A prospective naturalistic study of 326 panic-agoraphobic patients treatedwith antidepressants

Objective: How far the results of randomized controlled studies apply to ev eryday care cannot be judged without regular measurements of outcomes in da ily practice. We report on systematic data from a 3-year naturalistic prosp ective study on panic disorder-agoraphobic (PDA) patients treated with anti depressants in a setting of routine clinical practice. Our aim is to descri be the evolution of PDA in relation to the treatments employed, and to expl ore demographic and clinical characteristics that might be predictive of ou tcome. Methods: 326 DSM-III-R PDA patients treated with antidepressants in a setti ng of routine clinical practice were included in a 3-year naturalistic pros pective study. We utilized structured and semi-structures instruments, incl uding the Structured Clinical Interview for Diagnosis and the Longitudinal Interview Follow-up Examination. The main antidepressants used were imipram ine (39%), clomipramine (28.5 %) and paroxetine (23.3 %); only 9 % of patie nts received other antidepressants. Results: 147 patients (45.1%) stayed on medication throughout the entire pe riod of the followup. Of those who interrupted the treatment, 38% stayed in remission. The probability of achieving at least one remission during the 3-year follow-up period was 96.5% for PD and 95.9% for Agoraphobia. Relapse s after a period of at least 2 months of complete remission were also commo n, and the probability of presenting at least one relapse during the 3-year s follow-up period was 67.1% for PD and 39% for Agoraphobia. The longest pe riod of remission of PD is associated with low severity, medium-lasting cou rse in patients with an onset of the illness in young adulthood. Less sever e agoraphobia associated with moderately severe panic attacks appears to co nfer a better control of phobic behavior. All three major drugs were reason ably well tolerated (only 9% dropped out because of side effects), with sex ual dysfunction and increased appetite being the most common side effects a t the last evaluation; in the first phase of the treatment anticholinergic effects and jitteriness were more common with TCAs. Conclusion: Both classical antidepressants and paroxetine emerge as a usefu l treatment in the long-term management of PDA; paroxetine appears particul arly useful in PDA patients because it was significantly less likely to ind uce jitteriness, thereby reducing barriers to compliance.