Antidepressants versus placebo for panic disorder in adults

Bighelli, Irene; Castellazzi, Mariasole; Cipriani, Andrea; Girlanda, Francesca; Guaiana, Giuseppe; Koesters, Markus; Turrini, Giulia; Furukawa, Toshi A; Barbui, Corrado

doi:10.1002/14651858.cd010676.pub2

Cited by 46 publications

(54 citation statements)

References 134 publications

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“…To our knowledge, this was the first meta-analysis of paroxetine versus placebo directly and individually in the treatment of PD, although paroxetine had been included in previous systematic reviews and meta-analyses. Our results were generally consistent with previous studies (Andrisano et al, 2013;Sugarman et al, 2014;Bighelli et al, 2018), however we made a more comprehensive comparison between paroxetine and placebo in terms of improving panic symptoms, anxiety, depression, and social function and other aspects. It's worth mentioning that the methodological quality of Andrisano's research might not be very high, because they included both non-randomized and non-placebo controlled studies (Andrisano et al, 2013;Bighelli et al, 2018).…”

Section: Agreements and Disagreements With Other Studies Or Reviewssupporting

confidence: 91%

“…I 2 ≥0% is non-heterogeneous, I 2 ≥25% is considered to be mild heterogeneity, I 2 ≥50% is considered to be moderate heterogeneity, and I 2 ≥75% is considered to be severe heterogeneity (Shi et al, 2019). P=0.10 is used as a threshold of statistical significance (Bighelli et al, 2018).…”

Section: Assessment Of Heterogeneitymentioning

confidence: 99%

“…Panic disorder (PD) is a common mental health disorder with a lifetime prevalence of 1.6% to 2.2% in the general population (American Psychiatric Association, 2009), while in primary care settings, panic syndromes have been reported to have a prevalence of around 10% (King et al, 2008). PD is characterized by repeated, unexpected panic attacks, which are discrete periods of fear or anxiety that have a rapid onset, reach a peak within 10 minutes, and in which at least 4 of 13 characteristic symptoms are experienced (Bighelli et al, 2018). Many of these symptoms involve bodily systems, such as a racing heart, chest pain, sweating, shaking, dizziness, flushing, stomach churning, faintness, and breathlessness (Bighelli et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…PD is characterized by repeated, unexpected panic attacks, which are discrete periods of fear or anxiety that have a rapid onset, reach a peak within 10 minutes, and in which at least 4 of 13 characteristic symptoms are experienced (Bighelli et al, 2018). Many of these symptoms involve bodily systems, such as a racing heart, chest pain, sweating, shaking, dizziness, flushing, stomach churning, faintness, and breathlessness (Bighelli et al, 2018). Unless the clinician has a high index of suspicion, panic disorder may remain undetected (Tsuboi and Masuko, 2001).…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Efficacy and Tolerability of Paroxetine Versus Placebo for Panic Disorder: A Meta-Analysis of Randomized Controlled Trials

et al. 2020

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Objective: To explore the short-term efficacy and tolerability of paroxetine in the treatment of panic disorder in adults. Methods: Multiple electronic databases were searched to find randomized controlled trials (RCTs) on paroxetine and panic disorder. The primary efficacy outcomes were: the mean change compared to the baseline in the total number of full panic attacks, Clinical Global Impression-Severity of Illness (CGI-S) score, and the proportion of participants with zero full panic attacks and with a 50% or greater reduction in the number of full panic attacks. The tolerability outcomes included withdrawal rate and the incidence of adverse events (AEs). Results: 13RCTs were included. The pooled analyses showed patients who received paroxetine experienced greater improvements in the number of full panic attacks (total: MD=-1.96, 95%CI-3.45 to-0.47, P=0.010; ≥50% reduction: OR=1.66, 95%CI 1.08 to 2.55, P=0.02; zero full panic attacks: OR=1.70, 95%CI 1.42 to 2.03, P < 0.00001) and CGI-S (MD=-0.37, 95%CI-0.74 to-0.01, P=0.05) than placebo. There was no evident difference in the total withdrawal rate (OR=0.91, 95%CI 0.76 to 1.08, P=0.26) and withdrawal rate due to AEs (OR=1.29, 95%CI 0.97 to 1.72, P=0.07) between the two groups. Withdrawal rate due to lack of efficacy or relapse (OR=0.44, 95%CI 0.31 to 0.63, P < 0.00001) and the incidence of serious AEs (OR=0.42, 95%CI 0.23 to 0.79, P=0.007) in the paroxetine group was lower than the placebo group. Meanwhile, the incidence of any treatment-emergent adverse events (TEAEs) (OR=1.32, 95%CI 1.05 to 1.64, P=0.02) in the paroxetine group was higher in comparison with the placebo. Conclusions: Paroxetine is an effective and well-tolerated short-term treatment for adults with panic disorder.

