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Drugs and Psychological Treatments for Agoraphobia/Panic and Obsessive–Compulsive Disorders: A Review

Published online by Cambridge University Press:  02 January 2018

Isaac Marks  and
Geraldine O'Sullivan
Geraldine O'Sullivan
Affiliation:
Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Abstract

In the short term, both antidepressants and exposure therapy usually improve agoraphobia/panic (AP) and obsessive–compulsive (OC) disorders and are accepted by most patients; psychological methods omitting exposure are not consistently helpful. Antidepressants have a broad-spectrum rather than specific anti-agoraphobia/panic or anti-obsessive–compulsive action. For long-term efficacy, there is good evidence for the value of exposure, but none for drugs. Because of relapse on ceasing drugs, and their side-effects, medication is less useful as the first line of treatment for chronic agoraphobia/panic or obsessive-compulsive disorder than is the lastingly helpful approach of exposure. Antidepressants are worth trying when patients refuse or fail with exposure therapy, or are dysphoric.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 153 , Issue 5 , November 1988 , pp. 650 - 658
Copyright
Copyright © Royal College of Psychiatrists, 1988 

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References

Agras, W. S., Chapin, N. & Oliveau, D. C. (1972) The natural history of phobia: course and prognosis. Archives of General Psychiatry, 26, 315–317.Google Scholar
Ananth, J., Pecknold, J. C., Van den Steen, N. & Engelsmann, F. (1981) Double-blind study of clomipramine and amitriptyline in obsessive neurosis. Progress in Neuropsychopharmacology, 5, 257–262.CrossRefGoogle ScholarPubMed
Ballenger, J. C., Burrows, G. D. & Dupont, R. L. (1988) Alprazolam in panic disorder and agoraphobia: I. Efficacy in short-term treatment. Archives of General Psychiatry, 45, 413–422.CrossRefGoogle ScholarPubMed
Boulougouris, J. C. (1977) Variables affecting outcome in obsessive–compulsive patients treated by flooding. In Treatment of Phobic and Obsessive–Compulsive Disorders (eds Boulougouris, J. C. & Rabavilas, A. D.), ch. 9, pp. 73–84. Oxford: Pergamon.Google Scholar
Burns, L. E., Thorpe, G. L. & Cavallaro, A. (1986) Agoraphobia 8 years after behavioral treatment. Behaviour Therapy, 17, 580–591.CrossRefGoogle Scholar
Cohen, S. D., Monteiro, W. & Marks, I. M. (1984) Two-year follow-up of agoraphobics after exposure and imipramine. British Journal of Psychiatry, 144, 276–281.Google Scholar
Cottraux, J., Nury, A. M., Mollard, E., Bouvard, M. & Sluys, M. (1988) Fluvoxamine and exposure in OCD (in press).Google Scholar
Dajas, F., Lista, A., Nin, A. et al (1985) Clinical and neurochemical effects of imipramine and diclofensine in panic and phobic disorders. Abstract 129.3 to World Congress of Biological Psychiatry, Philadelphia.Google Scholar
Den Boer, J. A., Westenberg, H. G., Kamerbeek, W. D., Verhoeven, W. M. & Kahn, R. S. (1987) Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. International Clinical Psychopharmacology, 2, 21–32.Google Scholar
Emmelkamp, P. M. G. & Kuipers, A. C. M. (1979) Agoraphobia: a follow-up study 4 years after treatment. British Journal of Psychiatry, 134, 352–355.CrossRefGoogle Scholar
Evans, L., Kenardy, J., Schneider, P. & Hoey, H. (1986) Effect of a selective serotonin uptake inhibitor in agoraphobia with panic attacks: a double-blind comparison of zimeldinc, imipramine and placebo. Acta Psychiatrica Scandinavia, 73, 49–53.Google Scholar
