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Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review

BACKGROUND: The efficacy of combined psychotherapy and benzodiazepine treatment for panic disorder is still unclear despite its widespread use. The present systematic review aims to examine its efficacy compared with either monotherapy alone. METHODS: All randomised trials comparing combined psychot...

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Autores principales: Watanabe, Norio, Churchill, Rachel, Furukawa, Toshi A
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894782/
https://www.ncbi.nlm.nih.gov/pubmed/17501985
http://dx.doi.org/10.1186/1471-244X-7-18
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author Watanabe, Norio
Churchill, Rachel
Furukawa, Toshi A
author_facet Watanabe, Norio
Churchill, Rachel
Furukawa, Toshi A
author_sort Watanabe, Norio
collection PubMed
description BACKGROUND: The efficacy of combined psychotherapy and benzodiazepine treatment for panic disorder is still unclear despite its widespread use. The present systematic review aims to examine its efficacy compared with either monotherapy alone. METHODS: All randomised trials comparing combined psychotherapy and benzodiazepine for panic disorder with either therapy alone were identified by comprehensive electronic search on the Cochrane Registers, by checking references of relevant studies and of other reviews, and by contacting experts in the field. Two reviewers independently checked eligibility of trials, assessed quality of trials and extracted data from eligible trials using a standardized data extraction form. Our primary outcome was "response" defined by global judgement. Authors of the original trials were contacted for further unpublished data. Meta-analyses were undertaken synthesizing data from all relevant trials. RESULTS: Only two studies, which compared the combination with behaviour (exposure) therapy, met our eligibility criteria. Both studies had a 16-week intervention. Unpublished data were retrieved for one study. The relative risk for response for the combination was 1.25 (95%CI: 0.78 to 2.03) during acute phase treatment, 0.78 (0.45 to 1.35) at the end of treatment, and 0.62 (0.36 to 1.07) at 6–12 months follow-up. Some secondary outcomes hinted at superiority of the combination during acute phase treatment. One study was identified comparing the combination to benzodiazepine. The relative risk for response was 1.57 (0.83 to 2.98), 3.39 (1.03 to 11.21, statistically significant) and 2.31 (0.79 to 6.74) respectively. The superiority of the combination was observed on secondary outcomes at all the time points. No sub-group analyses were conducted due to the limited number of included trials. CONCLUSION: Unlike some narrative reviews in the literature, our systematic search established the paucity of high quality evidence for or against the combined psychotherapy plus benzodiazepine therapy for panic disorder. Based on limited available published and unpublished data, however, the combined therapy is probably to be recommended over benzodiazepine alone for panic disorder with agoraphobia. The combination might be superior to behaviour therapy alone during the acute phase, but afterwards this trend may be reversed. We know little from these trials about their adverse effects.
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spelling pubmed-18947822007-06-20 Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review Watanabe, Norio Churchill, Rachel Furukawa, Toshi A BMC Psychiatry Research Article BACKGROUND: The efficacy of combined psychotherapy and benzodiazepine treatment for panic disorder is still unclear despite its widespread use. The present systematic review aims to examine its efficacy compared with either monotherapy alone. METHODS: All randomised trials comparing combined psychotherapy and benzodiazepine for panic disorder with either therapy alone were identified by comprehensive electronic search on the Cochrane Registers, by checking references of relevant studies and of other reviews, and by contacting experts in the field. Two reviewers independently checked eligibility of trials, assessed quality of trials and extracted data from eligible trials using a standardized data extraction form. Our primary outcome was "response" defined by global judgement. Authors of the original trials were contacted for further unpublished data. Meta-analyses were undertaken synthesizing data from all relevant trials. RESULTS: Only two studies, which compared the combination with behaviour (exposure) therapy, met our eligibility criteria. Both studies had a 16-week intervention. Unpublished data were retrieved for one study. The relative risk for response for the combination was 1.25 (95%CI: 0.78 to 2.03) during acute phase treatment, 0.78 (0.45 to 1.35) at the end of treatment, and 0.62 (0.36 to 1.07) at 6–12 months follow-up. Some secondary outcomes hinted at superiority of the combination during acute phase treatment. One study was identified comparing the combination to benzodiazepine. The relative risk for response was 1.57 (0.83 to 2.98), 3.39 (1.03 to 11.21, statistically significant) and 2.31 (0.79 to 6.74) respectively. The superiority of the combination was observed on secondary outcomes at all the time points. No sub-group analyses were conducted due to the limited number of included trials. CONCLUSION: Unlike some narrative reviews in the literature, our systematic search established the paucity of high quality evidence for or against the combined psychotherapy plus benzodiazepine therapy for panic disorder. Based on limited available published and unpublished data, however, the combined therapy is probably to be recommended over benzodiazepine alone for panic disorder with agoraphobia. The combination might be superior to behaviour therapy alone during the acute phase, but afterwards this trend may be reversed. We know little from these trials about their adverse effects. BioMed Central 2007-05-14 /pmc/articles/PMC1894782/ /pubmed/17501985 http://dx.doi.org/10.1186/1471-244X-7-18 Text en Copyright © 2007 Watanabe et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Watanabe, Norio
Churchill, Rachel
Furukawa, Toshi A
Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
title Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
title_full Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
title_fullStr Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
title_full_unstemmed Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
title_short Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
title_sort combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894782/
https://www.ncbi.nlm.nih.gov/pubmed/17501985
http://dx.doi.org/10.1186/1471-244X-7-18
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