Treatment of Endogenous Anxiety With Phobic, Hysterical, and Hypochondriacal Symptoms

TLDR

Endogenous anxiety, marked by sudden panic attacks and autonomic symptoms, has limited response to psychotherapy, behavior therapy, or tranquilizers. In a double‑blind, placebo‑controlled trial, 57 severely disabled patients (average 13‑year duration) received either imipramine, phenelzine, or placebo plus bi‑weekly supportive group therapy over three months. Both phenelzine and imipramine produced significant improvements versus placebo, with phenelzine showing superior gains on work/social disability and symptom severity/phobic avoidance scales.

Abstract

• Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior. Psychotherapy, behavior therapy, and tranquilizers have been of limited success in treating this syndrome. Fifty-seven patients severely disabled by the syndrome for a mean period of 13 years completed the three-month study. Randomly assigned in a double-blind, placebo-controlled design to imipramine hydrochloride, phenelzine sulfate, or placebo, they were seen in supportive group therapy every two weeks. Patients in the phenelzine and imipramine cells showed significant improvement over patients in the placebo group and over baseline on all outcome measures. The persistent trend for phenelzine to be superior to imipramine achieved significance only on the Work and Social Disability Scale and the Symptom Severity and Phobic Avoidance Scale. The implications for classification and theory are discussed.