Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-17T19:33:42.656Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment-Resistant Panic Disorder

Published online by Cambridge University Press:  07 November 2014

Borwin Bandelow  and
Eckart Rüther
Get access Rights & Permissions [Opens in a new window]

Abstract

A substantial number of patients with panic disorder and agoraphobia may remain symptomatic after standard treatment (including selective serotonin reuptake inhibitors, tricyclic antidepressants, benzodiazepines, or irreversible monamine oxidase inhibitors). In this review, recommendations for the treatment of patients with panic disorder and agoraphobia who do not respond to these drugs are provided. Nonresponse to drug treatment could be defined as a failure to achieve a 50% reduction on a standard rating scale after a minimum of 6 weeks of treatment in adequate dose. When initial treatments have failed, the medication should be changed to other standard treatments. In further attempts at treatment, drugs should be used that have shown promising results in preliminary studies, such as venlafaxine. Combination treatments may be used, such as the combination of an selective serotonin reuptake inhibitor and a benzodiazepine. Psychological treatments such as cognitive-behavioral therapy have to be considered in all patients, regardless whether they are nonresponders or not. According to existing studies, a combination of pharmacologic treatment with cognitive-behavioral therapy can be recommended.

Type
Review Articles
Information
CNS Spectrums , Volume 9 , Issue 10 , October 2004 , pp. 725 - 739
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Bandelow, B. Epidemiology of depression and anxiety. In: Kasper, S, ed. Handbook on Depression and Anxiety. New York, NY: M. Dekker; 2003:49–68Google Scholar
2.Bandelow, B, Behnke, K, Lenoir, S, et al.Sertraline vs. paroxetine in the treatment of panic disorder: results of an acute, double-blind non-inferiority comparison. J Clin Psychiatry. 2004;65:405–413.CrossRefGoogle Scholar
3.Black, DW, Wesner, R, Bowers, W, Gabel, J. A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disorder. Arch Gen Psychiatry. 1993;50:44–50.CrossRefGoogle ScholarPubMed
4.Slaap, BR, den Boer, JA. The prediction of nonresponse to pharmacotherapy in panic disorder: a review. Depress Anxiety. 2001;14:112–122.CrossRefGoogle ScholarPubMed
5.Shinoda, N, Kodama, K, Sakamoto, T, et al.Predictors of 1-year outcome for patients with panic disorder. Compr Psychiatry. 1999;40:39–43.CrossRefGoogle ScholarPubMed
6.Pollack, MH, Rapaport, MH, Clary, CM, Mardekian, J, Wolkow, R. Sertraline treatment of panic disorder: response in patients at risk for poor outcome. J Clin Psychiatry. 2000;61:922–927.CrossRefGoogle ScholarPubMed
7.Lotufo-Neto, F, Bernik, M, Ramos, RT, et al.A dose-finding and discontinuation study of clomipramine in panic disorder. J Psychopharmacol. 2001;15:13–17.CrossRefGoogle ScholarPubMed
8.Roy-Byrne, PP, Russo, J, Cowley, DS, Katon, WJ. Unemployment and emergency room visits predict poor treatment outcome in primary care panic disorder. J Clin Psychiatry. 2003;64:383–389.CrossRefGoogle ScholarPubMed
9.Baillie, AJ, Rapee, RM. Predicting who benefits from psychoeducation and self help for panic attacks. Behav Res Ther. 2004;42:513–527.CrossRefGoogle ScholarPubMed
10.Scheibe, G, Albus, M. Predictors and outcome in panic disorder: a 2-year pro-spective follow-up study. Psychopathology. 1997;30:177–184.CrossRefGoogle Scholar
11.Berger, P, Sachs, G, Amering, M, Holzinger, A, Bankier, B, Katschnig, H. Person-ality disorder and social anxiety predict delayed response in drug and be-havioral treatment of panic disorder. J Affect Disord. 2004;80:75–78.CrossRefGoogle Scholar
12.Heldt, E, Manfro, GG, Kipper, L, et al.Treating medication-resistant panic disorder: predictors and out-come of cognitive-behavior therapy in a Brazilian public hospital. Psychother Psychosom. 2003;72:43–48.CrossRefGoogle Scholar
13.Pollack, MH, Rapaport, MH, Fayyad, R, Otto, MW, Nierenberg, AA, Clary, CM. Early improvement predicts endpoint remission status in sertraline and placebo treatments of panic disorder. J Psychiatr Res. 2002;36;229–236.CrossRefGoogle ScholarPubMed
