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

Abstract

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.

Effects of Antidepressants on Sleep in Post-traumatic Stress Disorder: An Overview of Reviews

“…6 ). It is reported in the literature that sedation and hypersomnia are more commonly observed with paroxetine compared to other SSRIs [ 197 , 198 ], and that somnolence is a commonly reported adverse effect, especially in the short-term, slightly more commonly reported than insomnia [ 199 ]. This is perhaps due to the fact that paroxetine is the most anticholinergic of all SSRIs [ 200 ].…”

Should the demonstration of improved patient outcome be necessary to overhaul diagnostic approaches?: Comment on Bach and Tracy (2022).

“…The nonspecific aspects of treatment underlying the placebo response include the expectation of benefit, support from a clinician showing concern and attention, and symptom resolution due to the natural history of the disorder. For mood and anxiety disorders, recent meta-analyses have found placebo response rates of 35% to 40% for major depressive disorder (Papakostas et al, 2016), 30% to 40% for bipolar depression (Bartoli et al, 2018; Papakostas et al, 2016), 30% for bipolar mania (Bartoli et al, 2018; Welten et al 2015), 45% to 50% for panic disorder (Zhang et al, 2020), 40–50% for generalized anxiety disorder (Li et al, 2017), and 35% to 40% for social anxiety disorder (Li et al, 2020). Appreciable placebo response rates have even been found for patients who are considered treatment resistant.…”

Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for the treatment of anxiety, obsessive-compulsive, and stress disorders: a systematic review and network meta-analysis

“…Previous meta-analyses assessed the tolerability of SSRIs and SNRIs in the treatment of non-depressive disorders, but three key questions remain unanswered. First, previous studies restricted their inclusion criteria to specific medications (Li et al, 2018, 2020; Li, Zhu, Su, & Fang, 2017; Liu et al, 2018; Zhang et al, 2020), diagnoses (Li et al, 2020, 2017, 2018; Liu et al, 2018; Zhang et al, 2020), adverse events (Telang, Walton, Olten, & Bloch, 2018; Wang et al, 2022), or populations (Schwartz, Barican, Yung, Zheng, & Waddell, 2019). Thus, no large-scale quantitative review or network meta-analysis evaluated the comparative tolerability and rates of most adverse events associated with all SSRIs and SNRIS for the treatment of anxiety, obsessive-compulsive, and stress-related disorders.…”