Panic Disorder

Panic Attack

Panic Disorder

Recurrent Panic Attacks

Anticipatory Anxiety

Agoraphobia

Hypochondriasis

Demoralisation

Epidemiology

Age of Onset

Situation of Onset

Stressful Life Events

Early Life Events

Maternal Over-Protection

Separation Anxiety

Short and Long-term Outcomes

Comorbidity

Panic Disorder: Pathogenesis

Biological Findings

Provocative Agents

Neurotransmitter Systems

Neuroanatomical Models

Brain Imaging

Psychological Models

Psychodynamic Models

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Cognitive Models

Areas of Controversy and Debate

The Evolutionary Perspective

Panic Disorder: Treatment

Pharmacotherapy

Benzodiazepines

Tricyclic Antidepressants

Monoamine Oxidase Inhibitors

Selective Serotonin Re-uptake Inhibitors

Other Drugs

Psychotherapy

Overcoming Anxiety (Home) > Panic Disorder > Other Drugs

Drugs Treatment for Panic Disorder

There have also been studies of other drug treatments (non-antidepressant and non-BDZ), with limited controlled double-blind studies of efficacy: noradrenergic receptor agonists and antagonists, anticonvulsants GABA-B agonists, dopaminergic agents, calcium-channel blockers, drug active as neuropeptide receptors and strategies involving second-messenger systems.

In general, despite encouraging results for many of these agents in case reports and open trials, efficacy has not been substantially established in double-blind controlled studies.

Caveat

It is commonly accepted that, in the age of the evidence-based medicine, only well-designed controlled studies should be taken into consideration to evaluate the efficacy of a treatment. However, a series of limitations prevents the simple transposition of the findings of the clinical trials into medical practice, as they are. Clinical trials in phase III are undertaken for the regulatory agencies rather than to establish a real pattern of use of drugs. The real needs of the clinicians are not entirely answered by the clinical trials: long-term treatments, concomitant medical treatments, comorbid physical and psychiatric disorders, suicidality, subjective intolerance are all examples of variants that can strongly influence the prescriptive pattern, and for which there is scant, if any, information.

The newer antidepressants are surely much safer in overdose and generally better tolerated than TCAs. On the other hand, they are much more expensive and are not devoid of unwanted effects. The two main problems in the long-term treatment with traditional TCAs are not dry mouth, constipation or other side-effects, but weight gain and sexual problems. These may be also present with at least some SSRIs, such as paroxetine. Finally, there is the general bias of the commercial aspect: almost all the trials are sponsored and there is no guarantee that negative results have the same probability of being published.

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