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A dose-finding and discontinuation study of clomipramine in panic disorder

Institute of Psychiatry and Departament of Psychiatry, University of São Paulo Medical School, Brazil; Caixa Postal 3671 Departamento de Psiquiatria 01060—970 São Paulo Brazil; franciscolotufo{at}uol.com.br

Márcio Bernik

Renato T. Ramos

Laura Andrade

Institute of Psychiatry, University of São Paulo Medical School, Brazil

Clarice Gorenstein

Institute of Psychiatry and Pharmacology Departament, University of São Paulo, Brazil

Taki Cordás

Márcio Melo

Institute of Psychiatry, University of São Paulo Medical School, Brazil

Valentim Gentil

Institute of Psychiatry and Departament of Psychiatry, University of São Paulo Medical School, Brazil

Eighty-one panic disorder patients with or without agoraphobia were treated with flexible doses of clomipramine under single-blind conditions. Fifty-seven (70.3%) reached operational criteria for full remission in 16.2 ± 6.5 weeks, with a mean dose of 89.1 ± 8.2 mg/day. Fifty-four (81%) of them received a continuous post-remission maintenance treatment at full doses of clomipramine for 4–6 months. No patient relapsed during the clomipramine maintenance phase. Their medication was then tappered and discontinued with placebo substitution under double-blind conditions. Fifty-one (63%) patients were followed-up until relapse or recurrence for up to 3 years, with periodic assessments. Three different outcome groups were identified: the first (n = 19, 19; 37.2%) experienced an early/immediate relapse (5.2 ± 4.9 weeks after drug discontinuation); the second group (n= 22, 22; 43.1%) experienced recurrence after 42.9 ± 35 weeks following discontinuation; and the third group (n = 10, 10; 19.6%) remained assymptomatic and functionally well throughout the follow-up. Predictors of early relapse were: (1) higher baseline score in the Beck Depression Inventory; (2) higher global score on the phobic avoidance scale after the full remission criteria; and (3) the need for higher clomipramine doses to reach full remission. The need for long-term or intermittent maintenance for most patients is emphasized.

Key Words: clomipramine • discontinuation • maintenance treatment • panic disorder • recurrence • relapse • remission

Journal of Psychopharmacology, Vol. 15, No. 1, 13-17 (2001)
DOI: 10.1177/026988110101500103


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