RESEARCH ALERT: FIRST RESULTS FROM THE MULTI-CENTER CLINICAL TRIAL ON THE TREATMENT OF PANIC DISORDER - COGNITIVE BEHAVIOR TREATMENT VS. IMIPRAMINE VS. THEIR COMBINATION

At the Anxiety Disorders Association Conference in Boston (28 March 1998), Drs. David Barlow, Katherine Shear, and Scott Woods reported on the first firm results from the largest randomized clinical trial ever conducted with anxiety disorder patients that compared cognitive-behavioral therapy with pharmacotherapy (imipramine). From 1990 through 1996 this group of researchers conducted a randomized double-blind placebo controlled clinical trial evaluating imipramine, cognitive-behavioral therapy (CBT), and their combination across four different sites in 303 carefully screened patients with panic disorder. Combined CBT and placebo was also evaluated. Results revealed little advantage of combining CBT with either drugs or placebo over individual CBT or drug treatment. Individual CBT and imipramine worked approximately equally well at the end of acute treatment and after 6 months of maintenance and both treatments were significantly better than placebo on most measures at most points in time. Six months following treatment discontinuation, however, significantly more patients on imipramine, whether combined with CBT or not, had deteriorated compared to those receiving CBT without active drug, who tended to retain their gains.

Conclusions:

(1) Based on follow-up data documenting better durability of cognitive-behavioral therapy, and the medical principle of utilizing the least intrusive treatment first, the authors recommend a treatment strategy of cognitive-behavioral therapy followed by pharmacological therapy in those patients who require it. In other words, CBT should be the first treatment of choice. Imipramine should only be used when CBT is not available or for a limited number of patients who require additional pharmacotherapy.

We can draw two other conclusions from these findings:

(2) For patients with panic disorder, it does not seem advantageous to combine drug and cognitive-behavioral therapy and

(3) Although each individual treatment initially works approximately equally well, there appears to be a fairly substantial long-term advantage for CBT over imipramine with fewer relapses and better maintenance of CBT treatment gains compared to imipramine.

• Panic, CBT and Imipramine by Paul Salkovskis, 4/14/98
  • Combining CBT with imipramine vs. combining CBT with placebo by Georg Eifert, Ph.D., 4/21/98
    • Looking forward to the published data by Paul Salkovskis, 5/3/98