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Research Study Contrasts Medications and Psychotherapy

The best research study about how people with panic are doing, after treatment, was just published in a leading medical journal.  The research approach was "as good as it gets":  patients receiving medications were treated by a group well known for their success with those medications.  Patients receiving the therapy approach were also treated by a team expert in that approach.  If you ask "what works better, medications or therapy?", this is the study to look at -- it demonstrates the same results of smaller studies that were done previously, and adds to them the strongest research design yet.   You can read the details in the Journal of the American Medical Association (2000 May 17;283(19):2529-36), or the abstract , or my brief summary below. 

 

Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder:  
A Randomized Controlled Trial 

 David H. Barlow, PhD; Jack M. Gorman, MD; M. Katherine Shear, MD; Scott W. Woods, MD

As the title indicates, this is a randomized clinical trial (read about that research design here).  Five different approaches were compared, which required 8 years of research in several centers:

  1. Imipramine: an antidepressant commonly used when the study started (known to be effective)
  2. Placebo pills, prescribed in the same fashion as imipramine
  3. Cognitive behavioral therapy (CBT), using the manual of Barlow and colleagues (known to be effective)
  4. CBT and placebo (testing whether adding a pill of any kind changes CBT results)
  5. CBT and imipramine (are both together better than either alone?)

Simplifying things a bit, here are the results, indicating the percentage of people "panic free" (no panic attacks at all):

 

CBT

Imipramine

Placebo

At end of initial treatment
(3 months)
49% 46% 22%
After 6 months of maintenance treatment 40% 38% 13%
Six months after treatment stopped 32% 20% 13%

Combining imipramine with CBT was not clearly superior to CBT alone (it's a little complex how that came out, but the bottom line is pretty clear, at least in my view -- the medication does not add to the outcome, especially after the medication is tapered off). 

"Bottom Line": Although there is a strong tendency for people to "relapse" into having panic attacks again after treatment is over, fewer people relapse if they received CBT than if they received an antidepressant. 

 

 

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