Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study
L. M. Nagy, J. H. Krystal, S. W. Woods and D. S. Charney
Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, Conn.
Sixty patients with agoraphobia with panic attacks or panic disorder who
completed a 4-month combined drug and behavioral group treatment program
and were discharged on a regimen of alprazolam were interviewed 1.7 to 4
years (mean, 2.5 years) after discharge. At follow-up (FU), 18 (30%) of the
patients had discontinued alprazolam treatment, 36 (60%) continued with a
lower dose, 3 (5%) received the same dose, and 3 (5%) received an increased
dose compared with discharge. A lower frequency of panic attacks at
admission was associated with an increased ability to discontinue
alprazolam treatment. There was little evidence of tolerance to the
antipanic effects of alprazolam. Panic attack frequency dropped from a mean
of 4.4 attacks per week at admission to 1.2 attacks per week at discharge
and remained decreased at 1.6 attacks per week at FU. Treatment gains in
the program were maintained or enhanced on 11 of 14 behavioral measures at
FU and were similar in the groups that were receiving and not receiving
alprazolam. Patients receiving nonpharmacologic therapy in the FU period
tended to have greater symptom severity, possibly due to self-selection. A
lifetime diagnosis of major depression at admission was associated with
higher levels of depressive and anxiety symptoms and higher alprazolam
doses at FU. Episodes of major depression were common in the FU period and
did not appear to be prevented by initial alprazolam and behavioral therapy
or by low-dose alprazolam maintenance.(ABSTRACT TRUNCATED AT 250 WORDS)
