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Randomised placebo-controlled trial of moclobemide, cognitive–behavioural therapy and their combination in panic disorder with agoraphobia

Published online by Cambridge University Press:  02 January 2018

Bernd Loerch ,
Mechthild Graf-Morgenstern ,
Martin Hautzinger ,
Sabine Schlegel ,
Christoph Hain ,
Juergen Sandmann  and
Otto Benkert
Bernd Loerch*
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
Mechthild Graf-Morgenstern
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
Martin Hautzinger
Affiliation:
Department of Psychology, University of Mainz, Mainz, Germany
Sabine Schlegel
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
Christoph Hain
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
Juergen Sandmann
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
Otto Benkert
Affiliation:
Department of Psychiatry, University of Mainz, Mainz, Germany
*
Bernd Loerch, Department of Psychiatry, University of Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany
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Abstract

Background

In the treatment of panic disorder with agoraphobia, the efficacy of pharmacological, psychological and combined treatments has been established. Unanswered questions concern the relative efficacy of such treatments.

Aims

To demonstrate that moclobemide and cognitive–behavioural therapy (CBT) are effective singly and more effective in combination.

Method

Fifty-five patients were randomly assigned to an eight-week treatment of: moclobemide plus CBT; moclobemide plus clinical management (‘psychological placebo’); placebo plus CBT; or placebo plus clinical management.

Results

Comparisons between treatments revealed strong effects for CBT. Moclobemide with clinical management was not superior to placebo. The combination of moclobemide with CBT did not yield significantly better short-term results than CBT with placebo. The CBT results remained stable during a six-month follow-up, although a substantial proportion of patients treated with placebo plus CBT needed additional treatment.

Conclusions

CBT was highly effective in the treatment of panic disorder with agoraphobia and reduced agoraphobia to levels that were comparable to those of non-clinical controls.

Type
Papers
Information
The British Journal of Psychiatry , Volume 174 , Issue 3 , March 1999 , pp. 205 - 212
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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Footnotes

Declaration of interest

Supported by Hoffmann LaRoche AG.

