LONG-TERM OUTCOME AFTER ACUTE TREATMENT WITH ALPRAZOLAM OR CLONAZEPAMFOR PANIC DISORDER

The relative effectiveness of the available treatments for panic disor der may best be understood in the context of the longitudinal course o f the disorder. This study examines a number of clinically relevant is sues, including long-term outcome after acute treatment, the proportio n of patients remaining on single-agent treatment or requiring multipl e medications or nonpharmacologic interventions over time, evidence fo r dose escalation during maintenance high-potency benzodiazepine thera py, and predictors of acute and long-term response to treatment. Fifty -nine panic disorder patients originally randomized to treatment in a controlled trial comparing alprazolam, clonazepam, and placebo were re evaluated in a follow-up study. At a mean follow-up of 1.5 years, 78% of patients remained on medication and the mean dosage of alprazolam a nd clonazepam did not increase. Our data suggest that most patients ma intain benefit with long-term pharmacotherapy but that residual sympto matology may require more intensive or additional treatment strategies . Response at the endpoint of the acute trial was significantly associ ated with pretrial baseline Clinical Global Impression Scale score and the presence of dysthymia. Poor outcome at follow-up was associated w ith total duration of the disorder, agoraphobic subtype, and the prese nce of comorbid social phobia. We underscore the potential importance of comorbid affective and anxiety disorders as well as phobic patterns in determining long-term response to treatment.