Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

Nardi, Antônio Egídio; Valença, A.M.; Freire, Rafael C.; Mochcovitch, Marina Dyskant; Amrein, R.; Sardinha, Aline; Levitan, Michelle N.; Nascimento, Ingrid Oliveira do; de-Melo-Neto, V.L.; King, A.L.; Silva, A.C. de O. e; Veras, André Barciela; Dias, Gisele Pereira; Soares-Filho, G.L.; Costa, R.T. da; Mezzasalma, M.A.; Carvalho, Marcele Regine de; Cerqueira, Ana Cláudia Rodrigues de; Hallak, J.E.; Crippa, J.A.; Versiani, Márcio

doi:10.1590/s0100-879x2011000400015

Cited by 30 publications

(9 citation statements)

References 26 publications

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“…It is conceivable that clonazepam has become increasingly attractive due to the publication in the last 25 years of several successful randomized trials for anxiety disorders and related conditions, in a period where societal concerns and regulatory changes 28 have reduced enthusiasm to undertake trials on the other existing benzodiazepines. Randomized trials of clonazepam conducted during this period report effectiveness in panic disorder as monotherapy [38][39][40] and as an adjunct to sertraline, 41 efficacy as monotherapy in social anxiety disorder in monotherapy 42 and benefits on some outcomes as an adjunct to SSRI antidepressants in this disorder, 43,44 and efficacy in depression with or without anxiety as an adjunct to fluoxetine. 45,46 Whereas alprazolam, diazepam, lorazepam and oxazepam have longstanding United States FDA approvals for 'Management of Anxiety' or 'Management of Anxiety Disorders', the manufacturer of clonazepam, which was first marketed for other indications in 1975, did not secure FDA approval for its use in any anxiety disorder until the late 1990s, eventually receiving approval for panic disorder in 1998.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepine prescription in Ontario residents aged 65 and over: a population-based study from 1998 to 2013

Sjc

Jacob

Rudoler

et al. 2017

Therapeutic Advances in Psychopharmacology

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Background:Although commonly used in anxiety and insomnia, recent guidelines recommend caution when prescribing benzodiazepines in the elderly. Here we examined rates of benzodiazepine prescribing to older adults in Ontario, Canada from 1998 to 2013 and impact of legislation that made prescribing regulations more strict.Method:Annual benzodiazepine prescription rates for Ontario residents aged 65 and over were examined using the Ontario Drug Benefit database which captures all publicly funded prescriptions. Since most drugs, including benzodiazepines, are funded for residents aged ⩾65, data are essentially population-based. Weighted least squares regression methods were used to examine trends in prescribing rates (all benzodiazepines, anxiolytics, hypnotics, short- and long-acting drugs and individual drugs) from 1998 to 2013 for all Ontario residents aged ⩾65 and by sex and 5-year age bands. Impact on monthly prescribing rates of legislative changes (November 2011) which aimed to promote appropriate prescribing and dispensing practices for controlled substances, including requiring prescribers to record specified information, was assessed by constructing an interrupted time-series model.Results:Benzodiazepines were prescribed to 23.2% of the 1,412,638 Ontario residents aged ⩾65 in 1998, declining to 14.9% of 2,057,899 residents aged ⩾65 in 2013 (p < 0.001 for trend). Rates were significantly greater throughout in older age bands (p < 0.001) and 1.54–1.62 times greater in females than males (p < 0.001). Lorazepam was the most prescribed benzodiazepine throughout, but rates declined from 11.4% in 1998 to 8.5% in 2013. Diazepam rates fell from 2.3% to 0.7%. However, clonazepam prescription rates increased until 2011, 1.7-fold overall. After the November 2011 legal changes, downward shifts were observed in total benzodiazepine prescription rates and for each drug individually. The step function, conditional on covariates, suggested benzodiazepine rates after November 2011 were 2.89 per 1000 (p < 0.001) below rates observed previously, representing a relative reduction of 4.8% compared to the year before the intervention.Conclusion:Benzodiazepine prescribing rates declined markedly in this population from 1998 to 2013. Targeted legislation may have reduced rates, but the effect, although statistically significant, was small.

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Section: Discussionmentioning

confidence: 99%

Benzodiazepine prescription in Ontario residents aged 65 and over: a population-based study from 1998 to 2013

Sjc

Jacob

Rudoler

et al. 2017

Therapeutic Advances in Psychopharmacology

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“…SSRIs: Evidence from meta-analyses [195][196][197] and RCTs supports the use of the SSRIs citalopram [198][199][200], fluoxetine [201][202][203][204], fluvoxamine [195,[205][206][207][208][209][210], paroxetine [211][212][213][214][215][216][217][218][219], and sertraline [183,220,221,223,224] (all Level 1), as well as escitalopram [198] and paroxetine controlled-release (CR) [225] (both Level 2) for the treatment of panic disorder. In meta-analyses, SSRIs demonstrated significant improvements in panic symptoms, agoraphobic avoidance, depressive symptomatology, and general anxiety [195][196][197]226].…”

Section: First-line Agentsmentioning

confidence: 99%

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

Katzman¹,

Bleau²,

Blier³

et al. 2023

Preprint

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Background Anxiety 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. Methods These 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. Results These 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. Conclusions Anxiety 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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“…Indeed, when benzodiazepines and antidepressants were directly compared in controlled trials, a superiority of the former in both efficacy and side effect profile emerged . For instance, in Nardi et al's comparison of clonazepam vs. paroxetine in panic disorder , the benzodiazepine was not only faster and better during the short‐term treatment, but remained effective in long‐term (3 years) treatment, when tolerance developed to its sedative effect, while side effects of paroxetine such as sexual dysfunction and weight gain remained an issue. The original observation of non‐responsiveness of panic disorder to benzodiazepines (in contrast to imipramine) was probably mainly due to the usage of subtherapeutic doses of those drugs.…”

mentioning

confidence: 99%

Need for a realistic appraisal of benzodiazepines

2015

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Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

Cited by 30 publications

References 26 publications

Benzodiazepine prescription in Ontario residents aged 65 and over: a population-based study from 1998 to 2013

Benzodiazepine prescription in Ontario residents aged 65 and over: a population-based study from 1998 to 2013

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

Need for a realistic appraisal of benzodiazepines

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