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Efficacy of Combined Pharmacotherapy and Psychotherapy Versus Monotherapy in the Treatment of Anxiety Disorders

Published online by Cambridge University Press:  07 November 2014

Donald W. Black
Donald W. Black*
Affiliation:
Dr. Black is professor of psychiatry at the, University of Iowa, Roy J. and Lucille A. Carver College of Medicine in Iowa City
*
Donald W. Black, MD, University of Iowa Carver College of Medicine, 2-126-B Medical Education Building, Iowa City, Iowa 52242-1000; Tel: 319-353-4431; Fax: 319-353-3003; E-mail: donald-black@uiowa.edu
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Abstract

Anxiety disorders in the United States are prevalent, widespread, and disabling. These illnesses may account for almost one third of the $148 billion total mental health bill each year. Pharmacologic options include tricyclic antidepressants, monoamine oxidase inhibitors, serotonin norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and anxiolytics. Psychological treatments include cognitive-behavioral therapy (CBT), cognitive therapy, exposure, and ritual prevention therapies. Despite insufficient evidence, many experts recommend combined treatment, generally medication with CBT. A literature review was conducted to examine studies with random assignment, adequate methods and sample sizes, blind assessments, sufficient dosages and durations of treatment, and satisfactory reporting of data, to determine whether combined treatment was superior to monotherapy. Twenty-six randomized clinical trials were identified; nine met review criteria. A review of relevant studies could not confirm the superiority of combined treatment over monotherapy. In one of four studies of obsessive-compulsive disorder, combined treatment produced better results than monotherapy.  There was no evidence of superiority for combined therapy over monotherapy for the treatment of social phobia or generalized anxiety disorder. There were no studies that met review criteria for either specific phobia or posttraumatic stress disorder (PTSD). With panic disorder, there was evidence that combined treatment might actually lead to worse outcome. Combined treatment is commonly recommended, but empirical support is limited. More research is needed. There are few well-designed studies, and little data regarding PTSD and specific phobias.

Information

Type
Research Article
Information
CNS Spectrums , Volume 11 , Issue S12 , 2006 , pp. 29 - 33
Copyright
Copyright © Cambridge University Press 2006

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References

1.Rice, DP, Miller, LS. The Economic Burden of Schizophrenia:Conceptual and Methodological Issues, and Cost Estimates. In: Moscarelli, M, Sartorius, N, eds. Handbook of Mental Health Economics and Health Policy. New York, NY: John Wiley & Sons Ltd; 1996:321–34.Google Scholar
2.Ansseau, M, Dierick, M, Buntinkx, Fet al.High prevalence of mental disorders in primary care. J Affect Disord. 2004;78:49–55.CrossRefGoogle ScholarPubMed
3.Kessler, RC, Chiu, WT, Demler, O, Walters, EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–627.CrossRefGoogle ScholarPubMed
4.Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.CrossRefGoogle ScholarPubMed
5.Lindal, E, Stefansson, JG. The lifetime prevalence of anxiety disorders in Iceland as estimated by the US National Institute of Mental Health Diagnostic Interview Schedule. Acta Psychiatr Scand. 1993;88:29–34.CrossRefGoogle ScholarPubMed
6.Young, AS, Klap, R, Sherbourne, CD, Wells, KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58:55–61.CrossRefGoogle ScholarPubMed
7.Greenberg, PE, Sisitsky, T, RC, Kessleret al.The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60:427–435.CrossRefGoogle ScholarPubMed
8. U.S. Public Health Service. Mental Health: A Report of the Surgeon General. The costs of mental illness. Available at: http://www.mentalhealth.samhsa.gov/features/surgeongeneralreport/chapter6/sec2.asp. Accessed May 26, 2006.Google Scholar
9.Greenberg, PE, Stiglin, LE, Finkelstein, SN, Berndt, ER. The economic burden of depression in 1990. J Clin Psychiatry. 1993;54:405–418.Google ScholarPubMed
10.Gould, RA, Otto, MW, Pollack, MH. A meta-analysis of treatment outcome for panic disorder. Clin Psychol Rev. 1995;15:819–844.CrossRefGoogle Scholar
11.Goisman, RM, Warshaw, MG, Keller, MB. Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder, and social phobia, 1991-1996. Am J Psychiatry. 1999;156:1819–1821.CrossRefGoogle ScholarPubMed
12.Otto, MW, Smits, JA, Reese, HE. Cognitive-behavioral therapy for the treatment of anxiety disorders. J Clin Psychiatry. 2004;65(suppl 5):34–41.Google ScholarPubMed
13.The expert consensus guideline series. Treatment of Posttraumatic Stress Disorder. The Expert Consensus Panels for PTSD. J Clin Psychiatry. 1999;60(suppl 16):3–76.Google Scholar
14.Ursano, RJ, Bell, C, Eth, S, et al.Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry. 2004;161 (suppl 11):2–57.Google ScholarPubMed
15.Treatment of obsessive-compulsive disorder. The Expert Consensus Panel for obsessive-compulsive disorder. J Clin Psychiatry. 1997;58(suppl 4):2–72.Google Scholar
16.Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. 1998;155:1–34.Google Scholar
17.Foa, EB, Franklin, ME, Moser, J. Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? Biol Psychiatry. 2002;52:987–997.CrossRefGoogle ScholarPubMed
18.Cottraux, J, Mollard, E, Bouvard, M, et al.A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol. 1990;5:17–30.CrossRefGoogle ScholarPubMed
19.Hohagen, F, Winkelmann, G, Rasche-Ruchle, Het al.Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study. Br J Psychiatry Suppl. 1998;71–78.Google Scholar
20. van Balkom, AJ, de Haan, E, van Oppen, P, Spinhoven, P, Hoogduin, KA, van Dyck, R. Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. J Nerv Ment Dis. 1998;186:492–499.CrossRefGoogle ScholarPubMed
21.Foa, EB, Liebowitz, MR, Kozak, MJ, et al.Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 2005;162:151–161.CrossRefGoogle ScholarPubMed
22.Marks, IM, Swinson, RP, Basoglu, M, et al.Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776–787.CrossRefGoogle ScholarPubMed
23.Cottraux, J, Note, ID, Cungi, C, et al.A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia. Br J Psychiatry. 1995;167:635–641.CrossRefGoogle ScholarPubMed
24.Barlow, DH, Gorman, JM, Shear, MK, Woods, SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA. 2000;283:2529–2536.CrossRefGoogle ScholarPubMed
25.Power, KG, Simpson, RJ, Swanson, V, Wallace, LA. Controlled comparison of pharmacological and psychological treatment of generalized anxiety disorder in primary care. Br J Gen Pract. 1990;40:289–294.Google ScholarPubMed
26.Blomhoff, S, Haug, TT, Hellstrom, K, et al.Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. Br J Psychiatry. 2001;179:23–30.CrossRefGoogle ScholarPubMed