Evidence indicates that patients with major depression and co-occurring anxiety features are at risk for more severe symptoms and less favorable outcome than patients with major depression alone. In particular, the existence of co-occurring panic symptoms has been linked to more severe depressive episodes, poorer psychosocial functioning, and poorer response to both psychotherapeutic and pharmacological treatments for depression.

In The American Journal of Psychiatry, Ellen Frank, Ph.D., and colleagues at the University of Pittsburgh School of Medicine released their findings that the same holds true for patients who exhibit panic symptoms belonging to the panic-agoraphobic spectrum.

The researchers looked at a cohort of 61 women, who were subjects in a larger depression study, to determine their treatment outcome, based on how they scored on the Panic-Agoraphobic Spectrum Self-Report scale.

All patients in the larger study were female, ranging in age from 20 to 60, and in at least their second episode of major depression, as determined by DSM-IV. Patients were treated for 12 to 24 weeks to achieve remission of the current depressive episode. Patients were first treated with interpersonal psychotherapy until remission. If they were not responsive to psychotherapy alone, fluoxetine (Prozac) 10 mg/day to 20 mg/day was added to the treatment regimen. Patients who did not meet remission criteria after 24 weeks, or who deteriorated or relapsed, were removed from the study and offered other standard pharmacotherapy treatments.

Within this larger group, 61 women were given the Panic-Agoraphobic Spectrum Self-Report to assess their lifetime history of panic-agoraphobic spectrum symptoms. A score of 35 or higher was used to characterize patients as having clinically significant panic-agoraphobic symptoms. A chi-square test was used to compare the proportion of high- to low-scorers who responded to interpersonal psychotherapy alone. Next, the median time to remission (defined as a Hamilton Depression [HAM-D] Scale rating of 7 or lower during the first of three consecutive weeks) was compared for patients above and below the cut-off score.

Of the 61 patients, 23 (37.7%) were classified as high-scorers. As expected, more of these patients reported a lifetime history of panic disorder than did those who scored below the threshold. Only two (5.3%) of the 38 women who scored below 35 reported a lifetime history of panic or agoraphobia, as compared to nine (39.1%) who had high scores.

As predicted, women who had low scores responded better to psychotherapy (26 of 38, 68.4%) than those with high scores (10 of 23, 43.5%). In addition, high scorers were more likely to need pharmacologic treatment and had a longer median time to remission than low scorers (18.1 weeks versus 10.3 weeks, respectively).

The authors acknowledged several weaknesses in their study. First, only women were studied. Second, assessment with the Panic-Agoraphobic Spectrum Self-Report was only done at one point in the study, rather than longitudinally. Third, the sample size did not lend itself to separate analyses of time to remission for the psychotherapy group and the pharmacology group.

Nevertheless, the investigators summarized, “High levels of panic-agoraphobic spectrum symptoms over the lifetime are associated with a delayed response to treatment whether or not fluoxetine is added to the patient’s treatment regimen”.

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