Differential treatment of phobias: Use of imipramine for panic attacks

The core disorder in agoraphobia and mixed phobia typically is the “spontaneous” panic attack, which may be due to various psychologic and physiologic triggering mechanisms. The panics tend to lead to anticipatory anxiety and, consequently, avoidance behavior. Tricyclics and MAO inhibitors suppress the spontaneous panics. Once this is accomplished, psychotherapeutic intervention helps patients overcome their phobias. Supportive psychotherapy, imaginal desensitization and in vivo exposure appear to be equally effective. Phobics who do not experience spontaneous panics are unaffected by these drugs but improve with psychotherapeutic techniques.