14.Schmidt, NB, Woolaway-Bickel, K. The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity. J Consult Clin Psychol. 2000;68:13–18.CrossRefGoogle ScholarPubMed
15. European Medices Agency web site. Committee for Proprietary Medicinal Products. Note for guidance on the clinical investigation of medicinal products indicated for the treatment of panic disorder. http://www.emea.eu.int/pdfs/human/ewp/428002en.pdf2003.Google Scholar
16.Bandelow, B, Zohar, J, Hollander, E, Kasper, S, Möller, HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacol-ogical treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002;3:171–199.CrossRefGoogle ScholarPubMed
17.Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. 1998;155:1–34.Google Scholar
18.Uhlenhuth, EH, Balter, MB, Ban, TA, Yang, K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997. Depress Anxiety. 1999;9:107–16.3.0.CO;2-T>CrossRefGoogle Scholar
19.Wade, AG, Lepola, U, Koponen, HJ, Pedersen, V, Pedersen, T. The effect of cita-lopram in panic disorder. Br J Psychiatry. 1997;170:549–553.CrossRefGoogle ScholarPubMed
20.Amore, M, Magnani, K, Cerisoli, M, Ferrari, G. Short-term and long-term evaluation of selective serotonin reuptake inhibitors in the treatment of panic disorder: fluoxetine vs citalopram. Hum Psychopharmacol. 1999;14:435–440.3.0.CO;2-B>CrossRefGoogle Scholar
21.Stahl, SM, Gergel, I, Li, D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2003;64:1322–1327.CrossRefGoogle ScholarPubMed
22.den Boer, JA, Westenberg, HG. Serotonin function in panic disorder: a double blind placebo controlled study with fluvoxamine and ritanserin. Psychopharmacology (Berl). 1990;102:85–94.CrossRefGoogle ScholarPubMed
23.Hoehn-Saric, R, McLeod, DR, Hipsley, PA. Effect of fluvoxamine on panic dis-order. J Clin Psychopharmacol. 1993;13:321–326.CrossRefGoogle Scholar
24.Bakish, D, Hooper, CL, Filteau, MJ, et al.A double-blind placebo-controlled trial comparing fluvoxamine and imipramine in the treatment of panic disorder with or without agoraphobia. Psychopharmacol Bull. 1996;32:135–141.Google ScholarPubMed
25.Michelson, D, Allgulander, C, Dantendorfer, K, et al.Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder: randomised, placebo-controlled trial. Br J Psychiatry. 2001;179:514–518.CrossRefGoogle ScholarPubMed
26.Michelson, D, Lydiard, RB, Pollack, MH, et al.Outcome assessment and clinical improve-ment in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. Am J Psychiatry. 1998;155:1570–1577.CrossRefGoogle Scholar
27.Bystritsky, A, Rosen, RM, Murphy, KJ, Bohn, P, Keys, SA, Vapnik, T. Double-blind pilot trial of desipramine versus fluoxetine in panic patients. Anxiety. 1994;1:287–290.CrossRefGoogle ScholarPubMed
28.Amore, M, Magnani, K, Cerisoli, M, Casagrande, C, Ferrari, G. Panic disorder. A long-term treatment study: fluoxetine vs imipramine. Hum Psychopharmacol. 1999;14;429–434.3.0.CO;2-3>CrossRefGoogle Scholar
29.Oehrberg, S, Christiansen, PE, Behnke, K, et al.Paroxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study. Br J Psychiatry. 1995;167:374–379.CrossRefGoogle ScholarPubMed
30.Ballenger, JC, Wheadon, DE, Steiner, M, Bushnell, W, Gergel, IP. Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder. Am J Psychiatry. 1998;155;36–42.CrossRefGoogle ScholarPubMed
31.Pollack, MH, Doyle, AC. Treatment of panic disorder: focus on paroxetine. Psychopharmacol Bull. 2003;37(suppl 1):53–63.Google ScholarPubMed
32.Bakker, A, van Dyck, R, Spinhoven, P, van Balkom, A. Paroxetine, clomi-pramine, and cognitive therapy in the treatment of panic disorder. J Clin Psychiatry. 1999;60:831–838.CrossRefGoogle ScholarPubMed
33.Lecrubier, Y, Bakker, A, Dunbar, G, Judge, R. A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Acta Psychiatr Scand. 1997;95:145–152.CrossRefGoogle ScholarPubMed
34.Londborg, PD, Wolkow, R, Smith, WT, et al.Sertraline in the treatment of panic disorder: a multi-site, double-blind, placebo-controlled, fixed-dose investigation. Br J Psychiatry. 1998;173:54–60.CrossRefGoogle ScholarPubMed
