The general aim of the proposed research is to investigate the use of the antidepressant drug imipramine in the treatment of agoraphobia. More specifically we propose to separate the effects of imipramine from those of exposure to the phobic situation, a major confound affecting the interpretation of the results of previous studies. In addition, we propose to test several specific hypotheses concerning the mechanism of action of imipramine, including the questions whether such action is via panic suppression, an antidepressant effect, or the facilitation of self-exposure. To achieve these aims, 160 patients with agoraphobia, stratified as to initial levels of panic and depression, will be randomly allocated to either imipramine or placebo with or without exposure therapy, sequentially studying the panic suppression hypothesis, the interaction between imipramine and exposure, and the enduring effects of these treatments separately or in combination, by following patients over a two year period. A multidimensional assessment package will include self-report, behavioral assessment, ambulatory measurement of panic, and physiological recordings. The large sample size will allow us to examine the effects of various baseline measures upon outcome and the maintenance of treatment effects, including physiological parameters such as cardiovascular activation, and the response of such activation to treatment. This will begin to approach the issue of the right treatment (or combination of treatments) for specific subgoups of patients, an important consideration in the treatment of this common and often disabling disorder.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH040118-03
Application #
3378083
Study Section
(TDAB)
Project Start
1984-09-30
Project End
1989-08-31
Budget Start
1986-09-01
Budget End
1987-08-31
Support Year
3
Fiscal Year
1986
Total Cost
Indirect Cost
Name
Stanford University
Department
Type
Schools of Medicine
DUNS #
800771545
City
Stanford
State
CA
Country
United States
Zip Code
94305
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Sheikh, J I; King, R J; Taylor, C B (1991) Comparative phenomenology of early-onset versus late-onset panic attacks: a pilot survey. Am J Psychiatry 148:1231-3
Taylor, C B; Hayward, C; King, R et al. (1990) Cardiovascular and symptomatic reduction effects of alprazolam and imipramine in patients with panic disorder: results of a double-blind, placebo-controlled trial. J Clin Psychopharmacol 10:112-8
Taylor, C B; King, R; Margraf, J et al. (1989) Use of medication and in vivo exposure in volunteers for panic disorder research. Am J Psychiatry 146:1423-6
Hayward, C; Taylor, C B; Roth, W T et al. (1989) Plasma lipid levels in patients with panic disorder or agoraphobia. Am J Psychiatry 146:917-9
Margraf, J; Taylor, B; Ehlers, A et al. (1987) Panic attacks in the natural environment. J Nerv Ment Dis 175:558-65
Taylor, C B; King, R; Ehlers, A et al. (1987) Treadmill exercise test and ambulatory measures in panic attacks. Am J Cardiol 60:48J-52J