A Controlled, Prospective, 1-Year Trial of Citalopram in the Treatment of Panic Disorder
J Clin Psychiatry 1998;59(10):528-534
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Background: The objective of this study was to evaluate the efficacy and
tolerability of citalopram in the long-term treatment of adult outpatients with panic
disorder with or without agoraphobia.
Method: Patients in this double-blind, parallel-group trial were assigned
to 1 of 3 fixed dosage ranges of citalopram (10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60
mg/day), 1 dosage range of clomipramine (60 or 90 mg/day), or placebo. After the completed
8-week acute treatment period, the eligible patients could continue the treatment for up
to 1 year. Of the 475 patients who were randomly assigned for the short-term trial, 279
agreed to continue double-blind treatment at their assigned doses. The primary efficacy
measure used was the Clinical Anxiety Scale panic attack item, and the response was
defined as no panic attacks (score of 0 or 1). The other key measures used were the
Physician's Global Improvement Scale, the Patient's Global Improvement Scale, and the
Hamilton Rating Scale for Anxiety (HAM-A).
Results: In all drug-treated groups, except the group receiving the
lowest citalopram dose, the treatment outcome was generally better than with placebo. As
determined by a life table analysis of response, the probability of response during the 12
months was significantly greater with all treatment regimens than with placebo (p <
.05), with citalopram 20 or 30 mg/day demonstrating the best response. Panic attacks
tended to disappear in all patients remaining in the study until the end of follow-up.
Analysis of the difference in the number of patients in different treatment groups
remaining in the study (perhaps the best measure of long-term efficacy) also demonstrated
that the patients treated with citalopram in dosage ranges of 20 or 30 mg/day and 40 or 60
mg/day had better response than placebo-treated patients (p < .0002 and p < .004,
respectively). HAM-A and Global Improvement Scale scores also showed that patients treated
with active drug showed greater improvement than placebo-treated patients. All treatment
groups showed no new or exceptional adverse event clusters.
Conclusion: Citalopram in the dosage range of 20 to 60 mg/day is
effective, well tolerated, and safe in the long-term treatment of patients who have panic