METAANALYSIS ON THE TREATMENT OF PANIC DISORDER WITH AGORAPHOBIA - REVIEW AND REEXAMINATION

From three meta-analyses on treatment outcome in panic disorder with a goraphobia, method, results and conclusions were reviewed. The meta-an alyses differed in methods used and conclusions derived. The conclusio ns conflicted on the relative efficacy of treatment with antidepressan ts, high-potency benzodiazepines, psychological panic management, expo sure in vivo and combination treatments. These conflicting findings ca n be caused by confounding variables, present in 'between-study' compa risons. In 'within-study' comparison, so-called 'same experiment studi es', these confounding variables are controlled for. Therefore, the li terature was reviewed for same experiment studies. The differential ef ficacy of treatments compared within 25 identified same experiment stu dies was evaluated by calculating the effect size d between the treatm ents. Antidepressants and high-potency benzodiazepines were equally ef fective. The comparison between these drugs and psychological panic ma nagement remained inconclusive. Exposure in vivo was superior to psych opharmacological and psychological panic management. The efficacy of e xposure in vivo was not enlarged by the addition of psychological pani c management. There was some evidence that the addition of psychopharm acological drugs to exposure in vivo enlarged the efficacy of the latt er. This observation must be investigated more systematically.