Hostname: page-component-745bb68f8f-kw2vx Total loading time: 0 Render date: 2025-01-26T21:05:11.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Are there Anticompulsive or Antiphobic Drugs? Review of the Evidence

Published online by Cambridge University Press:  29 January 2018

Isaac Marks
Isaac Marks*
Affiliation:
Institute of Psychiatry, London SE5 8AF, and Bethlem Royal and Maudsley Hospital, London SE5 8AZ
Get access Rights & Permissions [Opens in a new window]

Summary

Review of 19 uncontrolled studies of antidepressants in phobic and in obsessive-compulsive disorders suggests that such drugs do not act reliably in the absence of symptoms of anxiety-depression (dysphoria). In dysphoric patients the drugs have a broad-spectrum effect not only reducing phobias and rituals but also anxiety-depression, panic, anger, and hostility, all of which are highly intercorrelated, but none yet demonstrated to be the core disturbance. Phobics, but not obsessive-compulsives, have an unusually high dropout rate from treatment when drugs or placebo are given. When antidepressants are stopped, even after 6–8 months, relapse is likely. The drugs do not reduce the liability of many phobics and obsessive-compulsives to have dysphoric episodes over the years. Exposure treatments are more lastingly effective for phobias and for rituals, but do not reduce the liability to later dysphoric episodes.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 143 , Issue 4 , October 1983 , pp. 338 - 347
Copyright
Copyright © 1983 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ananth, J. (1980) Systematic studies with clomipramine in obsessive neurosis. Pharmaceutical Medicine, 2, 148–51.Google Scholar
Berney, T. et al (1981) School phobia: a therapeutic trial with clomipramine and short-term outcome. British Journal of Psychiatry, 138, 110–18.CrossRefGoogle ScholarPubMed
Emmelkamp, P. M. (1982) Phobic and obsessive-compulsive disorders. New York: Plenum.CrossRefGoogle Scholar
Gittelman-Klein, R. & Klein, D. F. (1971) Controlled imipramine treatment of school phobia. Archives of General Psychiatry, 25, 204–7.CrossRefGoogle Scholar
Ghosh, A., Marks, I. M. & Carr, A. C. (1983) Journal of the Royal Society of Medicine (in press).Google Scholar
Insel, T., Murphy, M. D., Cohen, R. M., Allerman, I., Kilts, C., Linnoila, M. (1983) Obsessive-compulsive disorder. A double blind trial of clomipramine and clorgyline. Archives of General Psychiatry. In press.CrossRefGoogle Scholar
Kahn, R. J., McNair, D. M., Covi, L., Downing, R. W., Fisher, S., Lipman, R. S., Rickels, K. & Smith, V. K. (1981) Effects of psychotropic agents in high anxiety subjects. Psychopharmacology Bulletin, 17, 97–100.Google Scholar
Klein, D. F. (1964) Delineation of two drug-responsive anxiety syndromes. Psychopharmacologia, 5, 397.CrossRefGoogle ScholarPubMed
Lipsedge, M. et al (1973) The management of severe agoraphobia: a comparison of iproniazid and systematic desensitization. Psychopharmacologia, 32, 67–80.CrossRefGoogle ScholarPubMed
Marks, I. M. (1978) Living with Fear. New York: McGraw-Hill.Google Scholar
Marks, I. M. (1981) Cure and Care of Neuroses. New York: Wiley.Google Scholar
Marks, I. M. (1982) Toward an empirical science: Behavioural psychotherapy in the 1980's. Behavior Therapy, 13, 63–81.CrossRefGoogle Scholar
Marks, I. M. (1982a) Antidepressant drugs for phobias and rituals. Psychopharmacology Bulletin, 18, 78–84.Google Scholar
Marks, I. M. (1983) Stress and other risk factors in anxiety disorders. In Stress in Psychiatric Disorders (eds. Goldman, H. and Goldstone, S.). Bethesda, Maryland: NIMH Publication.Google Scholar
Marks, I. M. & Mathews, A. M. (1979) Brief standard self-rating for phobic patients. Behavior Research and Therapy, 17, 263–7.CrossRefGoogle ScholarPubMed
Marks, I. M. et al (1980) Clomipramine and exposure for compulsive rituals. British Journal of Psychiatry, 136, 1–25.CrossRefGoogle ScholarPubMed
Marks, I. M. et al (1983) Imipramine and exposure for agoraphobics. Archives of General Psychiatry, 40, 153–162.CrossRefGoogle ScholarPubMed
Mavissakalian, M. et al (1983). In preparation.Google Scholar
Mawson, D., Marks, I. M. & Ramm, L. (1982) Clomipramine and exposure for compulsive rituals. III. 2-year follow-up and further findings. British Journal of Psychiatry, 140, 11–18.CrossRefGoogle Scholar
McNair, D. M. & Kahn, R. J. (1981) Imipramine compared with a benzodiazepine for agoraphobia. In Anxiety: New Research and Changing Concepts (eds. Klein, D. F. and Rabkin, J.), pp. 69–80. New York: Raven Press.Google Scholar
Mountjoy, C. Q., Roth, M., Garside, R. F. & Leitch, I. M. (1977) A clinical trial of phenelzine in anxiety, depressive and phobic neuroses. British Journal of Psychiatry, 131, 486–92.CrossRefGoogle ScholarPubMed
Nies, A. & Robinson, D. S. (1981) Comparison of clinical effects of amitriptyline and phenelzine. In Monoamine Oxidase Inhibitors—State of the Art, (eds. Youdin, M. B. H. and Paykel, E. S.), pp 161–8. Chichester: Wiley.Google Scholar
Pecknold, J. C., McLure, D. J., Appeltauer, L., Allan, T., Wrzesinski, L. (1982) Potentiation of clomipramine by tryptophan in the treatment of agoraphobic and social phobic patients. British Journal of Psychiatry, 140, 484–90.CrossRefGoogle ScholarPubMed
Sheehan, D. V. (1982) Panic attacks and phobias. New England Journal of Medicine, 307, 156–8.CrossRefGoogle ScholarPubMed
Sheehan, D. V., Ballenger, J., Jacobsen, G. (1980) Treatment of endogenous anxiety and phobic, hysterical and hypochondriacal symptoms. Archives of General Psychiatry, 37, 51–9.CrossRefGoogle ScholarPubMed
Solyom, C. L., Lapierre, Y., Pecknoid, J. & Morton, L. (1981) Phenelzine and exposure in the treatment of phobias. Biological Psychiatry, 16, 239–47.Google ScholarPubMed
Telch, M. (1983) Ph.D. Dissertation, Stanford University, California.Google Scholar
Thoren, P., Åsberg, M., Cronholm, B., Jörnestedt, L., Träskman, L. (1980) Clomipramine treatment of obsessive-compulsive disorder. I. A controlled clinical trial. Archives of General Psychiatry, 37, 1281–5.CrossRefGoogle Scholar
Tyrer, P., Candy, J. & Kelly, D. (1973) Clinical effects of phenelzine and placebo in the treatment of phobic anxiety. Psychopharmacologia, 32, 237–54.CrossRefGoogle ScholarPubMed
Tyrer, P. & Steinberg, D. (1975) Symptomatic treatment of agoraphobia and social phobias: A follow-up study. British Journal of Psychiatry, 127, 163–8.CrossRefGoogle ScholarPubMed
Zitrin, C. M., Klein, D. F., Woerner, M. G. (1978) Behaviour therapy, supportive psychiatric treatment, imipramine and phobias. Archives of General Psychiatry, 35, 307–16.CrossRefGoogle ScholarPubMed
Zitrin, C. M., Klein, D. F., Woerner, M. G. (1980) Treatment of agoraphobia, with group exposure in vivo and imipramine. Archives of General Psychiatry, 37, 63–72.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.