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Maintenance Drug Treatment for Panic Disorder:  II. Short- and Long-term Outcome After Drug Taper

Karl Rickels, MD; Edward Schweizer, MD; Susan Weiss, RN, MEd; Steven Zavodnick, MD
Arch Gen Psychiatry. 1993;50(1):61-68. doi:10.1001/archpsyc.1993.01820130067010.
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• Forty-eight patients with panic disorder completing 8 months of maintenance treatment with alprazolam (mean dose, 5.2 mg [n=27]), imipramine hydrochloride (mean dose, 175 mg [n=11]), or placebo (mean dose, 8.0 pills [n=10]) underwent a gradual taper from medication over a 4-week period. A withdrawal syndrome was observed in almost all alprazolam-treated patients but in only a few imipramine- or placebo-treated patients. The clinical worsening of withdrawal symptoms after discontinuation tended to subside over the course of 3 medication-free weeks, but 33% of alprazolam-treated patients were unable to discontinue their medication regimen successfully. Severity of panic attacks at baseline but not daily alprazolam dose appeared as a significant independent predictor of taper difficulty. Forty-nine percent of the total study population continue to receive drug therapy: 82% alprazolam and 18% imipramine. Among patients who received alprazolam during study treatment and at follow-up, the mean daily dose was substantially reduced (6.1 vs 1.6 mg [n=14]). At follow-up, after 1 year of naturalistic treatment for panic symptoms and combining 8-month completers and study dropouts, there were no significant differences in remission (68% to 71%) or in antipanic medication intake (39% to 56%) at follow-up for the three original treatment groups. However, 8-month study completers compared with study dropouts had a significantly higher remission rate (85% vs 55%).

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