Treatment of panic disorder in older adults: a pilot study comparison of alprazolam, imipramine, and placebo.

OBJECTIVE: Several studies have documented that a variety of pharmacological compounds are quite effective in controlling acute symptomatology of panic disorder in the general population. However, there is a paucity of such studies in the management of panic disorder in older adults (ages 55 and above). The purpose of this study was to gather pilot data in older patients with panic disorder to begin to assess the efficacy of two commonly-used antipanic medications, imipramine and alprazolam. METHOD: Twenty-five (n = 25 (23 females; 2 males); 18 completers, 7 dropouts) older panic disorder (DSM-III-R) patients (age range = 55-73; mean = 61.24) were studied in an eight-week randomized, parallel-groups, double-blind, placebo-controlled, flexible dose design. Outcome was assessed weekly by global change ratings (Hamilton Anxiety and Depression Scales; Physicians' Global Impression ratings) and panic diaries. Because of small sample size, we present data descriptively. RESULTS: Subjects in active medication groups evidenced reductions in panic attacks and in level of overall anxiety and depression. Therapeutic dosages were approximately half those commonly used in younger panic disorder patients. CONCLUSION: Our data suggest the comparable efficacy of alprazolam and imipramine in the short-term treatment of older adults with panic disorder. There is clearly the need for a larger scale placebo-controlled study, preferably comparing imipramine and/or alprazolam with one of the SSRIs, to substantiate our findings.

Shared symptoms of panic disorder in an elderly couple.

The authors present a case report with details of an unusual presentation of panic disorder and shared symptomatology in a long-married elderly couple. At the initial diagnostic clinical interview, the couple shared in common six symptoms of panic disorder (husband with a total of six symptoms, wife with a total of eight symptoms) and manifested commonalities in avoidance behaviors. Authors discuss the duration and course of each patient's disorder, symptoms, and commonalities.

Somatization in young versus older female panic disorder patients.

BACKGROUND AND RATIONALE: Studies in younger patients with panic disorder suggest greater somatization compared to similarly aged normal controls. Thus, we compared the degree of somatization in young versus older female patients with panic disorder to ascertain whether similarly high levels of somatization exist in older panic disorder patients. METHOD: Community-dwelling subjects were recruited for clinical trials for panic disorder and met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for panic disorder as a primary diagnosis. Our sample (N = 64) contained 42 younger females (< 55 years of age; age range 21-54, mean age 34.6) who were compared to 22 older females (> or = 55 years of age; age range 55-73, mean age 60.8). Subjects were evaluated at baseline using the Self-Report Inventory for Somatic Symptoms (SISS). Statistical analysis of total somatization disorder scores (TSDS) was accomplished by t-tests for independent groups. RESULTS: Older patients showed statistically significantly higher total somatization disorder scores (TSDS) (X = 11.54, SD = 7.45) than did younger patients (X = 8.07, SD = 4.77; t(62) = 2.27, p = < 0.05). CONCLUSION: Our results are suggestive of a higher degree of somatization in older compared to younger female panic disorder patients.

Childhood abuse history in older women with panic disorder.

Seventeen female subjects (ages 55-73) participating in a clinical trial for older panic disorder patients were administered the Childhood Trauma Questionnaire. Seven subjects reported histories of sexual abuse. Physical abuse was reported by 10 subjects, including six of the seven who also reported sexual abuse. The data raise questions regarding the possible contributory role of childhood trauma in some panic disorder patients.