A Controlled, Prospective, 1-Year Trial of Citalopram in the Treatment of Panic Disorder

Background: The objective of this study was to evaluate the efficacy andtolerability of citalopram in the long-term treatment of adult outpatients with panicdisorder with or without agoraphobia.

Method: Patients in this double-blind, parallel-group trial were assignedto 1 of 3 fixed dosage ranges of citalopram (10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60mg/day), 1 dosage range of clomipramine (60 or 90 mg/day), or placebo. After the completed8-week acute treatment period, the eligible patients could continue the treatment for upto 1 year. Of the 475 patients who were randomly assigned for the short-term trial, 279agreed to continue double-blind treatment at their assigned doses. The primary efficacymeasure used was the Clinical Anxiety Scale panic attack item, and the response wasdefined as no panic attacks (score of 0 or 1). The other key measures used were thePhysician’s Global Improvement Scale, the Patient’s Global Improvement Scale, and theHamilton Rating Scale for Anxiety (HAM-A).

Results: In all drug-treated groups, except the group receiving thelowest citalopram dose, the treatment outcome was generally better than with placebo. Asdetermined by a life table analysis of response, the probability of response during the 12months was significantly greater with all treatment regimens than with placebo (p <.05), with citalopram 20 or 30 mg/day demonstrating the best response. Panic attackstended to disappear in all patients remaining in the study until the end of follow-up.Analysis of the difference in the number of patients in different treatment groupsremaining in the study (perhaps the best measure of long-term efficacy) also demonstratedthat the patients treated with citalopram in dosage ranges of 20 or 30 mg/day and 40 or 60mg/day had better response than placebo-treated patients (p < .0002 and p < .004,respectively). HAM-A and Global Improvement Scale scores also showed that patients treatedwith active drug showed greater improvement than placebo-treated patients. All treatmentgroups showed no new or exceptional adverse event clusters.

Conclusion: Citalopram in the dosage range of 20 to 60 mg/day iseffective, well tolerated, and safe in the long-term treatment of patients who have panicdisorder.