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Phobia Study Criteria-Reply

Isaac Marks, MD, FRCPsych
Arch Gen Psychiatry. 1983;40(10):1150. doi:10.1001/archpsyc.1983.01790090112021.
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In Reply.—  Dr Snaith criticized the studies by Zitrin et al and Marks et al for including patients who in the past had failed to respond to antidepressant drugs. Most chronic agoraphobics have had medication, commonly including antidepressants, at some point in their fluctuating course. The fact that the conditions of such patients may have improved while they were taking the drugs years before and relapsed later does not make the patients unresponsive now, but merely indicates that the problem has recurred or become aggravated.Spontaneous panics were the rule rather than the exception in the patients of Zitrin et al and Marks et al, who thus did not have "secondary phobic disorders" in Snaith's terms. In any case it is dubious whether the distinction between "secondary" and other phobias is valid, unless by secondary he meant without any mood disturbance, including panic, with which I would agree, because results of our

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