Panic disorder-comorbidity with major depression
ILIAS S., XILOURIS G., ANTONATOS S., MANTZARIS M., MAGLARA K.

Purpose: Study of co-morbidity of Panic Disorder with Major Depression.

Methods: We studied 100 patients (60F-40M) with Panic Disorder, who came to our department. We used the Hamilton scale of anxiety and depression, the Beck scale of depression, as well as the Marks and Mathews questionnaires for phobias, avoidant behaviors etc. We explored the presence of depression during the first examination of the patient,e past and throughout the duration of the study for 1 year. The diagnosis was made according to DSM-IV criteria. Out of 100 patients, 50 received treatment with drugs as well as cognitive-behavioral psychotherapy and 50 received treatment with drugs and supportive psychotherapy approximately once a month. Patients who had a recent first Panic Disorder episode and did not have depression received only alprazolam. Patients with chronic Panic Disorder or frequent relapses received both SSRI's and alprazolam. Patients with depression received SSRI's and alprazolam. In 90% of the patients who received alprazolam the dose was 1 mg/24h and in 77% of the patients who received SSRI's the doses were 20 mg of paroxetine, 20 mg of fluoxetine, 20 mg of citalopram and 50 mg of sertraline per day.

Results: The patients' average age was 43 (ranging from 18 to 65 years). The average duration of the Panic Disorder was 2.75.2 years.

23% had developed Major Depression in the past.

26% had Major Depression during the first examination.

10 of the 74 patients, who did not have depression during the first examination, developed Major Depression during the first year of follow-up. 6 of them were included in the group treated with drugs and supportive psychotherapy. 6 (6%) patients had attempted suicide in the past, 3 of them had a history of depression. During the study, 2 patients had a non-serious suicide attempt following an intense interpersonal incident. 45 out of 50 (90%) patients who had received cognitive-behavioral psychotherapy showed a significant improvement during the course of treatment. This improvement was maintained during the follow-up. In the second group, significant improvement was observed in 36 out of 50 patients (72%), which was also maintained during the follow-up. Out of the 26 patients with Major Depression, the depression:

The symptoms of depression that these patients developed were, in our opinion, secondary as a result of the Panic Disorder symptoms, except for a small percentage of patients where the depression symptoms co-existed with Panic Disorder independently. The intensity of the depression symptoms was related with the duration of the Panic Disorder. Along with the reduction or the elimination of the Panic Disorder symptoms, the depression symptoms simultaneously subsided. Patients with Major Depression had more severe depression and anxiety symptoms, a stronger avoidant behavior and poorer social adjustment. However, they did not have more panic attacks per week, compared to the patients with Panic Disorder without depression. The more severe the depression was, the worse the prognosis in comparison to the patients with less depressive symptoms.

Conclusions: Major Depression precedes, co-exists or follows Panic Disorder. Co-morbidity of Panic Disorder with Major Depression is an aggravating factor for the prognosis of Panic Disorder and is associated with more severe symptoms.

Key words: Panic disorder, depression, co-morbidity, treatment.