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REVIEW ARTICLES: TOSHI A. FURUKAWA, NORIO WATANABE, and RACHEL CHURCHILL Psychotherapy plus antidepressant for panic disorder with or without agoraphobia: Systematic review The British Journal of Psychiatry 2006; 188: 305-312 [Abstract] [Full text] [PDF]

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Psychotherapy plus antidepressant for panic disorder with or without agoraphobia

Dr Grace Ghunang, Hadi M Hussain,Army Medical College,Rawalpindi,Pakistan   (21 June 2006)

Psychotherapy plus antidepressant for panic disorder with or without agoraphobia 21 June 2006
Dr Grace Ghunang, Professor Of Physchiatry Department Of Mental Health ,Military hospital ,Rawalpindi,Pakistan, Hadi M Hussain,Army Medical College,Rawalpindi,Pakistan Send letter to journal: Re: Psychotherapy plus antidepressant for panic disorder with or without agoraphobia graceghunang_ias{at}yahoo.com.br Dr Grace Ghunang, et al.	Panic disorder with or without agoraphobia is a highly prevalent psychiatric disorder. As shown by the results of the National Comorbidity Survey Replication (1),life-time prevalence for panic disorder with agoraphobia is 1.1 and 3.7 for panic disorder without agoraphobia. Both pharmacotherapy, especially using antidepressants, and psychotherapy, especially cognitive-behavioral psychotherapy or CBT have been shown to be effective in treating the disorder. It is all the more striking that most current treatment fails to meet basic treatment guidelines (2). The question concerning combined pharmacotherapy and psychotherapy versus either one of the monotherapies has remained controversial. Conclusions of recent reviews have been variable, with some favouring the combination, some favouring monotherapy, some drawing mixed conclusions. The present study is important in that it makes two unambiguous statements: 1.The treatment combining antidepressants and psychotherapy is more effective than either monotherapy in the acute phase of the treatment and as long as treatment is continued 2.At follow-up, after discontinuation of treatment, the combination is still more effective than pharmacotherapy alone, but not more effective than psychotherapy alone In comparison with previous reviews, the present one has several strengths. First, it relies on the findings of systematic and comprehensive searches for relevant trials. Second, the meta-analyses performed in the study applied the intention-to-treat principle, with drop -outs being counted as non-responders. 3.Heterogeneity and sensitivity analyses indicated that the results of the analyses were quite robust. The study has some limitations. In particular, the nature of follow- up after termination of treatment is described as “naturalistic”, meaning that participants were usually free to seek further treatment between the termination of treatment and the follow-up assessments. In fact, 30-70% of the participants received additional treatment. Another limitation of the study is that it does not address the relative merits of combination therapy compared with sequential treatments. Additional studies are needed to confirm the results of the present review and to investigate the potential benefit of sequential versus combined treatments. References: 1. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K and Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry 2006; 63; 415-424 2. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB and Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 2005; 62 (6); 629-40