Treatment of Phobic States with Antidepressants

A Retrospective Study of 246 Patients

¹ Chief Assistant, Department of Psychological Medicine, St. Thomas's Hospital, London, S.E.1., Senior Lecturer and Consultant, St. George's Hospital Medical School, Atkinson Morely's Hospital, 31, Copse Hill, London, S.W.20
² Research Registrar, Department of Psychological Medicine, St. Thomas's Hospital, London, S.E.1., Consultant Psychiatrist, Behman Hospital, Helwan, Cairo
³ Psychiatrist in Charge, Child Psychiatric Clinic, Department of Psychological Medicine, St. Thomas's Hospital, London, S.E.1
⁴ Research Registrar, Department of Psychological Medicine, St. Thomas's Hospital, London, S.E.1
⁵ Physician in Charge, Department of Psychological Medicine, St. Thomas's Hospital, London, S.E.1

This is a retrospective study of 246 patients presenting with phobic anxiety who were treated with a monoamine oxidase inhibitor either alone, or combined with chlordiazepoxide or a tricyclic antidepressant. One hundred of the sample were adult N.H.S. patients (Group A); there were 96 private patients (Group B) and 50 children (Group C).

1. There was a highly significant improvement in the phobic ratings of all groups at one month and one year after starting treatment. The percentage of improvement at one year was 88 per cent in Group A, 93 per cent in Group B, and 93 per cent in Group C.

2. The mean social rating and depression scores at one month and one year showed statistically significant improvements compared with the initial ratings.

3. Panic attacks were experienced by 90 per cent of the patients in Group A before treatment, 42 per cent had lost their panic attacks a month after starting treatment and 58 per cent at a year, which was a highly significant improvement. This was an important finding in view of the deleterious effect of unexplained panic attacks occurring during behaviour therapy.

4. The previous personality of the adult patient, the type of phobia (agoraphobia or other phobia), or the presence of depression at initial interview made no significant difference to the outcome of treatment.

5. The side-effects and complications are fully described, the disadvantages of this type of treatment being dietary restrictions while on a M.A.O.I. and the length of maintenance treatment necessary to prevent relapse.

6. The results obtained are superior in many respects to that of a well known study in which behaviour therapy and `control' treatment of phobias were compared. The treatment described is easier and less time-consuming for general practitioners to carry out than psychotherapy or behaviour therapy for which special training is required.

7. The ways in which phobic reactions can arise in children are discussed. The response to treatment of the children was very similar to that of the adults, but long term maintenance therapy was usually not necessary.

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