Drug-Free Therapy Gives Patients Reprieve From Panic Disorder

The secret may lie in cognitive behavior therapy (CBT) - a psychological-based treatment the subjects received after halting their prescribed medication. CBT helps patients understand the nature of panic disorder and also helps them to change their reactions toward anxiety-provoking situations.

Researchers evaluated patients with panic disorder immediately after a 12-week course of CBT treatment and again six months later. One group of patients stopped taking antidepressants during the therapy, while the other group continued with their prescribed medication.

"Most of the patients who stopped taking their medications while undergoing CBT experienced no immediate or long-term problems," said Brad Schmidt, a study co-author and an associate professor of psychology at Ohio State University.

The study appears in a recent issue of Behaviour Research and Therapy.

Panic disorder - an unexplained sudden and intense onset of fear and anxiety - affects 6 to 14 million adults in the United States.

About half of the patients with panic disorder that come to Schmidt's clinic are on medication. But antidepressants have a slew of side effects, ranging from sexual problems to cardiovascular complications.

Although Schmidt looked only at antidepressants in this study, doctors also frequently prescribe benzodiazepines to their patients who have panic disorder. Benzodiazepines, such as Valium, are effective in controlling symptoms of anxiety.

"Patients are often told that they'll need to take medication indefinitely to control panic disorder," Schmidt said. "But that's not true for every patient - some people respond well with therapy and can forgo medications."

Nineteen people taking antidepressants to control panic disorder completed 12 weekly CBT treatments. Patients were put into two groups - one group (11 patients) stopped taking their medication by the eighth session, while the other group (eight patients) stayed on the prescribed drugs throughout the treatment.

CBT typically includes 10 to 15 sessions of treatments that help people change the thoughts and behaviors that lead to anxiety. It also helps them identify the particular sensations that they associate with fear - sensations such as a rapid heartbeat, paralyzing terror and dizziness. The patients learn how to respond to fear in order to minimize or eliminate symptoms. While treatments usually consist of one-on-one sessions with an occasional group session, the subjects in the current study were treated in groups of three to five individuals.

Each patient in the study was asked to fill out a self-evaluation before the first treatment session, immediately after the last session and again six months later. The evaluation rated individual feelings of panic and anxiety, any disability in function that the patient believed had been caused by the disorder, and the patient's level of depression.

The results were the same immediately following treatment and at the six-month follow-up: about 80 percent of patients who stopped taking antidepressants and 75 percent of patients who stayed on the medication were free from panic attacks and serious bouts of anxiety.

Schmidt advises people who want to stop taking antidepressants for panic disorder to seek out CBT first.

"There is a high relapse rate among people who try to quit on their own, often because they haven't learned the behavior skills necessary to discontinue taking the drugs," he said.

The prognosis is good for people who want to try CBT, Schmidt said.

"Patients are more likely to complete a trial of behavior therapy than they are to finish a medication regimen," he said. "Of those that do undergo CBT, a large percent function very well.

"In terms of good outcomes, there doesn't seem to be a difference between people taking an antidepressant to control panic disorder vs. those who choose CBT," he said. "With the latter, a lot of people can get results in a very short amount of time."

Schmidt conducted the research with graduate assistant Kelly Woolaway-Bickel and assistant professor Michael Vasey, both with the Department of Psychology at Ohio State; John Trakowski of the Walter Reed Army Medical Center in Washington, D.C.; and Helen Santiago, of the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md.

Grants from the USUHS and the Ohio Department of Mental Health supported this research.