A Controlled, Prospective, 1-Year Trial of Citalopram in the Treatment of Panic Disorder
J Clin Psychiatry 1998;59(10):528-534
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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