35.Pollack, MH, Otto, MW, Worthington, JJ, Manfro, GG, Wolkow, R. Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Arch Gen Psychiatry. 1998;55:1010–1016.CrossRefGoogle ScholarPubMed
36.Pohl, RB, Wolkow, RM, Clary, CM. Sertraline in the treatment of panic disor-der: a double-blind multicenter trial. Am J Psychiatry. 1998;155:1189–1195.CrossRefGoogle Scholar
37.Price, JS, Waller, PC, Wood, SM, MacKay, AV. A comparison of the post-marketing safety of four selective serotonin reuptake inhibitors including the investigation of symptoms occurring on withdrawal. Br J Clin Pharmacol. 1996;42:757–763.CrossRefGoogle ScholarPubMed
38.Stahl, MM, Lindquist, M, Pettersson, M, et al.Withdrawal reactions with selective serotonin reuptake inhibitors as reported to the WHO system. Eur J Clin Pharmacol. 1997;53:163–169.CrossRefGoogle Scholar
39.Klein, D. Delineation of two drug-responsive anxiety syndromes. Psychophar-macology. 1964;5:397–408.CrossRefGoogle ScholarPubMed
40.Zitrin, CM, Klein, DF, Woerner, MG. Treatment of agoraphobia with group exposure in vivo and imipramine. Arch Gen Psychiatry. 1980;37:63–72.CrossRefGoogle ScholarPubMed
41.Zitrin, CM, Klein, DF, Woerner, MG, Ross, DC. Treatment of phobias. I. Comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry. 1983;40:125–138.CrossRefGoogle ScholarPubMed
42.Uhlenhuth, EH, Matuzas, W, Glass, RM, Easton, C. Response of panic disorder to fixed doses of alprazolam or imipramine. J Affect Disord. 1989;17:261–270.CrossRefGoogle ScholarPubMed
43.Sheehan, DV, Raj, AB, Sheehan, KH, Soto, S. Is buspirone effective for panic disorder? J Clin Psychopharmacol. 1990;10:3–11.CrossRefGoogle ScholarPubMed
44.Cross-national Collaborative Panic Study. Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine, and placebo. Br J Psychiatry. 1992;160:191–202.CrossRefGoogle Scholar
45.Johnston, D, Troyer, I, Whitsett, S. Clomipramine treatment of agoraphobic women. An eight-week controlled trial. Arch Gen Psychiatry. 1988;45:453–459CrossRefGoogle ScholarPubMed
46.Bandelow, B, Broocks, A, Pekrun, G, et al.The use of the Panic and Agoraphobia Scale (PSA) in a controlled clinical trial. Pharmacopsychiatry. 2000;33:174–181.CrossRefGoogle Scholar
47.Cassano, GB, Petracca, A, Perugi, G, et al.Clomipramine for panic disorder: I. The first 10 weeks of a long-term comparison with imipramine. J Affect Disord. 1988;14:123–127.CrossRefGoogle ScholarPubMed
48.Modigh, K, Westberg, P, Eriksson, E. Superiority of clomipramine over imi-pramine in the treatment of panic disorder: a placebo-controlled trial. J Clin Psychopharmacol. 1992;12:251–261.Google ScholarPubMed
49.Lecrubier, Y, Judge, R. Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Acta Psychiatr Scand. 1997;95:153–160.CrossRefGoogle ScholarPubMed
50.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
51.International Classification of Diseases. 10th ed. Geneva, Switzerland: World Health Organization; 1991.Google Scholar
52Ballenger, JC, Burrows, GD, DuPont, RL Jr, et al.Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry. 1988;45:413–422.CrossRefGoogle ScholarPubMed
53.Lydiard, RB, Lesser, IM, Ballenger, JC, Rubin, RT, Laraia, M, DuPont, R. A fixed-dose study of alprazolam 2 mg, alprazolam 6 mg, and placebo in panic disorder. J Clin Psychopharmacol. 1992;12:96–103.CrossRefGoogle ScholarPubMed
54.Noyes, R Jr, Burrows, GD, Reich, JH, et al.Diazepam versus alprazolam for the treatment of panic disorder. J Clin Psychiatry. 1996;57:349–355.Google ScholarPubMed
55.Andersch, S, Rosenberg, NK, Kullingsjo, H, et al.Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicenter study. Acta Psychiatr Scand Suppl 1991;365:18–27.CrossRefGoogle ScholarPubMed
56.Dyukova, GM, Shepeleva, IP, Vorob'eva, OV. Treatment of negative crises (panic attacks). Neurosci Behav Physiol. 1992;22:343–345.CrossRefGoogle ScholarPubMed
57.Beauclair, L, Fontaine, R, Annable, L, Holobow, N, Chouinard, G. Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol. 1994;14:111–8.CrossRefGoogle ScholarPubMed
58.Moroz, G, Rosenbaum, JF. Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder: a placebo-controlled, multicenter study using optimized dosages. J Clin Psychiatry. 1999;60:604–612.CrossRefGoogle ScholarPubMed
59.Rosenbaum, JF, Moroz, G, Bowden, CL. Clonazepam in the treatment of panic disorder with or without agoraphobia: a dose-response study of efficacy, safety, and discontinuance. J Clin Psychopharmacol. 1997;17:390–400.CrossRefGoogle ScholarPubMed
60.Tesar, GE, Rosenbaum, JF, Pollack, MH, et al.Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry. 1991;52:69–76.Google ScholarPubMed
61.Charney, DS, Woods, SW. Benzodiazepine treatment of panic disorder: a com-parison of alprazolam and lorazepam. J Clin Psychiatry. 1989;50;418–423.Google Scholar
62.Schweizer, E, Pohl, R, Balon, R, Fox, I, Rickels, K, Yeragani, VK. Lorazepam vs. alprazolam in the treatment of panic disorder. Pharmacopsychiatry. 1990;23:90–93.CrossRefGoogle ScholarPubMed
63.Dunner, DL, Ishiki, D, Avery, DH, Wilson, LG, Hyde, TS. Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study. J Clin Psychiatry 1986;47:458–60.Google ScholarPubMed
64.Schweizer, E, Rickels, K, Case, WG, Greenblatt, DJ. Long-term therapeutic use of benzodiazepines. II. Effects of gradual taper. Arch Gen Psychiatry 1990;47:908–915.CrossRefGoogle ScholarPubMed
65.Rickels, K, Schweizer, E, Case, WG, Greenblatt, DJ. Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation Arch Gen Psychiatry 1990;47:899–907.CrossRefGoogle ScholarPubMed
66.Smith, DE, Landry, MJ. Benzodiazepine dependency discontinuation: focus on the chemical dependency detoxification setting and benzo-diazepine-polydrug abuse. J Psychiatr Res. 1990;24(suppl 2):145–156.CrossRefGoogle ScholarPubMed
67.Bradwejn, J. Benzodiazepines for the treatment of panic disorder and general-ized anxiety disorder: clinical issues and future directions. Can J Psychiatry. 1993;38(suppl 4):S109–S113.Google Scholar
68.Shader, RI, Greenblatt, DJ. Use of benzodiazepines in anxiety disorders. New Engl J Med. 1993;13:1398–1405.Google Scholar
69.Livingston, MG. Benzodiazepine dependence. Br J Hosp Med. 1994;51:281–286.Google ScholarPubMed
70.Nelson, J, Chouinard, G. Guidelines for the clinical use of benzodiazepines: pharmacokinetics, dependency, rebound and withdrawal. Canadian Society for Clinical Pharmacology. Can J Clin Pharmacol. 1999;6:69–83.Google ScholarPubMed
71.Schweizer, E, Rickels, K, De Martinis, N, Case, G, Garcia-Espana, F. The effect of personality on withdrawal severity and taper outcome in benzodiazepine dependent patients. Psychol Med. 1998;28:713–20.CrossRefGoogle ScholarPubMed
72.Rickels, K. Benzodiazepines in the treatment of anxiety. Am J Psychother. 1982;36:358–370.CrossRefGoogle ScholarPubMed
73.Otto, MW, Pollack, MH, Sachs, GS, Reiter, SR, Meltzer-Brody, S, Rosenbaum, JF. Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J Psychiatry. 1993;150:1485–1490.Google ScholarPubMed
74.Spiegel, DA. Psychological strategies for discontinuing benzodiazepine treat-ment. J Clin Psychopharmacol. 1999;19:17S–22S.CrossRefGoogle Scholar
75.Goddard, AW, Brouette, T, Almai, A, Jetty, P, Woods, SW, Charney, D. Early co-administration of clonazepam with sertraline for panic disorder. Arch Gen Psychiatry. 2001;58:681–686.CrossRefGoogle Scholar
76.Sheehan, DV, Ballenger, J, Jacobsen, G. Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry. 1980;37:51–59.CrossRefGoogle ScholarPubMed
77.Tiller, JW, Bouwer, C, Behnke, K. Moclobemide and fluoxetine for panic disor-der. International Panic Disorder Study Group. Eur Arch Psychiatry Clin Neurosci. 1999;249(suppl 1):S7–S10.CrossRefGoogle Scholar
78.Krüger, MB, Dahl, AA. The efficacy and safety of moclobemide compared to clomipramine in the treatment of panic disorder. Eur Arch Psychiatry Clin Neurosci. 1999;249(suppl 1):S19–S24.CrossRefGoogle ScholarPubMed
79.Loerch, B, Graf-Morgenstern, M, Hautzinger, M, et al.Randomised placebo-controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia. Br J Psychiatry. 1999;174;205–212.CrossRefGoogle ScholarPubMed
80.Uhlenhuth, EH, Warner, TD, Matuzas, W. Interactive model of therapeutic response in panic disorder: moclobemide, a case in point. J Clin Psychophar-macol. 2002;22:275–284.CrossRefGoogle ScholarPubMed