References

Ballenger, J. C. (1994) Overview of the pharmacotherapy of panic disorder. In Treatment of Panic Disorder. A Consensus Development Conference (eds Wolfe, B. E. & Maser, J. D.), pp. 59–72. Washington, DC: American Psychiatric Press.Google Scholar
Barlow, D. H. (1997) Cognitive–behavioral therapy for panic disorder: current status. Journal of Clinical Psychiatry, 58 (suppl. 2). 32–36.Google ScholarPubMed
Bisserbe, J. C., Lapine, J. P. & the GRP group (1994) Moclobemide in social phobia: a pilot open study. Clinical Neuropharmacology, 17 (suppl. 1), 88–94.CrossRefGoogle ScholarPubMed
Black, D. W., Wasner, R., Bowers, W., et al (1993) A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disorder. Archives of General Psychiatry, 50, 44–50.CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, G. C., Jasin, S. E., et al (1985) Mobility Inventory. Behavior Research and Therapy, 23, 35–44.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., et al (1994) A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759–769.CrossRefGoogle ScholarPubMed
Clum, G. A., Clum, G. A. & Surls, R. (1993) A meta-analysis of treatments for panic disorder. Journal of Consulting and Clinical Psychology, 61, 317–326.CrossRefGoogle ScholarPubMed
Coté, G., Gauthier, J. G., Laberge, B., et al (1994) Reduced therapist contact in the cognitive behavioral treatment of panic disorder. Behavior Therapy, 25, 123–145.CrossRefGoogle Scholar
Cottraux, J., Note, I.-D., Cungi, C., et al (1995) A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia. British Journal of Psychiatry, 167, 635–641.CrossRefGoogle ScholarPubMed
Cox, B. J., Endler, N. A., Lee, P. S., et al (1992) A meta-analysis of treatments for panic disorder with agoraphobia: imipramine, alprazolam, and in vivo exposure. Journal of Behaviour Therapy and Experimental Psychiatry, 23, 175–182.CrossRefGoogle ScholarPubMed
De Beurs, E., Van Dyck, R., van Balkom, A. J. L. M., et al (1994) Assessing the clinical significance of outcome in agoraphobia research: a comparison of two approaches. Behavior Therapy, 25, 147–158.CrossRefGoogle Scholar
Durham, R. C., Murphy, T., Allan, T., et al (1994) Cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder. British Journal of Psychiatry, 165, 315–323.CrossRefGoogle ScholarPubMed
Ehlers, A. & Margraf, J. (1993) Fragebogen zu körperbezogenen Ängsten, Kognitionen und Vermeidung (AKV). Weinheim: Beltz Test.Google Scholar
Elkin, L., Shea, T., Watidins, J. T., et al (1989) National Institute of Mental Health treatment of depression collaborative research program, general effectiveness of treatments. Archives of General Psychiatry, 46, 971–983.CrossRefGoogle ScholarPubMed
Fava, G. A., Zieiezny, M., Savron, G., et al (1995) Long-term effects of behavioural treatment for panic disorder with agoraphobia. British Journal of Psychiatry, 166, 87–92.CrossRefGoogle ScholarPubMed
Gould, R. A., Otto, M. W. & Pollack, M. H. (1995) A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15, 819–844.CrossRefGoogle Scholar
Klosko, J. S., Barlow, D. H., Tassinari, R., et al (1990) A comparison of alprazolam and behavior therapy in treatment of panic disorder. Journal of Consulting Clinical Psychology, 58, 77–84.CrossRefGoogle ScholarPubMed
Marks, I. M. & Mathews, A. M. (1979) Brief standard serf-rating for phobic patients. Behaviour Research and Therapy, 17, 263–267.CrossRefGoogle Scholar
Marks, I. M., Gray, S., Cohen, D., et al (1983) Imipramine and brief therapist-aided exposure in agoraphobics having serf-exposure homework. Archives of General Psychiatry, 40, 153–162.CrossRefGoogle ScholarPubMed
Marks, I. M., Swinson, R. P., Basoglu, M., et al (1993) Alprazolam and exposure alone and combined in panic disorder with agoraphobia: a controlled study in London and Toronto. British Journal of Psychiatry, 162, 776–787.CrossRefGoogle ScholarPubMed
Marubini, E. & Valsecchi, M. G. (1995) Analysing Survival Data from Clinical Trials and Observational Studies. Chichester: Wiley.Google Scholar
Mattick, R. P., Andrews, G., Hadzi-Pavlovic, D., et al (1990) Treatment of panic and agoraphobia: an integrative review. Journal of Nervous and Mental Disease, 178, 567–576.CrossRefGoogle ScholarPubMed
Mavissakalian, M. (1993) Combined behavioral therapy and pharmacotherapy of agoraphobia. Journal of Psychiatric Research, 27 (suppl. 1), 179–191.CrossRefGoogle ScholarPubMed
Mavissakalian, M. & Michelson, L. (1983) Self-directed in vivo exposure practice in behavioral and pharmacological treatment of agoraphobia. Behovior Therapy, 14, 506–519.CrossRefGoogle Scholar
Mavissakalian, M. & Michelson, L. (1986) Agoraphobia: relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine. Journal of Clinical Psychiatry, 47, 117–122.Google ScholarPubMed
Micheson, L. K. & Marchione, K. (1991) Behavioral, cognitive and pharmacological treatments of panic disorder with agoraphobia: critique and synthesis. Journal of Consulting and Clinical Psychology, 59, 100–114.CrossRefGoogle Scholar
National Institute of Mental Health (1976) CGI, Clinical Global Impressions. In Manual for the EDCEU Assessment Battery 2 (revised edition) (eds Guy, W. & Bonato, R. R.), pp. 12-1–12-6. Maryland: Chevy Chase.Google Scholar
Oehrberg, S., Christiansen, P. E., Behnke, K., et al (1995) Paroxetine in the treatment of panic disorder: a randomised, double-blind, placebo-controlled study. British Journal of Psychiatry, 167, 374–379.CrossRefGoogle ScholarPubMed
Priest, R. G., Gimbrett, R., Roberts, M., et al (1995) Reversible and selective inhibitors of monoamine oxidase A in mental and other disorders Acta Psychiatrica Scandinavica, 386 (suppl.), 40–43.CrossRefGoogle ScholarPubMed
Sheehan, D. V. (1986) The Anxiety Disease (revised edition). New York: Bantam Books.Google Scholar
Sheehan, D. V., Ballenger, J. & Jacobson, G. (1969) Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Archives of General Psychiatry, 37, 51–59.CrossRefGoogle Scholar
Solyom, L., Hesekine, G. F., McClure, P. J., et al (1973) Behavior therapy versus drug therapy in the treatment of panic neurosis. Canadian Psychiatric Association Journal, 18, 25–31.CrossRefGoogle Scholar
Spitzer, R. L., Williams, J. B., Gibbon, M., et al (1990) Structured Clinical Interview for DSM–III–R. Patient version (SCID-P. 1.0). Washington. DC: American Psychiatric Press.Google Scholar
Telch, M. J., Agras, W. S., Tsylor, C. B., et al (1985) Combined pharmacological and behavioral treatment for agoraphobia. Behaviour Research and Therapy, 21 325–335.CrossRefGoogle Scholar
Telch, M. J. & Lucas, R. A. (1994) Combined pharmacological and psychological treatment of panic disorder: current status and future directions. In Treatment of Panic Disorder. A Consensus Development Conference (eds Wolfe, B. E. & Maser, J. D.) pp. 177–197. Washington. DC: American Psychiatric Press.Google Scholar
Tiller, J. (1994) Moclobemide for anxiety disorders: a focus on moclobemide in panic disorder. European Neuropsychopharmocology, 6 (suppl. 3). 150.CrossRefGoogle Scholar
Van Balkom, A. J. L. M., Bakker, A., Spinhoven, P., et al (1997) A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioural and combination treatments. Journal of Nervous and Mental Disease, 185, 510–516.CrossRefGoogle ScholarPubMed
Wilkinson, G., Balestrieri, M., Ruggeri, M., et al (1991) Meta-analysis of double-blind placebo-controlled trials of antidepressants and benzodiazepines for patients with panic disorders. Psychological Medicine, 21, 991–998.CrossRefGoogle ScholarPubMed
Versiani, M., Nardi, A. E., Mundim, F. D., et al (1992) Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. British Journal of Psychiatry, 161, 353–360.CrossRefGoogle ScholarPubMed
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1978) Behavior therapy, supportive psychotherapy, imipramine and phobias. Archives of General Psychiatry 35, 307–316.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Zitrin, C. M., Klein, D. F. & Woerner, M. G., et al (1983) Treatment of phobias: comparison of imipramine hydrochloride and placebo. Archives of General Psychiatry, 49, 125–133.CrossRefGoogle Scholar
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