A 6-Year Posttreatment Follow-up of Panic Disorder Patients: Treatment With Clonazepam Predicts Lower Recurrence Than Treatment With Paroxetine

• Published in: Journal of clinical psychopharmacology Vol. 37; no. 4; pp. 429 - 434
• Main Authors: Freire, Rafael C, Amrein, Roman, Mochcovitch, Marina D, Dias, Gisele P, Machado, Sergio, Versiani, Marcio, Arias-Carrión, Oscar, Carta, Mauro G, Nardi, Antonio E
• Format: Journal Article
• Language: English
• Published: United States 01-08-2017
• Subjects: Adult; Clonazepam - therapeutic use; Female; Follow-Up Studies; GABA Modulators - therapeutic use; Humans; Male; Middle Aged; Panic Disorder - diagnosis; Panic Disorder - drug therapy; Paroxetine - therapeutic use; Predictive Value of Tests; Prospective Studies; Recurrence; Serotonin Uptake Inhibitors - therapeutic use; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0271-0749; 1533-712X
• DOI: 10.1097/JCP.0000000000000740

The aim of this study was to identify factors associated with relapse in panic disorder (PD).
This was an observational study conducted in the outpatient clinic of a psychiatric hospital in Rio de Janeiro, Brazil. In a previous study, 120 patients diagnosed as having PD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were randomized to receive clonazepam or paroxetine. After 3 years, treatment was discontinued in patients who had achieved remission. These subjects were included in the current study and were followed up for 6 years. The follow-up assessments were made at 1, 2, 3, 5, and 6 years after treatment discontinuation. Assessment included the number of panic attacks per month, Clinical Global Impression-Severity, and other measures. Patients who had initiated psychotherapy or pharmacological treatment because of PD symptoms or who had Clinical Global Impression-Severity scores greater than 1 or panic attacks in the month preceding the assessment were considered relapse cases. Data were collected from January 2003 to August 2012.
Eighty-five patients completed the follow-up. Cumulative relapse rates were 50% (n = 33) at 1 year and 89.4% (n = 76) at 6 years. One-year relapse rates were lower in patients previously treated with clonazepam (P = 0.001) compared with those treated with paroxetine. Low 6-year relapse rates were associated with high Hamilton Anxiety Rating Scale scores before treatment (P = 0.016) and previous treatment with clonazepam.
Relapse is a frequent problem in PD, and long-term treatment does not protect these patients in the long run. Treatment with clonazepam predicts lower relapse when compared with paroxetine.