ANTIDEPRESSANTS IN THE TREATMENT OF ANXIETY DISORDERS

这项研究由双盲、随机、安慰剂对照 预期使用丙咪嗪或安慰剂维持12个月，然后6个月 80例惊恐障碍患者停药1个月和停药80例 对开放有良好和稳定反应的广场恐惧症患者 丙咪嗪固定重量调整剂量2.25治疗 在积极治疗的前6个月内为mg/kg/d。前80名 患者在4个月和6个月时均有明显反应 对积极治疗的评估将随机分配到 相同剂量的丙咪嗪或安慰剂，计划每2次进行一次评估 月份。评估将包括人口统计和临床信息以及 全面的临床医生和患者评分最高 疾病的显著主要症状领域：恐慌、恐惧症和 烦躁不安/抑郁以及手术和临床相关 反应和复发的标准。拟议研究的具体目标 是：1)评估具体由于以下原因而出现的逆转/复发的程度 在1年内停用丙咪嗪，2)评估 哪些持续的改进和响应特别归功于继续 暴露于药物治疗的药理作用，3) 通过研究丙咪嗪与丙咪嗪的关系来表征丙咪嗪的长期疗效 在维持过程中的症状和血浆药物水平之间的关系。 因此，这项研究将评估丙咪嗪在 维持药物引起的原有改善/反应，并将 提供关于急性和非急性发作后复发率比较的试点数据 维持治疗阶段。鉴于长期的和波动的 这种疾病的病程和越来越多的患者 用丙咪嗪或类似药物有效治疗，结果 这项研究应该对长效管理有重要的意义 广场恐惧症患者的惊恐障碍，即复发和持续时间 停用丙咪嗪后复发的风险-收益比 维持治疗和依从性。此外，这项研究还扩展了我们的 丙咪嗪短程定征的程序性研究 对这种疾病的影响。

The study consists of a double-blind, randomized, placebo-controlled prospective 12 month maintenance on imipramine or placebo, followed by a 6 month discontinuation and drug/pill free phase in 80 panic disorder with agoraphobia patients who have shown good and stable response to open treatment with imipramine at the fixed weight adjusted dosage of 2.25 mg/kg/day in the preceding 6 months of active treatment. The first 80 patients to show marked response at both the 4 month and 6 month assessments of active treatment will randomly be assigned to maintenance on the same dose of imipramine or placebo with planned assessments every 2 months. Assessments will include demographic and clinical information and a comprehensive battery of clinician and patient ratings of the most salient major symptom domains of the disorder: panic, phobia and dysphoria/depression as well as operationalized and clinically relevant criteria of response and relapse. The specific aims of the proposed study are: 1) to assess the extent of reversals/relapse due specifically to withdrawal of imipramine over a 1 year period, 2) to assess the extent to which maintained improvement and response are specifically due to continued exposure to the pharmacological effects of pharmacotherapy, 3) to characterize imipramine's longterm effects by studying the relationship between symptomatology and plasma drug levels over the maintenance course. Thus, the study will assess the net beneficial effects of imipramine in maintaining the original improvement/response induced by the drug and will provide pilot data on the comparative rates of relapse after acute and maintenance treatment phases. In view of the chronic and fluctuating course of this disorder and the increasing numbers of patients who are effectively treated with imipramine or similar drugs, the results of the study should have important implications for the longterm management of panic disorder with agoraphobia patients, i.e., relapse and duration to relapse upon discontinuation of imipramine, risk-benefit ratio of maintenance treatment and compliance. In addition, the study extends our programmatic research in the characterization of imipramine's shorterm effects in this disorder.