Several studies have documented that a variety of pharmacological compounds are quite effective in controlling acute symptomatology of panic disorder in the general population. However, there is a paucity of such studies in the management of panic disorder in older adults (ages 55 and above). The purpose of this study was to gather pilot data in older patients with panic disorder to begin to assess the efficacy of two commonly-used antipanic medications, imipramine and alprazolam.
Method:
Twenty-five (n = 25 (23 females; 2 males); 18 completers, 7 dropouts) older panic disorder (DSM-III-R) patients (age range = 55–73; mean = 61.24) were studied in an eight-week randomized, parallel-groups, double-blind, placebo-controlled, flexible dose design. Outcome was assessed weekly by global change ratings (Hamilton Anxiety and Depression Scales; Physicians' Global Impression ratings) and panic diaries. Because of small sample size, we present data descriptively.
Results:
Subjects in active medication groups evidenced reductions in panic attacks and in levels of overall anxiety and depression. Therapeutic dosages were approximately half those commonly used in younger panic disorder patients.
Conclusion:
Our data suggest the comparable efficacy of alprazolam and imipramine in the short-term treatment of older adults with panic disorder. There is clearly the need for a larger scale placebo-controlled study, preferably comparing imipramine and/or alprazolam with one of the SSRIs, to substantiate our findings.
BlazerDGeorgeLKHughesD. The epidemiology of anxiety disorders: An age comparison. In: SalzmanCLebowitzBD, editors. Anxiety in the elderly: Treatment and research. New York: Springer Publishing, 1991:17–30.
2.
SheikhJISalzmanC. Anxiety in the elderly: Course and treatment. Psychiatric Clinics of North America1995;18:871–883.
3.
KleinDF. Anxiety reconceptualized. In: KleinDFRabkinJG, editors. Anxiety: New research and changing concepts. New York: Raven Press, 1981:235–263.
4.
LiebowitzMRFyerAJGormanJMDillonDApplebyILLevyGAndersonSLevittMPalijMDaviesSO. Lactate provocation of panic attacks. I: Clinical and behavioral findings. Archives of General Psychiatry1984;41:764–770.
5.
RothM. Anxiety and anxiety disorders-A general overview. In: RothMNoyesRBurrowsGD, editors. Biological, clinical and cultural perspectives. Amsterdam, Netherlands: Elsevier/North Holland Science Publishers; 1988:1–44.
6.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Edition. Washington, DC: American Psychiatric Association, 1994.
7.
KatonWVitilianoPAndersonKJonesMRussoJ. Panic disorder: Residual symptoms after the acute attacks abate. Comprehensive Psychiatry1987;28:151–158.
8.
KushnerMGSherKJBeitmanBD. The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry1990;147:685–695.
9.
WeissmanMMKlermanGLMarkovitzJSOueletteR. Suicidal ideation and suicide attempts in panic disorder and attacks. The New England Journal of Medicine1989;321:1209–1214.
10.
CoryellW. Mortality of anxiety disorders. In: NoyesRJrRothMBurrowsGD, editors. Handbook of anxiety, Vol 2: Classification, etiological factors and associated disturbances. Amsterdam, Netherlands: Elsevier/North Holland Science Publishers, 1988:311–320.
11.
SheikhJIKingRJTaylorCB. Comparative phenomenology of early-onset versus late-onset panic attacks: A pilot survey. American Journal of Psychiatry1991;148;1231–1233.
12.
OehrbergSChristiansenPEBehnkeKBorupALSeverinBSoegaardJCalbergHJudgeROhrstromJKMannichePM. Paroxetine in the treatment of panic disorder: A randomized, double-blind, placebo-controlled study. British Journal of Psychiatry1995;167:374–379.
13.
SchneierFRLeibowitzMRDaviesSOFairbanksJHollanderECampeasRKleinDF. Fluoxetine in panic disorder. Journal of Clinical Psychopharmacology1990;10:119–121.
14.
ZitrinCMKleinDFWoernerMGRossDC. Treatment of phobias. I: Comparison of imipramine hydrochloride and placebo. Archives of General Psychiatry1983;40;125–138.
15.
SheehanDVBallengerJJacobsenG. Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Archives of General Psychiatry1980;37:51–59.
16.
MavissakalianMMichelsonL. Agoraphobia: Relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine. Journal of Clinical Psychiatry1986;47:117–122.
17.
BallengerJCBurrowsGDuPontRIJrLesserIMNoyesRJrPecknoldJCRifkinASwinsonRP. Alprazolam in panic disorder and agoraphobia: Results from a multicenter trial. I: Efficacy in short-term treatment. Archives of General Psychiatry1988;45:413–422.
18.
TesarGERosenbaumJFPollackMHHermanJBSachsGSMahoneyEMCohenLSMcNamaraMGoldsteinS. Clonazepam vs. alprazolam in the treatment of panic disorder: Interim analysis of data from a prospective double-blind, placebo-controlled trial. Journal of Clinical Psychiatry1987;48(suppl 10):16–21.
19.
SteinerMOakesRGergelIP. A fixed-dose study of paroxetine (10 mg, 20 mg, 40 mg) and placebo in the treatment of panic disorder. Presented at the annual American Psychiatric Association Meeting, Miami, Florida, May 1995.
20.
de BeursEvan BalkomAJLangePKoelePvan DyckR. Treatment of panic disorder with agoraphobia: Comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. American Journal of Psychiatry1995;152(5):683–691.
21.
SpitzerRLWilliamsJBGibbonM. Structured clinical interview for DSM-III-R—Patient version (SCID-P, 4/1/87). New York: Biometrics Research Department, New York State Psychiatric Institute, 1987.
22.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research1975;12:189–198.
23.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd Edition, Revised. Washington, DC: American Psychiatric Association, 1987.
24.
HamiltonM. The assessment of anxiety states by rating. British Journal of Medical Psychology1959;32:50–55.
25.
MaierWBullerRPhillipMHeuserI. The Hamilton Anxiety Scale: Reliability, validity, and sensitivity to change in anxiety and depressive disorders. Journal of Affective Disorders1988;14:61–68.
26.
HamiltonM. A rating scale for depression. Journal of Neurology and Neurosurgery and Psychiatry1960;23:56–62.
27.
GuyW: ECDEU assessment manual for psychopharmacology. Washington, DC: Psychopharmacology Research Branch, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, US Department of Health, Education, and Welfare, Public Health Service, 1976.
28.
BallengerJC. Pharmacological treatment of panic disorder. In: den BoerJAAd SitsenJM, editors. Handbook of depression and anxiety: A biological approach. New York: Marcel Dekker, 1994:275–289.
29.
LiebowitzMRFyerAJGormanJMCampeasRBSandbergDPHollanderEPappLAKleinDF. Tricyclic therapy of the DSM-III anxiety disorders: A review with implications for further research. Journal of Psychiatric Research1988;22(suppl 1):7–31.
30.
CoplanJDPineDSPappLAGormanJM. An algorithm-oriented treatment approach for panic disorder. Psychiatric Annals1996;26:192–201.
31.
SheehanDVHarnett-SheehanK. The role of SSRIs in panic disorder. Journal of Clinical Psychiatry1996;57(suppl 10):51–58.
