April 1988

Drug Therapy for Agoraphobia

Author Affiliations

Department of Psychology College of Wooster Wooster, OH 44691
Phobia Clinic, Department of Psychiatry Case Western Reserve University College of Medicine 2040 Abington Rd Cleveland, OH 44106

Arch Gen Psychiatry. 1988;45(4):387. doi:10.1001/archpsyc.1988.01800280105014

To the Editor.—  In their article concerning panic and avoidance in agoraphobia, Klein et al1 address the important issue of desynchrony between "spontaneous" panics and avoidance behavior that is often observed in clinical practice. However, although we agree that tricyclic medication can be useful in helping some agoraphobic patients to attempt exposure, we are unable to accept the conclusion drawn by Klein and colleagues that "if [the agoraphobic] wishes to become free of panic, then drug therapy is distinctly superior to exposure therapy." There are some severe limitations in the design of their study.First, exposure-treatment groups were given ten weeks of treatment at most, compared with 26 weeks for medication groups. This is unfortunate in that the absence of a panic effect for the exposure treatment was demonstrated only in the 26-week evaluation—13 weeks after the termination of exposure treatment. At this point medication treatment had not yet

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