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% CI1.02-1.52) or psychotherapy (RR=1.16,95% CI1.03-1.30). After termination of the acute-phase treatment, the combined therapy was more effective than pharmacotherapy alone (RR=1.61,95% CI1.23-2.11) and was as effective as psychotherapy (RR=0.96, 95% CI 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.