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Drug Treatment of Panic Disorder: Comparative Efficacy of Alprazolam, Imipramine, and Placebo

Cross-National Collaborative Panic Study, Second Phase Investigators

Published online by Cambridge University Press:  02 January 2018

Gerald L. Klerman
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Abstract

The Cross-National Collaborative Panic Study, Phase Two, compared alprazolam with imipramine and with placebo in a sample of 1168 randomly assigned subjects. The study, conducted at 12 centres, assessed clinical change over eight weeks of double-blind drug treatment. Improvement occurred with alprazolam by week 1 and 2, and with imipramine by week 4. By the end of week 8, however, the effects of the two active drugs were similar to each other, and both were superior to placebo for most outcome measures.

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Papers
Information
The British Journal of Psychiatry , Volume 160 , Issue 2 , February 1992 , pp. 191 - 202
Copyright
Copyright © Royal College of Psychiatrists, 1992 

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Footnotes

A detailed listing of participants appears at the end of the article.

References

Alexander, P. E. & Alexander, D. D. (1986) Alprazolam treatment for panic disorders. Journal of Clinical Psychiatry, 47, 301–304.Google ScholarPubMed
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Amin, M. M., Ban, T. A., Pecknold, J. C., et al (1977) Clomipramine (Anafranil) and behavior therapy in obsessive-compulsive and phobic disorders. Journal of Internal Medical Research, 5, 42–48.Google ScholarPubMed
Ashcroft, G. W., Beaumont, G., Bonn, J., et al (1987) Consensus statement: panic disorder. British Journal of Psychiatry, 150, 557–558.Google Scholar
Baldessarini, R. (1985) Drugs used in the treatment of psychiatric disorders. In The Pharmacological Basis of Therapeutics (7th edn) (eds Gilman, S. G., Goodman, L. S., Pall, T. W., et al). New York: MacMillan.Google Scholar
Ballenger, J. C. (1986) Pharmacotherapy of the panic disorders. Journal of Clinical Psychiatry, 47, 27–32.Google ScholarPubMed
Ballenger, J. C., Burrows, G., DuPont, R., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Archives of General Psychiatry, 45, 413–422.Google Scholar
Barlow, D. H. (1988) Anxiety and its Disorders. New York: Guilford Press.Google Scholar
Beaudry, P., Fontaine, D., Chouinard, G., et al (1984) Bromazepam, another high potency benzodiazepine for panic attacks. American Journal of Psychiatry, 141, 464–465.Google ScholarPubMed
Breier, A., Charney, D. S. & Heniger, G. R. (1985) The diagnostic validity of anxiety disorders and their relationships to depressive illness. American Journal of Psychiatry, 142, 787–797.Google Scholar
Buller, R., Maier, W. & Benkert, O. (1986) Clinical subtypes in panic disorders: their descriptive and prospective validity. Journal of Affective Disorders, 11, 105–114.CrossRefGoogle ScholarPubMed
Busto, U., Sellers, E. M., Naranjo, C. A., et al (1984) Withdrawal reaction after long-term therapeutic use of benzodiazepines. New England Journal of Medicine, 315, 854–859.Google Scholar
Carr, D., Sheehan, D. V., Surman, O. S., et al (1986) Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy. American Journal of Psychiatry, 143, 483–494.Google Scholar
Cassano, G. B., Petracca, A., Perugi, G., et al (1988) Clomipramine for panic disorder: I. The first 10 weeks of a long-term comparison with imipramine. Journal of Affective Disorders, 14, 123–127.Google Scholar
