Posted by SalArmy4me on August 24, 2001, at 7:05:37
In reply to Prozac - does it help for Panic/Anxiety, posted by Margit on August 23, 2001, at 22:18:05
MICHELSON, DAVID. Continuing treatment of panic disorder after acute response: randomised, placebo-controlled trial with fluoxetine. British Journal of Psychiatry. 174(3):213-218, March 1999:
"- Among patients whose panic disorder symptoms respond to 10 weeks of acute treatment with 10 or 20 mg of fluoxetine, additional treatment with fluoxetine is associated with continued benefit compared with placebo for a further 24 weeks.
- For most patients with panic disorder who respond to acute fluoxetine treatment, rapid, full-blown return of illness is less common than a gradual return of symptoms.
- Abrupt discontinuation of fluoxetine in patients with panic disorder who have responded to treatment is well tolerated and not associated with an excess of adverse events or rebound panic attacks compared with patients who continue to take fluoxetine."
Uhlenhuth, E. H. MD *. [S]. Do Antidepressants Selectively Suppress Spontaneous (Unexpected) Panic Attacks? A Replication. Journal of Clinical Psychopharmacology. 20(6):622-627, December 2000:
"These findings potentially have significant implications in several respects. Most investigators now agree that the pathogenesis of panic disorder arises from an interaction between a biological substrate and cognitive processes.17 However, some investigators focus on disturbed biology as the primary source of the disorder, whereas other investigators focus on distorted cognition as the primary pathogenic mechanism. The present results are consistent with the presence of both disordered biology, clinically manifested and identifiable as spontaneous panic attacks, and disordered cognitive processing, two components of the illness that may respond differentially to a biological treatment. Whether the cognitive symptoms evaluated here might right themselves over a longer period of treatment with antidepressants, of course, is not addressed by these short-term studies.
For heuristic purposes, we conceptualized the cognitive aspects of panic disorder as phenomena that are potentially transmissible in families by learning processes. A more refined and complex conceptual formulation would take account of recently emerging evidence indicating that phobic behavior 33-35 and anxious cognitive styles 36 have heritable (biological) underpinnings. Even these new data, however, suggest a major environmental effect in cognitive processes specific to anxiety disorders.
From the practicing clinician's perspective, the results of these reanalyses cast some doubt on the currently accepted view that antidepressants have a similar effect on all aspects of panic disorder with agoraphobia. Our results imply that it is especially patients with frequent spontaneous panic attacks who may stand to benefit from antidepressants. Furthermore, the distinctive dose-responses of the two components of panic disorder imply that an optimal overall response requires the careful titration of dosage with consideration of possible trade-offs among component responses as antidepressant doses are increased. Repeated dose increases in an effort to cope with a partial response may not always be useful. If a selective effect of antidepressants on spontaneous panic attacks is replicated in longer-term studies, this also would support the widespread current practice of adding psychotherapy to medication in the treatment of panic disorder to address the more cognitively determined components..."
Michelson, David MD. Outcome Assessment and Clinical Improvement in Panic Disorder: Evidence From a Randomized Controlled Trial of Fluoxetine and Placebo. American Journal of Psychiatry. 155(11):1570-1577, November 1998:
"The results of this study provide evidence for the efficacy and safety of fluoxetine in the acute and continuation treatment of panic disorder and suggest that panic attack frequency is an incomplete measure of clinical response. Treatment with 10 mg/day of fluoxetine was associated with statistically significantly greater reductions in total number of panic attacks than was placebo, and 20 mg/day of fluoxetine, particularly, was associated with statistically significantly greater improvement than placebo in a range of symptom domains, including anxiety, phobia, and depression. This broad response was reflected in superior improvement scores on the CGI and improvement in disease-associated functional impairment. Both 10-mg/day and 20-mg/day fluoxetine doses were well tolerated and had discontinuation rates similar to that of placebo treatment. Correlations between overall improvement and individual symptoms suggested that for all treatments, change in panic attack frequency was less important than changes in other symptom domains as a determinant of recovery."
poster:SalArmy4me
thread:76185
URL: http://www.dr-bob.org/babble/20010822/msgs/76206.html