Intervention Review

Combined psychotherapy plus benzodiazepines for panic disorder

  1. Norio Watanabe1,*,
  2. Rachel Churchill2,
  3. Toshi A Furukawa1

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 10 NOV 2004

DOI: 10.1002/14651858.CD005335.pub2


How to Cite

Watanabe N, Churchill R, Furukawa TA. Combined psychotherapy plus benzodiazepines for panic disorder. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005335. DOI: 10.1002/14651858.CD005335.pub2.

Author Information

  1. 1

    Nagoya City University Graduate School of Medical Sciences, Department of Psychiatry & Cognitive-Behavioral Medicine, Nagoya, Aichi, Japan

  2. 2

    University of Bristol, Academic Unit of Psychiatry, Community Based Medicine, Bristol, Avon, UK

*Norio Watanabe, Department of Psychiatry & Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan. noriow@med.nagoya-cu.ac.jp.

Publication History

  1. Publication Status: New
  2. Published Online: 21 JAN 2009

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The efficacy of combining psychotherapy and benzodiazepines for panic disorder is unclear, despite widespread use.

Objectives

To examine the efficacy of the combination compared with either treatment alone.

Search methods

Randomised trials comparing the combination of psychotherapy and benzodiazepine with either therapy alone for panic disorder were identified. The Cochrane Depression, Anxiety and Neurosis Group Studies and References Registers were searched. References of relevant trials and other reviews were checked. Experts in the field were contacted. Additional unpublished data were sought from authors of the original trials.

Selection criteria

Two authors independently checked the records retrieved by the searches to identify randomised trials comparing the combined therapy versus either of the monotherapies, among adults with panic disorder.

Data collection and analysis

Two authors independently checked eligibility, assessed quality and extracted data from the eligible trials using a standardised data extraction form. The primary outcome was "response" based on global judgement. Random-effects meta-analyses were conducted, combining data from included trials.

Main results

Three trials met eligibility criteria. A 16-week behaviour therapy intervention was used in two trials, and a 12-week cognitive-behaviour therapy intervention in the third. Duration of follow-up varied, ranging from 0 to 12 months.
Two trials (total 166 participants) provided data comparing combination with psychotherapy alone (both using behaviour therapy). No statistically significant differences were observed in response during the intervention (relative risk (RR) for combination 1.25, 95% CI 0.78 to 2.03, P = 0.35), at the end of the intervention (RR 0.78, 0.45 to 1.35, P = 0.37), or at the last follow-up time point, although the follow-up data suggested that the combination might be inferior to behaviour therapy alone (RR 0.62, 0.36 to 1.07, P = 0.08).
One trial (77 participants) compared combination with a benzodiazepine alone. No differences were found in response during the intervention (RR 1.57, 0.83 to 2.98, P = 0.17). Although the combination appeared to be superior to the benzodiazepine alone at the end of treatment (RR 3.39, 1.03 to 11.21, P = 0.05) the finding was only borderline statistically significant, and no significant differences were observed at the 7-month follow-up (RR 2.31, 0.79 to 6.74, P = 0.12).

Authors' conclusions

The review established the paucity of high quality evidence investigating the efficacy of psychotherapy combined with benzodiazepines for panic disorder. Currently, there is inadequate evidence to assess the clinical effects of psychotherapy combined with benzodiazepines for patients who are diagnosed with panic disorder.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychotherapy and a benzodiazepine combined for treating panic disorder

Panic disorder is characterised by the repeated occurrence of unexpected panic attacks, during which the individual experiences a strong fear with anticipation of death. These attacks are often accompanied by somatic symptoms such as palpitations, dyspnoea or faintness. Those suffering from panic disorder have persistent anticipatory fear of recurrent attacks and feel anxious even while they have no occurrence of panic attacks for a certain period. Panic disorder is strongly associated with an increased risk for agoraphobia and depression. The prevalence of panic disorder is reported to be around 2 to 3 percent in the general population. Two broad categories of treatment have been shown to be effective in treating panic disorder, one being pharmacotherapy with antidepressants or benzodiazepines, the other being psychotherapy. These treatments are often combined, yet the efficacy of combining psychotherapy and benzodiazepine for panic disorder is unclear, despite its widespread use. This review included randomised controlled trials comparing the combination of psychotherapy and a benzodiazepine with either the psychotherapy or the benzodiazapine alone for people with panic disorder. We were able to include only three trials in this review. Two could be used in the comparison of the combination of psychotherapy and benzodiazepine versus psychotherapy alone and one in the comparison of the combination with benzodiazepine. These comparisons involved just 166 patients and 77 patients, respectively. These small numbers make it difficult to detect any differences between combination treatments and either treatment alone. The trials which compared the combination of treatments with psychotherapy alone (both using behaviour therapy) indicated no differences in response between the two approaches, either during the intervention, at the end of the intervention, or at the last follow-up time point. The trial which compared the combination of treatments with a benzodiazepine alone demonstrated no differences in response during the intervention. Although the combination of treatments appeared to be more effective than the benzodiazepine alone at the end of treatment, no significant differences were observed at the 7-month follow-up. Before evidence-based treatment recommendations are possible, more randomised controlled trials are required, comparing the combination of psychotherapy and benzodiazepines with either treatment alone, and involving enough people to be able to detect a true difference between the treatments if one exists.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

