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New treatments for panic

Published online by Cambridge University Press:  16 April 2020

JC Ballenger*
Affiliation:
Department of Psychiatry and Behavioural Sciences, Medical University Of South Carolina, 171 Ashley Avenue, Charleston, SC 29425-0742, USA
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Summary

Panic disorder is a chronic condition for many patients and can be socially, emotionally and occupationally disabling. Until recently, clomipramine and alprazolam were the only drugs approved for its treatment. While widely used in the US and Europe, both belong to drug classes (tricyclics and benzodiazepines) with well-recognised side effects that can be problematic and thus limit their use. Recently, paroxetine became the first selective serotonin reuptake inhibitor to receive approval and licensing for panic disorder.

The short- and long-term efficacy and tolerability of paroxetine in panic disorder has been established in clinical trials of almost 1,000 patients meeting Diagnostic and Statistical Manual (DSM)-IIIR criteria for panic disorder, with or without agoraphobia. In a 12-week double-blind study of 120 panic patients receiving standardised cognitive therapy, paroxetine was significantly more effective than placebo in reducing panic attack frequency. In a 12-week placebo-controlled comparison in 367 panic patients, paroxetine was at least as effective as clomipramine and better tolerated. There was also some evidence that paroxetine had an earlier onset of action than clomipramine.

A 9-month extension of the placebo-controlled comparison with clomipramine showed that the efficacy of paroxetine and clomipramine is maintained when treatment is continued into the longer term. In a relapse prevention study, 105 responders to 3 months' treatment with paroxetine or placebo were re-randomised, either to continue existing treatment or to receive placebo for 3 months. Only 5% of patients who continued to take paroxetine experienced a relapse compared with 30% of those who switched to placebo (P = 0.002). Paroxetine was generally well tolerated. In the short-term trials, the frequency of withdrawals due to adverse events (7.3%) was lower than that for placebo (11.4%) or clomipramine (14.9%). In the longer term, the dropout rate due to adverse events increased in the clomipramine group (19.0%) but was unchanged in the paroxetine group (7.4%). Since most patients with panic disorder will require prolonged treatment, the long-term tolerability of paroxetine and its lack of potential for dependence are important advantages that will encourage good compliance with treatment and improve the quality of life of patients.

Type
Research Article
Copyright
Copyright © Elsevier, Paris 1998

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References

Alexander, PE, Alexander, DDAlprazolam treatment for panic disorders J Clin Psychiatry 47 1986 301304Google ScholarPubMed
American Psychiatric Association Edition 3DSM-IIIR: Diagnostic and Statistical Manual of Mental Disorders 1987 APA AmsterdamGoogle Scholar
Cassano, GB, Petracca, A, Perugi, Get alClomipramine for panic disorder I: the first 10 weeks of a long-term comparison with imipramine J Affective Disord 14 1988 123127CrossRefGoogle ScholarPubMed
Cookson, JSide-effects of antidepressants Br J Psychiatr 163suppl 201993 2024CrossRefGoogle Scholar
Dunbar, GC, Steiner, M, Oakes, R, Gergel, I, Burnham, D, Wheadon, DEA fixed dose study of paroxetine (10mg, 20mg, 40mg) and placebo in the treatment of panic disorder Eur Neuropsychopharm 5 1995 361Google Scholar
Judge, R, Steiner, MThe long-term efficacy and safety of paroxetine in panic disorder EurNeuropsychopharm 6suppl 31996 207Google Scholar
Keller, MB, Yonkers, KA, Warshaw, MGet alRemission and relapse in subjects with panic disorder and panic with agoraphobia: a prospective short-interval naturalistic follow-up J Nerv Ment Dis 182 1994 290296CrossRefGoogle ScholarPubMed
Lecrubier, Y, Bakker, A, Dunbar, G, Judge, RA comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder Acta Psychiatr Scand 95 1997 145152CrossRefGoogle ScholarPubMed
Lecrubier, Y, Judge, RCollaborative Paroxetine Panic Study Investigators Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder Acta Psvchiatr Scand 95 1997 153160CrossRefGoogle ScholarPubMed
Oehrberg, S, Christiansen, PE, Behnke, Ket alParoxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study Br J Psychiatry 167 1995 374379CrossRefGoogle ScholarPubMed
Pollack, MH, Otto, MWLong-term course and outcome of panic disorder J Clin Psychiatry 58suppl 21997 5760Google ScholarPubMed
Salzman, CBenzodiazepine treatment of panic and agoraphobic symptoms: use, dependence, toxicity, abuse J Psychiatric Res 27 1993 4768CrossRefGoogle Scholar
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