Clomipramine treatment of panic disorder: pros and cons.
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.
Papp
L A
LA
New York State Psychiatric Institute, NY 10032, USA.
Schneier
F R
FR
Fyer
A J
AJ
Leibowitz
M R
MR
Gorman
J M
JM
Coplan
J D
JD
Campeas
R
R
Fallon
B A
BA
Klein
D F
DF
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
D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine