Treatment of Panic Disorder in Individuals with Depression

In a review of CBT for panic disorder, Mennin and Heimberg (2000) described the minimal impact of comorbid mood disorders, particularly at follow-up assessments. Dimensional studies of depressive symptoms at baseline do not reliably predict outcome of CBT treatment of panic disorder (Basoglu et al., 1994; Black, Wesner, Gabel, Bowers, & Monahan, 1994; Jansson, Ost, & Jerremalm, 1987). Likewise, categorical analysis of the presence or absence of comorbid major depression suggested similar efficacy of CBT treatment of panic disorder (Brown, Antony, & Barlow, 1995; Laberge, Gauthier, Cote, Plamondon, & Cormier, 1993; McLean, Woody, Taylor, & Koch, 1998). For example, McLean et al. compared 37 patients with comor-bid panic disorder and major depression to 53 patients with panic disorder only. All patients received 10 sessions of CBT for panic disorder; comorbid depression had no effect on treatment outcome for panic disorder.

Treatment outcome studies also indicate that depression symptoms often improve with panic treatment (e.g., Clark et al., 1994; Ost, Thulin, & Ramnero, 2004; Tsao, Mystkowski, Zucker, & Craske, 2002). For example, Tsao and associates investigated the effects of CBT for panic disorder on comorbid conditions, including depression. They found that comorbid diagnoses in general declined from 60.8% at pretreatment to 37.3% at posttreatment. They also found that a comorbid diagnosis of clinical depression (major depression and dysthymia) declined from 18% pretreatment to 6% posttreatment. This study demonstrated that not only did a comorbid diagnosis of depression not interfere with panic treatment, but also that CBT treatment for panic significantly reduced clinical depression. However, cautionary evidence is provided by Maddock and Blacker (1991). Although they found that secondary depression (depression emerging after the onset of panic disorder) did not predict negative treatment outcome, primary depression was linked to poorer outcome. Depression chronicity tends to be a reliable predictor of poorer outcome in studies of depression treatment (e.g., Keller et al., 1992); hence, this effect may have less to do with the order of onset of the disorders, and more with the relatively early onset and duration of the depression.

Nonresponse of depression in panic treatment also has been studied. Woody, McLean, Taylor, and Koch (1999) compared 49 outpatients with major depression and no panic disorder to 37 outpatients who had received CBT for panic disorder without resolution of their depression. All patients received 10 sessions of CBT for depression; results indicated that both groups improved equally on depression outcome measures, with no significant effect for previous panic disorder comorbidity. Accordingly, if depression does not improve during panic treatment, there are indications that subsequent CBT targeting depression leads to anticipated levels of improvement.

In summary, current research on panic disorder indicates that brief programs of CBT targeting panic disorder lead to strong treatment effects regardless of the presence of depression. In some cases, comorbid depression does improve with the treatment of the panic disorder, but if this is not the case, initial study indicates that subsequent CBT targeting the depression can help to resolve it. Similar encouraging evidence is also available for the CBT of social phobia.

Defeat Depression

Defeat Depression

Learning About How To Defeat Depression Can Have Amazing Benefits For Your Life And Success! Discover ways to cope with depression and melancholic tendencies! Depression and anxiety particularly have become so prevalent that it’s exceedingly common for individuals to be taking medication for one or even both of these mood disorders.

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