Pharmacological Interventions Reviewed for Panic Disorder
A review of 35 studies that included 6,785 participants found no difference between antidepressants and benzodiazepines with regards to response rate in the treatment of panic disorder, however the evidence was deemed low-quality.
Both antidepressants and benzodiazepines are considered the mainstay of treatment for panic disorder. In this study, researchers analyzed the Specialised Register of theCochrane Common Mental Disorders Group (CCMDCTR) for double-blind randomized controlled trials which allocated adult panic disorder patients to antidepressants or benzodiazepines vs. any other active treatment with antidepressants or benzodiazepines to assess efficacy evidence for these agents.
Only a few of the 35 trials contained data on the researcher's primary outcomes. Low-quality evidence was found suggesting no difference between antidepressants and benzodiazepines in terms of response rate (RR 0.99, 95% CI 0.67 to 1.47; two studies, N=215).
Benzodiazepines showed an advantage compared to antidepressants in terms of all-cause dropouts, although this again had low-quality evidence with confidence interval (CI) ranging from almost no difference to benefit with benzodiazepines (RR 1.64, 95% CI 1.03 to 2.63; seven studies, N=1,449). No clinically significant differences were found between individual benzodiazepines.
The limited scope of the studies included in the review were not sufficient to comprehensively address the author's stated aim of assessing the effects of antidepressants and benzodiazepines in treating panic disorders. Additionally, the study protocol was unavailable for almost all studies making it difficult to make judgments on the possibility of outcome reporting bias.
The authors suggest that their review highlights a need for further higher-quality studies to be conducted comparing antidepressants and benzodiazepines for this condition. The choice of which antidepressant and/or benzodiazepine, state the authors, “should be based on evidence of antidepressants and benzodiazepines efficacy and tolerability, including data from placebo-controlled studies, as a whole."
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