Antidepressants and panic disorder

Several pharmacological approaches showed efficacy for the treatment of patients with panic disorder (PD). However, current guidelines do not provide information about the relative benefit of each pharmacological compound over the others and about how an optimal treatment for each individual patient could be achieved. The aim of the present article is therefore to review available evidence focusing on comparative studies of antidepressants currently used for the treatment of PD. Main findings suggest that selective serotonin reuptake inhibitors (SSRIs) and the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine should be considered as first line agents for the treatment of PD patients because their clinical efficacy is as high as those observed with other classes of antidepressants such as triciclycs but they are associated with a significantly lower likelihood of side effects. Furthermore, some differences could exist among reviewed drugs such that venlafaxine 225 mg could have some advantages over paroxetine 40 mg for the reduction of several anxiety measures, fluoxetine and escitalopram could be associated with a faster onset of action as compared with citalopram and, overall, serotonergic drugs such as paroxetine and citalapram could be more effective than noradrenergic drugs such as reboxetine and maprotiline. On the basis of reviewed data, however, the extent to which other antidepressants vary in terms of efficacy and acceptability is unclear. Because the understanding of which drug could be best tailored to the needs of each individual patient is crucial for improving treatment outcomes of PD patients, further systematic research in this direction is needed.