Marks I, O'Sullivan G
Institute of Psychiatry, London.
Br J Psychiatry. 1988 Nov;153:650-8. doi: 10.1192/bjp.153.5.650.
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.
短期内，抗抑郁药和暴露疗法通常都能改善广场恐怖症/惊恐障碍（AP）和强迫症（OC），且大多数患者都能接受；而不包含暴露环节的心理方法效果并不稳定。抗抑郁药具有广谱作用，而非特异性的抗广场恐怖症/惊恐或抗强迫作用。就长期疗效而言，有充分证据表明暴露疗法有价值，但药物治疗则不然。由于停药后会复发以及药物存在副作用，对于慢性广场恐怖症/惊恐障碍或强迫症，药物作为一线治疗手段不如具有持久疗效的暴露疗法有用。当患者拒绝接受暴露疗法或治疗失败，或者情绪烦躁时，抗抑郁药值得一试。
