This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Isaac M. Marks, MD; Sue Gray; Daryl Cohen, MB; Robert Hill, MB; David Mawson, MD; Elizabeth Ramm, RMN; Richard S. Stern, MD

Arch Gen Psychiatry. 1983;40(2):153-162.

Abstract
• Forty-five chronic agoraphobics were randomly assigned to treatment by placebo or imipramine in doses up to 200 mg/ day for 28 weeks. All patients also had systematic selfexposure homework with an instruction manual. In addition, half of each drug group had therapist-aided exposure and half had therapist-aided relaxation, each totaling three hours. Patients in both drug groups improved substantially and maintained their gains for one year of follow-up. Imipramine had no significant therapeutic effect despite satisfactory plasma levels and significant drug side effects. Patients' low initial Hamilton depression scores might explain the absence of any drug effect. Antidepressants may be ineffective for agoraphobics who have normal mood. Brief therapist-aided exposure improved phobias and panics to a significant but limited extent, and is a useful adjuvant to self-exposure homework, which can be a powerful therapeutic agency by itself.

Author Affiliations
From the Institute of Psychiatry, London. Drs Hill and Stern are now with St George's Hospital, London.

Footnotes
Accepted for publication March 12, 1982.

Reprint requests to Institute of Psychiatry, Maudsley Hospital, Denmark Hill, London SE5 8AF, England.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Psychotherapy Plus Antidepressant for Panic Disorder With or Without Agoraphobia: Systematic Review
Furukawa et al.
Focus 2008;6:528-538.
ABSTRACT | FULL TEXT  

Psychotherapy plus antidepressant for panic disorder with or without agoraphobia: Systematic review
FURUKAWA et al.
Br. J. Psychiatry 2006;188:305-312.
ABSTRACT | FULL TEXT  

Behavioral Interventions for Recent Trauma: Empirically Informed Practice Guidelines
Gray and Litz
Behav Modif 2005;29:189-215.
ABSTRACT  

A dose-finding and discontinuation study of clomipramine in panic disorder
Lotufo-Neto et al.
J Psychopharmacol 2001;15:13-17.
ABSTRACT  

Flawed Meta-Analyses Comparing Psychotherapy With Pharmacotherapy
Klein
Am. J. Psychiatry 2000;157:1204-1211.
ABSTRACT | FULL TEXT  

Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder: A Randomized Controlled Trial
Barlow et al.
JAMA 2000;283:2529-2536.
ABSTRACT | FULL TEXT  

Double-blindness Procedures, Rater Blindness, and Ratings of Outcome: Observations From a Controlled Trial
Basoglu et al.
Arch Gen Psychiatry 1997;54:744-748.
ABSTRACT  

The effectiveness of cognitive-behavior therapy for panic disorder without concurrent medication treatment: a reply to Power and Sharp
Otto et al.
J Psychopharmacol 1996;10:254-256.
 

Clomipramine, a better reference drug for panic/agoraphobia. I. Effectiveness comparison with imipramine
Gentil et al.
J Psychopharmacol 1993;7:316-324.
ABSTRACT  

Maintenance Drug Treatment of Panic Disorder: I. Results of a Prospective, Placebo-Controlled Comparison of Alprazolam and Imipramine
Schweizer et al.
Arch Gen Psychiatry 1993;50:51-60.
ABSTRACT  

Caudate Glucose Metabolic Rate Changes With Both Drug and Behavior Therapy for Obsessive-Compulsive Disorder
Baxter et al.
Arch Gen Psychiatry 1992;49:681-689.
ABSTRACT  

Imipramine in panic disorder. 1. Clinical response and pharmacological changes
Nutt and Glue
J Psychopharmacol 1991;5:56-64.
ABSTRACT  

Imipramine Dose-Response Relationship in Panic Disorder With Agoraphobia: Preliminary Findings
Mavissakalian and Perel
Arch Gen Psychiatry 1989;46:127-131.
ABSTRACT  

Overview of the Cross-National Collaborative Panic Study: I. Efficacy in Short-term Treatment
Klerman
Arch Gen Psychiatry 1988;45:407-412.
ABSTRACT  

Alprazolam in Panic Disorder and Agoraphobia: Results From a Multicenter Trial: I. Efficacy in Short-term Treatment
Ballenger et al.
Arch Gen Psychiatry 1988;45:413-422.
ABSTRACT  

Clomipramine Treatment of Agoraphobic Women: An Eight-Week Controlled Trial
Johnston et al.
Arch Gen Psychiatry 1988;45:453-459.
ABSTRACT  

The Cause and Treatment of Agoraphobia
Lelliott and Marks
Arch Gen Psychiatry 1988;45:388-389.
ABSTRACT  

The Cause and Treatment of Agoraphobia-Reply
Klein
Arch Gen Psychiatry 1988;45:389-392.
ABSTRACT  

Panic and Avoidance in Agoraphobia: Application of Path Analysis to Treatment Studies
Klein et al.
Arch Gen Psychiatry 1987;44:377-385.
ABSTRACT  

Agoraphobia, panic disorder and related conditions in the DSM-IIIR and ICD-10
Marks
J Psychopharmacol 1987;1:6-12.
 

Social Phobia: Review of a Neglected Anxiety Disorder
Liebowitz et al.
Arch Gen Psychiatry 1985;42:729-736.
ABSTRACT  

Noradrenergic Function and the Mechanism of Action of Antianxiety Treatment: II. The Effect of Long-term Imipramine Treatment
Charney and Heninger
Arch Gen Psychiatry 1985;42:473-481.
ABSTRACT  

The Anxiety Disorders
BROWN et al.
ANN INTERN MED 1984;100:558-564.
ABSTRACT