Flament, M. F., Rapoport, J. L., Berg, C. J. et al (1985) Clomipramine treatment of childhood OCD. A double-blind controlled study. Archives of General Psychiatry, 42, 977–983.CrossRefGoogle Scholar
Foa, E. B. & Goldstein, A. (1978) Continuous exposure and complete response prevention in obsessive-compulsive neurosis. Behaviour Therapy, 9, 821–829.CrossRefGoogle Scholar
Geisler, A. & Schou, M. (1969) Lithium treatment for obsessive–compulsive neurosis. Nordisk Psychiatrica, 23, 493–495.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., Delgado, T. L., Heninger, G. R. & Charney, D. S. (1988) Efficacy of fluvoxamine in OCD (in press).Google Scholar
Hafner, R. J. & Marks, I. M. (1976) Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation. Psychological Medicine, 6, 71–88.Google Scholar
Hafner, R. J. & Milton, F. (1977) The influence of propanolol on the exposure in vivo of agoraphobics. Psychological Medicine, 7, 419–425.Google Scholar
Hand, I. (1986) In Panic and Phobias (eds Hand, I. & Wittchen, H. U.). New York: Springer Verlag.Google Scholar
Hesso, R. & Thorell, L. H. (1969) Lithium treatment for obsessive–compulsive neurosis. Nordisk Psychiatrica, 23, 496–499.Google Scholar
Husain, M. Z. (1971) Desensitization and flooding (implosion) in treatment of phobias. American Journal of Psychiatry, 127, 1509–1514.Google Scholar
Insel, T. R., Murphy, D. L., Cohen, R. M., Alterman, I., Kilts, C. & Linnoila, M. (1983a) Clomipramine and clorgyline in OCD. Archives of General Psychiatry, 40, 605–612.Google Scholar
Insel, T. R., Hamilton, J. A., Guttmacher, L. B. & Murphy, D. L. (1983b) d-amphetamine in obsessive–compulsive disorder. Psychopharmacology, 80, 231–235.Google Scholar
Insel, T. R., Mueller, E. A., Alterman, I. et al (1985) Obsessive–compulsive disorder and serotonin: is there a connection? Biological Psychiatry, 20, 1174–1188.Google Scholar
Johnston, D. & Gath, D. (1973) Arousal levels and attribution effects in diazepam-assisted flooding. British Journal of Psychiatry, 122, 463–466.CrossRefGoogle Scholar
Johnston, D. G., Troyer, I. E. & Whitsett, S. F. (1988) Clomipramine treatment of agoraphobic women. Archives of General Psychiatry, 45, 453–459.Google Scholar
Kavikis, Y. & Marks, I. M. (1988) Clomipramine and exposure for OCD. II: 2-year follow-up. Journal of Anxiety Disorders (in press).Google Scholar
Klein, D. F. (1967) Importance of psychiatric diagnosis in prediction of clinical drug effects. Archives of General Psychiatry, 16, 118–126.CrossRefGoogle ScholarPubMed
Klosko, J. S., Barlow, D. H., Tassinari, R. B. & Cerny, J. A. (1988) Alprazolam vs cognitive behavior therapy for panic disorder: a preliminary report. In Panic and Phobias: 2 (eds Hand, I. & Wittchen, H. U.). New York: Springer Verlag.Google Scholar
Lelliott, P. T., Marks, I. M., Monteiro, W. O. et al (1987) Agoraphobics five years after imipramine and exposure: outcome and predictors. Journal of Nervous and Mental Diseases, 175, 599–605.Google Scholar
Lipsedge, M., Hajioff, J., Huggins, P. et al (1973) Iproniazid and systematic desensitization for severe agoraphobia. Psychopharmacologia, 32, 67–80.Google Scholar
Marks, I. M. (1971) Phobic disorders four years after treatment. British Journal of Psychiatry, 118, 683–688.Google Scholar
Marks, I. M. (1981) Cure and Care of Neuroses. New York: Wiley.Google Scholar