81.Pollack, MH, Allgulander, C, Bandelow, B, et al.WCA recommendations for the long-term treatment of panic disorder. CNS Spectr. 2003;8(suppl):17–30.CrossRefGoogle ScholarPubMed
82.Lepola, UM, Wade, AG, Leinonen, EV, et al.A controlled, prospective, 1-year trial of cita-lopram in the treatment of panic disorder. J Clin Psychiatry. 1998;59:528–534.CrossRefGoogle ScholarPubMed
83.Rapaport, MH, Wolkow, R, Rubin, A, Hackett, E, Pollack, M, Ota, KY. Sertraline treatment of panic disorder: results of a long-term study. Acta Psychiatr Scand. 2001;104:289–298.CrossRefGoogle ScholarPubMed
84.Michelson, D, Pollack, M, Lydiard, RB, Tamura, R, Tepner, R, Tollefson, G. Continuing treatment of panic disorder after acute response: randomised, pla-cebo-controlled trial with fluoxetine. Br J Psychiatry. 1999;174:213–218.CrossRefGoogle ScholarPubMed
85.Mavissakalian, M, Perel, JM. Protective effects of imiptamine maintenance treatment in panic disorder with agoraphobia. Am J Psychiatry. 1992;149:1053–1057.Google ScholarPubMed
86.Mavissakalian, M, Perel, JM. Clinical experiments in maintenance and discon-tinuation of imipramine therapy in panic disorder with agoraphobia. Arch Gen Psychiatry. 1992;49;318–323.CrossRefGoogle Scholar
87.Lepola, U, Arato, M, Zhu, Y, Austin, C. Sertraline versus imipramine treatment of comorbid panic disorder and major depressive disorder. J Clin Psychiatry. 2003;64:654–662.CrossRefGoogle ScholarPubMed
88.Boyer, W. Serotonin uptake inhibitors are superior to imipramine and alprazo-lam in alleviating panic attacks: a meta-analysis. Int Clin Psychopharmacol. 1995;10:45–49.CrossRefGoogle ScholarPubMed
89.Rizley, R, Kahn, RJ, McNair, DM, Frankenthaler, LM. A comparison of alprazo-lam and imipramine in the treatment of agoraphobia and panic disorder. Psychopharmacol Bull. 1986;22:167–172.Google ScholarPubMed
90.Charney, DS, Woods, SW, Goodman, WK, et al.Drug treatment of panic disorder: the com-parative efficacy of imipramine, alprazolam, and trazodone. J Clin Psychiatry. 1986;47:580–586.Google Scholar
91.Lepola, U, Heikkinen, H, Rimon, R, Riekkinen, P. Clinical evaluation of alprazo-lam in patients with panic disorder a double-blind comparison with imipramine. Hum Psychopharmacol. 1990;5:159–163.CrossRefGoogle Scholar
92.Taylor, CB, Hayward, C, King, R, et al.Cardiovascular and symptomatic reduction effects of alprazolam and imipramine in patients with panic disorder: results of a double-blind, placebo-controlled trial. J Clin Psychopharmacol. 1990;10:-118.CrossRefGoogle ScholarPubMed
93.Allgulander, C, Hackett, D, Salinas, E. Venlafaxine extended release (ER) in the treatment of generalised anxiety disorder: twenty-four-week placebo-controlled dose-ranging study. Br J Psychiatry. 2001;179;15–22.CrossRefGoogle Scholar
94.Pollack, MH, Worthington, JJ 3rd, Otto, MW, et al.Venlafaxine for panic disorder: results from a double-blind, placebo-controlled study. Psychopharmacol Bull. 1996;32:667–670.Google ScholarPubMed
95.Lepola, U, Pollack, M, Emilien, G, Tzanis, E, Whitaker, T. Venlafaxine XR and paroxetine in the short-term treatment of panic disorder. Eur Neuropsychopharmacol. 2003;13:S378–S378.CrossRefGoogle Scholar
96.Versiani, M, Cassano, G, Perugi, G, et al.Reboxetine, a selective norepinephrine reuptake inhibitor, is an effective and well-tolerated treatment for panic disorder. J Clin Psychiatry. 2002;63:31–37.CrossRefGoogle ScholarPubMed
97.Sheehan, DV, Raj, AB, Hamett Sheehan, K, Soto, S, Knapp, E. The relative efficacy of high-dose buspirone and alprazolam in the treatment of panic disorder: a double-blind placebo-controlled study. Acta Psychiatr Scand. 1993;88:1–11.CrossRefGoogle ScholarPubMed
98.Schweizer, E, Rickels, K. Buspirone in the treatment of panic disorder: a con-trolled pilot comparison with clorazepate [letter]. J Clin Psychopharmacol. 1988;8:303.CrossRefGoogle Scholar
99.Sheehan, DV, Davidson, J, Manschreck, T, Van Wyck Fleet, J. Lack of efficacy of a new antidepressant (bupropion) in the treatment of panic disorder with phobias. J Clin Psychopharmacol. 1983;3:28–31.CrossRefGoogle ScholarPubMed
