|
Triple therapy best for panic disorder with agoraphobia.
by Olwen Glynn Owen
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.
back to
research
home
|
|
|
