Brief dynamic therapy combined with pharmacotherapy in the treatment of panic disorder with concurrent depressive symptoms.

Abstract: Objective: until now no studies have compared brief dynamic therapy (BDT) to other types of psychological approach in combination with SSRIs pharmacotherapy in the treatment of panic disorder with depressive symptomatology, while a number of recent investigations have demonstrated the efficacy of supplemental BDT among patients with depressive disorders. The objective of the present study was to compare the efficacy of BDT and brief supportive therapy (BSP) in the combined treatment of panic disorder with concurrent depressive symptoms. Method: a 12-month randomized clinical trial compared standard selective serotonin reuptake inhibitors treatment with supplemental BDT (n = 16) or BSP (n = 19) in patients with panic disorder and concurrent depressive symptoms. BDT and BSP were added during the first 16-week trial; all patients continued to be treated with pharmacotherapy alone in the following continuation phase. The primary efficacy assessments were the Hamilton Rating Scale for Anxiety and the 17-item Hamilton Rating scale for Depression; the secondary efficacy measure was the Clinical Global Impression Severity scale. The data analysis was conducted on the ‘intent to treat’ (ITT) efficacy patient sample. Results: 35 patients completed the study. Although at the end of the combined therapies no differences emerged between the two treatment approaches, the group of patients treated with supplemental BDT showed a further clinical improvement at the end of the study: a significant intergroup difference emerged in terms of reduction of symptoms on the HAM-A (F = 4.418; p = 0.045) and HAM-D (F = 1.108; p = 0.037) mean scores. The difference in response rates on the HAM-A and HAM-D is statistically significant favouring BDT. Conclusions: BDT combined with antidepressants is effective and preferable to supportive psychotherapy combined with medication in the treatment of patients affected by panic disorder with concurrent depressive symptoms.