Selective serotonin-reuptake inhibitors in the treatment of panic disorder: a systematic review of placebo-controlled studies

Mochcovitch, Marina Dyskant; Nardi, Antônio Egídio

doi:10.1586/ern.10.110

Cited by 23 publications

(11 citation statements)

References 49 publications

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“…Previous studies showed the efficacy of antidepressants using the definition of remission as a panic-free state at the end point of the study 18). In our study, 96 of 119 (80.7%) patients had a panic-free state at week 24, which was compatible to previous studies using paroxetine 40 mg/day19) (86.0% remission rate at week 10) and venlafaxine 225 mg/day20) (70% remission rate at week 10).…”

Section: Discussionsupporting

confidence: 90%

Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial

Choi

Woo

Kim

et al. 2012

Clin Psychopharmacol Neurosci

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ObjectivePanic disorder is characterized by recurrent panic attacks, persistent concerns about additional attacks, and worry about the implications of the attack or significant changes in behavior related to the attacks. We examined the efficacy of 24-week naturalistic, open-label escitalopram treatment in terms of the response and remission rates and functional disability in 119 adult Korean patients with panic disorder from 6 clinical centers in South Korea.MethodsClinical severity and functional impairment were assessed at baseline and at 4, 12, and 24 weeks after the treatment using the Panic Disorder Severity Scale and Sheehan Disability Scale. Ninety-six patients (80.7%) showed a treatment response, and 87 patients (73.1%) had attained remission after 24 weeks of escitalopram treatment.ResultsContinuous improvement in the Panic Disorder Severity Scale and Sheehan Disability Scale scores was found over the 24 weeks of treatment.ConclusionThese findings suggest that escitalopram treatment is very effective for panic disorder in terms of both response and remission rates and that long-term pharmacotherapy with escitalopram continuously improved panic symptoms and functional disability in Korean patients with panic disorder.

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Section: Discussionsupporting

confidence: 90%

Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial

Choi

Woo

Kim

et al. 2012

Clin Psychopharmacol Neurosci

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“…They are used in the treatment of depression but also have known anxiolytic effects [39, 40]. Their broad use is attributed, in part, to the absence of side effects [41].…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Serotonergic Modulation of Conditioned Fear

Homberg

2012

Scientifica

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Conditioned fear plays a key role in anxiety disorders as well as depression and other neuropsychiatric conditions. Understanding how neuromodulators drive the associated learning and memory processes, including memory consolidation, retrieval/expression, and extinction (recall), is essential in the understanding of (individual differences in vulnerability to) these disorders and their treatment. The human and rodent studies I review here together reveal, amongst others, that acute selective serotonin reuptake inhibitor (SSRI) treatment facilitates fear conditioning, reduces contextual fear, and increases cued fear, chronic SSRI treatment reduces both contextual and cued fear, 5-HT1A receptors inhibit the acquisition and expression of contextual fear, 5-HT2A receptors facilitates the consolidation of cued and contextual fear, inactivation of 5-HT2C receptors facilitate the retrieval of cued fear memory, the 5-HT3 receptor mediates contextual fear, genetically induced increases in serotonin levels are associated with increased fear conditioning, impaired cued fear extinction, or impaired extinction recall, and that genetically induced 5-HT depletion increases fear conditioning and contextual fear. Several explanations are presented to reconcile seemingly paradoxical relationships between serotonin levels and conditioned fear.

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“…Further, this led to an accumulation of clinical data illustrating the therapeutic effects on panic of a number of drugs that target the serotonergic system (Bell and Nutt, 1998b;Mochcovitch and Nardi, 2010;Nutt, 2005) and the inevitable hypothesis that dysfunctional serotonergic systems may be central to the etiology or pathophysiology of PD, or both (Bell and Nutt, 1998a;Graeff, 2004). …”

Section: Introduction To Panic Disordermentioning

confidence: 99%

The Deakin/Graeff hypothesis: Focus on serotonergic inhibition of panic

Paul

Johnson

Shekhar

et al. 2014

Neuroscience & Biobehavioral Reviews

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The Deakin/Graeff hypothesis proposes that different subpopulations of serotonergic neurons through topographically organized projections to forebrain and brainstem structures modulate the response to acute and chronic stressors, and that dysfunction of these neurons increases vulnerability to affective and anxiety disorders, including Panic Disorder. We outline evidence supporting the existence of a serotonergic system originally discussed by Deakin/Graeff that is implicated in the inhibition of panic-like behavioral and physiological responses. Evidence supporting this panic inhibition system comes from the following observations: 1) serotonergic neurons located in the ‘ventrolateral dorsal raphe nucleus (DRVL) as well as the ventrolateral periaqueductal gray (VLPAG) inhibit dorsal periaqueductal gray-elicited panic-like responses; 2) chronic, but not acute, antidepressant treatment potentiates serotonin’s panicolytic effect; 3) contextual fear activates a central nucleus of the amygdala-DRVL/VLPAG circuit implicated in mediating freezing and inhibiting panic-like escape behaviors; 4) DRVL/VLPAG serotonergic neurons are central chemoreceptors and modulate the behavioral and cardiorespiratory response to panicogenic agents such as sodium lactate and CO2. Implications of the panic inhibition system are discussed.

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Selective serotonin-reuptake inhibitors in the treatment of panic disorder: a systematic review of placebo-controlled studies

Cited by 23 publications

References 49 publications

Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial

Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial

Serotonergic Modulation of Conditioned Fear

The Deakin/Graeff hypothesis: Focus on serotonergic inhibition of panic

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