title: SECOND-STAGE TREATMENTS FOR RELATIVE NONRESPONDERS TO COGNITIVE BEHAVIORAL THERAPY (CBT) FOR PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA-CONTINUED CBT VERSUS SSRI: A RANDOMIZED CONTROLLED TRIAL.
abstract: Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT.
  
  
  
  The current trial is a second-step stratified randomized design comparing two treatment conditions-selective serotonin reuptake inhibitor (SSRI; paroxetine or citalopram; n = 34) and continued CBT (n = 24)-in a sample of individuals classified as treatment nonresponders to an initial course of CBT for panic disorder. Participants were randomized to 3 months of treatment and then followed for an additional 9 months. Only treatment responders after 3 months were maintained on the treatment until 12-month follow-up. Data analysis focused on panic disorder symptoms and achievement of response status across the first 3 months of treatment. Final follow-up data are presented descriptively.
  
  
  
  Participants in the SSRI condition showed significantly lower panic disorder symptoms as compared to continued CBT at 3 months. Results were similar when excluding individuals with comorbid major depression or analyzing the entire intent-to-treat sample. Group differences disappeared during 9-month naturalistic follow-up, although there was significant attrition and use of nonstudy therapies in both arms.
  
  
  
  These data suggest greater improvement in panic disorder symptoms when switching to SSRI after failure to fully respond to an initial course of CBT. Future studies should further investigate relapse following treatment discontinuation for nonresponders who became responders. Clinicaltrials.gov Identifier: NCT00000368; https://clinicaltrials.gov/show/NCT00000368.
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Payne
authors.affiliation: Department of psychological sciences, University of Missouri - St. Louis, St. Louis, Missouri.
authors.forename: Kamila S
authors.initials: KS
authors.lastname: White
authors.affiliation: Department of Psychology, University of Houston, Houston, TX.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gallagher
authors.affiliation: Department of Psychiatry, Yale University, New Haven, Connecticut.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Woods
authors.affiliation: Columbia University School of Social Work, New York, New York.
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
authors.affiliation: Franklin Behavioral Health Consultants, New York, New York.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Gorman
authors.affiliation: Center for Anxiety and Related Disorders at Boston University, Boston, Massachusetts.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Farchione
authors.affiliation: Center for Anxiety and Related Disorders at Boston University, Boston, Massachusetts.
authors.forename: David H
authors.initials: DH
authors.lastname: Barlow
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D015283:Citalopram / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D017374:Paroxetine / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors
keywords: agoraphobia; cognitive behavioral therapy; panic disorder; selective serotonin reuptake inhibitor; treatment failure