A double-blind crossover comparison of clomipramine and desipramine in thetreatment of panic disorder

Objective: To compare the efficacy of clomipramine hydrochloride (CMI), a s erotonin reuptake inhibitor with the noradrenergic tricyclic antidepressant agent, and desipramine hydrochloride (DMI) for patients with panic disorde r (PD). Method: Following a 2-week, single-blind placebo washout phase, 17 PD outpatients completed a 16-week, double-blind, crossover comparison of C MI and DMI. Key outcome measures included panic attacks frequency, the NIMH Global Scales for Anxiety, Depression and Impairment, Hamilton Anxiety Sca le (Psychic and Somatic Subscales), Zung Anxiety Inventory (Raw and Index S ubscales) and the Spielberger State Anxiety Scale. Results: Both CMI and DM I led to significant improvement from baseline placebo state in panic attac ks frequency and behavioral ratings (p<0.001). CMI led to a greater reducti on in the frequency of panic attacks (p=0.028) and was superior to DMI on r atings of anxiety: NLMH Global Anxiety, Zung Anxiety Scale (Raw and Index) and the Spielberger Anxiety Scale. No difference was found between the drug s on the NIMH Global Impairment Scale and the Hamilton Somatic and Psychic Scales. Conclusion: Both drugs appeared to have significant therapeutic eff ects in patients with PD, but CMI appeared to be more effective. The effect iveness of the serotonergic drug suggests that the role of the serotonergic system in the pathogenesis of PD should be further explored. (C) 1999 Publ ished by Elsevier Science Ireland Ltd. All rights reserved.