Psychiatric Clinic, University of Pisa, 56100 Pisa, Italy; "Department of Psychology, Boston University, Boston, Massachusetts 02215
Although the efficacy of imipramine (IMI), phenelzine, and alprazolam in the treatment of panic disorder is well established (7,8,11-15), the usefulness of other members of the same drug classes remains to be proved. One aim of this comparative study was to ascertain whether a tricyclic antidepressant (TCA) with predominantly serotoninergic effects, such as clomipramine (CLO), had a different antipanic action from IMI. After more than 30 years as a standard comparative compound for clinical drug trials of antidepressants, IMI is currently the most widely used TCA for panic disorder. Although no drug has yet obtained an official antipanic indication in the United States, IMI has become the unofficial standard for comparison. In the last few years, several clinical studies have suggested that CLO also may be effective in the treatment of panic-agoraphobic disorders (2,4,5,10). Most of these were open and uncontrolled clinical trials that used CLO dosages lower than IMI. Other anecdotal information from personal communications with academic investigators supported these open trial findings. Moreover, CLO had been employed by us in the prior treatment of a group of panic-agoraphobic disorders, and we used comparable CLO and IMI dosages. Our findings were consistent with the reports cited in indicating CLO efficacy. Based on our findings and the other reports, we began to employ routinely both CLO and IMI as pharmacotherapies for panic-agoraphobic disorders en­countered in our clinical practice. We decided to randomly assign the drugs to patients with panic attacks used in our more formal double-blind clinical trials. As phenelzine is not available on the Italian market and alprazolam has become available only very recently, IMI and CLO were the two drug therapies most widely used in our practice. The CLO versus IMI study is still in progress, and this article reports a preliminary analysis of the findings to date.

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