Drug Treatment of Panic Disorder

Abstract

Drug treatment of panic disorder is reviewed with focus on recent controlled studies. The efficacy of alprazolam, a triazolobenzodiazepine, and imipramine, a tricyclic antidepressant, has consistently been demonstrated, but there is reasonable evidence that other benzodiazepines or antidepressants might also be effective if equipotent doses are used. Most controlled studies demonstrate drug efficacy on several psychopathological symptoms, including the core symptom panic attacks. Limited evidence indicates that alprazolam may be more efficacious in treating panic attacks than avoidance behaviour, and the reverse when imipramine is concerned. Drug efficacy appears to be most consistently documented in moderately to severely ill panic patients. The benzodiazepines are better tolerated than antidepressants in terms of patient acceptance, and the improvement sets in faster with benzodiazepines. In the presence of depressive symptoms considered secondary to panic attacks and/or agoraphobia, both types of drugs appear efficacious. Difficulty discontinuing high-dose benzodiazepine treatment remains the most important side effect of the treatment but sedation can, like anticholinergic side effects of the tricyclic antidepressants, be troublesome, thereby diminishing patient compliance. The role of newly developed antidepressants with a more specific mode of action and milder side effects awaits evaluation in controlled trials.

Comparison of fluvoxamine, imipramine, and placebo in the treatment of outpatients with panic disorder

“…The present study supports the consistent finding in the literature that imipramine is more effective than placebo in the treatment of Panic Disorder (e.g., Rosenberg, 1993). Apart from the limited attack change score, all the 95% CI for the outcome variables are positive and in favour of imipramine compared to placebo.…”

Common effects of chronically administered antipanic drugs on brainstem GABAA receptor subunit gene expression

“…49,50 While the present study was underway, we found in a separate series of experiments, that chronic treatment with various benzodiazepine-site ligands produces transient changes in GABA A receptor mRNA levels. 41 This finding suggests the possibility that alprazolam causes its effects on GABA A receptor gene expression at an earlier time period than 21 days in a similarly transient manner.…”

“…Indeed, previous data have indicated that ␣3␤1␥2 receptors display lower GABA-gated maximal current amplitudes and higher GABA EC 50 values compared to many other receptor subtypes. [55][56][57][58][59][60] Hence, the substitution of a given receptor subtype for the ␣3␤1␥2 subunit combination may decrease GABAergic inhibition, while a change in the total number of GABA A receptors would alter GABAergic tone at a particular synapse in a similar manner.…”

Psychopharmacological Treatment of Panic Disorder

“…Ample evidence shows that pharmacological treatments are effective in reducing the symptoms of panic disorder and panic disorder with agoraphobia, including panic attacks, phobic avoidance, and anticipatory anxiety, and the occupational and social disability associated with panic disorder (Ballenger, 1993;Keller et al, 1993;Lepola, Rimon, & Riekkinen, 1993;Rosenberg, 1993). There is evidence that some drugs are more effective in treating panic attacks, whereas others are more effective in reducing phobic avoidance or anticipatory anxiety (Rosenberg, 1993).…”

“…There is evidence that some drugs are more effective in treating panic attacks, whereas others are more effective in reducing phobic avoidance or anticipatory anxiety (Rosenberg, 1993). Basoglu et al (1994) studied the relationship between panic attacks, anticipatory anxiety, and phobic avoidance in individuals treated for panic disorder.…”