100.Simon, NM, Emmanuel, N, Ballenger, J, et al.Bupropion sustained release for panic disorder. Psychopharmacol Bull. 2003;37;66–72.Google ScholarPubMed
101.Munjack, DJ, Crocker, B, Cabe, D, et al.Alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. J Clin Psychopharmacol. 1989;9:22–27.CrossRefGoogle ScholarPubMed
102.Noyes, R Jr, Anderson, DJ, Clancy, J, et al.Diazepam and propranolol in panic disorder and agorapho-bia. Arch Gen Psychiatry. 1984;41;287–292.CrossRefGoogle Scholar
103.Ravaris, CL, Friedman, MJ, Hauri, PJ, McHugo, GJ. A controlled study of al-prazolam and propranolol in panic-disordered and agoraphobic outpatients. J Clin Psychopharmacol. 1991;1:344–350.Google Scholar
104.Lum, M, Fontaine, R, Elie, R, Ontiveros, A. Divalproex sodium's antipanic effect in panic disorder: a placebo-controlled study. Biol Psychiatry. 1990;27:164A–165A.Google Scholar
105.Benjamin, J, Levine, J, Fux, M, Aviv, A, Levy, D, Belmaker, RH. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Am J Psychiatry. 1995;152:1084–1086.Google ScholarPubMed
106.DeMartinis, NA, Schweizer, E, Rickels, K. An open-label trial of nefazodone in high comorbidity panic disorder. J Clin Psychiatry. 1996;57:245–248.Google ScholarPubMed
107.Bystritsky, A, Rosen, R, Suri, R, Vapnik, T. Pilot open-label study of nefa-zodone in panic disorder. Depress Anxiety. 1999;10:137–139.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
108.Papp, LA, Coplan, JD, Martinez, JM, de Jesus, M, Gorman, JM. Efficacy of open-label nefazodone treatment in patients with panic disorder. J Clin Psychopharmacol 2000;20:544–546.CrossRefGoogle ScholarPubMed
109.Carpenter, LL, Leon, Z, Yasmin, S, Price, LH. Clinical experience with mirta-zapine in the treatment of panic disorder. Ann Clin Psychiatry. 1999;11:81–86.CrossRefGoogle ScholarPubMed
110.Primeau, F, Fontaine, R, Beauclair, L. Valproic acid and panic disorder. Can J Psychiatry. 1990;35:248–50.CrossRefGoogle ScholarPubMed
111.Keck, PE Jr, Taylor, VE, Tugrul, KC, McElroy, SL, Bennett, JA. Valproate treatment of panic disorder and lactate-induced panic attacks. Biol Psychiatry. 1993;33:542–546.CrossRefGoogle ScholarPubMed
112.Woodman, CL, Noyes, R Jr.Panic disorder: treatment with valproate. J Clin Psychiatry. 1994;55:134–136.Google ScholarPubMed
113.Rayburn, NR, Otto, MW. Cognitive-behavioral therapy for panic disorder: a review of treatment elements, strategies, and outcomes. CNS Spectr. 2003;8:356–362.CrossRefGoogle ScholarPubMed
114.Marks, IM, Gray, S, Cohen, D, et al.Imipramine and brief therapists-aided exposure in agoraphobics having self-exposure homework. Arch Gen Psychiatry. 1983;40:153–162.CrossRefGoogle ScholarPubMed
115.Marks, IM, Swinson, RP, Basoglu, M, et al.Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776–787.CrossRefGoogle ScholarPubMed
116.Barlow, DH. Cognitive-behavioral therapy for panic disorder: current status. J Clin Psychiatry. 1997;58:32–37.Google ScholarPubMed
117.Beck, AT, Emeery, G, Greenberg, RL. Anxiety Disorders and Phobias: A Cognitive Perspective. New York, NY: Basic Books; 1985.Google Scholar
118.Barlow, D. Effectiveness of behavior treatment for panic disorder with and without agoraphobia. In: Wolfe, B, Maser, J, eds. Treatment of panic disor-der. A consensus development conference. Washington, DC: American Psychiatric Press; 1994:105–120.Google Scholar
119.Clark, D. Cognitive therapy for panic disorder. In: Wolfe, B, Maser, J, eds. Treatment of panic disorder: A Consensus Development Conference. Washington, DC: American Psychiatric Press: 1994:121–132.Google Scholar
120.Barlow, D, Craske, M, Cerny, J, Klosko, J. Behavioral treatment of panic disor-der. Behav Ther. 1989;20:261–282.CrossRefGoogle Scholar
121.Gould, RA, Clum, GA. Self-help plus minimal therapist contact in the treat-ment of panic disorder: a replication and extension. Behav Ther. 1995;24:241–252.CrossRefGoogle Scholar
122.Klosko, JS, Barlow, DH, Tassinari, R, Cerny, JA. A comparison of alprazolam and behavior therapy in treatment of panic disorder. J Consult Clin Psychol. 1990;58:77–84.CrossRefGoogle ScholarPubMed
