualized form of psychodynamic psychotherapy, demonstrated that 3-month, weekly psychodynamic psychotherapy in addition to clomipramine (CMI) significantly reduced relapse rate at 18-month follow-up (9 percent 18 month relapse rate-combined cell), in comparison with patients treated with CMI alone (91 percent). This study unfortunately did not control for frequency of therapist contact.
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