THE TREATMENT OF PANIC DISORDER IN A CLINICAL SETTING - A 12-MONTH NATURALISTIC STUDY

In the treatment of panic disorder double-blind controlled studies hav e demonstrated that imipramine (IMI) was effective at doses higher tha n 125 mg/day. However a high rate of dropouts because of side effects has been reported in these subjects. In clinical settings, the adminis tration of benzodiazepines (BDZ) in combination with IMI has been prop osed to reduce the frequency and severity of side effects. In this nat uralistic study, 49 patients affected by panic disorder with agoraphob ia (n = 36) or without agoraphobia (n = 13) were treated with IMI plus lorazepam (LRZ) and followed for 12 months. The mean effective doses were 63.5 +/- 35.5 mg/day for IMI and 2.4 +/- 1.3 mg/day for LRZ. Duri ng the follow-up period, panic attacks disappeared in 75.5% of patient s and 69.5% of agoraphobics were free of phobic avoidance. The patient s with comorbid mood disorders and longer duration of illness required higher doses of both drugs. The combined treatment of IMI and LRZ all owed the use of low doses of the drugs, reduced the frequency and seve rity of the side effects and improved patient compliance. In fact, onl y 1 patient (2%) dropped out because of the severity of side effects. Furthermore, the patients who tapered LRZ treatment did not show BDZ w ithdrawal syndrome.