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Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial
D H Barlow1, J M Gorman, M K Shear
1Center for Anxiety and Related Disorders, Boston University, 648 Beacon St, Sixth Floor, Boston, MA 02215, USA.
JAMA
|May 18, 2000
Summary
Both imipramine and cognitive-behavioral therapy (CBT) effectively treat panic disorder compared to placebo. CBT showed durable effects after treatment cessation, suggesting it as a valuable long-term panic disorder management strategy.
Area of Science:
- Psychiatry and Behavioral Sciences
- Clinical Psychology
- Pharmacology
Background:
- Panic disorder (PD) treatment options include pharmacotherapy, psychosocial interventions, or combination therapy.
- Previous evaluations have not definitively established the relative and combined efficacies of these treatment modalities.
- An unbiased assessment is crucial for optimizing PD management strategies.
Purpose of the Study:
- To compare the efficacy of imipramine (a drug) and cognitive-behavioral therapy (CBT) against placebo for panic disorder.
- To determine if one treatment modality is superior to the other.
- To assess whether combined imipramine and CBT therapy offers greater benefits than monotherapy.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 312 patients diagnosed with panic disorder.
- Participants were assigned to receive imipramine, CBT, placebo, CBT plus imipramine, or CBT plus placebo.
- Treatment efficacy was evaluated using the Panic Disorder Severity Scale (PDSS) and Clinical Global Impression Scale (CGI) during acute, maintenance, and follow-up phases.
Main Results:
- Both imipramine and CBT demonstrated significantly greater efficacy than placebo during the acute and maintenance phases, as measured by PDSS and CGI.
- Combined therapy showed a trend towards higher response rates but did not reach statistical significance compared to monotherapies in the acute phase.
- CBT monotherapy exhibited durable effects, with higher response rates during the 6-month follow-up period compared to imipramine alone.
Conclusions:
- Imipramine and CBT are both effective treatments for panic disorder, outperforming placebo.
- Combined therapy provided modest acute benefits but more significant advantages by the end of the maintenance phase.
- Cognitive-behavioral therapy demonstrated sustained effectiveness post-treatment, indicating its long-term utility in managing panic disorder.
