Open‐Label Support for Duloxetine for the Treatment of Panic Disorder

Abstract

Panic disorder with or without agoraphobia is a common, often chronic and refractory anxiety disorder. Although a number of pharmacotherapies are now indicated for panic disorder, many patients do not respond to available interventions. We hypothesized that duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI) that has greater initial noradrenergic effects than venlafaxine, would have broad efficacy for individuals with panic disorder. Fifteen individuals with panic disorder with or without agoraphobia received 8 weeks of open label duloxetine flexibly dosed from 60 to 120 mg per day. Duloxetine treatment resulted in significant anxiolysis as measured by the primary outcome measure, the Panic Disorder Severity Scale (PDSS) (paired t(df) = 4.02(14), P= 0.0013), as well as measures of generalized anxiety, depression and quality of life (all P < 0.05). Although definitive conclusions are limited due to its small open-label nature, this first prospective study provides preliminary support for the efficacy of duloxetine for panic disorder and suggests larger randomized controlled study is warranted.

Duloxetine in panic disorder with somatic gastric pain

“…The opportunity to have another therapeutic option with fewer adverse effects is important and helpful. Other researchers, such as Simon et al, have hypothesized and confirmed that duloxetine, a serotonin-norepinephrine reuptake inhibitor with greater initial noradrenergic effects than venlafaxine, has broad efficacy in individuals with panic disorder 9,10. Our interest in duloxetine lies in the possibility of treatment for panic disorder with the added benefit of resolution of gastric symptoms.…”

Panic Disorder: Assessment and Treatment

“…It has been used as a treatment outcome measure for panic disorder as well as a variety of other disorders, such as bipolar disorder, major depression, and body dysmorphic disorder Phillips & Rasmussen, 2004;Rodriguez, Bruce, Pagano, & Keller, 2005;Simon, Kaufman, et al, 2009). …”

“…Although an open-label study showed promise for the efficacy of the SNRI duloxetine (Simon, Kaufman, et al, 2009), controlled data are needed. SNRIs are generally well-tolerated and have safety and side-effect profiles similar to those of SSRIs.…”

Novel Antidepressants and Panic Disorder: Evidence beyond Current Guidelines

“…The side effects experienced by at least 10% but ! 25% of the subjects reported in the study by Simon et al [41] included: constipation, dry mouth, nausea, headache, sexual dysfunction, urinary hesitation, insomnia and sedation. Only 2 patients discontinued the trial because of side effects.…”

“…A single study [41] on 15 subjects suggested that duloxetine could reduce symptoms' severity, with 8 patients not experiencing full panic attacks in the past 2 weeks and 4 achieving full remission.…”