CLOMIPRAMINE IN THE TREATMENT OF AGORAPHOBIC INPATIENTS RESISTANT TO BEHAVIORAL-THERAPY

Background: Both behavior-modification methods and antidepressants hav e proved to be effective in the treatment of agoraphobia. The authors examined the effects of clomipramine on agoraphobia in patients who fa iled to respond to exposure-based behavioral treatment. Method: Eighte en patients with panic disorder with agoraphobia who had not responded to previous inpatient behavioral treatment were recruited to a 12-wee k, placebo-controlled, double-blind crossover study of clomipramine, a t top doses of 150 mg/day for 3 weeks. The patients were assessed on m easures of phobic avoidance, agoraphobic cognitions, panic, state and trait anxiety, subjective anxiety, and depression. Results: One patien t dropped out of the study after 6 weeks. On most outcome measures, th e 17 study completers had significantly (p <.05) lower symptom scores at posttest in the active drug period than at posttest in the placebo period; however, the clinical gains were modest. Conclusion: The short -term efficacy of clomipramine for agoraphobic patients who failed to respond lastingly to behavioral treatment was demonstrated. It remains to be shown that clomipramine can lead to clinically significant and lasting benefits in these patients.