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Original Research

A Controlled, Prospective, 1-Year Trial of Citalopram in the Treatment of Panic Disorder

Ulla M. Lepola, Alan G. Wade, Esa V. Leinonen, Hannu J. Koponen, John Frazer, Ingemar Sjödin, Jukka T. Penttinen, Tommy Pedersen, and Heikki J. Lehto

Published: October 15, 1998

Article Abstract

Background: The objective of this study was to evaluate the efficacy andtolerability of citalopram in the long-term treatment of adult outpatients with panicdisorder with or without agoraphobia.

Method: Patients in this double-blind, parallel-group trial were assignedto 1 of 3 fixed dosage ranges of citalopram (10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60mg/day), 1 dosage range of clomipramine (60 or 90 mg/day), or placebo. After the completed8-week acute treatment period, the eligible patients could continue the treatment for upto 1 year. Of the 475 patients who were randomly assigned for the short-term trial, 279agreed to continue double-blind treatment at their assigned doses. The primary efficacymeasure used was the Clinical Anxiety Scale panic attack item, and the response wasdefined as no panic attacks (score of 0 or 1). The other key measures used were thePhysician’s Global Improvement Scale, the Patient’s Global Improvement Scale, and theHamilton Rating Scale for Anxiety (HAM-A).

Results: In all drug-treated groups, except the group receiving thelowest citalopram dose, the treatment outcome was generally better than with placebo. Asdetermined by a life table analysis of response, the probability of response during the 12months was significantly greater with all treatment regimens than with placebo (p <.05), with citalopram 20 or 30 mg/day demonstrating the best response. Panic attackstended 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 groupsremaining in the study (perhaps the best measure of long-term efficacy) also demonstratedthat the patients treated with citalopram in dosage ranges of 20 or 30 mg/day and 40 or 60mg/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 treatedwith active drug showed greater improvement than placebo-treated patients. All treatmentgroups showed no new or exceptional adverse event clusters.

Conclusion: Citalopram in the dosage range of 20 to 60 mg/day iseffective, well tolerated, and safe in the long-term treatment of patients who have panicdisorder.

Volume: 59

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