RELATIONSHIP OF PAST DEPRESSIVE EPISODES TO SYMPTOM SEVERITY AND TREATMENT RESPONSE IN PANIC DISORDER WITH AGORAPHOBIA

Background. Many investigators have reported that panic disorder (PD) patients with comorbid major depression (MD) have more severe symptoms and a poorer response to treatment than patients with PD alone. It is not known if this is due to a distinct and more serious underlying di sorder in these patients or simply a result of the simultaneous presen ce of the two disorders. Method. Nondepressed patients presenting for treatment of panic disorder with agoraphobia (PDA) were studied before treatment (N = 180) and after 4 weeks of treatment with adinazolam su stained release (N = 89) or placebo (N = 91) Twenty-nine percent (N = 53) of the patients had a past history of MD. Symptom severity and tre atment outcome were compared in patients with primary, secondary, sing le, recurrent, or no past MD. Results: There were no consistent differ ences in symptom severity or treatment outcome in patients with a past history of primary, secondary, or single episode MD compared with pat ients with no history of MD. However, a small number of patients with history of recurrent MD exhibited consistently greater symptom severit y and poorer response to treatment than patients with no history of MD . Conclusion: The greater severity and worse outcome of comorbid PD an d MD observed in earlier studies are more likely due to the simultaneo us presence of the two disorders than to a more serious and enduring u nderlying disorder. However, our results suggest that recurrent MD may indicate a more serious condition in patients with PDA. This possibil ity warrants further study.