Phobic Anxiety Syndrome Complicated by Drug Dependence and Addiction

The evidence of the efficacy of antidepressants in the treatment of the "phobic anxiety syndrome" is reviewed. This syndrome, characterized by panic attacks, subsequent development of anticipatory dread and consequent emergence of phobias, is seen most often in the patient with evidence of having been a fearful dependent child with a great deal of separation anxiety and the patient with some type of endocrine imbalance. A malignant complication of this synarome is the abuse of sedatives and alcohol. We view this form of drug abuse as an incorrect attempt at self-medication whereas proper psychopharmacologic treatment with imipramine is enormously helpful. The clinical courses of two groups of patients followed from six months to three years are compared. The patients on imipramine did well and did not return to drug or alcohol abuse, but those not maintained on imipramine tended to return to drug abuse, were rehospitalized, and responded poorly to ECT and phenothiazines.