Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-20T00:24:25.718Z Has data issue: false hasContentIssue false
  • English
  • Français

Drug Treatment of Panic Disorder

Reply to Comment by Marks and Associates

Published online by Cambridge University Press:  02 January 2018

Gerald L. Klerman
Gerald L. Klerman*
Affiliation:
Department of Psychiatry, Cornell University Medical College, New York, NY 10021, USA
*
Dr Klerman died on 3 April 1992. Correspondence should be sent to his wife, Dr Myrna Weissman, Columbia University College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168th St. Unit 14, New York, NY 10032
Get access Rights & Permissions [Opens in a new window]

Extract

The February 1992 issue of the British Journal of Psychiatry contained the summary report from the Second Phase of the Cross-National Collaborative Panic Study (CNCPS) on a clinical treatment trial of panic disorder. This manuscript was submitted in 1988 and took four years of response to critiques and revisions to generate a manuscript that was acceptable to the Editor of the British Journal of Psychiatry. In the same issue, Marks et al (1992) provided a ‘Comment’ which was critical of the study, calling it an “elephantine labour” which “resulted in the delivery of a mouse” and was highly critical of the statistical analyses and interpretation. Moreover, their ‘Comment’ was a springboard for discussing general issues in the treatment of panic disorder and the relative value of pharmacological versus psychological treatments. In our opinion, the Marks et al ‘Comment’ is inaccurate and misleading. At many points, they make reference to topics being missing that are actually addressed to our manuscript and they presented a statistical summary in Table 1 (p. 203) of our data which was inaccurate. In this Comment, we address each item criticised.

Type
Comment
Information
The British Journal of Psychiatry , Volume 161 , Issue 4 , October 1992 , pp. 465 - 471
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1.

This comment was compiled by Gerald Klerman and co-authored by: Per Bech, Otto Benkert, Sydney Brandon, Giovanni B. Cassano, George C. Curtis, Juan R. de la Fuente, Jose Guimon, Jose Luis Ayuso Gutierrez, Heinz Katschnig, Philip W. Lavori, Carlos A. Leon, J. Lopez-Ibor, Jr, Juan Massana, Mogens Mellergard, Jan-Otto Ottoson, Raben Rosenberg, Sir Martin Roth, Javier Sepulveda-Amor, Leslie Solyom, Marco Versiani, and Jean Wilmotte.

References

Alexander, P. E. & Alexander, D. D. (1986) Alprazolam treatment for panic disorders. Journal of Clinical Psychiatry, 47, 301–304.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Andersch, S., Rosenberg, N. K., Kullingsjo, H., et al (1991) Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicentre study. Acta Psychiatrica Scandinavica, 365 (suppl. 83): 18–27.CrossRefGoogle Scholar
Ballenger, J. C., Burrows, G. D., DuPont, R. L., 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.CrossRefGoogle ScholarPubMed
Barlow, D. H. (1988) Anxiety and its Disorders. New York: Guilford Press.Google Scholar
Chouinard, G., Annahble, 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
Cross-National Collaborative Panic Study, Second Phase Iinvestigators (1992) Drug treatment of panic disorder: comparative efficacy of alprazolam, imipramine, and placebo. British Journal of Psychiatry, 160, 191–202.Google Scholar
Deltito, J. A., Argyle, N. & Klerman, G. L. (1991) Patients with panic disorder unaccompanied by depression improve with alprazolam and imipramine treatment. Journal of Clinical Psychiatry, 52, 121–127.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.Google Scholar
Healy, D. (1991) Alprazolam and panic disorder (Expert opinion). Psychiatric Bulletin, 15, 682–683.CrossRefGoogle Scholar
Kerwin, R. & Bailey, P. (1991) Archives of General Psychiatry, June, 1991 (Expert opinion). Psychiatric Bulletin, 15, 738–739.Google Scholar
Klerman, G. L. (1988) Overview of the Cross National Collaborative Panic Study. Archives of General Psychiatry, 45, 407–412.Google Scholar
Klerman, G. L., Freedman, D. X. & Shader, R. I. (1988) The separation of panic and agoraphobia from other anxiety disorder: Introduction to the Conference Proceedings. Journal of Psychiatric Research, 22, 3–5.CrossRefGoogle Scholar
Klerman, G. L., Ballenger, J. C., Burrows, G. D., et al (1989). In reply. The efficacy of alprazolam in panic disorder and agoraphobia: A critique of recent reports. Archives of General Psychiatry, 46, 670–672.Google Scholar
Lavori, P. (1989) Statistical issues - Sample size and dropout. In Methodology of the Evaluation of Psychotropic Drugs (eds Benkert, Maier & Rickels), pp. 91–104. Berlin: Springer.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., De Albuguergue, A., Cottraux, J., et al (1989) The efficacy of alprazolam in panic disorder and agoraphobia: a critique of recent reports. Archives of General Psychiatry, 46, 668–672.Google ScholarPubMed
Marks, I. M. & Swinson, R. P. (1990) Alprazolam and exposure for panic disorder with agoraphobia: summary of London/Toronto results. Journal of Psychiatric Research, 24, 100–101.Google Scholar
Marks, I. M., Greist, J., Basoglu, M., et al (1992) Comment on the Second Phase of the Cross-National Collaborative Panic Study. British Journal of Psychiatry, 160, 202–205.CrossRefGoogle Scholar
Noyes, R., DuPont, R. L., Pecknold, J. C., 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.Google Scholar
Noyes, R., Garvey, M. J., Cook, B., et al (1991) Controlled discontinuation of benzodiazepine treatment for patients with panic disorder. American Journal of Psychiatry, 148, 517–523.Google Scholar
Shear, M. K. & Barlow, D. (1988) Panic disorder. In Annual Review of Psychiatry (eds A. Frances & F. Hales), vol. 8. Washington, DC: American Psychiatric Press.Google Scholar
Sheehan, D. V. (1982) Panic attacks and phobias. New England Journal of Medicine, 303, 156–158.CrossRefGoogle Scholar
Sheehan, D. V., Ballenger, J. & Jacobson, G. (1981) Relative efficacy of monoamine oxidase inhibitors and tricyclic antidepressants in the treatment of endogenous anxiety. In Anxiety: New Research and Changing Concepts (eds D. F. Klein & J. G. Rabkin), pp. 47–67. New York: Raven Press.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.