Behavioral Health Matters - Chronic and Relapsing Patients continued...
[Drug Benefit Trends 12(11):2BH-3BH, 2000. © 2000 Cliggott Publishing Co., Division of SCP/Cliggott Communications, Inc.]

Panic Disorder Katschnig and colleagues[1] reported a 4-year follow-up of 367 patients who participated in the Cross National Collaborative Panic Study of alprazolam and imipramine. At follow-up, 50% of the patients were still taking medication. Patient outcome varied, with 31% recovering and staying well, 50% achieving an intermediate response characterized by recurrent or mild to moderate symptomatology, and 19% experiencing a more severe, chronic course. Noyes and colleagues[2] reported a relapse rate of more than 50%, most in the first 2 months, when attempting discontinuation of a tricyclic medication for panic disorder. Only a quarter of the patients remained in remission for 2 years or longer. The American Psychiatric Association practice guideline for patients on medication for panic disorder recommends a trial of discontinuation after 12 to 18 months, providing that the patient has experienced significant or full improvement. This conclusion is supported, in part, by a study by Mavissakalian and Perel[3] showing that longer-term treatment (18 months versus 6 months) following remission in patients who were treated with antidepressants resulted in a lower rate of relapse after discontinuation. continued...		Section 2 of 4 CONTENTS Introduction Panic Disorder Obsessive-Compulsive Disorder Conclusion References