AIMS: To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting. DESIGN: Quantitative analysis by a decision tree. DATA SOURCES: Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy". METHODS: I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model. STUDY SELECTION: Evidence summary, systematic reviews, meta-analysis and clinical guidelines. RESULTS: Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough. CONCLUSIONS: The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.
AIMS: To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting. DESIGN: Quantitative analysis by a decision tree. DATA SOURCES: Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy". METHODS: I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model. STUDY SELECTION: Evidence summary, systematic reviews, meta-analysis and clinical guidelines. RESULTS: Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough. CONCLUSIONS: The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.
Authors: Peter Roy-Byrne; Jason P Veitengruber; Alexander Bystritsky; Mark J Edlund; Greer Sullivan; Michelle G Craske; Stacy Shaw Welch; Raphael Rose; Murray B Stein Journal: J Am Board Fam Med Date: 2009 Mar-Apr Impact factor: 2.657
Authors: Anna Lee; Gavin M Joynt; Anthony M H Ho; Sheri Keitz; Thomas McGinn; Peter C Wyer Journal: J Gen Intern Med Date: 2009-02-27 Impact factor: 5.128