Marks, I. M. (1983) Are there anticonvulsive or antiphobic drugs? Review of the evidence. British Journal of Psychiatry, 143, 338–347.Google Scholar
Marks, I. M. (1987) Fears, Phobias and Rituals. New York: Oxford University Press.Google Scholar
Marks, I. M., Basoglu, M., Lelliott, P. et al (1988) Clomipramine and exposure in OCD. A replication. British Journal of Psychiatry (in press).Google Scholar
Marks, I. M., Gray, S., Cohen, D., Hill, R., Mawson, D., Ramm, E. & Stern, R. (1983) Imipramine and brief therapist-aided exposure in agoraphobics having self-exposure homework. Archives of General Psychiatry, 40, 153–162.Google Scholar
Marks, I. M., Hodgson, R. & Rachman, S. (1975) Treatment of chronic OCD 2 years after in vivo exposure. British Journal of Psychiatry, 127, 349–364.CrossRefGoogle Scholar
Marks, I. M., Lelliott, P., Basoglu, M. & Noshirvani, H. (1988) Clomipramine and exposure for compulsive rituals. British Journal of Psychiatry, 152, 522–534.Google Scholar
Marks, I. M., Stern, R. S., Mawson, D., Cobb, J. & McDonald, R. (1980) Clomipramine and exposure for obs–compulsive rituals: I. British Journal of Psychiatry, 136, 1–25.Google Scholar
Mavissakalian, M. R. & Michelson, L. (1983a) Self-directed in vivo exposure practice in behavioral and drug treatments of agoraphobia. Behaviour Therapy, 14, 505–519.Google Scholar
Mavissakalian, M. R. & Michelson, L. (1983b) Tricyclic antidepressants in obsessive-compulsive disorder. Journal of Nervous and Mental Diseases, 171, 301–306.Google Scholar
Mavissakalian, M. R. & Michelson, L. (1986) Two year follow-up of exposure and imipramine treatment of agoraphobia. American Journal of Psychiatry, 143, 1106–1112.Google Scholar
Mawson, D., Marks, I. M. & Ramm, E. (1982) Clomipramine and exposure for chronic OC rituals: III. Two-year follow-up. British Journal of Psychiatry, 140, 11–18.Google Scholar
McNair, D. M. & Kahn, R. J. (1981) Imipramine and chlordiazepoxide for agoraphobia. In Anxiety: New Research and Changing Concepts. New York: Raven Press.Google Scholar
McPherson, F. M., Brougham, L. & McLaren, S. (1980) Maintenance of improvement in agoraphobic patients treated by behavioural methods – a four-year follow-up. Behaviour Research and Therapy, 18, 150–152.Google Scholar
Montgomery, S. A. (1980) Clomipramine in obsessional neurosis: a placebo-controlled trial. Pharmacological Medicine, 1, 189–195.Google Scholar
Mountjoy, C. Q., Roth, M., Garside, R. F. & Leitch, I. M. (1977) Phenelzine in anxiety, depression and phobic neurosis. British Journal of Psychiatry, 13, 486–492.Google Scholar
Munby, M. & Johnston, D. W. (1980) Agoraphobia: the long-term follow-up of behavioural treatment. British Journal of Psychiatry, 137, 418–427.CrossRefGoogle ScholarPubMed
Munjack, D. J., Rebal, R., Shaner, R. et al (1985) Imipramine vs propanolol for panic attacks: a pilot study. Comprehensive Psychiatry, 26, 80–89.Google Scholar
Noyes, R., Anderson, D. J., Clancy, J. et al (1984) Diazepam and propanolol in panic disorder and agoraphobia. Archives of General Psychiatry, 41, 287–292.Google Scholar
Pecknold, J. C., McClure, D. J., Appeltauer, L. et al (1982) Does tryptophan potentiate clomipramine for agoraphobics and social phobics. British Journal of Psychiatry, 140, 484–490.Google Scholar
Pecknold, J. C., Swinson, R. P., Kuch, K. & Lewis, C. P. (1988) Alprazolam in panic disorder and agoraphobia: a multicentre trial. III. Discontinuation effects. Archives of General Psychiatry, 45, 429–436.Google Scholar
