Reply to the Letter to the Editor Entitled “The Drugs Used for Panic Disorders May Affect the Circadian Variation in Blood Pressure Measurements and Autonomic System”

Abstract

We thank Ozturk et al 1 for their comments regarding our study.2 Cardiovascular diseases and hypertension were exclusion criteria in our study, and none of the patients were using b-blockers.2 If we look at the antidepressants which patients received, 6 patients used paroxetine, 3 venlafaxine, 2 escitalopram, 1 sertraline, 1 duloxetine, and 4 patients used alprazolam as additional treatment. We showed that night-time blood pressure (BP) dipping was less in patients with panic disorder, and night-time diastolic BP was higher in patients who received antidepressants than those who did not. 2Venlafaxine and duloxetine are antidepressants of the serotonin-norepinephrine reuptake inhibitor class and these are known to increase systolic and diastolic BP. 3,4 There was no statistically significant difference between drugs in our study but we do not claim a definitive conclusion on this issue because of the small sample size.Are the antidepressants suspects for the nondipper BP pattern in panic disorder in our study? To clarify this question, we compared healthy controls with patients who did not use any drugs and again observed reduction in nocturnal BP dipping. This situation explains the circadian BP impairment, and additionally, antidepressant use may cause night-time BP increases in patients with panic disorder.