Psychotherapy Plus Antidepressant for Panic Disorder With or Without Agoraphobia: Systematic Review

Background: Panic disorder can be treated with psychotherapy, pharmacotherapy or a combination of both. Aims: To summarise the evidence concerning the short- and long-term benefits and adverse effects of a combination of psychotherapy and antidepressant treatment. Method: Meta-analyses and meta-regressions were undertaken using data from all relevant randomised controlled trials identified by a comprehensive literature search. The primary outcome was relative risk (RR) of response. Results: We identified 23 randomised comparisons (21 trials involving a total of 1709 patients). In the acute-phase treatment, the combined therapy was superior to antidepressant pharmacotherapy (RR = 1.24, 95% CI 1.02–1.52) or psychotherapy (RR = 1.16, 95% CI 1.03–1.30). After termination of the acute-phase treatment, the combined therapy was more effective than pharmacotherapy alone (RR = 1.61, 95% CI 1.23–2.11) and was as effective as psychotherapy (RR = 0.96, 95% CI 0.79–1.16). Conclusions: Either combined therapy or psychotherapy alone may be chosen as first-line treatment for panic disorder with or without agoraphobia, depending on the patient's preferences. (Reprinted with permission from British Journal of Psychiatry 2006; 188:305–312)