Perse, T. L., Greist, J. H., Jefferson, J. W., Rosenfeldt, R. & Dar, R. (1988) Fluvoxamine treatment of OCD. American Journal of Psychiatry, 144, 1543–1548.Google Scholar
Petursson, H. & Lader, M. H. (1981) Benzodiazepine dependence. British Journal of Addiction, 76, 133–145.CrossRefGoogle ScholarPubMed
Rapoport, J., Elkins, R. & Mikkelsen, E. (1980) Chlorimipramine in adolescents with obsessive-compulsive disorder. Psychopharmacology Bulletin, 16, 61–63.Google Scholar
Rizley, R., Kahn, R. J., McNair, D. M. & Frankentheler, L. M. (1986) A comparison of alprazolam and imipramine in the treatment of agoraphobia and panic disorder. Psychopharmacology Bulletin, 22, 167–172.Google Scholar
Robertson, J. (1979) A controlled investigation of the treatment of obsessive-compulsive disorders. MD dissertation, Middlesex Hospital, London.Google Scholar
Sheehan, D., Ballenger, J. & Jacobsen, G. (1980) Treatment of endogenous anxiety. Archives of General Psychiatry 37, 51–59.CrossRefGoogle ScholarPubMed
Solyom, C., Heseltine, G. F., McCluse, D. J. et al (1971) Aversion relief and desensitization for phobias. British Journal of Psychiatry, 119, 299–303.CrossRefGoogle ScholarPubMed
Solyom, C., Solyom, C., LaPierre, Y., Pecknold, J. & Morton, L. (1981) Phenelzine and exposure in the treatment of phobias. Biological Psychiatry, 16, 239–247.Google Scholar
Telch, M., Agras, W. S., Taylor, C. B. et al (1985) Imipramine and behavioral treatment for agoraphobia. Behaviour Research and Therapy, 23, 325–335.Google Scholar
Tesar, G. E., Rosenbaum, J. F., Pollack, M. H. et al. (1987) Clomazepam vs alprazolam in panic disorder. Interim data from a double-blind placebo-controlled trial. Journal of Clinical Psychiatry, 48, Suppl., 16–21.Google Scholar
Thorén, P., Åsberg, M., Bertilsson, L. et al (1980) Clomipramine treatment of obsessive–compulsive disorder. II. Archives of General Psychiatry, 37, 1289–1294.CrossRefGoogle ScholarPubMed
Tyrer, P., Candy, J. & Kelly, D. (1973) Phenelzine in phobic anxiety: a controlled trial. Psychopharmacologia, 32, 237–254, and Psychological Medicine, 3, 120–124.Google Scholar
Tyrer, P. & Steinberg, D. (1975) Symptomatic treatment of agoraphobia and social phobias: a follow-up. British Journal of Psychiatry, 127, 163–168.Google Scholar
Ullrich, R., Ullrich, G., Crombach, G. & Peikert, V. (1975) Three flooding procedures for agoraphobia. In Progress in Behaviour Therapy (ed. Brengelmann, J. C.), pp. 59–67. New York: Springer-Verlag.Google Scholar
Volavka, J., Neziroglu, F. & Yaryura-Tobias, J. A. (1985) Clomipramine and imipramine in obsessive–compulsive disorder. Psychiatry Research, 14, 83–91.Google Scholar
Yaryura-tobias, J. A. & Neziroglu, F. A. (1983) Obsessive–compulsive disorders: pathogenesis – diagnosis – treatment. Marcel Dekker AG, Basel.Google Scholar
Yaryura-tobias, J. A., Neziroglu, F. A. & Bergman, L. (1976) Chlorimipramine for obsessive–compulsive neurosis. Current Therapy Research, 20, 541–547.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1980) Treatment of agoraphobia with group exposure in vivo and imipramine. Archives of General Psychiatry, 37, 63–72.Google Scholar
Zitrin, C. M., Klein, D. F., Woerner, M. G. & Ross, D. C. (1983) Treatment of phobias. I. Imipramine and placebo. Archives of General Psychiatry, 40, 125–138.Google Scholar
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