0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Drs. Goodwin and Olfson Reply
RENÉE GOODWIN, PH.D.; MARK OLFSON, M.D., M.P.H.
Am J Psychiatry 2002;159:681-682. doi:10.1176/appi.ajp.159.4.681-b

To the Editor: We were interested to learn from Drs. Ruini and Fava that a low prevalence of major depression has been found in a clinical study group of patients with panic disorder who were treated with cognitive behavior therapy. This observation is consistent with the association we reported of a lower incidence of major depression among individuals in an epidemiologic sample who received some form of treatment for panic. We are less impressed, however, with evidence linking the treatment of patients with panic disorder with antidepressants to a poorer outcome, specifically in terms of a greater risk of major depression. After a close reading of the literature, we have failed to find strong empirical support for the sensitizing effects of antidepressant medications. At least in the short term, there appears to be evidence that antidepressant medications are associated with a greater, rather than lower, incidence of depression among patients with panic disorder (1).

The work by Fava et al. (2001), suggesting that the combined use of antidepressants and benzodiazepines is associated with a worse prognosis among those with panic disorder, is based on a clinical study group and is open to selection bias. Specifically, patients with more severe or complex psychopathology may be at greater risk of developing comorbid depression and may also be more likely to be prescribed antidepressant medications.

We are in complete agreement with the sentiments expressed by Drs. Ruini and Fava that this is a topic of clinical and public health significance. Research is needed to evaluate the long-term outcome associated with the pharmacological and psychological treatment of broadly representative patient groups with panic disorder.

Michelson D, Lydiard RB, Pollack MH, Tamura RN, Hoog SL, Tepner R, Demitrack MA, Tollefson GD (The Fluoxetine Panic Disorder Study Group): Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. Am J Psychiatry 1998; 155:1570-1571; erratum,  1999; 156:161
 
+

References

Michelson D, Lydiard RB, Pollack MH, Tamura RN, Hoog SL, Tepner R, Demitrack MA, Tollefson GD (The Fluoxetine Panic Disorder Study Group): Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. Am J Psychiatry 1998; 155:1570-1571; erratum,  1999; 156:161
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 12.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 6.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 59.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 38.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 47.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles