Sertraline Versus Imipramine Treatment of Comorbid Panic Disorder and Major Depressive Disorder
J Clin Psychiatry 2003;64:654-662
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To evaluate the efficacy and
tolerability of sertraline and imipramine in patients with
comorbid panic disorder and major depressive disorder.
Method: Outpatients meeting a DSM-IV diagnosis
of panic disorder and concurrent major depressive disorder were
randomized in a 2:1 ratio to 26 weeks of double-blind treatment
with either sertraline, in daily doses of 50 to 100 mg, or
imipramine, in daily doses of 100 to 200 mg. Primary outcome
measures were panic attack frequency (derived from patient
diaries) and the Montgomery-Asberg Depression Rating Scale
Results: 138 patients were treated with
sertraline (76% female; mean age = 40 years) and 69 with
imipramine (70% female; mean age = 40 years). The symptoms of
both major depressive disorder and panic disorder responded
significantly and equivalently to both drugs. Endpoint
improvement with sertraline versus imipramine, respectively, on
the MADRS was 11.1 ± 10.8 versus 11.2 ± 10.4, and on the
Clinical Global Impressions-Improvement scale (CGI-I) was 2.1 ±
1.3 versus 2.4 ± 1.6. Among study completers, CGI-I responder
rates were 88% with sertraline and 91% with imipramine. Treatment
outcome was concordant for both diagnoses in approximately 70% of
patients and discordant in approximately 30%. Overall, sertraline
was significantly better tolerated with significantly fewer
discontinuations due to adverse events (11% vs. 22%; chi2 = 4.39, df = 1, p = .04).
Conclusion: Both sertraline and imipramine were
found to be highly effective treatments for both major depressive
disorder and panic disorder, with sertraline showing
significantly greater tolerability and compliance during
long-term treatment than imipramine.