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Imipramine and Brief Therapist-Aided Exposure in Agoraphobics Having Self-exposure Homework

Isaac M. Marks, MD; Sue Gray; Daryl Cohen, MB; Robert Hill, MB; David Mawson, MD; Elizabeth Ramm, RMN; Richard S. Stern, MD
Arch Gen Psychiatry. 1983;40(2):153-162. doi:10.1001/archpsyc.1983.01790020047004.
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• Forty-five chronic agoraphobics were randomly assigned to treatment by placebo or imipramine in doses up to 200 mg/ day for 28 weeks. All patients also had systematic selfexposure homework with an instruction manual. In addition, half of each drug group had therapist-aided exposure and half had therapist-aided relaxation, each totaling three hours. Patients in both drug groups improved substantially and maintained their gains for one year of follow-up. Imipramine had no significant therapeutic effect despite satisfactory plasma levels and significant drug side effects. Patients' low initial Hamilton depression scores might explain the absence of any drug effect. Antidepressants may be ineffective for agoraphobics who have normal mood. Brief therapist-aided exposure improved phobias and panics to a significant but limited extent, and is a useful adjuvant to self-exposure homework, which can be a powerful therapeutic agency by itself.

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