CLOMIPRAMINE TREATMENT OF PANIC DISORDER - PROS AND CONS

Background: Controlled trials suggest that clomipramine may be a highl y effective antipanic drug. Lowering the starting dose may alleviate t roublesome initial side effects and increase acceptability and complia nce. Method: Fifty-eight patients with DSM-III-R panic disorder with o r without agoraphobia underwent 13 weeks of clomipramine treatment. St arting at 10 mg/day, the dose was gradually increased to a mean dose o f 97 mg/day. Results: While completers showed highly significant impro vement, the benefits were severely limited by a high dropout rate due to adverse reactions occurring mostly during the first 2 weeks of trea tment. Conclusion: Given the alternatives, clomipramine should not be used as a first-line antipanic medication.