恐慌症合併心理(psychotherapy)與苯二氮(benzodiazepines)治療

儘管大量的使用,合併使用心理治療及苯二氮來治療恐慌症的效果並不清楚

目標

檢視合併治療及單一治療的效果

搜尋策略

挑選針對恐慌症合併心理及苯二氮治療與單一治療的隨機試驗。於Cochrane Depression, Anxiety and Neurosis Group Studies and References Registers中搜尋。亦檢視其他相關試驗或回顧性文章。也聯繫了領域內的專家。更從試驗的原作者獲得額外未發表的資料。

選擇標準

2位作者個別檢視由研究中擷取的資料,來辨認針對恐慌症成人所做比較合併治療及單一治療的隨機試驗。

資料收集與分析

2位作者獨立使用標準化資料擷取表來檢視由合適的試驗中所提取資料的合適性及品質。主要成果(primay outcome)是依據整體評估所得的"反應(response)"。從被包含的試驗中,資料合併進行隨機效用整合分析。

主要結論

3個試驗符合合適的標準。其中2個使用16週的行為治療,另1個則使用12週的認知行為治療。追蹤期則各異,從0到12個月。2個試驗(共166位受試者),提供比較合併與單獨心理治療(2者都使用行為治療)的資料。在治療期(RR:合併:1.25,95% CI 0.78 to 2.03, P = 0.35)、治療結束(RR 0.78, 0.45 to 1.35, P = 0.37)或最後一個追蹤時間點,並無統計尚無有意義的差異,雖然後續(followup)數據呈現出合併可能比單一行為治療差(RR 0.62, 0.36 to 1.07, P = 0.08)。另1個試驗(77個受試者)比較合併治療與單一苯二氮。在介入期的反應並無差異(RR 1.57, 0.83 to 2.98, P = 0.17)。雖然在治療結束時,合併治療效果比單一苯二氮治療效果好(RR 3.39, 1.03 to 11.21, P = 0.05),這個結果只稍具有統計意義,且追蹤7個月後並無特殊差異(RR 2.31, 0.79 to 6.74, P = 0.12)。

作者結論

這些回顧性文章發現,研究心理治療合併苯二氮治療恐慌症缺乏高品質的證據。目前,對於被診斷為恐慌症的病人接受心理治療合併苯二氮的臨床效果仍不足。

翻譯人

本摘要由彰化基督教醫院莫庚翰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

合併心理治療及苯二氮治療恐慌症: 恐慌症的特點是無預期的恐慌反覆的發生,個案會經歷預期死亡所帶來的強烈的害怕。這些發作通常伴隨身體症狀,例如:心悸、氣促(dyspnoea)或昏眩(faintness)。這些恐慌症的病人會有持續擔心反覆恐慌發作的害怕且即使已經一段時間未再發作仍會感到焦慮。恐慌症與增加罹患懼曠症及憂鬱症的風險有強烈相關。恐慌症在一般人的盛行率約在百分之2∼3。有2大類的治療方式是對於恐慌症有效的,一種是藥物治療使用抗憂鬱劑或苯二氮,其他的就是心理治療。這些治療通常是合併的,隨然被廣泛使用,但針對恐慌症合併心理及苯二氮治療的效用仍不清楚。這篇回顧性文章包含針對恐慌症的隨機試驗比較合併心理、苯二氮治療與心理或苯二氮單一治療。在本篇回顧性文章內含3個試驗。其中2個用來比較合併心理及苯二氮與單一心理治療,另一個則是比較合併與苯二氮治療。這些試驗分別包含了166位病人及77位病人。因樣本數較小,所以無法發現合併及個別治療間的差異。比較合併與單一心理治療(都使用行為治療)的試驗,發現這2種方式並無反應上的差別,不論是在治療中、治療結束時或最後一次追蹤。比較合併與苯二氮治療的試驗於治療中的反應並沒有差別。雖然於治療結束時,合併治療的效果比苯二氮好,追蹤7個月後發現並無差異。在實證治療建議出現之前,需要更多的隨機控制試驗,來比較合併心理治療與苯二氮及單一治療,且增加樣本數以期發現治療間的差異。