123.Lidren, DM, Watkins, PL, Gould, RA, Clum, GA, Asterino, M, Tulloch, HL. A comparison of bibliotherapy and group therapy in the treatment of panic disorder. J Consult Clin Psychol. 1994;62:865–869.CrossRefGoogle ScholarPubMed
124.Margraf, J, Barlow, DH, Clark, DM, Telch, MJ. Psychological treatment of panic: work in progress on outcome, active ingredients, and follow-up. Behav Res Ther. 1993;31;1–8.CrossRefGoogle ScholarPubMed
125.Swinson, RP, Fergus, KD, Cox, BJ, Wickwire, K. Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia. Behav Res Ther. 1995;33:465–469.CrossRefGoogle ScholarPubMed
126.Telch, MJ, Lucas, JA, Schmidt, NB, Hanna, HH, LaNae Jaimez, T, Lucas, RA. Group cognitive-behavioral treatment of panic disorder. Behav Res Ther. 1993;31:279–287.CrossRefGoogle ScholarPubMed
127.Telch, MJ, Schmidt, NB, Jaimez, TL, Jacquin, KM, Harrington, PJ. Impact of cognitive-behavioral treatment on quality of life in panic disorder patients. J Consult Clin Psychol. 1995;63:823–830.CrossRefGoogle ScholarPubMed
128.Williams, SL, Falbo, J. Cognitive and performance-based treatments for panic attacks in people with varying degrees of agoraphobic disability. Behav Res Ther. 1996;34:253–264.CrossRefGoogle ScholarPubMed
129.Gould, RA, Clum, GA, Shapiro, D. The use of bibliotherapy in the treatment of panic: a preliminary investigation. Behav Ther. 1993;24;241–252.CrossRefGoogle Scholar
130.Barlow, DH, Gorman, JM, Shear, MK, Woods, SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA. 2000;283;2529–2536.CrossRefGoogle ScholarPubMed
131.Beck, AT, Sokol, L, Clark, DA, Berchick, R, Wright, F. A crossover study of focused cognitive therapy for panic disorder. Am J Psychiatry. 1992;149;778–783.Google ScholarPubMed
132.Marks, I, Gray, S, Cohen, D, Hill, R, Mawson, D, Ramm, E, Stern, R. Imipramine and brief therapist-aided exposure in agoraphobics having self-exposure homework. Arch Gen Psychiatry. 1983;40:153–162.CrossRefGoogle ScholarPubMed
133.Mavissakalian, M, Michelson, L. Agoraphobia: behavioral and pharmacological treatment (n=49). Psychopharmacol Bull. 1983;19;116–118.Google Scholar
134.Mavissakalian, M, Michelson, L. Agoraphobia—relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine. J Clin Psychiatry. 1986;47;117–122.Google ScholarPubMed
135.Michelson, L, Mavissakalian, M, Marchione, K. Cognitive, behavioral, and psychophysiological treatments of agoraphobia—a comparative outcome investigation. Behav Ther. 1988;19:97–120.CrossRefGoogle Scholar
136.Shear, MK, Pilkonis, PA, Cloitre, M, Leon, AC. Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder. Arch Gen Psy-chiatry. 1994;51:395–401.CrossRefGoogle ScholarPubMed
137.Teusch, L, Bohme, H, Finke, J. Conflict-centered individual therapy or inte-gration of psychotherapy methods. Process of change in client-centered psychotherapy with and without behavioral exposure therapy in agoraphobia with panic disorder [German]. Nervenarzt. 2001;72:31–39.CrossRefGoogle ScholarPubMed
138.Hoffart, A, Martinsen, EW. Exposure-based integrated vs. pure psychodynamic treatment of agoraphobic inpatients. Psychotherapy. 1990;27:210–218.CrossRefGoogle Scholar
139.Goldstein, AJ, de Beurs, E, Chambless, DL, Wilson, KA. EMDR for panic dis-order with agoraphobia: comparison with waiting list and credible atten-tion-placebo control conditions. J Consult Clin Psychol. 2000;68:947–956.CrossRefGoogle Scholar
140.Feske, U, Goldstein, AJ. Eye movement desensitization and reprocessing treatment for panic disorder: a controlled outcome and partial dismantling study. J Consult Clin Psychol. 1997;65:1026–1035.CrossRefGoogle ScholarPubMed
141.Broocks, A, Bandelow, B, Pekrun, G, et al.Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. AM J Psychiatry. 1998;155:603–609.CrossRefGoogle ScholarPubMed
142.Telch, M, Agras, W, Taylor, C, Roth, W, Gallen, C. Combined pharmacological and behavioral treatment for agoraphobia. Behav Res Ther. 1985;23:325–335.CrossRefGoogle ScholarPubMed
143.Clark, DM, Salkovskis, PM, Hackmann, A, Middleton, H, Anastasiades, P, Gelder, M. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry. 1994;164:759–769.CrossRefGoogle ScholarPubMed
