title: Clomipramine treatment of panic disorder: pros and cons.
abstract: BACKGROUND
  Controlled trials suggest that clomipramine may be a highly effective antipanic drug. Lowering the starting dose may alleviate troublesome initial side effects and increase acceptability and compliance.
  
  
  METHODS
  Fifty-eight patients with DSM-III-R panic disorder with or without agoraphobia underwent 13 weeks of clomipramine treatment. Starting at 10 mg/day, the dose was gradually increased to a mean dose of 97 mg/day.
  
  
  RESULTS
  While completers showed highly significant improvement, the benefits were severely limited by a high dropout rate due to adverse reactions occurring mostly during the first 2 weeks of treatment.
  
  
  CONCLUSIONS
  Given the alternatives, clomipramine should not be used as a first-line antipanic medication.
authors.affiliation: New York State Psychiatric Institute, NY 10032, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Papp
authors.forename: F R
authors.initials: FR
authors.lastname: Schneier
authors.forename: A J
authors.initials: AJ
authors.lastname: Fyer
authors.forename: M R
authors.initials: MR
authors.lastname: Leibowitz
authors.forename: J M
authors.initials: JM
authors.lastname: Gorman
authors.forename: J D
authors.initials: JD
authors.lastname: Coplan
authors.forename: R
authors.initials: R
authors.lastname: Campeas
authors.forename: B A
authors.initials: BA
authors.lastname: Fallon
authors.forename: D F
authors.initials: DF
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000188:drug therapy / Q000453:epidemiology; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D002997:Clomipramine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010352:Patient Dropouts; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine