No abstract

We report the results of an 8-week open trial of imipramine in 15 patients with social phobia. Nine patients completed the trial; six dropped out early because of adverse effects. The mean reduction in the Liebowitz Social Anxiety Scale was 15% and 18% for the intent-to-treat and completer groups, respectively; the overall response rate (based on the Clinical Global Impression Scale of 1 or 2, very much or much improved) was 20% (3/15) and 22% (2/9), respectively. The results from this open trial do not support the efficacy of imipramine as a treatment for social phobia.

Panic patients were clearly more sensitive to the anxiogenic effects of CO2 than comparison subjects, and CO2 was a more potent anxiogenic stimulus than room-air hyperventilation. Seven percent CO2 discriminated best between patients and comparison subjects and should be the focus of further research.

SummaryAtypical depression differs from typical (endogenomorphic) depression not only in terms of the primary determinant, mood reactivity, but also by the presence of at least one of four atypical symptoms, hyperphagia, hypersomnia, rejection sensitivity and leaden paralysis. In addition to the differential therapeutic response reported by various authors, these two types of depression can be differentiated by various biological measures including the dexamethasone suppression test, tyramine excretion following loading, REM latency, etc. A series of studies comparing phenelzine with imipramine and placebo in subgroups of atypical depressives showed better results with the tricyclic than with placebo; however phenelzine consistently gave the best results in this type of depression. The hypothesis is advanced that the difference between typical and atypical classes of depression could be accounted for by the loss of the ability to experience both “anticipatory” or “consummatory” pleasure in typical depression, but only anticipatory pleasure in atypical depression.

Seven patients with schizophrenia and panic attacks all showed marked improvement of positive and negative schizophrenic symptoms when alprazolam was openly added to antipsychotic medication. Panic attacks may identify alprazolam-responsive schizophrenic patients and may define a distinct pathophysiologic subgroup.