Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder

Nardi, Antônio Egídio; Lopes, Fabiana L.; Valença, Alexandre Martins; Freire, Rafael C.; Nascimento, Isabella; Veras, André Barciela; Mezzasalma, Marco A.; de-Melo-Neto, Valfrido L.; Soares-Filho, Gastão L.; King, Anna Lucia Spear; Grivet, Leila O.; Rassi, Arabella; Versiani, Márcio

doi:10.1016/j.psychres.2008.06.025

Cited by 20 publications

(7 citation statements)

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“…In a RCT, phenelzine was more effective than placebo and as effective as imipramine (Level 2) [240]. In a small randomized, uncontrolled trial, tranylcypromine demonstrated efficacy for patients with comorbid panic and social anxiety disorders (Level 3) [243]. …”

Section: Panic Disorder and Agoraphobiamentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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BackgroundAnxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.MethodsThese guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.ResultsThese guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.ConclusionsAnxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

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Section: Panic Disorder and Agoraphobiamentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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“…Nardi et al [20] compared the efficacy and tolerability of 30 mg/day and 60 mg/day of tranylcypromine in PD patients with comorbid social anxiety disorder. The main instrument for clinical assessment was the Sheehan Panic and Anticipatory Anxiety Scale, from which the main efficacy measure -the percentage of patients with no PAs -was obtained.…”

Section: Resultsmentioning

confidence: 99%

“…The results from the open-label study from Shah et al [17] indicate that vortioxetine may be an effective drug for the treatment of PD, including treatment-resistant patients. The study from Nardi et al [20] was the only tranylcypromine clinical trial with PD. This drug was effective and associated with few adverse events in PD patients.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological and Neuromodulatory Treatments for Panic Disorder: Clinical Trials from 2010 to 2018

Zugliani

Cabo

Nardi

et al. 2019

Psychiatry Investig

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Objective Treatment for panic disorder (PD) have evolved, although there is still a strong unmet need for more effective and tolerable options. The present study summarizes and discusses recent evidence regarding the pharmacological and neuromodulatory treatment of PD. Methods MEDLINE, Cochrane Library, PsycINFO and Thomson Reuters’s Web of Science were searched for clinical trials published between 2010 and 2018. We included all prospective experimental studies including randomized controlled trials (RCT) and other clinical trials with more than 10 patients. Results Only 11 articles met the inclusion criteria, including 4 RCT, 3 open clinical trials and 5 comparative clinical trials. RCT demonstrated efficacy of transcranial magnetic stimulation (TMS) in only one of two trials. Neither pindolol nor d-fenfluramine were effective in blocking flumazenil-induced panic attacks. Augmentation with quetiapine was not superior to placebo. Open trials indicated that escitalopram, vortioxetine and TMS may be effective. Comparative trials did not demonstrate superiority from any drug, but confirmed tranylcypromine, paroxetine, clonazepam and alprazolam as effective options. Conclusion The current study confirmed the efficacy of tranylcypromine, paroxetine, clonazepam, alprazolam and escitalopram. Vortioxetine and TMS, with duration of 4 or more weeks, also seems to be effective. Quetiapine, pindolol and d-fenfluramine were not considered effective compounds.

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“…Table 6 gives a summary of important controlled studies with tranylcypromine. In a recent study tranylcypromine, 60 mg daily, was found effective in the treatment of panic disorder and social anxiety disorder comorbidity (Nardi et al, 2010). …”

Section: Indications In Parkinson's Diseasementioning

confidence: 99%

MAO-inhibitors in Parkinson's Disease

Riederer¹,

2011

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Monoamine oxidase inhibitors (MAO-I) belong to the earliest drugs tried in Parkinson's disease (PD). They have been used with or without levodopa (L-DOPA). Non-selective MAO-I due to their side-effect/adverse reaction profile, like tranylcypromine have limited use in the treatment of depression in PD, while selective, reversible MAO-A inhibitors are recommended due to their easier clinical handling. For the treatment of akinesia and motor fluctuations selective irreversible MAO-B inhibitors selegiline and rasagiline are recommended. They are safe and well tolerated at the recommended daily doses. Their main differences are related to (1) metabolism, (2) interaction with CYP-enzymes and (3) quantitative properties at the molecular biological/genetic level. Rasagiline is more potent in clinical practise and has a hypothesis driven more favourable side effect/adverse reaction profile due to its metabolism to aminoindan. Both selegiline and rasagiline have a neuroprotective and neurorestaurative potential. A head-to head clinical trial would be of utmost interest from both the clinical outcome and a hypothesis-driven point of view. Selegiline is available as tablet and melting tablet for PD and as transdermal selegiline for depression, while rasagiline is marketed as tablet for PD. In general, the clinical use of MAO-I nowadays is underestimated. There should be more efforts to evaluate their clinical potency as antidepressants and antidementive drugs in addition to the final proof of their disease-modifying potential. In line with this are recent innovative developments of MAO-I plus inhibition of acetylcholine esterase for Alzheimer's disease as well as combined MAO-I and iron chelation for PD.

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Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder

Cited by 20 publications

References 24 publications

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Pharmacological and Neuromodulatory Treatments for Panic Disorder: Clinical Trials from 2010 to 2018

MAO-inhibitors in Parkinson's Disease

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