title: Rate of improvement during and across three treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy, selective serotonin reuptake inhibitor or both combined.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Frequency of panic attacks was not assessed beyond the full year of treatment. Second, only one process variable was used.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. f.j.van.apeldoorn@umcg.nl
authors.forename: Franske J
authors.initials: FJ
authors.lastname: Van Apeldoorn
authors.forename: Wiljo J P J
authors.initials: WJ
authors.lastname: Van Hout
authors.forename: Marieke E
authors.initials: ME
authors.lastname: Timmerman
authors.forename: Peter Paul A
authors.initials: PP
authors.lastname: Mersch
authors.forename: Johan A
authors.initials: JA
authors.lastname: den Boer
mesh_terms: D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Agoraphobia; Cognitive behavioral therapy; Drug treatment; Panic attacks; Panic disorder; Process study; Randomized controlled trials; Rate of improvement