Charney, D. S. & Heninger, G. R. (1985) Noradrenergic function and the mechanism of action of antianxiety treatment. Archives of General Psychiatry, 42, 473–481.CrossRefGoogle ScholarPubMed
Charney, D. S., Woods, S. W., Goodman, W. K., et al (1986) Drug treatment of panic disorder: the comparative efficacy of imipramine, alprazolam, and trazodone. Journal of Clinical Psychiatry, 47, 580–586.Google ScholarPubMed
Charney, D. S. & Woods, S. W. (1989) Benzodiazepine treatment of panic disorder: a comparison of alprazolam and lorazepam. Journal of Clinical Psychiatry, 50, 418–423.Google ScholarPubMed
Chouinard, G., Annable, L., Fontaine, R., et al (1982) Alprazolam in the treatment of generalized anxiety and panic disorders: a double-blind placebo controlled study. Psychopharmacology, 77, 229–233.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Chalkley, A. J., et al (1985) Respiratory control as treatment of panic attacks. Journal of Behavioral Therapy and Experimental Psychiatry, 16, 23–30.Google Scholar
Deltito, J., Argyle, N. & Klerman, G. L. (1991) Patients with panic disorder unaccompanied by depression improved with alprazolam and imipramine treatment. Journal of Clinical Psychiatry, 52, 121–127.Google Scholar
Derogatis, L. R., Lipman, R. S. & Covi, L. (1973) SCL–90: an outpatient psychiatric rating scale: preliminary report. Psychopharmacology Bulletin, 9, 13–28.Google ScholarPubMed
Dunner, D. L., Ishiki, D., Avery, D. H., et al (1986) Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study. Journal of Clinical Psychiatry, 47, 458–460.Google ScholarPubMed
Escobar, J. I. & Landbloom, R. P. (1976) Treatment of phobic neurosis with clomipramine: a controlled clinical trial. Current Therapeutic Research, 20, 680–685.Google Scholar
Fleiss, J. L., Spitzer, R. L., Endicott, J., et al (1972) Quantification of agreement in multiple psychiatric diagnoses. Archives of General Psychiatry, 26, 168.Google Scholar
Fyer, A. J. & Sandberg, D. P. (1988) Pharmacologic treatment of panic disorder. In Annual Review of Psychiatry (eds Frances, A. J. & Hales, R. E.), pp. 88 120, vol. 7. Washington, DC: American Psychiatric Press.Google Scholar
Gelder, M. G. (1989) Panic disorder: fact or fiction? (editorial). Psychology, 19, 277–283.Google ScholarPubMed
Hamilton, M. (1959) The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.Google Scholar
Katz, M. M. & Klerman, G. L. (1979) Overview of the clinical studies program. NIMH Collaborative Program on Psychobiology of Depression. American Journal of Psychiatry, 136, 49–51.Google Scholar
Kelley, D., Guirguis, W., Frommer, E., et al (1970) Treatment of phobic states with antidepressants. British Journal of Psychiatry, 136, 49–51.Google Scholar
Klein, D. F. (1964) Delineation of two drug-responsive anxiety syndromes. Psychopharmarcologia, 5, 397–408.Google Scholar
Klein, D. F. (1981) Anxiety reconceptualized. In Anxiety: New Research and Changing Concepts (eds Klein, D. F. & Rabkin, J. G.), pp. 235–263. New York: Raven Press.Google Scholar
Klerman, G. L. (1988) Overview: The Cross-National Collaborative Panic Study. Archives of General Psychiatry, 45, 407–412.Google Scholar
Klerman, G. L. (1990) Depression and panic anxiety: the effect of depressive comorbidity on response to drug treatment of patients with panic disorder and agoraphobia. Journal of Psychiatric Research, 24 (suppl. 2), 27–41.Google Scholar
Klerman, G. L., Coleman, J. H., Purpura, R. P., et al (1986) The design and conduct of the Upjohn Cross-National Collaborative Panic Study. Psychopharmacology Bulletin, 45, 407–412.Google Scholar
Klerman, G. L., Ballenger, J. C., Burrows, G. D., et al (1989) The efficacy of alprazolam in panic disorder and agoraphobia: a critique of recent reports (letter). Archives of General Psychiatry, 46, 670–672.Google Scholar
Lahti, R. A., Sethy, V. H., Barsuhn, C., et al (1983) Pharmacological profile of the antidepressant adinazolam, a triazolobenzodiazepine. Neuropharmacology, 22, 1227–1282.CrossRefGoogle ScholarPubMed
Lavori, P. W., Louis, P. A., Bailar, J. C., et al (1983) Designs for experiments: parallel comparisons of treatment. New England Journal of Medicine, 309, 1291–1298.Google Scholar
Lesser, I. & Rubin, M. (1988) Secondary depression in panic disorder and agoraphobia. Archives of General Psychiatry, 45, 437–443.CrossRefGoogle ScholarPubMed
Levine, J. & Schooler, N. R. (1986) SAFTEE: a technique for the systematic assessment of side effects in clinical trials. Psychopharmacology Bulletin, 22, 343–381.Google Scholar
Liebowitz, M. R., Fyer, A. J., Gorman, J. M., et al (1986) Alprazolam in the treatment of panic disorder. Journal of Clinical Psychopharmacology, 6, 13–20.Google Scholar
Lopez-Ibor, J. J. (1950, 1970) La Angusta Vital. Madrid: Paz Montalvo.Google Scholar
Lydiard, R. B., Lesser, I. M., Ballenger, J. C., et al (1992) A fixed dose study of 2 mg alprazolam, 6 mg alprazolam and placebo in panic disorder. Journal of Clinical Psychopharmacology (in press).Google Scholar
Markowitz, J., Weissman, M. M., Ouelette, R., et al (1989) Quality of life in panic disorder. Archives of General Psychiatry, 46, 984–992.Google Scholar
Marks, I. M. (1987a) Fears, Phobias and Rituals. New York: Oxford University Press.Google Scholar
Marks, I. M. (1987b) Agoraphobia, panic disorder, and related conditions in the DSM–III–R and ICD–10. Journal of Psychopharmacology, 1, 6–12.CrossRefGoogle Scholar
Marks, I. M. & Matthews, A. M. (1979) Brief standard self-rating for phobic patients. Behavioral Research Therapy, 17, 263–267.Google Scholar
Marks, I. M., Albuquerque, A. D., Cottraux, J., et al (1989) The efficacy of alprazolam in panic disorder and agoraphobia: a critique of recent reports (letter). Archives of General Psychiatry, 46, 668–670.Google Scholar
McNair, D. M. & Fisher, S. (1978) Separating anxiety from depression. In Psychopharmacology: A Generation of Progress (eds Lipton, M. A., DiMascio, A. & Killam, K. F.), pp. 1411–1418. New York: Raven Press.Google Scholar
Noyes, R. Jr, Anderson, D. J., Clancey, J., et al (1984) Diazepam and propranolol in panic disorder and agoraphobia. Archives of General Psychiatry, 41, 287–292.Google Scholar
Noyes, R. Jr, Dupont, R. L. Jr, Pecknold, J., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety. Archives of General Psychiatry, 45, 423–428.CrossRefGoogle ScholarPubMed
O'Conner, W. T., Earley, B., Leonard, B. E., et al (1985) Antidepressant properties of the triazolobenzodiazepines, alprazolam and adinazolam: studies on the olfactory bulbectomized rat model of depression. British Journal of Clinical Pharmacology, 19, 458–568.Google Scholar
Pecknold, J., Swinson, R., Kuch, K., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial III. Discontinuation effect. Archives of General Psychiatry, 45, 429–436.Google Scholar
Rosenbaum, J. (1987) New uses for clonazepam in psychiatry. Journal of Clinical Psychiatry, 48 (suppl. 3).Google ScholarPubMed
Roth, M. (1959) The phobic anxiety–depersonalization syndrome and some general aetiological problems in psychiatry. Journal of Neuropsychiatry, 1, 293–306.Google Scholar
Roth, M. & Argyle, N. (1988) Anxiety, panic and phobic disorders: an overview. Journal of Psychiatric Research, 22 (suppl. 1), 33–54.Google Scholar
Roy-Byrne, P. P. & Katon, W. (1987) An update on treatment of the anxiety disorders. Hospital and Community Psychiatry, 38, 835–843.Google ScholarPubMed
Sethy, V. H. & Hodges, D. H. (1982) Alprazolam in biochemical model of depression. Biochemical Pharmacology, 31, 3155–3157.CrossRefGoogle ScholarPubMed
Shear, M. K. & Barlow, D. (1988) Panic disorder. Annual Review of Psychiatry (eds Frances, A. & Hales, F.), vol. 8. Washington, DC: American Psychiatric Press.Google Scholar
Sheehan, D. V. (1982) Current concepts in psychiatry: panic attacks and phobias. New England Journal of Medicine, 307, 156–158.Google Scholar
Sheehan, D. V., Ballenger, J. C., Jacobson, G., et al (1980) Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Archives of General Psychiatry, 36, 51–59.Google Scholar
Sheehan, D. V. & Sheehan, K. E. (1982) The classification of anxiety and hysterical states. Journal of Clinical Psychopharmacology, 2, 235–243.Google ScholarPubMed
Sheehan, D. V., Davidson, J., Manschreck, T., et al (1983) Lack of efficacy of a new antidepressant (bupropion) in the treatment of panic disorder with phobias. Journal of Clinical Psychopharmacology, 3, 28–31.Google Scholar
Sheehan, D. V., Raj, A. B., Sheehan, K. H., et al (1988) The relative efficacy of buspirone, imipramine and placebo in panic disorder: a preliminary report. Pharmacology, Biochemistry and Behavior, 29, 815.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria (RDC); rationale and reliability. Archives of General Psychiatry, 35, 773–782.Google Scholar
Spitzer, R. L. & Williams, J. B. W. (1983) Structured Clinical Interview for DSM–III (SCID). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Spitzer, R. L. & Williams, J. B. W. (1988) Revised diagnostic criteria and a new structured interview for diagnosing anxiety disorders. Journal of Psychiatric Research, 22 (suppl. 1), 55–86.Google Scholar
Tesar, G. E., Rosenbaum, J. F., Pollack, M. H., et al (1984) Clonazepam vs. alprazolam in the treatment of panic disorder: interim analysis of data from a prospective, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 48 (suppl. 11), 16–19.Google Scholar
Tyrer, P. (1984) Neurosis divisible. Lancet, i, 685–688.Google Scholar
Tyrer, P. (1986) Classification of anxiety disorders. Journal of Anxiety Disorders, 11, 991–994.Google ScholarPubMed
Tyrer, P. & Shawcross, C. (1988) Monoamine oxidase inhibitors in anxiety disorders. Journal of Psychiatric Research, 22 (suppl. 1), 87–98.Google Scholar
Uhlenhuth, E. H., Matsuzas, W., Glass, R. M., et al (1989) Response of panic disorder to fixed dose of alprazolam or imipramine. Journal of Affective Disorders, 17, 261–270.CrossRefGoogle ScholarPubMed
Versiani, M., Gentile, V., Paprocki, J., et al (1985) Data about 508 cases of panic disorder and responses to treatment with alprazolam clomipramine, imipramine, and tranylcypromine. In Biological Psychiatry: Proceedings from the IVth World Congress of Biological Psychiatry (eds Shagass, C., Josiassen, R. C., Bridger, W. H., et al). Amsterdam: Elsevier Science.Google Scholar
Weissman, M. M., Klerman, G. L., Markowitz, J. S., et al (1989) Suicidal ideation and suicide attempts in panic disorder and attacks. New England Journal of Medicine, 321, 1209–1214.Google Scholar
Westphal, C. (1872) Die Agoraphobie, cine neuropathische Erscheinung. Archives of Psychiatric Nervenkrankh, 3, 138–161.CrossRefGoogle Scholar
Williams, J. & Spitzer, R. (1992) SCID–UP reliability. American Journal of Psychiatry (in press).Google Scholar
World Health Organization (1988) International Classification of Disease. Draft proposal for Tenth Edition (ICD–10). Geneva: WHO.Google Scholar
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