Psychotherapy plus antidepressant for panic disorder with or without agoraphobia - Systematic review

Background Panic disorder can be treated with psychotherapy, pharmacotherapy or a combination of both. Aims To summarise the evidence concerning the short- and long-term benefits and adverse effects of a combination of psychotherapy and antidepressant treatment. Method Meta-analyses and meta-regressions were undertaken using data from all relevant randomised controlled trials identified by a comprehensive literature search. The primary outcome was relative risk (RR) of response. Results We identified 23 randomised comparisons (21 trials involving a total of 1709 patients). In the acute-phase treatment, the combined therapy was superior to antidepressant pharmacotherapy (RR=1.24,95% Cl 1.02-1.52) or psychotherapy (RR=1.16,95% Cl 1.03-1.30). After termination of the acute-phase treatment, the combined therapy was more effective than pharmacotherapy alone (RR=1.61,95% Cl 1.23-2.11) and was as effective as psychotherapy (RR=0.96, 95% Cl 0.79-1.16). Conclusions Either combined therapy or psychotherapy alone may be chosen as first-line treatment for panic disorder with or without agoraphobia, depending on the patient's preferences. Declaration of interest T.A.F. has received research grants and fees for speaking from several pharmaceutical companies. These companies did not provide funding for the current study (see Acknowledgements).