New treatment options for panic disorder: clinical trials from 2000 to 2010

@article{Freire2011NewTO,
  title={New treatment options for panic disorder: clinical trials from 2000 to 2010},
  author={Rafael Christophe Freire and Jaime E.C. Hallak and Jos{\'e} A. S. Crippa and Ant{\^o}nio Eg{\'i}dio Nardi},
  journal={Expert Opinion on Pharmacotherapy},
  year={2011},
  volume={12},
  pages={1419 - 1428}
}
Introduction: Panic disorder (PD) is a prevalent psychiatric disorder characterized by unexpected and recurrent panic attacks. PD patients present significant psychosocial impairment and a high risk of psychiatric comorbidities and suicide. PD should be treated effectively as soon as the symptoms emerge because the longer these patients remain without treatment, the worse the prognosis will be. Areas covered: The authors carried out a systematic review of the literature regarding the… 
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Pharmacological Therapy in Panic Disorder: Current Guidelines and Novel Drugs Discovery for Treatment-resistant Patient
TLDR
The importance of immediate and proper treatment, the gap in the current management of PD with special emphasis on pharmacotherapy, and evidence regarding the novel anti-panic drugs including the drugs in developments such as metabotropic glutamate (mGlu 2/3) agonist and levetiracetam are covered.
Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines
TLDR
Despite strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD, few trials have performed head-to-head comparisons of these two drug classes, which could help improve the evidence-based pharmacotherapy of PD.
ANTIDEPRESSANTS AND PANIC DISORDER
TLDR
Comparison studies of antidepressants currently used for the treatment of panic disorder suggest selective serotonin reuptake inhibitors and venlafaxine should be considered as first line agents because their clinical efficacy is as high as those observed with other classes of antidepressants but they are associated with a significantly lower likelihood of side effects.
Latency to selective serotonin reuptake inhibitor vs benzodiazepine treatment in patients with panic disorder: a naturalistic study.
TLDR
A substantial delay in implementing adequate pharmacological treatments in patients with PD is confirmed, and the discrepancy between recommendations from international treatment guidelines and common clinical practice in relation to BDZ prescription is highlighted.
Pharmacological Treatment of Panic Disorder with Non-Selective Drugs
TLDR
It is important to use existing scientific evidences regarding effectiveness, tolerability and safety, combined with clinical experience, to plan a rational treatment sequence for panic disorder patients.
Emerging drugs for panic disorder
TLDR
Defining biomarkers and endophenotypes in PD may offer advantages in both understanding the pathophysiology of the disorder and selecting appropriate targets and outcomes for planning future pharmacological research.
Treatment–resistant panic disorder: a systematic review
TLDR
Augmentation of the pharmacological treatment with cognitive-behavioral therapy demonstrated some short-term efficacy in treatment–resistant PD, and preliminary evidences of efficacy for monotherapy with reboxetine and olanzapine, and augmentation with pindolol, divalproex sodium, aripiprazole and OlanzAPine in short- term treatment.
Newer antidepressants and panic disorder: a meta-analysis
TLDR
The following antidepressants were significantly superior to placebo for PD patients with the following increasing order of effectiveness: citalopram, sertraline, paroxetine, fluoxetines, and venlafaxine for panic symptoms and paroxETine,fluoxetne, fluvoxetus, and mirtazapine for overall anxiety symptoms.
Clonazepam for the treatment of panic disorder.
TLDR
It has been shown that panic attacks can more readily be induced by CO2 in PD patients with the respiratory subtype than those with the non-respiratory subtype, and clonazepam, alone or combined with selective serotonin reuptake inhibitors and/or behavioral therapy remains an important therapeutic modality for the management of PD.
Current pharmacological interventions in panic disorder.
TLDR
Recent data indicate that augmentation strategies with aripiprazole, olanzapine, pindolol or clonazepam may be effective and D-cycloserine is a promising agent in the augmentation of cognitive behavioral therapy.
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References

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A comparison of citalopram and paroxetine in the treatment of panic disorder: a randomized, single-blind study.
TLDR
Evidence that the serotonergic system plays a significant role in the anti-panic properties of these two SSRIs is supported, and paroxetine and citalopram show similar anti- panic properties and a good tolerability profile.
Duration of untreated illness in panic disorder: a poor outcome risk factor?
Selective serotonin-reuptake inhibitors in the treatment of panic disorder: a systematic review of placebo-controlled studies
TLDR
The authors explore the anxiolytic mechanism of action of this antidepressant drug class and the preclinical studies that are being developed to clarify the etiopathogenic mechanisms of PD and, more precisely, the role of the serotoninergic system in this pathogenesis.
Comparison of the treatment with paroxetine and reboxetine in panic disorder: a randomized, single-blind study.
TLDR
The results showed a greater effect of paroxetine on panic attacks than reboxettine, while no differences for anticipatory anxiety and avoidance were found, suggesting a different role of noradrenaline and serotonin in the treatment of PD.
Clomipramine and fluoxetine effects in the treatment of panic disorder.
TLDR
A pilot double blind clinical trial designed to compare the effects of two studied drugs in the treatment of panic disorder found that clomipramine and fluoxetine produced similar antipanic effectiveness.
Reboxetine, a selective norepinephrine reuptake inhibitor, is an effective and well-tolerated treatment for panic disorder.
TLDR
Reboxetine was effective and well tolerated in the treatment of panic disorder and improvement in Hamilton Rating Scale for Depression, Hopkins Symptom Checklist-90, and Sheehan Disability Scale scores were greater in the reboxetine group compared with the placebo group.
Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients
Venlafaxine extended release (XR) in the treatment of panic disorder
TLDR
Venlafaxine extended release (XR) was effective and well tolerated in both the short-term and long-term treatment of panic disorder and significantly improved patient quality of life and functioning.
Open‐Label Support for Duloxetine for the Treatment of Panic Disorder
TLDR
This first prospective study provides preliminary support for the efficacy of duloxetine for panic disorder and suggests larger randomized controlled study is warranted.
Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison.
TLDR
SERTraline and paroxetine had equivalent efficacy in panic disorder, but sertraline was significantly better tolerated and was associated with significantly less clinical worsening during taper than paroxettine.
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