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Success shown with drugs and psychotherapy

People plagued by panic attacks need not fear one thing: Treatment works.

Panic disorders respond well to psychotherapy, drug treatment and a combination of the two, according to one of the largest studies of the condition.

Panic disorder affects several million Americans, crippling them with recurrent bouts of profound anxiety and physical symptoms that can include chest pain and pounding, as well as rapid heartbeats and shortness of breath. Many people also feel that, in the midst of an attack, they’re in danger of dying.

Perhaps it’s understandable, then, that people with this condition often feel there’s no hope of treatment. Fortunately for them, they’re wrong.

This conclusion won’t come as a surprise to specialists, who’ve been treating the condition with drugs and psychotherapy for many years. But, the researchers say, it should reinforce the message that panic disorder is a real diagnosis, and one that can be brought under control. Their findings appear in this week’s issue of the Journal of the American Medical Association.

Boston University researcher David Barlow and colleagues at three other clinics treated 312 patients from 1991 to 1998. Participants received one of five treatments: up to 300 milligrams a day of the antidepressant imipramine; a combination of imipramine and cognitive-behavioral therapy [CBT]; CBT alone; CBT plus a placebo; or a placebo alone.

Cognitive-behavioral therapy [CBT] tries to give people more control over their runaway fears by helping them recognize and stave off impending attacks through breathing exercises, desensitization techniques and other devices.

Participants received treatment once a week for three months. If they showed improvement, their treatment was eased back to once a month over a six-month maintenance period. They then were observed for an additional six months.

Using one psychiatric yardstick, known as the Panic Disorder Severity Scale, both the drug and psychotherapy treatments scored better than no treatment at reducing symptoms of panic disorder during the first phase of the study. However, neither bested the placebo when measured on another yardstick, the Clinical Global Impression Scale.

Among the people who improved during the first three months, both treatments were definitively better on each scale than the placebo during the maintenance stage. And the combination of the two was more effective than either treatment alone.

The researchers note, however, that more participants abandoned imipramine than psychotherapy because of the drug’s unpleasant side effects, which include dry mouth and dizziness.

“Our results demonstrate that both imipramine and cognitive-behavioral therapy [CBT] are better than pill placebo for treatment” of panic disorder, the researchers write in the journal report. “Imipramine produced a superior quality of response, but CBT was more durable and was somewhat better tolerated.”

Dr. Richard Glass, a Chicago psychiatrist and deputy editor of the Journal of the American Medical Association, says the study emphasizes the importance of viewing panic disorder as a treatable, chronic illness. “It hasn’t been as widely known as it should be,” says Glass, who wrote an editorial accompanying the journal article.

Panic attacks, which occur about twice as commonly in women as men, can mimic some of the symptoms of heart attack. As a result, many doctors may overlook the emotional disorder as a cause of chest symptoms and do nothing about it when they find that a patient isn’t having a heart episode, Glass says.

Similarly, many people who have panic attacks are unaware they have a wide range of treatment options, he says.

In addition to imipramine, which has been available for some two decades, newer antidepressants like Zoloft and Paxil also have been approved for treatment of panic disorder. These drugs are as effective as imipramine, Glass says, but have the advantage of not being fatal if taken in overdose amounts.

What To Do

“We know that these treatments work, but we don’t yet know which treatments work best for which people,” says Jerilyn Ross, a Washington, D.C., social worker and president of the Anxiety Disorders Association of America.

Ross, author of Triumph Over Fear (Bantam, 1994), says the worst thing a person with panic disorder can do is neglect it because the condition can lead to depression and substance abuse if unchecked.

Nor should patients who fail one therapy lose hope and think they’ll be luckless with others, she says.