University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
J Affect Disord. 2013 Sep 5;150(2):313-9. doi: 10.1016/j.jad.2013.04.012. Epub 2013 May 12.
Existing literature on panic disorder (PD) yields no data regarding the differential rates of improvement during Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitor (SSRI) or both combined (CBT+SSRI).
Patients were randomized to CBT, SSRI or CBT+SSRI which each lasted one year including three months of medication taper. Participating patients kept record of the frequency of panic attacks throughout the full year of treatment. Rate of improvement on panic frequency and the relationship between rate of improvement and baseline agoraphobia (AG) were examined.
A significant decline in frequency of panic attacks was observed for each treatment modality. SSRI and CBT+SSRI were associated with a significant faster rate of improvement as compared to CBT. Gains were maintained after tapering medication. For patients with moderate or severe AG, CBT+SSRI was associated with a more rapid improvement on panic frequency as compared to patients receiving either mono-treatment.
Frequency of panic attacks was not assessed beyond the full year of treatment. Second, only one process variable was used.
Patients with PD respond well to each treatment as indicated by a significant decline in panic attacks. CBT is associated with a slower rate of improvement as compared to SSRI and CBT+SSRI. Discontinuation of SSRI treatment does not result in a revival of frequency of panic attacks. Our data suggest that for patients without or with only mild AG, SSRI-only will suffice. For patients with moderate or severe AG, the combined CBT+SSRI treatment is recommended.
现有的恐慌障碍（PD）文献没有关于认知行为疗法（CBT）、选择性 5-羟色胺再摄取抑制剂（SSRI）或两者联合治疗（CBT+SSRI）期间改善率差异的数据。
患者被随机分配到 CBT、SSRI 或 CBT+SSRI 组，每组持续一年，包括三个月的药物逐渐减量期。参与的患者记录了整个治疗年中惊恐发作的频率。检查了惊恐频率改善率以及改善率与基线广场恐怖症（AG）之间的关系。
每种治疗方式的惊恐发作频率都显著下降。与 CBT 相比，SSRI 和 CBT+SSRI 与改善率显著加快相关。在减少药物剂量后，仍能保持疗效。对于中度或重度 AG 的患者，与接受单一治疗的患者相比，CBT+SSRI 与惊恐频率更快改善相关。
治疗结束后一年以上，未评估惊恐发作的频率。其次，仅使用了一个过程变量。
PD 患者对每种治疗均有良好反应，表现为惊恐发作显著减少。与 SSRI 和 CBT+SSRI 相比，CBT 与改善率较慢相关。停止 SSRI 治疗不会导致惊恐发作频率的复发。我们的数据表明，对于无或仅有轻度 AG 的患者，SSRI 单药治疗就足够了。对于中度或重度 AG 的患者，建议联合 CBT+SSRI 治疗。