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Section: Agreements and Disagreements With Other Studies Or Reviewssupporting

confidence: 91%

Section: Assessment Of Heterogeneitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-Term Efficacy and Tolerability of Paroxetine Versus Placebo for Panic Disorder: A Meta-Analysis of Randomized Controlled Trials

et al. 2020

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“…Could the same be true of the positive value of meditation methods that focus on mindfulness of the present, or the shutting out of irksome reality? Conversely, could episodic panic attacks (Bighelli, Castellazzi, Cipriani, et al, 2018;Imai, Tajika, Chen, Pompoli, & Furukawa, 2016;Meuret, Kroll, & Ritz, 2017) represent a sudden failure of the neural mechanisms of reality denial? The reader may detect a tendency here toward an umbrella theory, but the fact remains that all the speculative suggestions above are consistent with the MORT theory.…”

Section: Does Human Psychological Ontogeny Recapitulate the Proposed mentioning

confidence: 99%

Did Human Reality Denial Breach the Evolutionary Psychological Barrier of Mortality Salience? A Theory that Can Explain Unusual Features of the Origin and Fate of Our Species

Varki

2019

Evolutionary Psychology

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Some aspects of human cognition and behavior appear unusual or exaggerated relative to those of other intelligent, warm-blooded, long-lived social species--including certain mammals (cetaceans, elephants, and great apes) and birds (corvids and passerines). One collection of such related features is our remarkable ability for ignoring or denying reality in the face of clear facts, a high capacity for self-deception and false beliefs, overarching optimism bias, and irrational risktaking behavior (herein collectively called "reality denial"). Such traits should be maladaptive for reproductive success when they first appear as consistent features in

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Anxiety Disorders

Szuhany

Simon

2022

JAMA

177

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ImportanceAnxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning.ObservationsAnxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder–7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% to 97%). Providing information about symptoms, diagnosis, and evidence-based treatments is a first step in helping patients with anxiety. First-line treatments include pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs, eg, sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, eg, venlafaxine extended release) remain first-line pharmacotherapy for generalized anxiety disorder, social anxiety disorder, and panic disorder. Meta-analyses suggest that SSRIs and SNRIs are associated with small to medium effect sizes compared with placebo (eg, generalized anxiety disorder: standardized mean difference [SMD], −0.55 [95% CI, −0.64 to −0.46]; social anxiety disorder: SMD, −0.67 [95% CI, −0.76 to −0.58]; panic disorder: SMD, −0.30 [95% CI, −0.37 to −0.23]). Cognitive behavioral therapy is the psychotherapy with the most evidence of efficacy for anxiety disorders compared with psychological or pill placebo (eg, generalized anxiety disorder: Hedges g = 1.01 [large effect size] [95% CI, 0.44 to 1.57]; social anxiety disorder: Hedges g = 0.41 [small to medium effect] [95% CI, 0.25 to 0.57]; panic disorder: Hedges g = 0.39 [small to medium effect[ [95% CI, 0.12 to 0.65]), including in primary care. When selecting treatment, clinicians should consider patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care.Conclusions and RelevanceAnxiety disorders affect approximately 34% of adults during their lifetime in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.

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Antidepressants versus placebo for panic disorder in adults

Cited by 46 publications

References 134 publications

Short-Term Efficacy and Tolerability of Paroxetine Versus Placebo for Panic Disorder: A Meta-Analysis of Randomized Controlled Trials

Short-Term Efficacy and Tolerability of Paroxetine Versus Placebo for Panic Disorder: A Meta-Analysis of Randomized Controlled Trials

Did Human Reality Denial Breach the Evolutionary Psychological Barrier of Mortality Salience? A Theory that Can Explain Unusual Features of the Origin and Fate of Our Species

Anxiety Disorders

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