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
- Behavioural Models
- 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
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.