144.Sharp, DM, Power, KG, Simpson, RJ, Swanson, V, Anstee, JA. Global measures of outcome in a controlled comparison of pharmacological and psychological treatment of panic disorder and agoraphobia in primary care. Br J Gen Pract. 1997;47:150–155.Google Scholar
145.Foa, EB, Franklin, ME, Moser, J. Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? Biol Psychiatry. 2002;52:987–997.CrossRefGoogle ScholarPubMed
146.Cottraux, J, Note, ID, Cungi, C, et al.A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia. Br J Psychiatry. 1995;167:635–641.CrossRefGoogle ScholarPubMed
147.de Beurs, E, van Balkom, AJ, Lange, A, Koele, P, van Dyck, R. Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. Am J Psychiatry. 1995;152:683–691.Google ScholarPubMed
148.Mavissakalian, M, Michelson, L, Dealy, RS. Pharmacological treatment of agoraphobia: imipramine versus imipramine with programmed practice. Br J Psychiatry. 1983;143:348–355.CrossRefGoogle ScholarPubMed
149.Wiborg, IM, Dahl, AA. Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Arch Gen Psychiatry. 1996;53:689–694.CrossRefGoogle ScholarPubMed
150.Nadiga, DN, Hensley, PL, Uhlenhuth, EH. Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorder. Depress Anxiety. 2003;17:58–64.CrossRefGoogle ScholarPubMed
151.Cohen, SD, Monteiro, W, Marks, IM. Two-year follow-up of agoraphobics after exposure and imipramine. Br J Psychiatry. 1984;144:276–81.Google ScholarPubMed
152.Mavissakalian, M, Michelson, L. Two-year follow-up exposure and imipramine treatment of agoraphobia. Am J Psychiatry. 1986;143:1106–1112.Google ScholarPubMed
153.Craske, M, Brown, T, Barlow, D. Behavioral treatment of panic disorder–a two year follow-up. Behav Ther. 1991;22:289–304.CrossRefGoogle Scholar
154.Bandelow, B. Panic and Agoraphobia Scale (PAS). Göttingen, Germany: Hogrefe & Huber Publishers; 1999.Google Scholar
155.Shear, MK, Brown, TA, Barlow, DH, et al.Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154:1571–1575.CrossRefGoogle ScholarPubMed
156.Hirschmann, S, Dannon, PN, Iancu, I, Dolberg, OT, Zohar, J, Grunhaus, L. Pindolol augmentation in patients with treatmentresistant panic disorder: a double-blind, placebo-controlled trial. J Clin Psychopharmacol. 2000;20:556–559.CrossRefGoogle ScholarPubMed
157.Tiffon, L, Coplan, JD, Papp, LA, Gorman, JM. Augmentation strategies with tricyclic or fluoxetine treatment in seven partially responsive panic disorder patients. J Clin Psychiatry. 1994;55:66–69.Google ScholarPubMed
158.Ontiveros, A, Fontaine, R. Sodium valproate and clonazepam for treatment-resistant panic disorder. J Psychiatry Neurosci. 1992;17:78–80.Google ScholarPubMed
159.Cournoyer, J. Rapid response of a disorder to the addition of lithium carbonate: panic resistant to tricyclic antidepressants [French]. Can J Psychiatry. 1986;31:335–338.CrossRefGoogle Scholar
160.Etxebeste, M, Aragüés, E, Malo, P, Pacheco, L. Olanzapine and panic attacks. Am J Psychiatry. 2000;157:659–660.CrossRefGoogle ScholarPubMed
161.Khaldi, S, Kornreich, C, Dan, B, Pelc, I. Usefulness of olanzapine in refractory panic attacks. J Clin Psychopharmacol. 2003;23:100–101.CrossRefGoogle ScholarPubMed
162.Pollack, MH, Simon, NM, Worthington, JJ, et al.Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. J Psychopharmacol. 2003;17:276–282.CrossRefGoogle ScholarPubMed
163.Pollack, MH, Otto, MW, Kaspi, SP, Hammerness, PG, Rosenbaum, JF. Cognitive behavior therapy for treatment-refractory panic disorder. J Clin Psychiatry. 1994;55:200–205.Google ScholarPubMed
164.Hegel, MT, Ravaris, CL, Ahles, TA. Combined cognitive-behavioral and time-limited alprazolam treatment of panic disorder. Behav Ther. 1994;25:183–195.CrossRefGoogle Scholar
165.Kampman, M, Keijsers, GP, Hoogduin, CA, Hendriks, GJ. A randomized, dou-ble-blind, placebo-controlled study of the effects of adjunctive paroxetine in panic disorder patients unsuccessfully treated with cognitive-behavioral therapy alone. J Clin Psychiatry. 2002;63;772–777.CrossRefGoogle Scholar
166.Hoffart, A, Due Madsen, J, Lande, B, Gude, T, Bille, H, Torgersen, S. Clomi-pramine in the treatment of agoraphobic inpatients resistant to behavioral therapy. J Clin Psychiatry. 1993;54;481–487.Google ScholarPubMed